@#HSR2018 - HST lead author Dr Linda Mureithi presented the findings of a qualitative multi-case study:
"Emergence of three general practitioner contracting-in models in South Africa", published in the International Journal for Equity in Health and co-authored by Mr Michael Burnett, Mr Adam Bertscher and Dr René English.
The paper explores the early inception and emergence of the GPCI and describes three models of contracting-in that emerged and interrogates key factors influencing their evolution. Findings from the decentralised-purchaser model show the importance of local context, provincial capacity and experience for influencing evolution of the models.
The published article can be accessed here:
Neziswa Mdaka, Cross-site Facilitator for HST's SA SURE Plus Project, attended the session hosted by Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), entitled 'Meaningful partnerships for health − the role of communities'.
The presenters were Gavin Reid (GFATM), Kumanan Rosanathan (World Health Organization), George Ayala (The Global Forum), Helen Chorlto, (Pediatric-Adolescent Treatment Africa − PATA) and Jerome Pfaff (United Nations Children's Fund – UNICEF).
It is clear that as we celebrate the 40th anniversary of the Alma Alta Declaration, there has been little progress towards one of its core principles − community involvement in the strengthening of health systems. As we move forward in the era of Sustainable Development Goals, we must consciously embed people-centred approaches and sustainable community participation for stronger health systems.
This requires navigating through legal issues associated with community engagement and power relations, and respecting the human rights facets of gender, religion, culture and language. Strong leadership means relinquishing power to others.
by Jackie Smith – SA SURE Plus Programme Manager
This session was run by Save the Children and focused on the importance of governments allocating sufficient funds to primary health care (PHC) so as to provide a stable platform of quality for universal health coverage (UHC).
The examples shared came from countries outside of South Africa, but some of the recommendations apply very aptly to the South African context. Notably, a case study from Zimbabwe reported that, against the backdrop of an 85% unemployment rate, the issue of collecting taxes to pay for UHC is almost a non-starter, as most of the recipients are living below the poverty line.
Nonetheless, it is encouraging to hear that with Zimbabwe's change in leadership, civil society has been afforded a more participatory role in discussions on health budgets, leading to some promising results.
Ronel Visser, Director of Health Systems Trust's Health Systems Strengthening Unit, attended a panel discussion that focused on identifying the challenges and opportunities for improving uptake of evidence in the journey from research to policy and practice.
The panellists' key observation was if researchers do not formulate a pivotal question – based on the policy-makers' and practitioners' requirements for new knowledge – from which a valid hypothesis and related intervention can be focused, the investigation will lack relevance for policy development and implementation.
In such instances, quantitative and qualitative findings that may be valuable on some grounds are not applicable for specific policy measurement, improvement or efficacy goals – and therefore are not or cannot be used as intended.
An ill-informed or inadequately defined research question lacks the contextual foundation needed to make decisions on the scope, study sample, objectives, methodology and desired data for collection and analysis. These decisions will in turn guide choices for administration and general resourcing of the project in terms of technical expertise, time and money. Overall, the successful design of an appropriate investigation hinges on a sound research question.
The 5th Global Symposium on Health Systems Research is being held in Liverpool UK from 8 to 12 October 2018. Members of the HST team attending the symposium will be sharing insights and learnings from the conference thought the week.
Mildred Shabangu, Operations Manager for Health Systems Trust's SA SURE Plus Project, attended a panel session on "making universal health coverage a reality by 2030" hosted by the ESRC DFID partnership (the Economic and Social Research Council and the UK's Department for International Development).
Evidence-based cases from Nigeria, Mozambique and Ethiopia were discussed during the session. All cases focused on investing in community health workers (CHWs) to support the achievement of universal health coverage by 2030. This calls for policy-makers to leverage existing initiatives rather than 'reinventing the wheel', and to involve all stakeholders in policy formulation.
Although there are a multitude of active CHWs in these countries, they are not supported in case-finding by their governments through resourcing with information systems or efficient referral mechanisms. This results in CHWs carrying the costs of engaging with and serving communities.
The presenters also shared successes achieved, notably collaboration between CHWs and the private sector to improve treatment uptake. The findings demonstrated that CHWs play an important role in mobilising their communities to engage in their healthcare issues.
Challenges noted included the uneven distribution of CHW capacity, a lack of salaries for CHWs, and poor supervision of CHWs. These challenges are also experienced in South Africa, where Outreach Team Leaders of CHWs lack proper supervision and inadequate human resources for health, as well as absenteeism and high staff turnover, place inordinate strain on the health system.
Health Systems Trust researcher and GIS (Geographic Information Systems) expert Noluthando Ndlovu was one of this year's participants in The Atlantic Fellows for Health Equity in South Africa programme. She has an MSc in Environmental Science, specialising in spatial epidemiology.
Hosted by TEKANO, the programme selects up to 30 fellows each year to participate in a programme of learning and experience that will enhance their ability to inspire and secure progressive social change. Tekano, founded in December 2016, is an organization based at the Isivivana Centre, Khayelitsha and works towards social justice and health equity.
"The programme runs around the world, in 48 countries and in 5 continents," explains Ndlovu. "In South Africa the programme focuses on health inequity, with approximately 25 fellows coming from different disciplines such as anthropology, law, environmental health, finance and of course public health".
I decided to apply because I am a researcher so I wanted to gain some context of all the data that we gather and work with across the public health system and to get a deeper understanding of the issues. We know that social determinants of health such as environmental and socio-economic issues are a major factor. For example, when treating a patient with TB it is important not just to understand the disease but to understand the whole context and underlying causes. In this way we can build more holistic approaches to issues affecting the public health system. It was also fascinating to learn about preventative approaches to healthcare instead of only focusing on the curative.
I wanted to develop my activism skills, so as a researcher it was great to learn from other fellows who come from social movements. I was able to meet and interact with people from different walks of life that I wouldn't usually be exposed to.
If you want to make a difference this programme will provide you with the network and some resources to tackle these issues. It also really helps to gain and strengthen skills in areas which are not necessarily your focus area.
I would encourage anyone who meets the criteria to apply, as it really gave me a broader understanding of the issues facing the public health system in a country like South Africa which is one of the most unequal in the world.
To learn more about the programme please go to
I am a DREAMS Ambassador working for HST, seconded to the uMgungundlovu Municipality. The goal of the DREAMS campaign is to help adolescent girls and young women develop into Determined, Resilient, Empowered, Aids-free, Mentored and Safe women.
I was invited to the 2018 International AIDS Society Conference by The US President's Emergency Plan For AIDS Relief (PEPFAR), a United States governmental initiative to address the global HIV and AIDS epidemic and help save lives.
PEPFAR invited me to share my personal story and my journey with DREAMS so that people can understand the impact that DREAMS has on the lives of girls, using my story of how I grew up and how DREAMS has helped me find my voice and heal my pain and anger.
I was also invited to moderate the DREAMS satellite session and spoke at some other sessions like the SANAC (South African National Aids Council) 'She Conquers' session. She Conquers is a national campaign that aims to empower adolescent girls and young women in South Africa and improve their lives.
I hope that I can try to advocate for prevention of sexual and gender-based violence, to support adolescent girls and young women (AGYW). For example, at our Thuthuzela Care Centres we can get assistance after a sexual assault, but there is nothing in place to prevent these crimes against AGYW.
The biggest highlight for me was the pre-conference session called Women Now. It's all about African women coming together to support and empower each other.
What a space, knowing you can say whatever you want in there and feel safe. We need that support and mentoring from other African women who have been through the things we went through. It just took me to another place. I loved it.
I learned so much there. Our great-grandmothers were fighting these issues and we are still fighting them. It ends with us. This generation of broken people ends with us. We will make this a better place for our kids so that they don't have to go through what we went through.
I've been to the US before, but this is my first time in Europe. The Netherlands is so different – the crime here is so low; you can actually walk around the city and not get scared. It is so safe and so quiet and so free. People are just free. You can just be you here.
People who sell sex here are protected by the law and can access health services. It really touched my heart.
Employee health and wellness is a crucial part of the fight against HIV and TB, as well as numerous non-communicable diseases such as hypertension, diabetes and heart disease.
The private sector has been a key player in implementing HIV and AIDS programmes since the early years of the AIDS epidemic. eThekwini is part of the Fast-Track Cities initiative supported by UNAIDS to engage urban leaders in developing multilateral partnerships to meet the 90-90-90 targets. This means that if 90% of people with HIV and TB know their status, get treated and stay on treatment, this will help prevent the spread of the disease and keep people healthy.
Sindy Naidoo, human resources manager at Reutech says employee wellness is important, not just to reduce absenteeism but also to remove the stigma around certain diseases.
"We encourage people to know their numbers – whether that is blood pressure, cholesterol or HIV and TB status. We need to create knowledge and understanding so we can take away the fear and stigma about these conditions." Naidoo adds that while Reutech has about 400 staff on site, it was also important to include contractors such as cleaning and security staff in this programme.
"We also know that it can be difficult for workers to get to the clinics for testing and treatment because the clinics are closed by the time they leave work. Having a day like this at least once a year is helpful as it allows staff to test for a range of conditions and get proper treatment."
Apart from employee welfare there is a clear business case for such an approach. Having staff tested and stable on treatment reduces absenteeism and makes it easier for the employer to plan and deliver on production.
HST offers this service completely free of charge to employers in the manufacturing sector in eThekwini.
For more information please contact Roger Tevan
Nozipho Mbembe (20)
I am from East London and I am a volunteer for the Siyakhanya community youth group.
My goal is to help young children who are depressed or get no love or attention at home. This can make them feel like there is a void inside, so they often try fill it with drugs or sex when they get older.
In my community there are very young girls getting pregnant, even before the age of 13! It is easy for men to exploit them by making them feel special and that someone cares.
I do this because I also went through abuse and depression until I started writing and sharing my story. Our group does activities with the kids such as traditional dancing, poetry and story writing.
My message to youth is that if you need help, please reach out to a teacher or social worker. Support is available and you are not alone.
Hlobisile Inamandla Masinga
I am from Inanda in KZN and I am a student at the University of Zululand. Our area is very traditional, so we try to create a welcoming environment for LGBT students. We also work with university employees such as campus security, so they understand how to deal with LGBT students sensitively when they make a complaint. Obviously, many of these are older people so it is important we educate them as well as our fellow students. Our goal is to integrate LGBT students within the university community, so we can work together as a cohesive whole.
"Normal" is relative – we need to embrace our incredible diversity as South Africans in all ways.
My name is Zamacebisa Zakwe and I am 26 years old, from KZN.
I am proud to be a DREAMS ambassador. DREAMS is a space for young people to come together and refuse to become just another statistic.
It is hard to be a girl growing up in South Africa. You have to fight all the time: fight to stay in school, fight against sexual violence, fight to stay HIV negative. In South Africa, HIV is the leading cause of death for girls between 15-19 years.
The problem is that girls do not have the power to negotiate safe sex or make reproductive health choices so it is hard to protect themselves. I grew up in extreme poverty and experienced issues like gender based violence at first hand. I was deprived of role models and dreams for the future.
We go to the community and educate girls, not just about HIV but about their life options. For example, we have girls’ clubs that teach girls about saving and starting a business. Not everyone can go to university. We also need entrepreneurship, so DREAMS educates girls holistically on issues ranging from business development to reproductive health.
DREAMS is not just about the here and now – we need to keep the legacy alive!
I am Lindiwe Msimang and I am working for Health Systems Trust. Like Zama, I am dedicated to using the DREAMS programme to improve the lives of girls and women. I work in uMgungundlovu which is one of the districts hardest hit by HIV.
My job is to ensure there is a coordinated response among a diverse range of stakeholders, from the mayor to the amakhosi to traditional healers. Each one has a vital role to play in ensuring we can implement the programme successfully.
For example, some traditional healers have had training on HIV prevention. When clients consult them, the healers not only dispel myths about HIV but also ensure they give clients information about safe sex. When amakhosi see our teams arrive in their areas, they understand what we are doing and support us.
This response is already showing an impact: the department of education tells us that the rate of teen pregnancies in schools in the district has dropped. We have also had anecdotal feedback that post-violence care has improved significantly.
As an older woman it is important for me to be there to support girls and young women, to help them realise their potential and reach their dreams.
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