By: Nomcebo Mthembu (Unfinished Business Project Clinical Advisor in Pongola Sub-District)
Children and caregivers showing their gifts after clinic support day.
With June being Youth Month in South Africa, a number of youth health awareness events were held across the country to celebrate the historic events that took place on 16 June 1976, now known as Youth Day.
In Zululand District in KwaZulu-Natal, this was the perfect moment for the Unfinished Business Project's Clinical Advisor for Pongola Sub-district, Nomcebo Mthembu, and the Pongola Clinic's Facility Team Lead, Simphiwe Myeni, to co-ordinate and facilitate the re-introduction of a Clinic Support Day event on Saturday 11 June 2022.
The main purpose of this event was to offer services that would ensure the continuity of care and viral suppression for all young people and children under 19 years who are living with HIV. A multi-disciplinary team consisting of a Health Systems Trust's Lay Counsellor, Psychosocial Advisor and Paediatric Case Manager, and a Social Worker and Lay Counsellor from Sinethemba community partner organisation, provided these wide-ranging health services.
The team helped each individual patient with developing an antiretroviral therapy (ART) plan as needed and suited to their personal circumstances, which would support long-term treatment adherence and viral suppression. The causes of high viral load among these young people were identified, and plans to reduce the causes were developed and explained to the patients and their caregivers.
Caregivers were supported and guided on how young patients should disclose their HIV status, and the patients' current ART regimens were reviewed to make sure that they were still on suitable treatments and clinical management was provided where changes had to be made.
Ten children and four caregivers attended the Clinic Support day. The young people were divided into groups according to their age for consultations, and their patient files were reviewed and updated once they had received the services.
Viral blood samples were drawn and the specimens were immediately sent to Itshelejuba Hospital for laboratory testing. All the children were also seen by the Psychosocial Advisor to help with the disclosure process, and they were issued with their medication and booked for their next appointment for follow-up in July.
Caregivers and adolescent patients received one-on-one sessions while the Lay Counsellors played fun games with the younger children. Sinethemba provided refreshments, and the clinic team thanked the young patients and their caregivers for their participation on the day. Gifts were donated for the children by a sponsor, and children could take photographs with their caregivers.
The caregivers were delighted with the event, and requested that more such programmes be offered on Saturdays, when they are not working.
By: Mzikazi Masuku (Community Co-ordinator for the DO ART Project)
Buxedene Clinic is situated in Ward 8 of Nongoma Sub-district in Zululand District. The total headcount of the facility is between 3 500 and 4 000, making it one of the sub-district's high-volume facilities. The clinic serves a catchment population from 18 villages in the ward. These areas are called Izigodi.
Management of the facility and the District's HIV and AIDS/STI/TB (HAST) officials have raised concerns about poor performance against targets for certain indicators. The facility team referred specifically to three indicators:
It was against this background that the Buxedene community was mobilised to participate in a dialogue about the health problems and social ills experienced within the community.
Community engagement entails the active participation of local people in identifying priority issues and being part of the process to determine solutions. The health of the community is vital, and sustainability is threatened if health services and programmes are unavailable or inappropriately used. The National Development Plan states that South Africa's health challenges are more than medical, and identifies behaviour and lifestyle as contributory factors to ill health.
Community dialogues are conducted in order to enhance community involvement in health promotion and at a later stage, community development to identify problems in context and act on them effectively.
Why community dialogues?
Community mobilisation and development are increasingly seen as a prerequisite for successful uptake of health services. Participation remains an essential part of community mobilisation and community development, especially when community-based health services are to be integrated with pre-existing structures and aligned with community interests.
The approach seeks to maintain a continuous process of engagement between the Department of Health (DoH) and citizenry through active participation in discussions and jointly seeking solutions, as a result of which communities will be recognised as partners and accountability will be sustained.
The specific objectives of the community dialogues were thus to:
Consultative meetings were held with stakeholders of Ward 8 of Nongoma to orientate the DoH and other stakeholders on the concept of community dialogues for enhancing community participation and ownership. The previous three months' data from Buxedene Clinic were analysed to identify under-performing indicators.
Community leadership structures were identified during a plenary meeting with four high schools in the area. Each school was represented by five learners who were identified by the schools' administration. The learners were divided into commissions, and each commission had a facilitator.
Mzikazi Masuku facilitates the Commission process with a group of learners
For each indicator, questions were raised regarding reasons for available services meant for community not being accessed, especially by youth, and how the facility can be supported to provide access to services, especially for young people.
The commissions discussed issues related to the following indicators:
Couple year protection rate
Learners presenting their Commission findings during the Buxedene Community Dialogue
Commission members present their insights to the forum
By: Lunga Memela (Health Systems Trust Communications Engagement Lead)
HST and DoH staff sharing a moment #EndAIDS2030.
Congratulations to the Health Systems Trust's (HST) SA SURE Project, which is funded by the United States President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S Centers for Disease Control and Prevention (CDC). A community outreach initiative championed by the project's Nurse Clinicians has been featured in a Spotlights Compendium launched in May 2022 by the University of California San Francisco's (UCSF) Optimizing Performance by Improving Quality (OPIQ) Project for enhanced management of TB and HIV in South Africa.
The World Health Organization named 2021 the 'Year of Health and Care Workers' in special recognition of their unwavering dedication in addressing the COVID-19 pandemic. HST's Nurse Clinicians in uMgungundlovu Health District have been commended for their work in supporting KwaZulu-Natal's Department of Health (DoH) during the pandemic through satellite pick-up points (PuPs) where residents in Imbali Township (Pietermaritzburg) could collect much-needed chronic medication and receive clinical services.
Painting the context
A Nurse Clinician consults with a client inside a mobile unit stationed at a community site in Thornville.
It's a scenic 8km drive through the steep hills and valleys of Thornville Ward 17 uMsunduzi, to Impilwenhle Clinic – the isiZulu name of the facility meaning 'healthy living'. However, to receive healthcare services and collect their chronic medication there, Thornville residents have to take two taxis to reach the clinic.
The residents of Thornville work hard to make a living, and want the best for each other, visitors to their community and their overall wellness. Nomvula Radebe, HST's SA SURE Project Manager in uMgungundlovu, explains that for local residents, there are stark realities to be reckoned with. Poverty, youth unemployment and paying for transportation while living on a government subsidy is the primary challenge. "It's not affordable!" residents say. "What can be done to help us?"
SA SURE Project Manager, Nomvula Radebe, unpacks the spate of challenges faced by residents of Imbali Township.
"As a District Support Partner (DSP) to the Health Department," says Radebe, "we are committed to implementing people-centred approaches for ensuring clients' linkage to and continuity of care. A standard operating procedure for the Nurse-led PuPs intervention was developed and endorsed by the Department of Health, and the roll-out has been expanded to serve both Spaced Fast Lane Central Chronic Medicine Dispensing and Distribution (CCMDD or Dablapmeds) and non-CCMDD patients at designated community sites, or at workplaces."
In the Thornville community, a significant number of residents are farm workers. "They could forfeit wages if they take a day off to go to the clinic, and so they opt to miss clinic appointments rather than lose out financially," Radebe explains. "During the lockdown periods, people either could not or were reluctant to leave their homes for fear of COVID-19 infection."
Recognising the need for employees to receive consistent health care, farm owners have opened their gates and welcomed the Nurse-led PuPs to operate at the farms on certain weekdays for a set period. This access means that farm workers can receive the services at their workplace without losing time or money.
The Nurse-led PuPs came as an incredible blessing to 59-year-old Zandile Mpehle (pictured above). She was severely beaten by criminals who broke into her house demanding the stokvel money they thought she had at home. She suffers from dizziness, has poor eyesight, experiences tremors, her knees hurt, and apart from her high blood pressure, she often needs painkillers. With Nurse-led PuPs being available in the community, she need not worry about the difficult task of commuting to Impilwenhle Clinic.
Sister Zondi, Impilwenhle Clinic's Acting Operational Manager, praised the level of diligence and commitment displayed by HST staff at the facility and during outreach initiatives. Although still short-staffed, the facility now opens on Saturdays as well, so that clients do not have to miss work during weekdays to visit the clinic, and all the work is driven by passion. Patients prefer to be seen by clinicians they already know, so the teams make a consistent effort to avoid rotation of staff.
HST's Sister Khumbuzile Phungla (left) is among the Nurse Clinicians working closely with Impilwenhle Clinic's Acting Operational Manager, Sister Thembi Zondi (right).
The DoH and HST outreach collaboration also entails conducting monthly health education visits in hard-to-reach areas, identifying missed opportunities for COVID-19 vaccination and immunisations for young children, Pap smears, and targeted care for patients with TB whose treatment has been interrupted. These joint efforts demonstrate the benefits gained by using grant funds to improve patients' health outcomes and strengthen the health system.
HST staff are proud to be part of the Nurse-led PuP journey.
Contextualising Nurse-led pick-up points in KwaZulu-Natal
A history of the PuP journey was documented in a blog article written by SA SURE's Copy and Content Editor, Judith King. She explained that in the past, in order to access existing DoH facility-based PuPs through registration in the CCMDD/Dablapmeds programme, patients must have been virally suppressed for at least 12 months. A community-based PuP, by contrast, broadens the population of patients who can receive medication within their community by deploying a Nurse Clinician to manage the patient's basic clinical needs at varying stages of viral suppression.
In January 2020 − before the COVID-19 pandemic took hold in South Africa − the SA SURE Project team in uMgungundlovu had launched Nurse-led PuPs as an innovative solution to improve clinical service delivery for patients who are not yet stable on their medication, and those who experience barriers to visiting a fixed clinic.
By the end of May 2020, four of the project's supported facilities were implementing these PuPs, and Impilwenhle Clinic in Edendale (which was the first facility to offer this option), had 12 pick-up points serving an average of 28 patients per site. By June 2020, the number of sites had increased by 138% from 13 to 32, tripling the number of patients provided with community-based clinical services, and by October 2020, 17 000 medicine parcels had been issued through this modality.
When lockdown restrictions on physical movement and proximity intensified the need for community-based HIV and other health services increased, especially in the district's hard-to-reach areas. Nurse-led PuPs also supported COVID-19 prevention and control measures by decongesting the facilities and reducing the numbers of people travelling to clinics.
The Nurse Clinicians work with the team's Case Managers and Linkage Officer to ensure that patients – especially those who have missed their scheduled appointments – are maintained in care and can make appointments for clinical services in the community. The Clinicians take the CCMDD patients' facility-stored medicines and deliver them via the PuPs. Facility-based patients are clustered geographically, registered in an appointment system, and traced via telephone call or SMS. These patients then meet the Nurse at a central point in the community, where the patient's medication is issued and other service elements such as HIV Testing Services (HTS) including index case contact testing, initiation on antiretroviral therapy (viral ART), load monitoring, and script renewal are provided.
By: Lunga Memela (Communications Engagement Lead)
63-year-old Community Caregiver, Mama Nelisiwe Mthabela, remembers how of the home delivery of antiretroviral therapy saved many lives in her community during COVID-19 Lockdown Level 5.
The fear, confusion and overall devastation that came with the COVID-19 pandemic, together with strict Level 5 lockdown regulations in South Africa, had many patients refusing to leave their homes, even when they needed to attend their nearest health facilities for check-ups and to collect their chronic medication, including HIV treatment, despite medical travel being permitted in the country at the time.
This raised serious concerns for dedicated healthcare professionals at Sigweje Clinic in the Alfred Duma Sub-district of KwaZulu-Natal's uThukela Health District – a renowned former Siyenza high-performing facility ‒ in response to this new challenge presented by the COVID-19 outbreak. Patients were missing clinic appointments, thereby risking treatment interruption, so an important strategy to deliver antiretroviral therapy (ART) to HIV-positive patients residing in nearby communities was introduced.
The U.S. Centers for Disease Control and Prevention (CDC) has supported care and treatment programmes in South Africa through a results-oriented initiative focused on scaling up proven public health interventions at the clinical level, especially identifying people living with HIV, initiating them on lifesaving treatment, and finding innovative ways to ensure their treatment continuity to achieve suppression of the virus.
Funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the CDC, the Health Systems Trust's (HST) SA SURE Project had long been supporting the Department of Health's TB and HIV programmes in uThukela when COVID-19 hit. The impact of the community-based ART delivery initiative was featured in a Spotlights Compendium launched in May 2022 by the University of California San Francisco's (UCSF) Optimizing Performance by Improving Quality (OPIQ) Project in efforts towards better management of TB and HIV in South Africa through shared best practices and innovative activities.
Taking ART into the community
HST's Acting District Co-ordinator, Mesuli Ntshalintshali (pictured above), explained that when patients started to miss their appointments due to COVID-19, facility staff had to make a plan to preserve the total number of patients remaining on ART (TROA) at 28 days. Clinic staff set out to decrease the number of patients on the Late Appointments list from 1.2% of the TROA in March 2020 to less than 1% by May 2020, using home medication delivery as an emergency response.
This was achieved by working closely with DoH-employed Community Caregivers (CCGs) such as Clinic Committee member Mama Nelisiwe Mthabela (pictured below), who, together with HST Campaign Agents (CAs), were allocated a set of patients grouped by location from the Late Appointments list. This emergency response was made possible by the collaboration of Community Health Workers (CHWs), as the intervention is labour-intensive and requires implementers to have excellent knowledge of the community context, as well as trust in them from the community. This work also strengthens a sustainable response for ongoing community-based support beyond the home deliveries that were necessitated by the lockdown conditions, through the establishment of outreach points.
Mama Mthabela started working as a Community Caregiver in 2007. Her testimonial on the reward she gets from promoting clinic services within the communities leaves any listener in awe of her passion for people, health and wellness. She said that the community really loves this particular clinic. "People come from far from wide to this one. The nurses here are caring and extremely dedicated." This is why she does what she does, and she wishes that the facility had even more nursing staff to lighten the workload.
Rolling out the project, Mama Mthabela and fellow CAs spent hours contacting patients telephonically to arrange a date and time for home delivery of their medication. The CAs would deliver ART to the patient's home and then report back to HST's Nurse Clinician after each home delivery. The information was documented in the patient's clinical chart and sent to the Data Capturer for recording on the DoH HIV Electronic Register, TIER.Net. "The best part about working with the CAs on this was that they themselves reside within the communities in which they operate, making it easy, accessible and comfortable for them to drop off medication within their geographical setting," says HST's Acting District Co-ordinator, Mesuli Ntshalintshali, who was working as a Quality Improvement Co-ordinator at the time.
"Another thing that contributed to the overall success of the intervention was the extension of clinic hours, which shifted from operating until 17h00, to instead closing at 19h00 daily. This helped in accommodating working patients who could not reach the clinic by 17h00," Ntshalintshali said.
Ntshalintshali said the community-based ART delivery initiative was definitely something that could be replicated in other communities and provinces as an emergency preparedness modality of care for patients on treatment. In this case, collaboration between HST and DoH staff was key. The main shortfall was that, because the CAs are not clinically trained, only patients who were stable on their HIV treatment could receive drop-offs of their medication.
Applauding the hard work of HST staff in supporting the Sigweje Clinic team was the DoH Alfred Duma Sub-district Primary Health Care (PHC) Manager, Yvonne Thembelihle Ndebele, popularly known as 'YT' (pictured above). She said the project was a great success and thanked HST staff for always wearing their epaulettes with pride at the clinic. "COVID-19 really highlighted our staff as unsung heroes. They were hands-on and always willing to go the extra mile."
She is planning to introduce staff recognition at the facility and beyond because she feels that with a little bit of extra motivation, much can be achieved collaboratively in the spirit of promoting health and saving lives.
Alfred Duma and St Chads Primary Health Care (PHC) Clinic Manager, Yvonne Thembelihle Ndebele; HST's SA SURE Project Operations Manager, Felicity Basson; and HST's uThukela Area Co-ordinator, Bathobile Mkhithi.
by Judith King (HSS Copy and Content Editor)
Inclusive change towards health, growth and thriving is the core meaning of 'development'. Knowledge management is a systematic process of gathering and packaging knowledge and connecting people to it so that they can use it effectively to improve lives.
As our funded work is informed by this mandate, it is important for the Health Systems Trust (HST) to harvest and share our implementation experiences so that we can:
To do this, we must describe what we have done, how we have done it, why the results are useful, and whom they can benefit. Publishing and presenting this information generates evidence of effective approaches and techniques, as well as areas that require strengthening, for better service delivery in the public health sector.
Project implementers in the field who are generally not well-practised in writing for publication may be reluctant to take on the development of case studies and related abstracts that capture various aspects of promising project interventions for good practice, hence the need for internal training to build their skills in this area.
In July 2022, five selected participants from the Unfinished Business for Paediatric and Adolescent HIV in KwaZulu-Natal (UB) Project attended a two-day workshop for this purpose, with a second workshop planned for a further five participants in October.
From left: Phumzile Matolo (Clinical Advisor, eThekwini), Nondumiso Mthembu (Psychosocial Advisor, eThekwini), Sitembile Maduna (Clinical Advisor, eThekwini), Judith King (Facilitator), Nomcebo Mthembu (Clinical Advisor, Zululand), Philani Bhengu (Quality Improvement Manager), Nelisiwe Ngcobo (Clinical Advisor, uMgungundlovu), and Nandipha Jacobs (Project Manager)
Using HST's Case Study Development Tool with accompanying guidelines, the participants prepared their case study outlines prior to the workshop, and these were reviewed collectively by the group during the workshop sessions.
This process highlighted techniques for verifying, contextualising, prioritising and summarising the information. Facilitated collaboration between the writers ensured a free flow of ideas, based on the experience that team mates have valuable contributions drawn from theory and practice for understanding what the author is trying to say.
Each case study draft was edited 'on the spot' so that all of the authors could witness first-hand what was being changed, added or removed, and why. "The 'live' editing was revealing," remarked one participant. "It showed me how to build the content properly, and I now realise how important it is to re-read one's draft to avoid language errors."
Once the draft manuscripts were ready, a structured abstract – a short version of the whole paper – was developed for each one, using the same group-review method.
The final task was to ensure that the abstracts were pared down to meet the required word limit, while keeping the content coherent and complete. One participant noted that she had "most enjoyed watching the 'shaving' of the abstract text to reach the word count limit", saying that although it was a challenging task, having it demonstrated in this way had convinced her that it was achievable.
The training incorporated general academic writing principles, tips on HST style conventions for terminology, vocabulary, tone, Vancouver reference formatting, usage of plain language, and the importance of using words and terms that entrench respect for the humanity of patients and all people connected to the health system.
Dossiers of workshop materials were provided, including hand-outs on the value of writing up implementation experiences, a description of the various types of documentation outputs composed for a range of audiences, guidelines for abstract development, and authorship criteria.
In the coming months, the facilitators will check in with each author via e-mail periodically to reflect on their progress as they work independently on finalising their case study manuscripts, and to offer ongoing support.
Once all 10 authors have been trained, the aim is to finalise a portfolio of abstracts in time for submission to the 2023 PHASA Conference, and to publish a compendium of UB case studies describing promising models and lessons learnt.
Looking forward to rolling out the Cervical Cancer Prevention and Control (CCPAC) Project in Zululand: HST's CCPAC Project Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe; KwaZulu-Natal's Department of Health Zululand District Clinical Specialist in Advanced Midwifery, Hlengiwe Myeza; and HST'S CCPAC Project Manager, Eugenny Booysen.
A critical baseline study has commenced in 12 clinics situated in Zululand sub-districts of Abaqulusi and eDumbe in KwaZulu-Natal, as part of the initial implementation phase of an important three-year Cervical Cancer Prevention and Control (CCPAC) project that is being piloted by the Health Systems Trust (HST) in support of the Provincial Department of Health (KZN DoH).
The CCPAC project is funded by the Bristol Myers Squibb Foundation and is being implemented under the auspices of a consortium comprising HST, the Zululand DoH (ZDoH), the Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU) of the University of KwaZulu-Natal (UKZN), and Genius Quality (GQ). The lack of adequate cervical cancer services in Zululand District has hindered the development of a sustainable and holistic approach to women's health being built into the district's health systems to improve outcomes for women.
The project is aimed at saving the lives of women and girls from cervical cancer – the only preventable cancer, and one which can be easily treated if it is detected early. Ninety-nine percent of cases are linked to infection with high-risk human papillomavirus (HPV), "an extremely common virus transmitted through sexual contact" and which is associated with HIV infection. The project therefore also addresses the alarming rate of sexually transmitted infections (STIs) – HPV and human immunodeficiency virus (HIV) – within the local communities.
Globally, HIV is still most prevalent in South Africa. The link between HIV and HPV infection, and cervical cancer is well established, and therefore, screening for cervical cancer for early detection is mandated in national health guidelines. However, low uptake and service interruptions the caused by the COVID-19 pandemic have reduced the widespread screening that is required. The project aims to re-energise screening, improve skills, and capacitate healthcare workers such that the efficacy of Pap smears is improved and all results are actioned timeously. The desired outcome of the project is improved early detection of and decreased mortality rates from cervical cancer in the district through improved patient-centred care.
The reality on the ground
HST's CCPAC Project Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe; Mondlo II Clinic Operational Manager, Sister Thandeka Mhlungu; and HST'S CCPAC Project Manager, Eugenny Booysen.
One of the facilities visited by the Project Manager and the Monitoring and Evaluation Officer during the baseline study was Mondlo II Clinic. They were received by the warm-hearted Clinic Operational Manager, Sister Thandeka Mhlungu (pictured above). The facility has a catchment population of 20 825 and is open for 24 hours, seven days a week. HST supports the facility with services, including the provision of antiretroviral therapy (ART) to HIV-positive patients. These services are now being expanded to improve cervical cancer screening, prevention, early detection, and care and treatment.
HST's Project Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe; Thembumusa Clinic Professional Nurse, Busisiwe Mtshali; Thembumusa Clinic Catchment Operational Manager, Thuli Zulu; and HST'S CCPAC Project Manager, Eugenny Booysen.
Thembumusa Clinic, which has a catchment of 25 132, services three wards. The facility's Operational Manager, Thuli Zulu, together with Professional Nurse, Busisiwe Mtshali, said they are glad that the Health Department has lowered the cervical cancer screening age from 30 to 20 years. As with Mondlo II Clinic, their numbers for cervical cancer detection and prevention are on the rise. They also need more equipment for Pap smears, including mobile screens. HST staff are thanked for their continued hard work and support.
Project Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe; Zululand District Clinical Specialist in Advanced Midwifery, Hlengiwe Myeza; and HST'S CCPAC Project Manager, Eugenny Booysen.
Passionate about the project, the trio (pictured above) are determined to make a difference. Chatting with HST's Communications Unit, Advanced Midwife, Hlengiwe Myeza, and HST'S CCPAC Project Manager, Eugenny Booysen are both mothers of two daughters and custodians of women's and young girls' health. Despite some feeling that it is an uncomfortable conversation, they insist that mothers and fathers should confront the reality of STIs and be able to speak to their sons and daughters about sex and its associated risks. The project's Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe, also feels strongly that men have an active role to play in protecting women from STIs and other health issues. "Eradicating the problem will take collective action," they agree. "Sex should not be a taboo subject, and open conversations must be had in order to save lives!"
What men should know
Men's health fora, including the DoH MINA Campaign, Phila Ndoda and Isibaya samadoda, are gaining momentum in KZN. The three campaigns are socially constructed, creating a new school of thought for young and older men that is intended to promote behaviour change that will foster healthier societies. One of the factors to be reckoned with is that men can and should protect women's health. The machismo associated with having multiple sexual partners is a major sexual health risk that has a negative impact on both women and men, exposing them to elevated risk of STIs such as HIV and HPV, and women to the risk of cervical cancer. Conversations that encourage delayed sexual debut for young men and women must be encouraged.
Without bias, Myeza and Booysen said that young men need to know that all their actions have consequences. "Yes, it's a glamorous time of life, but you have to be in control of your emotions. You have to think about the person you love and take each other on a protective journey. Young men should be educated to understand that they don't need to prove their manhood sexually."
Ndwandwe noted that Life Orientation as a school subject is contributing effectively to promoting health consciousness among children and adolescents. However, while this is valued, it is health professionals who understand disease progression. "The subject has assisted in laying the foundation for health education. We need more healthcare professions on board, because they understand the disease process." The colleagues also observe that there is a national shortage of Oncologists, and Cancer and Palliative Care Nurses – all of whom can play an active role in preventing cervical cancer. The CCPAC project enables DoH staff members, healthcare workers and other stakeholders to pursue additional training and education to improve capacity in cancer prevention, treatment and palliative care.
About the Project Manager
HST has entrusted Eugenny Booysen (pictured above) to manage the project. In addition to her years of expertise, she spent three years as an Oncology Nurse in Saudi Arabia, and strongly advocates for cancer prevention. She said: "Because I come from an oncological background and worked in a chemotherapy suite, I have observed many women coming in with late-stage cervical cancer. The biggest problem in State hospitals is that women with cancer need to have radiotherapy and chemotherapy together. The waiting list is long. Once the cancer is too advanced, we then have to refer the patient to palliative care. Resources are a challenge."
Booysen feels that awareness should be raised about cervical cancer, especially among HIV-positive women, and that men should be more involved. "The woman comes by herself to the clinic for treatment and there's no spouse or partner to help counsel her. Also, men are carriers of HIV and HPV. Worst still, if the woman comes home and reports to be diagnosed with cervical cancer, she may be stigmatised or even fear mentioning it at all, making it difficult for the health issue to be dealt with."
Booysen and Nurse Myeza stressed that even if women test HIV-negative, if they are sexually active, they still need to receive a Pap smear every three years for ongoing prevention of cervical cancer and to ensure their sexual and reproductive health.
(Left) HST's Area Co-ordinator for Nongoma Sub-district, Sifiso Mdletshe, and (right) HST Nurse Clinician, Muziwakhe Ndima, reflect on positive outcomes yielded by the Phila Ndoda campaign in Zululand.
The narrative that South African men refuse to attend their nearest clinic for medical attention, even when they are ill, is slowly being dispelled. Instead, there are other factors to be considered. This is visible in KwaZulu-Natal's Zululand District where the Department of Health's (DoH) Phila Ndoda campaign is making a considerable difference! The campaign is an increasingly well-received men-friendly clinic designed to address men's health issues, with the main focus being on HIV, TB, sexually transmitted infections (STIs) and non-communicable diseases (NCDs).
In an article published in July 2021, the Health Systems Trust (HST) highlighted an upsurge of healthcare services attended by men young and old in Zululand, thanks to Phila Ndoda – an isiZulu term which, in itself, prompts men to be accountable for their health, thereby fostering healthier communities through men protecting themselves and their loved ones from infectious diseases and other health conditions.
The success of the campaign was also featured in a Spotlights Compendium that was recently launched in May 2022 by the University of California San Francisco's (UCSF) Optimizing Performance by Improving Quality (OPIQ) Project in efforts towards better management of TB and HIV in South Africa. The publication comprises 20 'spotlight stories' of health service quality improvement, which offer clear, concise and useful guidance on good practice, designed to help health professionals provide optimal care to clients.
The Phila Ndoda campaign is strongly supported by HST's SA SURE Project which is funded by the United States President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC).
SA SURE Project Operations Manager, Felicity Basson (pictured above) describes how HST works closely with the Health Department to promote health and wellness for all people ̶ regardless of gender, culture, religious beliefs or socio-economic backgrounds ̶ and in line with the UNAIDS 95-95-95 targets for fast-tracking HIV epidemic control by 2030.
HST's Nurse Clinician, Muziwakhe Ndima, spoke about his joyful experience at HST and within the Phila Ndoda initiative.
The good news about the status of the campaign was shared by HST's Nurse Clinician, Muziwakhe Ndima, who was radiant when narrating his journey with Phila Ndoda. Not only did he grow up knowing that he would one day become of a nurse by profession because of his caring nature, kindness and compassion ̶ he also knew and felt that there was pressing need for more intense promotion of men's health issues. "Previously, men didn't really speak about their emotions, let alone matters pertaining to their health," he explained. Today, Muziwakhe is living his dream through the work that he does at HST and within Phila Ndoda.
HST's Area Co-ordinator for Nongoma Sub-district, Sifiso Mdletshe, with Queen Nolonolo Clinic's Facility Operational Manager, Sister Nomusa Zungu.
The programme was adopted and initiated in 2019 at Queen Nolonolo Clinic, Nongoma, where Ndima works under the stewardship of HST's now District Quality Improvement Co-ordinator, Siyabonga Gwala. The Facility's Operational Manager, Sister Nomusa Zungu, confirms that while there have been staffing challenges, the overall impact of the campaign is very successful.
From the initial idea of taking a mobile clinic to the local Nongoma taxi-rank in order to provide targeted men's health services to clients once a week, the clinic now operates five days a week and, among other achievements, the clinic staff are able to quickly find new HIV cases, link clients into care, and improve the tracking and tracing of patients whose treatment has been interrupted, including chronic medication. "It's an integrated service approach that really works. We work with HST and other District Support Partners (DSPs) to improve the overall health of the community," said Sr Zungu. "When it began, we used loudhailers and worked with Community Mobilisers for encouraging men to attend the launch of the campaign."
Contextualising the real challenge
According to Sr Zungu, DoH and HST colleagues, male clients do want to access healthcare services – they simply hate standing in long queues at the clinic, as this often results in taxi drivers (for instance) missing opportunities to put food on the table because of long waiting periods when they come to seek medical attention at the facilities. Male clients are also not comfortable with discussing their health issues with female nurses, and in the presence of other female clients at clinics and hospitals.
The need for the Phila Ndoda mobile clinic sited at the taxi-rank was informed by a 2019 clinic survey, the results of which showed how difficult it was to meet the UNAIDS 90-90-90 targets when male clients struggled to either schedule and/or wait for clinic appointment dates and times. The clients also felt that there had to be a better way to talk about health issues comfortably in a private setting shielded from on-lookers. This is also why there is a desperate need for the appointment of more male healthcare workers, who can tailor-make services that will appeal to and attract male attendance for healthcare. The community needs more male Nurse Clinicians and Lay Counsellors to speed up health service delivery in the Zululand District. The isiZulu idiom 'Okuhlula amadoda kuyabikwa!' maintains that men must not hold back from talking about challenges that they may experience as overwhelming.
Amplifying the critical need for men's health services in Zululand and beyond
A true community builder is Men's Health Champion in Zululand, Mr (uBaba) Solomon Kunene.
Only a few men in Zululand have not heard the pearls of wisdom shared by uBaba Solomon Kunene (or uMtimande as often referred to by clan name). As a former Councillor and priest, he is a staunch believer in men's health and building healthy families and communities. As young people would say it: He loves dropping knowledge!
Through his community standing and facilitation skills, Ubaba uKunene has enabled Queen Nolonolo Clinic and HST staff to drive into KwaNongoma taxi-rank and make Phila Ndoda services effective and accessible to local male clients. He firmly believes that every individual, family and household should be deeply rooted in health consciousness and understanding that 'your health is your wealth'. He said: "You could own 100 cattle, but if your health is compromised then all will be lost at your demise." He sits with izinduna, and is Chief of the local taxi association, a father, a loving husband, and an exemplary beacon of hope to many.
Ubaba uKunene does not understand why people do not take active care of their health, and he wants this to stop. That is why he firmly believes in Phila Ndoda and the invaluable work performed by the Queen Nolonolo Clinic staff and HST colleagues based at the facility. While on air at the local community radio station, Nongoma FM, and lauding the Phila Ndoda campaign and its implementers, he was happy to mention that more and more taxi drivers are starting to understand that one cannot presume to know one's HIV status, for instance, only by virtue of one's partner having been tested.
There is much more work to be done. South Africa remains the epicentre of the global HIV pandemic, with KwaZulu-Natal Province having the highest HIV prevalence in the country. Facing this challenge requires strengthening and intensifying all interventions, especially in the light of TB co-infection, the growing burden of NCDs, the impact of the recent COVID-19 pandemic, barriers to healthcare access, and a multitude of socio-economic factors that underlie HIV transmission and general vulnerability to illness.
Nurse Clinician, Sibusiso Ntshangase, (pictured above) will not rest until levels of sexually transmitted infections (STIs) decline, when more if not all men go for voluntary medical male circumcision, and substance abuse subsides.
HST's Area Co-ordinator for KwaNongoma Sub-district, Sifiso Mdletshe, shared the isiZulu expression: 'Ukuphila kwendoda ukuphila kwesizwe sonke' ̶ loosely interpreted and understood in the local Zululand context as meaning: No nation will thrive in the absence of quality men's health.
Youngsters enjoying soccer amongst other games that were played on the day.
Saturday, 18 June 2022, will be a day to remember for quite a while amongst eThekwini Metro's Department of Health (DoH) staff, the Health Systems Trust (HST), collaborating District Support Partners (DSPs) and especially the youngsters residing in New Germany as well as the neighbouring Clermont and KwaDabeka townships following a fun-filled sports and entertainment event that was held at Solomon Mahlangu Hall in commemoration of Youth Day.
It wasn't merely the music, dancing, soccer, netball, indigenous games, cultural activities and the variety of free health screening services available on site that made the day one of sheer joy, but also the safe space created for the promotion and integration of the DoH's Adolescent and Youth Friendly Services (AYFS) into the community.
HST's Health Systems Strengthening Manager, Rakshika Bhana, recently explained that HST's Unfinished Business for Adolescent and Paediatric HIV programme in KwaZulu-Natal (UB project), funded by the ELMA Philanthropies, is implemented in three health districts in KwaZulu-Natal, namely eThekwini, uMgungundlovu and Zululand, and seeks to improve outcomes for the age group 0–19 years across the HIV 90-90-90 cascade.
Hard-working and passionate about the youth: HST's Psycosocial Advisor (UB) Nonhle Maphumulo; New Germany Clinic's Nursing Services Manager, Sameer Rajah; and HST's Clinical Advisor (UB) Phumzile Matolo.
The Youth Day event was nothing short of a dream come true for New Germany Clinic's Nursing Services Manager, Sameer Rajah, who said the clinic was excited to introduce AYFS into the facility for the benefit of the youth in the community and its surrounding areas. For him, the Youth Day event was a reminder of how the COVID-19 pandemic has interrupted optimal healthcare service delivery in eThekwini, especially access to healthcare, adherence to chronic medication and adequate health screening, importantly in the prevention of TB, HIV and other non-communicable diseases (NCDs).
"The young ones are close to our hearts," Rajah said. "We have to groom them because the world is their oyster." He said the New Germany facility has been longing to do a youth intervention. Launching AYFS at the facility was a big win, and so the Youth Day event was just a bonus. "We want to have more such youth interventions, but sometimes resources are a limitation."
"AYFS is a platform for us to fast engage with youth, to know the concerns straight from the horse's mouth. We are concerned about the prevalence of teenage pregnancy, STIs, new HIV infections, and alcohol and drug abuse that has been on the rise." Healthcare has always been his passion, and he said that as DoH colleagues, they are blessed to be supported by dedicated HST staff.
Colleagues turned into friends Nonhle Maphumulo and Phumzile Matolo have both been at HST for over three years and are still going strong. They enjoy working under the UB project because it deals directly with young people. "The youth is our future so if we can groom them as early as possible that is key," said Matolo.
Maphumulo said it was sad to see young people being infected with HIV, "and so the idea is to provide as much care, support and health education as possible."
The day's activities included COVID-19 vaccine promotion, voluntary medical male circumcision (VMMC) and free health screening for an array of illnesses, which was done in partnership with other DSPs that were present on the day.
HST and DoH staff happy to be of service at the Youth Day event.
By: Nandipha Jacobs (Project Manager UB eThekwini) and Rakshika Bhana (Programme Manager: Health Systems Strengthening)
Addington Hospital – HAST Unit, discussion on patient case management
The Unfinished Business for Adolescent and Paediatric HIV programme in KwaZulu-Natal (UB project), funded by the ELMA Philanthropies, is implemented in three districts, namely eThekwini, uMgungundlovu and Zululand, and seeks to improve outcomes for the age group 0–19 years across the HIV 90-90-90 cascade. This multi-year programme is implemented in collaboration with the KwaZulu-Natal Department of Health (DoH) and is part of a UB Consortium comprising CHAI (National Co-ordination), ANOVA Health Institute, WITS RHI and the Health Systems Trust (HST).
A delegation from ANOVA Health Institute led by Dr Carol Tait (Project Advisor: Paediatric and Adolescent Scale-up Project) and Dr Nomcebo Nene (Project Manager: Paediatric and Adolescent Scale-up Project) visited the Unfinished Business project in eThekwini district for a benchmarking visit on 26 and 27 May 2022. The purpose of the visit was to look at, and assess HST strategies and interventions targeting the 15 to 19-year-old age groups. This visit took place over two days comprising of health facility visits at selected facilities, a presentation by HST's community case management partner Cindi Network and a debriefing session.
Three facilities in eThekwini district were selected for the facility visits. These were Addington Hospital, Chesterville Clinic and Sivananda Clinic. These facilities were selected based on their HIV performance cascade targets, the resources mix, UB strategies implemented at the different facilities and different institutional arrangements that exist in each, for example, Chesterville Clinic is a municipal clinic.
Some of the key lessons learnt from the visit as captured from the debriefing session included:
HST's Health Systems Strengthening Manager, Rakshika Bhana said: "HST is passionate about promoting AYFS that are tailored to the needs of youth, and at the same time ensuring that the quality of service standards are met."
Bhambayi and Phoenix township residents benefit from free health services offered by the Department of Health and its District Support Partners as part of the 'Isibhedlela Kubantu' outreach initiative at Fernham Sports Ground.
KwaZulu-Natal's Provincial Department of Health (KZN DoH) is making good progress in promoting COVID-19 vaccine uptake and mobilising communities to take charge of their health through its Isibhedlela kubantu initiative. In isiZulu, this Nguni term refers to continued efforts by the KZN DoH to take critical hospital services closer to where the people live.
The province still faces high poverty rates, youth unemployment, and a variety of socio-economic ills. Many households are led by the elderly who rely solely on social grants to survive, and who themselves are often physically challenged to travel and reach the province's health facilities.
While KZN has no shortage of clinics and hospitals, one of the issues addressed by Isibhedlela kubantu is the pressing challenge of access. Although clinic services offer a good range of critical Primary Health Care (PHC) services, hospitals offer a much broader bouquet. This was explained by the Deputy Director for eThekwini Health District's North West Service Area, Nonhlanhla Masondo, when she welcomed residents flocking in from the neighbouring Phoenix and Bhambayi townships to Isibhedlela kubantu, which was held at Fernham Sports Ground on 3 June 2022, coinciding with Child Protection Week.
Deputy Director Nonhlanhla Masondo (centre) with HST and DoH staff at one of HST's mobile units during the event.
Deputy Director Masondo was thrilled to announce that entire families could be screened and treated for a variety of ailments at the various stations in which KZN DoH District Support Partners (DSPs) such as the Health Systems Trust (HST) were staffed on the field. She said: "Isibhedlela kubantu is our way of showing you that we care. Through this initiative, our DSPs drive in with their mobile units to help us to give you the very best of healthcare services."
As with the recent DoH Phuthuma Week that promoted COVID-19 vaccine uptake and integrated services at community level across KZN, locals were attended to holistically during Isibhedlela Kubantu in Phoenix.
Isibhedlela kubantu is a one-stop-shop health promotion approach, with KZN DoH personnel teaming up with DSP staff to offer free health screening for tuberculosis (TB), HIV, non-communicable diseases (NCDs) and more. Deputy Director Masondo explained: "Through this initiative, we aim to give our clients a 'real life' hospital experience, and are also offering X-rays, Pap smears, eye and dental care services, voluntary medical male circumcision, nurse-initiated management of antiretroviral treatment (NIMART), assistive devices for the elderly … the works!"
Both working in eThekwini's Phoenix Cluster, HST's Lay Counsellor, Thulani Mdluli (left) and Nurse Clinician Sister Lorraine Nzimande (right) say that they are passionate about community outreach and helping other people in general. They provided HIV testing services at the event.
"I love working with people. Being of help and service is in my nature," said Mdluli from KwaMashu, who also said that men should always be encouraged to take good care of their health and wellbeing. "My mother was a caregiver and I think I got it from her."
"The day is going great," said Bongani Mbatha, HST's Area Co-ordinator (Phoenix Cluster). He works closely with HST's Phoenix Cluster Facility Team Lead, Noluvuyo Sibisi. They agreed on the importance of bringing services to the people, stressing the need for promoting TB and HIV testing, treatment initiation, and ensuring that patients whose treatment for chronic conditions has been interrupted are brought back into care.
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