Pretoria - Three professors from different disciplines at the University of Pretoria have joined forces to co-ordinate care for homeless people.
The academics are contributing to a national policy for the homeless with a project that forms part of the framework for South Africa’s National Health Insurance, in collaboration with the Presidency.
Professor Debashis Basu, academic and clinical head of the Department of Public Health Medicine at the university, said: “We are not talking the talk; we are practising it”.
They are doing this through the research unit of the university’s Community Oriented Primary Care project. This is where the university’s Department of Public Health connects with the Department of Family Medicine, headed by Professor Jannie Hugo.
Collaborating further with the University of Pretoria’s Centre for Faith and Community, where Professor Stephan de Beer is at the helm, the three are making strides in addressing the interconnected health and social problems of the most vulnerable people in Tshwane.
Hugo said co-ordinating care was the most important aspect to ensuring the success of the National Health Insurance, “which means building efficiencies that don’t exist”.
“So this is a very particular focus to co-ordinate care. It is not an NGO project distributing blankets. It is essentially an implementation research endeavour to say: How do we implement this in a structured manner that has impact and that makes sense in the long run?”
At a Un Habitat and the Institute for Global Homelessness in New York in April, Professor Stephan de Beer said: “As long as overcoming homelessness is seen as a charity or social development concern only, and not as an expression of social justice, the global homeless population will not be free.”
He spoke about the university's involvement in the Tshwane Homelessness Forum, established in 2015 between local government, non-profit organisations and universities.
Tshwane adopted the forum’s policy on homelessness and is now implementing it.
In 2020, the Covid-19 pandemic forced the establishment of a Homeless Task Team. Tshwane then tasked the university to formalise it, and they created an operational centre run by the non-profit sector.
The university provides technical capacity and research support.
“We run quarterly communities of practice, where non-profit workers, government officials and researchers reflect together on what we are learning,” said De Beer.
“In a 10-day period, we were able to open 27 temporary shelters housing 2 000 people, complemented by psychosocial and health-care services, family reconciliation and vocational preparation. We managed to do in 10 days what we could not do in 10 years before that. We can never again say it's impossible to house the homeless population – because Covid-19 proved we can if we want to.
“For the first time since 2021, the province has a policy on homelessness and invests in homeless programmes,” De Beer said.
He explained to the UN gathering that 50% of the homeless population in Tshwane were young and healthy but unemployed, and there was also a growing number of working homeless who chose to live near where they worked to avoid spending long hours travelling, exasperated by spatial inequalities and poor public transport.
Combined efforts created four transitional housing facilities and developed 1500 social housing units, accommodating more than 5000 people per night.
“If this can be replicated all across the city, homelessness can end for large percentages of people.”
Basu attributed the success of the university’s health interventions with homeless communities to the university’s approach, a sense of goodwill that its prominent branding reinforced.
He said they went to sites and offered Covid-19 vaccinations, with the aim of hitting target numbers, and used the opportunity of vaccinating the homeless to screen them for chronic diseases, such as blood pressure, to understand their basic health needs.
He mentioned one incident where they had helped a victim of a stabbing at the homeless shelter at 2 Struben Street, Pretoria, providing medical care to the victim following that incident helped UP gain the trust of the community.
“I've seen it repeatedly, when we enter a community, and they see the university car, they’re satisfied and say, ‘OK, let them come’. That gives us a tremendous opportunity,” said Basu.
“That is the uniqueness of the University of Pretoria branding, as well as our comprehensive care co-ordination, which is the added value we bring,” he said.
The university is now integrating its work with Tshwane’s homeless into the first steps towards an operational NHI. Without an electronic database that can identify people, NHI would not be able to operate.
With many people, both local and foreign, being undocumented, working with an identity document alone is not the answer.
The government has set up the Health Patient Registration System, which Basu explained is an “alphanumeric code for everybody who will be accessing the NHI, a uniform number that will identify people when entered into the system.”
As it includes IDs, so far, 57 million are registered in the Health Patient Registration System system.
The Covid-19 Electronic Vaccination Data System also helped this registration, said Hugo, adding it was “an international example of a successful data system that integrated all the sectors in health in South Africa, including the private sector, the public sector, the NGO sector.
“This is an important first example of engaging the undocumented in an NHI-type service.”
Basu said the university’s project was linking the registration with the National Health Laboratory service - the database of 40 million people who had a medical specimen in that lab.
“In a hospital like Steve Biko Academic, the challenge is that if you don't have an ID, you cannot enter. But we treat anybody who has an emergency, even if you are a homeless person or are in the country illegally. They have a hospital file number.
“So we have these five elements which we are integrating into one database for ‘Joe Slow’, so that person ‘Joe Slow’ can be identified from all the numbers in our system.
“And we have started integrating homeless people into that system. This is a long journey, and we have started the journey,” said Basu.
Pretoria News