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March 22
Educate yourself to fight TB


Photo: Rogan Ward

Carol Zulu may only be 18, but she knows enough about communicable diseases to take care of her own health.

Last year the Grade 12 student from Mpophomeni became ill with flu-like symptoms that she couldn't shake for over a month.

"I lost my appetite, had night sweats and bad pains in my arms and shoulder and feet.  I went to see a private doctor but he said the only problem was that I am overweight so he didn't test me."

Her health continued to deteriorate so a week later she decided to go to the local clinic to test for TB.

"I know the symptoms of TB because I studied it in LO (Life Orientation) class at school. I was still very sick so I went to the clinic and the nurses asked about my symptoms and gave me a sputum test. When the results came back they said I had TB. They also tested for HIV but luckily I am negative.

They also found I had gout in my shoulder and feet from TB."

Other members of her household were also tested for TB and educated on protecting themselves with measures such as opening windows and ensuring that the home is well ventilated.

"My family really helped by reminding me to take my pills, even when I didn't feel like it because the medication made me dizzy. I was on treatment for six months and completed the course of medicine in January this year".

20190320_RWX4614.jpg Photo: Rogan Ward

She says she faced some stigma from girls at school who spread rumours that she was also HIV-positive because she had TB. "I told my teacher at school and some of my close friends. I lost weight when I was sick so people talked behind my back and said I have HIV. They think everyone with TB also has HIV, which is not true."​

She now goes out of her way to educate her peers and neighbours about how to stay TB-free.

"Some people don't know about TB so I advise them that if they have any symptoms they must be tested immediately before it gets too bad."

She says that she pays no attention to the gossipers because "I know my status so I don't care what they say." She continues to encourage others to test for both TB and HIV and to challenge denial: "I tell my friends that we are living with these diseases around us so there is no point in denying it. The only thing we can do is to try to protect ourselves and get tested and treated if you start feeling ill. It really is that simple." ​​


​IN 2017: ​

322 000 people fel​l ill with TB

= 187 000 males, 135 000 females, 38 000 children

  • 220 163 TB cases notified​​​​
  • 101 837 people not notified or not diagnosed​​

8 000 TB dea​ths (including 56 000 deaths among people living w​​​​ith HIV)​

​TB treatment coverage was 68%, and treatment success rate was 82% (operational End TB target is 90% by 2025)

​14 000 people fell ill with drug-resistant TB; 10 259 were notified and put on treatment

​193 000 people living with HIV fell ill with TB; 12 148 were notified; 109 799 were notified and are on ARVs. HIV is by far the highest risk factor for TB infection.

​​​53% HIV-positive people (newly enrolled in care) were on TB preventative treatmen​t​


Source: WHO Global TB Report using South Africa data for 2017


March 12
Prevention is better than cure

The winner of this year's Emerging Public Health Practitioner is 26-year old Kganetso Sekome, a lecturer in public health and community physiotherapy in the health science faculty at the University of the Witwatersrand.

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Sekome won the prize for his submission on clinical practice guidelines for stroke patients in rural hospital settings.

"I first heard of this award in 2015 when one of my lecturers from UKZN won it.  I was so inspired by it being won by someone I knew.

When I was doing my community service in a rural hospital in r Bushbuckridge, I realised that my colleagues weren't using the stroke guidelines or were unaware of them. If these patients don't get the proper treatment after a stroke they could die or become disabled.

When I work with patients I emphasise that it is important to have the family involved throughout the whole rehab process, so that the treatment is sustainable.

Non-communicable diseases like diabetes and hypertension can lead to strokes and this is sadly becoming more prevalent due to lifestyle changes, genetics and a Westernised diet with too much salt and sugar.  There are efforts underway to reduce sugar, such as the "sugar tax" which is already affecting the way people consume cold drinks. But we also need to be aware of how we are training our children's palates when we routinely add unnecessary salt and sugar to food we prepare at home.

We must focus less on curative and more on preventive medicine. We are successfully treating HIV and TB so people are living longer but we now face the challenge of an increase in rising non-communicable diseases.

I'm from Bushbuckridge and I know that people have lost faith in the public hospitals because of poor service delivery.  I grew up in this context so I can relate to the concerns and issues of the community. Each year I send my students to Bushbuckridge for community service and clinical training so that they can give something back and ensure help deliver high quality care.

I hope this award will inspire my students and peers, as well as anyone else thinking about going into public health. We need to tell young public health practitioners not to be intimidated and go ahead and apply for this award. I am still in disbelief that I am the recipient of the emerging public health practitioner award, this recognition will enable me to grow my network and meet people in the health systems trust that I can collaborate with and learn from.


March 08
Girls’ Clubs

​On this International Women's Day, we wanted to bring you a good news story about empowerment programmes for girls and young women that deliver results!​

We have all read the worrying statistics from districts like uMgungundlovu in KwaZulu-Natal, where at least one in every five adolescent girls and young women is living with HIV, and by age 16, one in every 10 women accessing antenatal care is HIV-positive. 

What you may not have heard about are the organisations working tirelessly on programmes to reduce the risks of girls and young women becoming infected with HIV. The Community Media Trust (CMT) is running a programme to end the economic exclusion and social isolation that often put girls between the ages of 10 and 24 at risk of HIV infection.

Heading up the Girls' Clubs programme, which is implemented in Pietermaritzburg and Durban in KZN, are Lerato Maloka and Debbie Van Zyl.

"The pressure that women receive – from society, religion, culture, tradition as well as the biological expectations around childbearing and raising children – make it difficult for women to find themselves," explains Maloka. "The Girls' Club programme has provided a platform for young women and girls to explore and find themselves, and it has been exciting to see these seeds planted, and watching them grow and develop."

The Girls' Clubs are run by local female mentors, aged 18 to 30, who are able to relate to participants' unique experiences and challenges. Weekly meetings of each club of about 20 adolescent girls and young women (AGYW) cover a curriculum on HIV and sexual and reproductive health topics, social skills, safety planning, and financial literacy. Mentors make use of storytelling and role-play to improve AGYWs' negotiation skills and sense of self-worth.

"Participants of the Clubs have fun while building friendships and learning important knowledge and skills to help guide them safely through adolescence," says Van Zyl. "An additional bonus has been seeing the mentors blossom into confident, empowered young women, developing their knowledge and skillsets, furthering their own career paths, and accessing much needed employment opportunities." 

The Girls' Club sessions take place in walkable communities and in safe spaces. AGYW in need are referred to appropriate services delivered at local health facilities, including for HIV testing and counselling, and comprehensive sexual and reproductive health, as well as those offered through other partners providing such services in the local area.

The intended impact is to build the protective assets (health, social, cognitive and economic) of the beneficiaries to empower them to transition safely from adolescence into adulthood.

The community mentors trained by the programme say that it is an enriching experience which benefits them as much as their mentees. "As a mentor in my community, parents started to entrust their girl-children with me," says Sanelisiwe Mbatha from CMT in Pietermaritzburg.  "They saw that the programme brought such a positive impact in their lives. I also gained a lot of insight from my interactions with the young women I was working with."

Thandi Phoswa from the Richmond Caregivers Organisation, with which CMT has partnered to implement Girls' Clubs in the past, agrees: "Our area is deeply rural, so people in our community do not want to teach their girls about sex. The project has brought a change to the people's mindset, has brought transformation and brought hope. We are so grateful to DREAMS for giving us this life-changing opportunity."

Maloka says that while the programmes are delivering much-needed services and support to girls and young women, on this International Women's Day we need to stop and take stock of the status of women. "I believe that until society and culture changes the way that women are viewed and treated, we will not make the progress needed in order for all women to be safe and empowered and able to achieve their dreams."

October 16
Developing a model for strengthening community health worker programme implementation in South Africa - Rene English

HST's Naomi  Massyn attended the 5th Global Symposium on Health Systems Research held in Liverpool, where she presented a poster on behalf of Rene English, HST's director of Health Systems Research.

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The poster on "Developing a model for strengthening community health worker programme implementation in South Africa" is available below.​​​​

October 15
@#HSR2018 - HST lead author Dr Linda Mureithi presented the findings of a qualitative multi-case study

​@#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:

October 12
Meaningful partnerships for health − the role of communities

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.


October 12
Back to the future: Making the global health agenda local with a return to Alma Ata

by Jackie Smith – SA SURE Plus Programme Manager

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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.

Key conclusions:

  • No country will achieve UHC without first providing PHC for all.
  • Governments should mobilise domestic resources to increase investment in PHC.
  • How money is spent is as important as how much is spent.
  • External donor support should be invested in strengthening PHC.
  • It is impossible to measure what we don't know. Analysis of expenditure against programme performance is crucial.
  • PHC is about serving communities and therefore, civil society and community governance structures should play a key role in health budget discussions.


October 10
HSR2018: 5th Global Symposium on Health Systems Research: Liverpool, UK – 8 to 12 October 2018


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. ​​

October 09
The case for investing in community healthworkers

​​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.​

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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.

September 04
Education to fight inequality in 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

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