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Feb 16
Child Immunisation Awareness: Measles

By Siyabonga Gema – HST Communications Officer

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The COVID-19 pandemic disrupted health programmes and caused delays in surveillance and immunisation programmes across the globe. School health activities, routine check-ups and other programmes took a backseat as the scramble for a COVID-19 vaccine took centre stage. The global suspension of immunisation programmes, as well as decreases in immunisation rates and surveillance, have exposed millions of children to preventable diseases such as measles. Measles is a highly contagious disease caused by a virus. It spreads easily when an infected person breathes, coughs or sneezes, it can cause severe disease, complications, and even death.

Symptoms of measles usually begin 10–14 days after exposure to the virus. A prominent rash is the most visible symptom. Early symptoms usually last 4–7 days. They include:

  • runny nose
  • cough
  • red and watery eyes
  • small white spots inside the cheeks.


In December 2023, the National Institute for Communicable Diseases (NICD) reported that a total of 1 317 laboratory-confirmed measles cases were reported between epidemiological week 40 2022 to week 47 2023 in South Africa. Limpopo had reported the most number of cases (532), followed by Gauteng (256) and then North West (226).  Due to intensified measles immunisation efforts, measles mortality has decreased substantially worldwide, particularly in sub-Saharan Africa (SSA). However, the recent measles outbreak has caused concern and highlighted the ongoing challenges that hinder the successful implementation of vaccination programmes and effective control efforts in South Africa.

The role of primary healthcare in controlling outbreaks of diseases such as measles is indisputable, however, the challenge of access to primary healthcare services, especially in rural areas, calls for a concerted approach and collaboration amongst various stakeholders.  Recognising this, the Departments of Basic Education and Health jointly implemented the Integrated School Health Programme (ISHP) that will extend, over time, the coverage of school health services to all learners in primary and secondary schools. Its strategic objectives are to:

  • increase knowledge and awareness of health-promoting behaviours
  • develop systems for the mainstreaming of care and support for teaching and learning
  • facilitate early identification and treatment of health barriers to learning
  • increase knowledge and awareness of health
  • promote health-seeking behaviours.


Although measles is highly contagious, an effective and safe vaccine is available for prevention and control. A nation-wide measles response strategy has been put into place by the National Department of Health (NDoH) in co-ordination with the World Health Organization (WHO), and a mass vaccination campaign is being carried out in every province for children between the ages of six months to 15 years. WHO staff have been deployed to support all aspects of the response: co-ordination; information management and surveillance; case management; supplies and logistics; and risk communication and community engagement.

 Other response activities include:

  • active case search, investigation and line listing of fever and rash cases;
  • support team meetings and situation reports conducted with all provinces;
  • weekly interim reports based on the results of laboratory tests being issued by the NDoH and NICD;
  • deployment of provincial and district rapid response teams (RRTs) to affected neighbourhoods; and
  • training in preparation for the national immunisation campaign, completed in all provinces.


WHO advises that the MCV1 vaccine is given at the age of 9 months in countries with both ongoing transmission and a high risk of measles mortality among infants. These countries should administer the routine MCV2 at the age of 15-18 months. In South Africa, MCV1 is given at 6 months and MCV2 at 12 months. A 95% population coverage of MCV1 and MCV2 is required to stop measles circulation. Reaching all children with two doses of the measles vaccine is recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose.

Although there is no cure for measles, parents need to ensure that children get vaccinated as part of their regular immunisation schedule. If a child has not been immunised, measles can still be prevented by getting the vaccination within three days of being exposed to the virus. If you are an adult and are not sure whether you have been vaccinated against measles, speak with your healthcare provider about receiving the vaccine. Current evidence suggests that immunity after the disease is life-long, whereas the response after two doses of measles-containing vaccine declines within 10–15 years.

To learn more about immunisation, visit https://www.health.gov.za/immunization/


Feb 08
The Importance of STI Awareness and Condom Use

​By Mandisa Dlamini - HST Communications Intern


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Sexual health is a crucial aspect of overall well-being, and promoting awareness about sexually transmitted infections is a vital step towards a healthier society. This article emphasises the importance of being aware of sexually transmitted infections and highlights the role of using condoms in preventing their spread. During STI/Condom Week, let's focus on educating, preventing, and reducing the stigma associated with sexual health.

Understanding STIs

Sexually transmitted infections (STIs)are infections that can be transmitted through sexual contact. This includes vaginal, anal, or oral sex with an infected individual. STIs can be caused by bacteria, viruses, or parasites, and they can affect both men and women. Sexually transmitted infections can impact individuals of any age, gender, or sexual orientation.

Untreated STIs can lead to severe health complications. For example, certain types of human papillomavirus (HPV) can increase the risk of cervical cancer, and untreated syphilis can affect the heart and nervous system.

Early Detection and Treatment

Seeking medical attention at the first signs of STI symptoms is crucial for individual health, preventing complications, reducing transmission, and promoting overall community well-being. Regular STI screenings, open communication with healthcare providers, and practicing safe sex are essential components of maintaining sexual health. Seeking medical attention provides an opportunity for individuals to receive counselling and education about safe sex practices, risk reduction, and preventive measures. Healthcare professionals can offer guidance on how to protect oneself and others from STIs. Early detection and treatment can prevent complications and reduce the risk of transmission.

Condoms as a Preventive Measure

Condoms are highly effective in preventing the transmission of various infections, including sexually transmitted infections and HIV. Condoms act as a barrier that helps reduce the risk of infection by preventing the exchange of bodily fluids, such as semen, vaginal fluids, and blood, between sexual partners.

Breaking Stigmas

The stigma associated with STIs can have a significant impact on people who are trying to get the medical care they need. This stigma is frequently caused by cultural conventions, beliefs, and views toward sexuality in society. It's critical to encourage judgment-free, candid discussions regarding sexual health. It is important to create safe spaces where people may open up about their worries and experiences without fear of social rejection. Fostering empathy, understanding, and open communication can help us create a more accepting and helpful environment for people who are struggling with sexually transmitted infections.

As we observe STI/Condom Week, let's pledge to promote openness, education, and proactive healthcare. By recognising the significance of STI awareness and advocating for consistent condom use, we empower individuals to make informed choices, fostering a healthier and safer society. Sexual health is crucial for overall well-being, and through collective efforts, we can create a world where everyone has the knowledge and resources to safeguard themselves and their partners.

For more information visit the CDC website https://www.cdc.gov/std/saw/resources.htm




Feb 05
Men more likely to die by suicide

By Willemien Jansen – HST Copy and Content Editor

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Suicide is an often misunderstood and stigmatised cause of death, even though it is one of the leading causes of death globally. In 2019, South Africa ranked 10th according to the suicide rates by country (World Population Review), at a rate of 23.5 per 100 000 people. Its prevalence among men is disproportionately higher than among women, according to the South African Society of Psychiatrists (SASOP). But, why is that?

The suicide crisis amongst men in South Africa was brought into view in 2022 when IOL published an article about South African men in the entertainment industry that died by suicide over a short period of time. These included hip hop pioneer Riky Rick, veteran actor Patrick Shai, Arendsvlei actor Ceagan Arendse and Yizo Yizo actor Jabu Christopher Kubheka.

Dr Talatala from SASOP says that risk factors for suicide include unemployment and occupational issues, divorce and adverse childhood experiences.  "The tools used for surveys for depression and for diagnosis of depression are not designed to pick up 'male depression' as men are likely to present with substance abuse, risk-taking behaviour, poor impulse control, anger, and irritability. Yet even though not reported in surveys, many of those men dying by suicide are due to depression."

Dr Talatala goes on to say that "men don't seek help due to the 'macho male stereotype' in society expecting men to 'man up' and adopt the 'boys don't cry' mentality. It's this attitude of men portrayed as being brave and fearless that leads to men considering themselves in a negative light if they suffer from mental health conditions. And for this very reason, they see it as putting themselves in a vulnerable position when seeking help." SASOP urges men to speak up before it's too late, and break the stigma that it's 'unmanly' and a sign of weakness to ask for help.

In a discussion with eNCA, Nicolene Trom from the Umntu Ngumntu Ngabantu Foundation said that men don't know how to speak about the things that make them angry. "Where men are concerned, they are unable to speak out and say 'these are the things that make me angry'", says Trom. Men therefore have no outlet for their feelings and suppress their emotions.

Women are more likely to attempt suicide, but men are more likely to die by suicide, according to an article published by The Hill. Cassey Chambers, The South African Depression and Anxiety Group (SADAG) operations director, told IOL that men are five times more likely to die by suicide than women. "They often use more aggressive methods. While women may be diagnosed with depression more than men, men don't speak about their feelings till it is too late," said Chambers.

Signs of depression in men look slightly different from that in women and loved ones should know how to recognisethem. According to Healthline, symptoms can be divided into four categories.

1.      Physical

  • chest tightness
  • digestive problems like gas, diarrhea, and constipation
  • erectile dysfunction and other sexual problems
  • headaches
  • hormonal issues like low testosterone
  • pain
  • racing heart, or heart palpitations
  • unintended weight loss (and sometimes weight gain)
     

2.      Mental

  • inability to concentrate
  • memory problems
  • obsessive-compulsive thought patterns
  • racing thoughts
  • sleep issues, usually difficulty falling asleep or staying asleep
  • suicidal thoughts
     

3.      Emotional

  • agitation
  • aggression
  • anger
  • emotional withdrawal from friends, family, and colleagues
  • hopelessness
  • lack of interest in family, community, hobbies, and work
  • lack of libido
  • restlessness
     

4.      Behavioural

  • difficulty meeting work, family, and other personal responsibilities
  • drug misuse
  • drinking alcohol in excess
  • engaging in risky activities, such as driving recklessly or having unprotected sex
  • social isolation
  • suicide attempts


If you or someone you know needs help, contact The South African Depression and Anxiety Group on 0800 121 314, or send an SMS to 32312 and a counsellor will call you back.


Feb 01
The Right Nutrition Leads to a Healthy Nation

By Siyabonga Gema – HST Communications Officer


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The start of the year can mean different things to different people. For most, it represents new beginnings – a brand new slate. While there are different ways to ensure that you start the year on the right note, a common view is that making the right health choices now, and sticking to them, is one of the best ways to start your year. The famous saying 'an apple a day keeps the doctor away' may sound clichéd, but it is an excellent example of how one simple act can benefit your health in the future.

For many families, healthy choices are tied to their economic situations. This is especially true in South Africa, where the cost of living is on a continuous incline and many communities struggle to access basic services such as clean water. The World Health Organization (WHO) shared ten healthy choices to make in 2024, most of which are quite easy to achieve and maintain for most people. However, the reality is that for some, something as simple as following a healthy diet is the least of their worries when putting food on the table seems impossible.

Nutrition is arguably the biggest enabler of achieving positive health outcomes, which is why many governments globally focus on suppressing factors associated with malnutrition, especially among children. For developing countries with an increasing population, like South Africa, the stakes are much higher. According to Statistics South Africa, results indicate that, in 2021, of almost 17.9 million households, almost 80% (14.2 million) reported that they had adequate access to food, while 15% (2.6 million) and 6% (1.1 million) respectively stated that they had inadequate and severe inadequate access to food. Further to this, more than half a million (683 221) households with children aged five years or younger reported experiencing hunger in 2021. On the other hand, for those with adequate access to nutrition, obesity is on the rise. Obesity statistics in South Africa are concerning, as roughly 31% of men and 68% of women in the country are obese. Being overweight or obese can lead to a range of lifestyle diseases, including diabetes and heart disease.

Whichever way you look at it, there is serious cause for concern when it comes to nutrition. A range of mitigating actions have been implemented, aimed at increasing awareness, educating the public on food safety, and providing access to food for those in need. In line with the Sustainable Development Goals, the government developed The National Food and Nutrition Security Plan for South Africa; its main goal being to implement a priority set of actions to deliver significant improvements in food and nutrition status by 2023. One prime example is the establishment of the government's School Nutrition Programme, which feeds millions of children across the country and helps ensure they attend class regularly. The main objective of the programme is to provide nutritious meals to learners to improve their ability to learn. The programme also teaches learners and parents how to live a healthy lifestyle and promotes the development of school vegetable gardens.

Clearly, the benefits of achieving food security stretch far; for children of school-going age it means improved concentration at school, while for the working-class adults it means increased productivity, thereby increasing participation in the economy. So, if you're on the 'New Year, New Me' journey, perhaps your starting point should be doing thorough research on what nutritious choices to make for yourself. As the saying goes, 'you are what you eat'.


Dec 14
World AIDS Day 2023 commemoration: Letting communities lead

Compiled by: Eddy Moyambo (Clinic‒Laboratory Interface Co-ordinator: HST), Joslyn Walker (HSS Programme Manager), and Judith King (HSS Copy and Content Editor)


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South Africa implements the largest HIV treatment programme in the world. This is an enormous achievement, made possible by collaboration and partnerships at all levels of the health system.

Noting that we have such a successful programme, it is important to recognise that we still have a very long way to go in terms of epidemic control, which entails ensuring that 95% of people living with HIV know their status, 95% of those who know their status are on treatment, and 95% of those on treatment are virally suppressed. This will dramatically reduce new infections and will enable us to achieve the UNAIDS targets.

Every year, we mark World AIDS Day with mixed feelings, because we understand the magnitude of what is still required. We celebrate how far we have come from the unfortunate times when we lost so many lives to HIV and AIDS before the range of antiretroviral drugs became available: we remember our mother activist Gugu Dlamini, the brave Nkosi Johnson, and many more. Sadly, we have still not overcome HIV-related prejudice, stigma and discrimination, which is pulling us back in terms of treatment accessibility. We also pay tribute to healthcare workers, political leaders and civil society for their efforts to ensure that patient rights and access to treatment, prevention and education remains front of mind.

This year was no different, and each of the four HST-supported districts hosted events with and in communities to mark this auspicious day. The National Department of Health (NDoH) commemoration on 1 December was hosted in KwaZulu-Natal (KZN) this year, at the Ngcedomhlophe Sportsground in Mandeni, Zululand.

The Health Systems Trust (HST) supported this event in the interests of education and treatment literacy. Our teams provided testing support, briefed leaders on our strategies and progress, and mobilised with communities for health education at all events.

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HST's Outreach Team members at the WAD 2023 event in Mandeni, Zululand

The proceedings were co-chaired by KZN Premier Nomagugu Simelane Dube, and Patrick Mdletshe, Chairperson of the KZN Civil Society Forum and Deputy General Secretary of the Treatment Action Campaign (TAC). Speakers included the Minister of Health, Dr Joe Phaahla, Deputy President Mr Paul Mashatile, and U.S. Ambassador Reuben Brigety.

It was noted that KZN has reached the first UNAIDS 95 target for HIV epidemic control, however, we remain short of the second 95, with the shortfall reflecting gaps in leadership action to implement agreed strategies and innovations.

The speakers voiced the need to embody the theme 'Let communities lead' in all our strategies and approaches. In order for us to climb the last hill, our communities must lead, and through working together and embracing Ubuntu, our villages will and can 'raise a child'.

At this year's commemoration, the South African Charter of the Global Alliance to End HIV/AIDS by 2030 highlighted political willingness and decisive leadership, representing a strong step towards government ownership and sustainability. The Deputy Minister emphasised the objectives of focus, i.e.:

  • Elimination of mother-to-child transmission (EMTCT)
  • - access for children is still below 70%
  • Jointly confronting prejudice, stigma and discrimination in our society
  • - gender-based violence, fear of disclosure, high rate of loss to follow-up
  • Ensuring universal access to treatment
  • - treatment availability for the community with minimal effort.


We know that epidemics and disasters happen and will continue to do so despite good preparation and prevention strategies. What we have learnt from the COVID-19 pandemic is that we need an adaptive response strategy, and to keep vigilant, with warning systems in place.

The COVID-19 experience has shown us that combatting diseases must start with letting communities lead.

As HST, we pride ourselves in ensuring that we integrate all activities designed to support HIV control and accessibility of care for a range of illnesses. We collaborate and co-ordinate at community level up to provincial level, maintaining grassroots availability and visibility through our Outreach Teams' services which respond to community needs and synergise action with community partners.

This is reflected in direct services that HST provided at the WAD 2023 event Mandeni. Two Outreach Teams mobilised 167 people for HIV literacy, tested 67 people for HIV, and identified three people who were HIV-positive and did not know their status, as well as 13 people who knew their HIV status. At a WAD 2023 event held on 10 December in Klaarwater, eThekwini, a further 49 people were tested and two new patients were diagnosed.

All diagnosed clients received counselling and treatment literacy information, were initiated on treatment, and were directly linked to a facility convenient to them for lifelong care. The teams also provided TB education and prescribing of TB preventative therapies, along with health education about sexually transmitted infections and non-communicable diseases.


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HST's Outreach Team provided health services at the Klaarwater event in Pinetown.

This comprehensive care package is regularly provided by our Outreach Teams, but commemorative events are valuable opportunities to magnify the scope and availability of the services to the general public.

Continuous coal-face visibility ensures that demand creation is available and healthcare services are accessible. Training support, new information and data trends dictate that healthcare workers keep learning in order to hone their skills for provision of quality health care, and ongoing skills audits allow for critical in-service trainings to take place.

HST's partnerships at district and sub-district levels ensure that performance on agreed indicators is monitored, reviews are conducted, and shortcomings are redressed through quality-improvement interventions. Layering of services with the Department of Health (DoH) is conducted with the aim of sharing knowledge and transferring skills from Implementing Partners to DoH staff through mentoring and coaching, with the clear objective of promoting ownership and sustainability.

HST research experience influences policy, and this knowledge is disseminated through reviews on a quarterly basis. We also participate in periodic amendments and updates for NDoH guidelines, which enable tailor-made solutions for an effective HIV response.

As a supporting partner, we see ourselves as central in this last push to reach and exceed the 95-95-95 targets, and remain positive that our experience will contribute to the formulation of adaptive response strategies. Our efforts are increasingly focused on the community, working together with civil society organisations to strengthen our support and fulfil government commitments to ending HIV and AIDS.

As our Campaign Agent, Mr Lungelo Joka, advised eThekwini Mayor Mxolisi Kaunda, we work with the DoH and communities to increase knowledge about HIV and how to prevent it, and provide lifesaving treatment in communities and facilities.

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The eThekwini Outreach Team

Tracing people who miss appointments and providing people-centred services rests on Community Health Workers (CHWs), who are often the face of health care in the community. They see the daily struggles that patients face in accessing and adhering to treatment, and their struggle with stigma and discrimination. The CHWs also see the triumphs of treatment adherence and treatment as prevention.

While these commemorative days are important to communicate our messages and elevate them into the media and public consciousness, we are reminded that HIV is with us every day, not only on 1 December every year. Together, we must support communities to lead us to an AIDS-free generation.

HST extends special thanks to Lungelo Joka for providing a voice for healthcare workers to His Excellency the Mayor, and for presenting the great work of CHWs in mobilising for improved adherence and retention. We are also grateful to our Outreach Teams for their hard work at the events in KwaDabeka, Tongaat and Klaarwater.




Dec 13
A Day in the Life of Nqobile Myende

​by Siyabonga Gema – HST Communications Officer


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Nqobile Myende's journey at Health Systems Trust (HST) is nothing short of inspirational; from humble beginnings as an Intern in 2019, to notable career achievements. Now HST's Research Assistant: Research Implementation Science, Nqobile says that she is a naturally very inquisitive person and enjoys burying herself in research papers every chance she gets; the perfect space for someone in Research. HST's Communications Officer recently interviewed Nqobile to get to know her better.

Please give a brief overview of your educational and professional background.

I have a Bachelor's Degree in Public Health, obtained at Monash University in 2017. I will be enrolling for a Postgraduate Diploma in Public Health in 2024 and, thereafter, I will tackle my Masters in Public Health. Health Systems Trust gave me a chance as an intern in 2019, straight out of the retail industry, which I had been working in for two years without any success in finding employment in my field. I then began my career in Public Health at HST.

How long have you been with HST and what does your role entail?

I went from being an intern, to Junior Research Assistant and I am now a Research Assistant. I have been employed at HST for four years. As a Research Assistant, I am part of the Research and Implementation Sciences Unit; I support the Researchers and Senior Researchers in data collection tool creation, data collection, data analysing (qualitative data), report writing and I ensure that all projects are in order whenever tasks are delegated to me. I hope to continue my work here and gain experience in this very valuable field.

What interested you about research?

When I was at university I used to read so many research papers, I became fascinated with the information and the knowledge that I gained from them. These days I read research papers on absolutely EVERYTHING for fun. I am naturally a very inquisitive person, so research was the best fit for me.

Who/what has influenced you the most in your career?

Nandipha Jacobs was my very first manager at HST and she taught me everything I needed to know about Research. She agreed to take someone who had never worked on a project a day in her life, and was patient with me and saw my potential. Although she no longer works at HST, I will never forget all the gems she taught me. 

Why HST?

HST gave me a chance when every other company or organisation wanted four to five years' experience. I had just gotten out of university; it was impossible to have that much experience at the time; and HST gave me a chance to prove myself and show that this is the right field for me. I am eternally grateful and I hope I never let HST down.

Why do you think ethics are important in the research field?

They protect the rights of our participants. Our participants are who give us information/data when it comes to our job and they deserve the utmost respect and to be protected in the process of us collecting data from them. I am very grateful for ethics committees that force us to keep our standards high. A lot of harm has been done to study participants in the past and now we have rules and regulations in order to avoid that. We care for our participants as HST and I am proud to be a part of that.  

Share any recent improvements in data collection methods and how these have changed the research landscape.

My favourite improvement is the ability to create data collection tools using technology and to also be able to collect data using technology. I am able to create a questionnaire using Survey Monkey and collect the data using the same application. It's amazing! Paper-based data collection is still very heavily used, however tech makes it so simple and makes storage easy. Printing papers for data collection is killing our trees!  

Do you have any notable work accomplishments at HST (or anywhere else)? if yes, please share.

I appeared in the Indicators chapter of the latest South African Health Review as a co-author. I was so proud, especially because writing isn't my strong point. I got a chance to shine with my wonderful colleagues. Thank you to Noluthando Ndlovu (Senior Researcher – RIS) for giving me that chance. I wouldn't have done it without her.

How do you spend your time away from work?

I spend my time away from work playing with my dogs, I have two babies (the dogs) and they make me so happy. I also spend time with my family members and friends, I exercise five days a week at 04:00am (great start to my day) and I also meditate. I am a big art and nature lover.

What's the best advice you've ever received?

"If you can't beat fear, just do it scared." I struggle with anxiety and I wouldn't have gotten so far in my career if I let it take over. Whenever I feel like I can't beat the fears within me, I do whatever I have to do scared, and it always works out for the best. God holds my hand through it and I get what I have to do, done!


Dec 12
Universal Health Coverage Day 2023: How HST's health system strengthening supports health for all

​by Judith King – HSS Copy and Content Editor and Joslyn Walker – HSS Programme Manager

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Commemorated on 12 December every year, Universal Health Coverage (UHC) Day focuses attention on Sustainable Development Goal targets 3.8.1 (health service coverage) and 3.8.2 (financial hardship), to be reached by 2030.

This focus arises within a global year-end season of human rights campaigns, such as the 16 Days of Activism for No Violence Against Women and Children, HIV and AIDS on 1 December, and Human Rights Day on 10 December, which foreground the call for action against commitments – hence this year's theme of 'Time for Action'.

Although centred on health as a human right, UHC also encompasses broader factors of well-being, such as social inclusion, equality, economic growth and human dignity, signifying that a whole-of-society response is required to fulfil the ideal of a supportive environment for health, wherein people have the knowledge and access needed to control and improve their health.

Striving for stronger health systems

Ensuring access to good-quality, affordable health services has been elemental for Health Systems Trust's vision and mission since its establishment in 1992, and is the foundation for the health systems strengthening work conducted by the organisation during the past 31 years in partnership with the Department of Health (DoH).

Supported by a range of funders and in collaboration with civil society, this work has entailed research and implementation projects spanning a range of priority programme areas, bolstered by consistent and comprehensive knowledge-sharing, with reviews of and input into health policy and legislation. Alongside direct service delivery, technical assistance is rendered in the form of training, mentoring and coaching on supportive interventions, and innovation for good practice, in tandem with monitoring and evaluation services and development of health information systems.

Building effective, efficient and equitable national health systems in a responsive manner characterises HST's engagement with DoH programming, with an increasing focus on community-orientated Primary Health Care (PHC) and supporting communities to participate and lead in reinforcing aspects of governance that address inequities in health and health care at facility, sub-district and district levels.

The Health Facilities Baseline Audit – 2011 to 2012

Funded by the National Department of Health, HST led this seminal, year-long project. The audit covered every public health facility in South Africa to provide data for analysis of how the type, quantity and quality of services was meeting the population's needs, identify health system strengths and gaps, and assess current and future requirements for quality improvement strategies such as National Health Insurance (NHI). Based on the findings, recommendations were made for the National Core Standards database in relation to facilities' functional descriptions, compliance with ministerial priority areas, service provision, human resources, and health technology.

HST projects supporting UHC

HST's more contemporary suite of projects reflects deployment of our institutional knowledge and expertise towards achieving UHC Day's sub-themes of creating resilient health systems, expanding PHC, working across sectors and communities, and promoting innovation to reach everyone.

  • Over the past eight years, HST has supported the National Health Insurance Information System (NHI-IS) programme to provide and train users on digital health systems for patient registration, reaching 3 205 facilities across 46 districts in eight provinces.

  • Now in its third cycle of five-year grants from the US President's Emergency Plan for AIDS Relief/Centers for Disease Control and Prevention (CDC), the SA SURE PRO Project contributes to the country's rapid scale-up of HIV and TB prevention, treatment and care responses, with HST serving as District Support Partner in four KwaZulu-Natal (KZN) districts to transfer skills for sustainable capacity and quality service delivery. Our approach to integrated healthcare and systems strengthening, and our focus on people-centred care in this project reinforces the approach to UHC across the programme.

  • Our role extends to that of Provincial Support Partner to the KZN-DoH, offering technical support for Strategic Health Programmes delivered in all 10 districts and the eThekwini Metro. Key activities include Ideal Clinic Realisation and Maintenance (ICRM) reviews, COVID-19 provincial operations, a baseline assessment of the province's readiness for full UHC implementation through NHI, and a KZN Online Data Visualisation Dashboard which enables various components of the NHI Unit to track and monitor metrics, trends, actionable insights and consolidated data.

  • Funds are leveraged through SA SURE PRO grant to support health systems strengthening through the Central Chronic Medicines Dispensing and Distribution Programme (CCMDD), and the Synchronised National Communication in Health (SyNCH) electronic information system that automates CCMDD process management – these being key programmes for differentiated models of care that represent the synergy between the public and private health sectors required to manifest UHC through NHI.

  • The Unfinished Business for Adolescent and Paediatric HIV (UB) Project, funded by ELMA Philanthropies, operates in three KwaZulu-Natal districts to refine and test strategies for accelerating the identification and enrolment of HIV-positive children and adolescents on treatment, and ensuring that they remain in care. Nested within this programme is the Electronic Integrated Management of Childhood Illness (eIMCI) Project to improve child survival.

  • With funding from the Bill & Melinda Gates Foundation, the Delivery Optimization of Antiretroviral Therapy (DO ART) Demonstration Project has provided comprehensive HIV screening services, treatment initiation, and ongoing community-based management of patients on antiretroviral therapy in eight KZN sub-districts – achieving notable results that complement clinic-based services.

  • Layering on HST's HIV/TB footprint for accelerated community entry, the Global VAX Project seeks to improve uptake of COVID-19 vaccination in six KZN sub-districts, particularly in rural and hard-to-reach areas. Demand-creation activities focus on those most at risk of COVID-19 infection, with the aim of reaching a total of 27 000 people.

  • The Cervical Cancer Prevention, Access and Control (CCPAC) Project in Zululand, funded by the Bristol Myers Squibb Foundation, addresses the challenge of high cervical cancer incidence and mortality by improving access to early screening, diagnostic treatment and palliative services in the district. This work is grounded in capacity-building and skills development for clinical staff and community structures.

  • HST provides clinical and non-clinical capacity-building and HWSETA-accredited skills programmes to enable expansion of UHC through NHI and initiatives such as PHC re-engineering.

HST's vision is for improved health access and outcomes in South Africa and beyond, and we continue to strengthen health systems for equitable access. We pride ourselves on our collaborative and multi-disciplinary approaches to improved health outcomes for all, and our projects – both historic and current – are testament to our commitment to universal health coverage.


Dec 11
Taking the COVID-19 vaccine to the community: TFGH Global Vax community vaccinations in Ulundi, Zululand District

by Siyabonga Gema ‒ HST Communications Officer


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One of the identified drivers of the persistent COVID-19 epidemic ‒ which, as early as February this year, had affected 728 708 people in KwaZulu-Natal (KZN) ‒ is vaccine hesitancy. This is especially prevalent in rural areas where a majority of people lack basic information on the benefits of taking the COVID-19 vaccination.

Since April 2023, the HST Global Vax project, embedded in the SA SURE PRO programme and funded through the Task Force for Global Health, has rolled out community vaccination in the Zululand and uMgungundlovu Districts of KwaZulu-Natal, providing the platform for community dialogues in the COVID-19 vaccine, and making the vaccine available to willing community members. The purpose is to improve the uptake of COVID-19 vaccination in six sub-districts in KwaZulu-Natal Province. This project works closely with the Department of Health in the district and with civil society to bring health services into the community.

On 21 and 24 November 2023, the Zululand-based Global Vax team hosted two community vaccination events in Babanango and Hlophekhulu in Ulundi. HST brought a number of health services to the community, including cervical cancer screening and HIV testing and counselling. The first event took place at Babanango Community Hall, where 120 people were vaccinated. Members of the public engaged with health workers from the KZN Department of Health and HST. The second session was held at Hlophekhulu Community Hall and 128 people were vaccinated.

 

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HST's Cervical Cancer Prevention, Access and Control (CCPAC) Project bus at Hlophekhulu Community Hall, where cervical cancer screening and testing services were offered to the community

In February this year, the KZN Department of Health reported that 29 351 cases had been identified in Zululand District, with 28 651 recoveries. What these statistics reflect is the rapid rate at which people are recovering from the COVID-19 virus, which is largely due to the ramped-up efforts of making the vaccine available to the public.  An important role played by the healthcare workers was to provide factual information on the COVID-19 vaccine, to debunk popular myths.

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HST's health workers administering the COVID-19 vaccine at Babanango Community Hall

Udaya Veeramachaneni, Global Vax Project Manager, says that there is still some work to do to address the COVID-19 vaccine myths that prevent people from taking the vaccine: "To tackle these myths effectively, community engagement and collaboration with trusted local leaders are essential. Clear and concise communication, along with informed healthcare workers, will play a pivotal role in dispelling myths and encouraging more community members to make informed decisions about COVID-19 vaccination.

Addressing these myths is not only about individual protection, but also about safeguarding vulnerable populations who may be at higher risk of severe illness from COVID-19. It is through such community-based initiatives, ongoing education, and joint efforts that we can collectively work towards increasing vaccine uptake, and ultimately mitigating the impact of COVID-19 in these areas."

Members of the public who wish to receive the COVID-19 vaccine can access a number of readily available sources of credible information and contact details, or contact their nearest healthcare facility.


National Health Hotline: 0800 029 999

WhatsApp Support Line: 0600 123 456

healthhotline@health.gov.za


 


Dec 01
WORLD AIDS DAY 2023

​How effective HIV care and treatment management helps sero-discordant couples and patients co-infected with HIV and TB

by Sanele Mvelase – Cross-site Facilitator: Health Promotion and Primrose Sithole - Special Project Co-ordinator: Zululand District


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The Health Systems Trust (HST) has been receiving funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) since 2012. We work in partnership with the Department of Health in four districts in KwaZulu-Natal, where we provide technical assistance for TB and HIV programmes, and have placed supplemental staff in facilities to provide direct services to patients.

In the course of this work, we hear many stories from patients ‒ some motivating us to do more, some helping us improve our patient-centred approaches, and some that demonstrate the difference that our work makes in people's lives through PEPFAR's commitment to the dual pandemics of HIV and TB in South Africa.

This article touches on the stories of three patients who are partners in sero-discordant couples, and a patient with TB and HIV co-infection. These patients have shared their experiences with us in order to inspire others to seek treatment and dispel myths that contribute to the stigmatisation of people living with HIV. We also speak to the clinicians responsible for helping patients to remain on life-saving treatment.

Msizi Zikalala (not his real name) is from Zwelisha in Estcourt, a farming town in the uThukela District of KwaZulu-Natal, where he and his three siblings were raised by his mother. Now 32 years old, he is an informal vendor selling snacks, sweets and cigarettes at a local taxi-rank.

When his partner was pregnant, she was not feeling well and they decided to visit the Zwelisha Clinic, where they both consented to be tested for HIV. During the consultation, the healthcare worker asked them whether they would accept whatever the test results showed, even if their status was not the same; they agreed to accept the results and support each other as a couple.

"I know that there are other couples out there with other health conditions, like one partner has diabetes and the other does not," says Msizi. "Such couples do not give up on each other but continue with support and love for one another. It's the same with HIV, so I believe couples should support each other if one is HIV-positive and the other is not."

When the test results showed that Msizi's partner was HIV-positive and he was HIV-negative, the nurse assured them that the situation could be managed, and that many couples in a similar situation were healthy, happy and still in love.

Because they received their test results together, they spoke about their sero-discordant status immediately during the consultation. "My partner was emotional and crying," recalls Msizi. "I comforted her, and assured her that everything would be fine. I still love her and will not leave her. We are in this together and we will conquer. I believe that it's important to stay loyal to your partner and never allow anything to come between you. Another man might have moved on to another partner, only to find that that person is HIV-positive as well."

"The nurse offered me PrEP tablets (pre-exposure prophylaxis), which she explained would help to keep me HIV-negative, and my partner received antiretroviral therapy (ART)," says Msizi. "I have gone for repeat medication twice, and each time my vital signs are checked and I am re-tested for HIV."

To support each other on their treatment journey, the couple aligned their joint appointment dates, and ensured that they each receive the same number of months' medication supply, so that they return to the clinic together on the same day. The couple is grateful for the health services they receive. "The most important advice we were given was about me taking PrEP to stay healthy and HIV-negative, and my partner adhering to the treatment she needs," says Msizi.

Before learning about his negative HIV status, Msizi's greatest fear was his partner's reaction if his test result was HIV-positive. "Of course, now we wish that we were both HIV-negative, but the nurse helped me by explaining exactly what this diagnosis would mean, and the importance of accepting our results. She advised us on what we can do together to have a healthy life, and gave us leaflets containing more information."

Once diagnosed, Msizi committed to always being there for his partner so that if she falls pregnant again, she will have his support. "My partner had a miscarriage, and we don't have a child yet," he explains. "I hope to be a successful business man and run a proper tuck-shop so that we can build for our future."

Msizi's advice for other couples is to visit the clinic and be tested for HIV, so that they can receive either PrEP or ART, depending on their status, to stay healthy by taking treatment as required, and align their appointment dates to support each other.


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A 22-year-old woman, who lives with her mother and five-year-old daughter, sells fruit and vegetables at a local taxi-rank. When she had 'flu and breast tenderness, she asked her partner to accompany her to the clinic, where they were both tested for HIV and found to be HIV-negative. She also had a pregnancy test and was confirmed as expecting, so she enrolled in antenatal care.

The following month, the couple had a second HIV test; this time, she was HIV-positive and her partner tested negative. "I was scared that my partner would change and leave me, but he has been supportive and requested to take PrEP which was offered by our counsellor. I also did not understand what to do now that I was positive, but our counsellor explained HIV to me and the importance of adherence to treatment."

The nurse explained that she could still live a healthy life if she took her ART medication as required. "At first I could not remember everything we were told, since I was still confused about testing positive and my partner testing negative," says the patient. "We had been having unprotected sex for more than two years, and the nurse advised us that this can happen, which was a big lesson for us."

The patient made important life decisions after the couple's consultation. "I told myself that even though I will have to take treatment every day, I want to live a long life, grow my business and provide for my family. While I don't want to lose my partner, I also want to be independent, so I take my pills every day," she explains.

"We received proper counselling and support from the clinic, but we'd like the staff to create groups for people who have experienced the same thing ‒ people of our age group with whom we can speak freely," she says.

"My advice to others is that when you test HIV-positive, you must take your treatment and have one partner. If you test negative, you should take PrEP and use condoms to protect your partner. You can live a healthy life if you take your treatment, and it is easy if your partner is supportive. We even request the same dates for our clinic appointments, and also for blood collection."


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At Pongola Fixed Clinic in Zululand, a 17-year-old HIV-positive patient describes her experience as a partner in a sero-discordant couple.

"I have one child and am not working, as I'm still at school doing Grade 11. When I became pregnant, I tested positive for HIV. For a month, I could not tell my partner about my diagnosis. Then one day, when we were fighting over his many girlfriends, I told him that I was HIV-positive and that I thought it was his mistake. We then both went to the clinic and when his test was negative, he was put on PrEP."

This patient's greatest fear was that she would be visibly ill and that people in her community would judge her and stigmatise her for being HIV-positive. "Then the counsellor assisted me by telling me that if I take my medication properly, the virus will be supressed and neither my partner nor my unborn child will be infected with HIV. The counsellor explained that I have to love my medication, exercise regularly, eat healthily and protect myself with a condom when I'm with my partner."

"My goal is to take my medication and practise safe sex so that I won't infect my child and I can live a long, healthy life. I've learnt that when you are still sexually active, protection is very important. My advice to others is that even if you are young and HIV-positive, treatment will keep you healthy, and if you are HIV-negative, you can still protect yourself by using PrEP."


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A clinician describes how a sero-discordant couple is counselled to inform the pair fully about their diagnosis and allay any fears:

"As clinicians, we counsel a discordant couple by firstly explaining what it means to be in a relationship with a discordant partner. They can both live a healthy and happy life without the fear of infecting one another if the HIV-positive partner takes ART as instructed, because an undetectable viral load means that the virus is untransmittable. The HIV-negative partner should use PrEP. The couple can join a support group for discordant couples, and should they have questions about the guidance, they have access to the clinic via phone at any time."


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Mlungisi Zakwe (not his real name) is 55 years old. He has three sons from his late first wife, and now lives with his second wife but they have no children.

"I used to work at an industrial firm around Durban," says Mlungisi. "I stopped working when my first wife got sick to come and take care of her and she died. My two sons are working and the last one is looking for a job."

He decided to have an HIV test because he believes that it is important to know yourself as a person.

"I learnt about my TB infection about a month ago," explains Mlungisi. "I was working in Dundee and fell ill, coughing a lot. I lost my appetite and couldn't eat or sleep at night, sweating and feeling cold at the same time. I was weak, couldn't walk properly, and couldn't carry on with my duties at work, so I was sent away to seek medical attention. I consulted two different doctors and both told me I was well – but I was feeling sick."

He then decided to visit his local clinic where they took a sputum test and discovered that had TB infection. "They explained what this meant and the importance of starting TB treatment immediately, as I was very ill. After starting the treatment, I was able to sleep."

Mlungisi says that he'd like to write to the newspaper about the care he has received from the clinic.

"Without that help, I wouldn't be alive today as I saw that my days were numbered. At first, I was concerned to know that I have two diseases inside me – HIV and TB – but then I was happy to find out exactly what was wrong, as the doctors I'd seen previously could not help me. The nurse was kind and explained both conditions to me, advising me on what the treatment journey involves. Now I understand that I can fight both diseases with the medication I'm given."

Mlungisi's greatest challenge in managing his treatment adherence was dealing with side-effects of the medication, especially during the first two weeks of TB treatment. "At first, I was not able to walk or be active in the yard. But when I go for return visits to the clinic, a health worker takes my vital signs and the nurse discusses my treatment experience with me, helping me to deal with the side-effects and re-assuring me that I will be fine. She also gave me a leaflet to refer to for more information, but I am also welcome to go to the clinic for any reason, even if it's to ask for more guidance. I know now that I should not procrastinate in seeking medical attention."

Mlungisi's wife has been very supportive, taking two weeks' leave to look after him when he first started to take his medication. "It was not easy," he recalls. "I don't know how I can thank her for everything she's done for me."

His advice to others who suspect that they may have TB is that they should visit the nearest clinic without delay. "Using myself as an example, the clinic will do proper screening and tests," he says.


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A healthcare provider describes the challenges faced by TB patients, especially those who are co-infected with HIV, and the clinician's role in supporting them through their treatment:

The pill burden is demanding, as co-infected patients have to take numerous tablets at the same time, and side-effects (especially those arising from TB treatment) affect their adherence.

Patients have to attend multiple appointments if their TB and HIV visit dates are not aligned (this happens mostly in the first month of TB treatment).

Most patients, particularly men, adhere to TB treatment but interrupt ART once they have completed their TB medication. By using campaigns such as MINA and peer education, we are working to improve adherence rates in men.

Offering treatment literacy and advanced adherence counselling, including a personalised adherence plan and careful management of side-effects, is of great help to such patients, as is ongoing counselling and psychosocial support during every visit. 

Disclosure to loved ones can also affect adherence, so on initiation of treatment, we link these patients with a Community Health Worker for home visits and support, and we encourage them to join support groups for easy communication and peer support.



Nov 29
Empowering Change: 16 Days of Activism Against Gender-Based Violence

​By Mandisa Dlamini, HST Communications Intern

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16 Days of Activism Against Gender-Based Violence is an annual global campaign that commences on 25 November, the International Day for the Elimination of Violence Against Women, and concludes on 10 December, Human Rights Day. In 2023, this period of activism holds even greater significance as the world unites to address and eradicate gender-based violence. In 1991, activists kicked off the campaign at the Women's Global Leadership Institute inauguration. Since then, people worldwide have adopted it as a strategy to rally against violence towards women and girls, aiming for prevention and elimination.

The theme

This year, the UNiTE campaign theme of the 16 Days is: Invest to Prevent Violence against Women & Girls. Violence against women and girls remains the most penetrating human rights violation around the world. In general terms, it appears in physical, sexual, and psychological manifestations, encompassing:

  • intimate partner violence (battering, psychological abuse, marital rape, femicide);
  • sexual violence and harassment (rape, forced sexual acts, unwanted sexual advances, child sexual abuse, forced marriage, street harassment, stalking, cyber-harassment);
  • human trafficking (slavery, sexual exploitation);
  • female genital mutilation; and
  • child marriage.


In order to put an end to violence against women, it is crucial that we address and challenge the attitudes that perpetuate, rationalise, and normalise such acts. We must also vehemently reject any denial of women's fundamental right to safety. The goal of Parliament is to make society fair and just by promoting democracy and protecting human rights, including those of women and children. Parliament has taken steps by passing laws to address and stop these problems in society.

16 Days of Activism Against Gender-Based Violence in 2023 is a crucial moment for global solidarity and collective action. By shedding light on the challenges, celebrating successes, and emphasising the importance of continued efforts, we can strive towards a world free from all forms of gender-based violence. Let's unite and take meaningful actions to support the 16 Days of Activism Against Gender-Based Violence campaign. Together, we can make a difference and contribute to creating a safer and more respectful world for everyone. Organisations such as POWA, Sonke Gender Justice, South African National AIDS Council, Ilitha Labantu, and TEARS Foundation actively participate in the fight against gender-based violence.

For more information visit: https://www.gov.za/16DaysOfActivism2023

https://www.unwomen.org/en/what-we-do/ending-violence-against-women/unite/16-days-of-activism


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