About Health Systems Trust

Health Systems Trust (HST) is an innovative non-profit organisation working to strengthen ongoing development of comprehensive health systems in southern Africa.  Using a primary health care approach, we specialise in conducting health research, providing technical support, and information dissemination.  Our strategies are designed to promote equity and efficiency in health and healthcare delivery.

Our vision
Health for all through strengthened health systems

Our mission
To be a partner of choice in building comprehensive and equitable health systems
Our approach
Our approach is based on:
  • the primary health care philosophy 
  • generating evidence-based interventions, good practice and innovations 
  • providing management, implementation and research support at all levels of the health system 
  • providing guidance, mentoring and training 
  • recognising the influence of the social determinants of health on the burden of disease 
  • tailoring our work to local contexts 
  • Creating, sharing, storing and curating new knowledge.
Our core values
We are a learning organisation that is:
  • committed to excellence 
  • people-centred 
  • honest and transparent 
  • innovative 
  • responsive 
  • knowledge-driven

HST’s Structure
HST employs about 400 staff members in two directorates, Programmes and Corporate Services, that collaborate in achieving the organisation’s goals. HST relies on the services of independent consultants when project demands exceed the capacity of the core staff.

The Programmes directorate comprises two units, Health Systems Research and Health Systems Strengthening. Through this structure and using a number of strategies, HST has played a key role in supporting the transformation of the health system in South Africa over the past nineteen years. HST has also demonstrated how a NPO in a developing country context can support both government and other civil society groups to strengthen an inefficient and inequitable public health sector. Through the work of its programmes HST has acquired a wealth of experience in the design and support of relevant health systems research, providing district managers with technical support and taking a lead in information dissemination within the health sector in South Africa and, increasingly, in southern Africa. In the process, HST has established relationships with the South African Department of Health, with all provincial health departments and with various public and private sector service providers nationally and internationally.

HST’s Programmes
Health Systems Research (HSR) unit:
The HSR unit commissions, funds and conducts policy-relevant health systems research on behalf of the South African government and international donors. The unit has a core of highly skilled project managers and researchers who participate in research priority setting processes within the country, develop research briefs, identify additional research consultants and manage the projects throughout the research process. In addition to the regular research project reports displayed on HST’s website, the programme continues to disseminate health perspectives and health information in our highly-acclaimed annual publications, South African Health Review and District Health Barometer.

The research unit embarked on fostering North-South partnerships as part of a strategy for fast tracking capacity building for local consultants. In this process the unit has established relationships with renowned international experts interested in North-South partnerships for conducting research. Specific areas of common interest include research in the following areas: HIV/AIDS/STI/TB, reproductive health, maternal and child health and human resources management. 

The unit’s Knowledge Management activities encourage and facilitate the use of information for evidence-informed decision making by various stakeholders. Electronic and hard copy information produced by HST and other stakeholders is disseminated. The unit also works in partnership with national and provincial legislators on promoting equity in health and health care through ongoing monitoring of health and health systems indicators and providing information and support directly to legislative structures.

Health Systems Strengthening (HSS) unit: the HSS unit grew out of the Initiative for Sub District Support (ISDS) established in 1996 to support the implementation of the District Health System in South Africa and, more recently, out of the activities of the District Strengthening and Community Development cluster and the Health Management Information System (HMIS) section. ISDS developed ‘best-practice districts’ in 21 district sites in all nine provinces of South Africa. Important lessons were learnt and fed into policy for the benefit of the entire health system. Many of these sites won awards, indirectly acknowledging HST for its support for District Health System development.
Health Systems Strengthening provides an excellent entry point into the entire health system by focusing on strengthening district, sub-district and facility management, also emphasizing strengthening community development and community involvement in primary health care.

The district management-related activities facilitate and support the implementation of health programmes in primary health care facilities by providing technical and managerial support to district management teams and frontline service providers. The community development component of the unit was established in 2001 to support selected districts in social development partnerships with community-based organisations and was successful in developing models for community development around key health issues.

In 2005 the unit was contracted to strengthen the National Health Information System in South Africa and built up a team of skilled staff working at national, provincial and district levels throughout the country to improve the quality of health information and the capacity of managers to use health information for planning and management.

The Staff
HST’s staff members include a wide range of professionals from mainly health and social science backgrounds. HST is committed to employment equity and diversity, with the result that the majority of staff are black and women. HST’s staff work from three main offices in Durban, Johannesburg and Cape Town, with a satellite office in Mbombela, Mpumalanga province. Staff travel to and work in all provinces, particularly in the rural areas of South Africa. Staff are also deployed to Southern African Development Community (SADC) countries as required. When working in other SADC countries HST has placed a high premium on developing partnerships with local professionals.

HST’s strong focus on skills and capacity development (both formally and, by virtue of the intellectually stimulating environment, informally) attracts many health professionals who are either supported by or pass through HST to obtain broad exposure and develop skills in health systems research and strengthening before moving to senior positions in government and other sectors.

HST has established a solid reputation of good governance and sound financial management and has consistently secured funding over the past 19 years to support the work of the organisation.

An independent Board of Trustees guides and provides oversight of HST. Board members collectively comprise a diverse group of individuals with professional standing and expertise in health systems development in and beyond South Africa.

Some of HST’s achievements in the last 19 years:

  • We have conducted extensive health systems research that has informed public health policy and practice in South Africa. A list of HST’s research and other health-related publications is available on the website.
  • We have developed capacity for health systems research in South Africa by funding and supporting interns in HST and other institutions and, through extensive grant-making, supporting the work of research institutions and other non-profit organisations.
  • We have developed best-practice sites to support the implementation of the District Health System (DHS) in 21 sites in all nine provinces of South Africa between 1997 and 2004. The sites provided models and many lessons that have informed national policy on the District Health System and provided numerous tools to facilitate health district planning and management. Some of the tools developed in these sites include the District STI Clinic Assessment (DISCA) tool, the DHER (District Health Expenditure Review), the Clinic Supervision Manual and others. Many of the HST-supported districts won ‘best district’ awards in national reviews of progress in implementing the DHS.
  • We have set up innovative systems for disseminating research, policy and other information to a wide range of role players in public health in South Africa. HST produces numerous publications and has hosted more than 100 electronic discussion lists that reach a range of groups – including rural doctors and pharmacists – around a range of key aspects of health systems – including equity, HIV and AIDS, drug management and District Health discussions.
  • Since 1995 HST has published the South African Health Review (SAHR) on an annual basis. The SAHR provides a South African perspective on prevailing local and international public health issues and has rapidly become a flagship product that is widely read, used and quoted as an authoritative reference work in South Africa and abroad. The District Health Barometer (DHB), also recognised as a flagship publication of the organisation, was developed in response to a need for accessible management information in South Africa. The publication provides, by means of an annual publication, a snapshot of the overall performance of the public health sector across the provinces and health districts in South Africa.
  • HST’s website is a well-used source of information for health managers, policy makers, health practitioners in the public and private sectors, academics, students and the media and is visited by over 14 000 people a month. The site was awarded two prizes by the UNESCO-funded WoYaa! Awards – 1st in the scientific category and 5th in the Community Development category.
  • We implemented a very successful model of an Integrated Nutrition Programme in rural areas in the poorest regions of the country for which HST was awarded an ‘Impumelelo Innovations Award’ in 2003 for innovative work in the field of food security and community development.
  • We support extensive research and advocacy for equity in southern Africa, including having hosted and supported the Global Equity Gauge (GEGA) and the first two editions of the Global Health Watch.
  • HST provides ongoing support to government at every level of the health system - from facility and district to provincial and national levels. HST is frequently requested to advise on policy and implementation, assist with evaluating health services and provide technical support on a variety of issues.