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Jun 01
Integrating critical health services with Covid-19 vaccine uptake amongst communities with limited access in Zululand

By: Lunga Memela (Communications Engagement Lead)

HST and KwaZulu-Natal's Department of Health (DoH) partners offer free health screening services to residents at the remote Sivule Community in uPhongolo, which is situated on the border of Zululand and eSwatini during the DoH's Phuthuma Week.

Meet Magugu Nxumalo. The soft-spoken and warm-hearted mother of two was thrilled when she and fellow community members heard the news that the provincial Department of Health (DoH) in partnership with the Health Systems Trust would be visiting their local Sivule Community in rural Zululand's uPhongolo Local Municipality during Phuthuma Week. She and her sons received free health screening at the outreach event.

Phuthuma is an isiZulu word that means 'hurry', and the DoH identified this particular week for the implementation of a strategy to regain the losses suffered by health services in the province as a result of the negative impact of a multitude of factors in the last two years: including the COVID-19 pandemic, the July 2021 civil unrest, the devastating April 2022 floods, as well as the unprecedented negative impact of misinformation and disinformation about vaccines in general. When the DoH sent out a directorate for local health districts to prioritise Phuthuma Week in the province from May 15 to 22, Health Systems Trust (HST) as its district support partner was present to play an active role in rolling out the strategy.
HST's Zululand District Co-Ordinator, Makhosazana Khoza

HST's Communications Unit supported the organisation's District Co-ordinator for Zululand, Makhosazana Khoza, during Phuthuma Week, where two community sites and a school were visited. Makhosi, as she is known as, is employed under HST's South Africa Sustainable Response to HIV/AIDS (SA SURE) Project, which is funded by the Centers for Disease Control and Prevention (CDC) through the United States President's Emergency Plan for AIDS Relief (PEPFAR).

Honing in on Zululand
ITshelejuba Hospital Chief Executive Officer, Mrs Thembisile Vilakazi

UPhongolo Local Municipality is fortunate enough to have a few clinics as well as a district rural hospital (iTshelejuba Hospital), however, transport issues coupled with a number of socio-economic factors in the iTshelejuba community and its surrounds prevent residents from accessing the health facilities as often as they would like to.

The overall picture was painted by Mrs Thembisile Vilakazi, a Nurse by profession and Chief Executive Officer of iTshelejuba Hospital and its clinic. Community outreach has always been at the heart of what she does. Her passion is helping people, but the community faces several challenges. "Poverty and other social determinants mean we are far from our clients. What I like to do is show[ing] up at the communities to understand the challenges faced by healthcare workers and understand how best to support them as well as the community members. HST plays a huge role in helping us reach out to communities."

Mrs Vilakazi said Phuthuma Week highlighted what has always been needed: integrated services at community level. Phuthuma Week encouraged the establishment of vaccination centres at all chronic (PHC) clinics to reach the elderly, persons with co-morbidities and persons classified as immunocompromised. It was also an opportunity for school health facilitated vaccinations to reach learners and surrounding communities; for Occupational Health clinics to promote vaccine uptake and  booster shots; and going back to SASSA and Post Office pay points to reach the elderly in efforts to help shield them and vulnerable individuals from severe COVID-19 through up-to-date vaccinations.

Despite the ongoing social ills and challenges, including teenage pregnancy; drug abuse; gangsterism; constantly migrating farm workers; cellphone network issues sometimes preventing cross-border client tracing; and (especially) cancer clients showing up to the hospital and clinic almost too late in the disease progression spectrum; clients still do want to access health services. Mrs Vilakazi and her team were pleased to see community members showing up in their numbers to receive free health screening services for TB, HIV, acute and minor illnesses during Phuthuma Week. Services included medical male circumcision and screening for prostate cancer; eye-care services and Pap smears offered in the mobile units; and assistive devices such as walking sticks were personalised and issued to the elderly.

Bringing health services to the people: HST's Area Co-ordinator for Zululand, Phindile Sangweni, consults with an elderly community member inside a mobile unit during Phuthuma Week.

Identified by the DoH as one of the best schools in the district, Mchitheki High School in KwaNgoma, Zululand, vaccinated an impressive 520 learners for COVID-19 on its first day of the Phuthuma Week drive. This was in line with the DoH strategy to increase the number of youngsters (aged 12–17) vaccinated against the pandemic. The school established a Vaccine Committee, led by one of the teachers, Mr Siyabonga Khumalo, in January 2022. Khumalo said managing the virus is critical. The committee has prioritised sourcing reliable information to share with the learners and the surrounding community. The learners are sanitised and screened daily, and the schools encourage them to wear masks and maintain social distancing.

The school principal, Mr Xolani Mthethwa said they were thrilled to be making a valuable contribution to the community. "We are a school operating within the community and so we have to play our part. It's great that the Department of Health will see that a school in the 'bundus' can make a difference – we like to be a candle lit in the community." The school was touched by the recent floods in Durban. They responded with a donation of over R5000 to the Durban Mayor's Office. The money was raised by teachers, learners and parents. Principal Mthethwa said it was great to see the parents supporting the vaccine drive at the school.
The School's COVD-19 Committee.Principal Xolani Mthethwa speaks to HST about the vaccine campaign during Phuthuma Week.

The Zululand visit concluded in Ngenetsheni Community, situated in Vryheid's Emahhokweni area that is serviced by the neighbouring Ikhambi Clinic in the Abaqulusi District. We spoke to Sister Daisy Ndebe who lauded HST's support, especially the outreach into remote communities. As primary healthcare professionals, they would also like to see more integrated services becoming more available in the area. To this end, they work closely with HST's Area Co-ordinator in Vryheid's Abaqulusi District, Cebo Ngobese.

Working hard to deliver health services in Vryheid: Cebo Ngobese, Zandile Mtshali and Sister Daisy Ndebe.

Together with the local Community Health Worker, Zandile Mtshali, Sister Ndebe explained that residents in the community identified for the Phuthuma Week outreach often feel neglected. There is a single taxi that leaves for the clinic each day. If the client misses that taxi, they will miss out on critical healthcare services. They said the Get Checked. Go Collect Campaign has really helped with increasing pick-up points for chronic medication patients.

Other challenges in the community include community members not having Identity Documents (IDs) and birth certificates. "This makes it extremely difficult to on-board clients to the health system and CCMDD. We need to establish strong interdepartmental referral pathways between the DoH and the Departments of Social Development and Home Affairs.

Trained by the HSTi, HST's Driver Mobilisor, Mondli Shelembe offers HIV testing services (HTS) in a mobile unit in Vryheid during Phuthuma Week.

Partners offering integrated services in Zululand during Phuthuma Week. 


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