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Dec 05
Commemorating World AIDS Day 2022 in Amajuba District

by Vukile Mavundla (Provincial Team Technical Advisor)

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Commencing the Provincial Government's commemoration of World AIDS Day (WAD) in Amajuba District, KwaZulu-Natal (KZN), Premier Nomusa Dube-Ncube led a contingent of Members of the Executive Council (MECs) on household visits in Ward 12 of Danhauser Sub-district, to gain a first-hand understanding of the community's challenges and needs. 

Premier Dube-Ncube (second from right) is accompanied by provincial mec for health, Dr Nomagugu Simelane, on household visits in the Dannhauser ward 12 community. (photo credit: KZNonline). 

Among the families visited was one where an elderly lady was living in a rundown house with 13 grandchildren. The principals committed to build them a proper house and to offer bursaries to the four children who had completed their Matric studies. 

During the public event at Vanjazi Sports Ground, a moment of silence and a candle-lighting ceremony honoured all those who have lost their lives to AIDS. 

Addressing the gathering on the 2022 World AIDS Day theme 'Equalise and Integrate to End AIDS', Premier Dube-Ncube thanked the audience for attending in numbers, and advocated for young people to delay their sexual debut and focus on their studies so that they can determine their future. "The youth are the future leaders of our country, so we need a healthy generation of young people who will take South Africa forward," she said. 

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KwaZulu-Natal Premier Nomusa Dube-Ncube (Photo credit: KZNonline) 

She emphasised the importance of practising safe sex, and the availability of male and female condoms, Family Planning and HIV services, and the Dablapmeds chronic medicine collection programme, all of which are free of charge through the public health system. 

"Reducing HIV-related stigma is a top priority for the provincial government, and we must love all those who are infected with and affected by HIV," she added. "We urge the people of KwaZulu-Natal to know their HIV status and if necessary, be initiated on treatment immediately." 

The Premier commended government for its efforts to control the country's HIV epidemic, notably through expanding access to life-saving antiretroviral therapy (ART), and the Chair of the KwaZulu-Natal Civil Society Forum acknowledged the support and resources brought by partners to reach communities in need of HIV care and treatment services.

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​HST’s Vukile Mavundla and Mr Jabulani Mndebele, Chief Director: District Health Services, listen to the Premier’s address.
​HST’s Vukile Mavundla with Ms Penny Msimango, Acting Deputy Director-General: Clinic Support Services, at the WAD event in Amajuba.

DoH Head of Department Dr Sandile Shabalala attended the WAD event


Vukile Mavundla, HST's Technical Advisor to the Office of the Chief Director: District Health Services, represented the SA SURE Pro project at the WAD event, highlighting the role we play in supporting the province's strategic health programmes and district HIV and TB interventions, with a joint commitment to more equitable and integrated clinic services.

Nov 30
World AIDS Day 2022: Case management, expert patients and the meaning of partnership

by: Joslyn Walker, Ntombifuthi Shezi, Sanele Mvelase, Primrose Sithole, Hlengiwe Ngcobo, and Judith King

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The SA SURE Pro project combines clinical interventions and peer mentorship to ensure inclusive and equitable access to HIV and TB care and treatment in public health facilities and in communities.

Partnering with the Department of Health (DoH), the Centers for Disease Control and Prevention (CDC), and the communities in which we live and work, the SA SURE Pro project is implemented in four districts in KwaZulu-Natal.

People living with or at risk of HIV and/or TB infection are central to all of the work we do. We strive to improve their experience of care by providing health education, support and treatment – but not as merely passive recipients of care.

For authentic parity in our care approach, we ensure that patients are actively engaged in their own journey to health and wellbeing. The healthcare worker and health system do not stand alone, but function productively only when strongly affiliated with the patient, whose unique experiential knowledge is drawn from individual circumstances, preferences and values.

In order to best serve the needs of people living with HIV (PLHIV) and TB, HST developed and implements the Case Management Model, which ‒ as a patient-focused modality ‒ allows for adjustment to suit the context and needs of the local population, environment, and leadership structures.

Case management is designed to put the patient first ‒ to regard the patient as a whole and competent person, and not as a 'package' of disease symptoms, or an epidemiological statistic. The success of this model relies on collaboration between the patient and healthcare worker, each on an equal footing. It entails the patient developing a trust in a Case Manager for psychosocial and clinical support, and the Case Manager being guided by the patient when monitoring patient's clinical progress towards viral suppression or being cured of TB. 

As a vital method for patient-centred care, case management brings improvements to the whole system by improving patients' waiting times and information systems, enabling regular and convenient appointments, and customising service delivery to individual needs.

Case management also integrates the HIV and TB programmes directly into Primary Health Care services, making the treatment pathways more accessible, more equitable and less stigmatising.

Although case-managing a patient is a clinical intervention, HST prioritises the involvement of patients in various initiatives to strengthen this care approach. We collaborate with the PLHIV sector to gain a deeper understanding of patients' experiences of care and their capacity for self-management. To break down some of the barriers to care, we employ PLHIV as expert patients – essential members of the healthcare team who can help those newly diagnosed with HIV to deal with their health status, and to walk the journey with them from a position of knowledge and empathy.

Collaborating with the District AIDS Council and PLHIV sector  

The District AIDS Councils are crucial platforms for partnership across sectors. In these fora, PLHIV, DoH officials, representatives of government departments, political and traditional leaders, non-government actors and other stakeholders can engage to improve health outcomes for the people of the district.

In eThekwini, the DAC is chaired by the city's Mayor, Councillor Mxolisi Kaunda. HST has assigned Nurse Clinician Amanda Mkhize as a technical advisor to the DAC, and together with the SA SURE Project Manager, Community Co-ordinator and other technical leads, we are working through the Mayor's agency in the DAC towards an AIDS-free generation in the city.

DAC Co-ordinator Nthabiseng Malakoane describes this collaborative approach: "Together, across eThekwini, the DAC and HST are implementing programmes for health promotion, behavioural change and our 'Welcome back' campaign. We work closely with the Chairperson and Secretary of the PLHIV sector, and have brought in the CINDI Youth Living with HIV to promote adherence to treatment."

Mayor Kaunda is a passionate advocate for HIV prevention and for equitable access to treatment for all PLHIV. He champions specific activities to address issues for communities, such as the MINA men's health campaign, by joining in men's gatherings to discuss the key issues affecting their lives and how the youth of eThekwini can be supported.

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Councillor Mxolisi Kaunda, Mayor of eThekwini and DAC Chairperson, launches the MINA campaign for men’s health

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The MINA campaign is a targeted, insights-based and data-informed brand that speaks directly to men on health and wellbeing generally, and on HIV care and treatment specifically. Having the Mayor as a MINA champion in eThekwini shows men that their health is truly in their hands.

In the lead-up to 16 Days of Activism for No Violence Against Women and Children, the Mayor hosted a breakfast session with PLHIV, where issues affecting this sector were discussed at length. Children born with HIV and living openly shared their testimonies and their willingness to support other children towards accepting their status. The key message for the day was voiced by the PLHIV and youth advocates: "We are where we are today through support groups, and would like to see our brothers and sisters benefitting as we have."

Ntokozo, a child living with HIV, had written a book on her experiences that she shared with the Mayor; she affirmed that the peer mentoring approach is the most effective route for achieving viral suppression.

HST's Sr Mkhize is making this wish a reality. Through her work in the DAC, and teaming up with a Lay Counsellor from HST's Unfinished Business project (our other flagship programme which works with children and adolescents), she has set up support groups in the Inanda area. 

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Joining Mayor Kaunda to welcome HST's Sr Amanda Mkhize as the DAC technical advisor are (from left) the Civil Society Forum Chairperson Siya Nzimande, HST's HAST Co-ordinator Lucia Myeza, and DAC Co-ordinator Ms Nthabiseng Malakoane.

Peer mentorship

The role of the Peer Mentor in Zululand District is to provide peer education and psychosocial support to adolescent girls and young women (AGYW) aged between15 and 24 years, as well as their partners, parents and families. Peer Mentors are HIV-positive young women who have voluntarily declared their HIV status so that they can support other young women; their goal in this work is to help in reducing new HIV infections, illness and death among youth, and promoting health-seeking behaviours through uptake of sexual, reproductive, maternal and child health services.

The Peer Mentors map the community services available in the catchment area, and visit households. To create an enabling environment for young women to engage with health services, they set up and facilitate Youth Clubs and parenting sessions in the community, as well as Youth Corners and Young Mothers' Clubs at facilities, along with referrals and linkage to healthcare and social services.

This programme has reduced HIV-related stigma and discrimination in facilities, especially for young women whose reluctance to disclose their status prevents their access to healthcare. The love and support offered by Peer Mentors boosts the self-esteem of young mothers living with HIV, and has increased the number of clients who are willing to disclose their status to their partners or children, as they find it easier to interact with someone who has been on the same journey. https://www.hst.org.za/PublishingImages/World%20AIDS%20Day%202022_4.pngYoung mothers breastfeeding week at KaHhemulana Clinic


Qobile Zenele Buthelezi

Peer mentor, KaHhemulana Clinic


I wanted to be a Peer Mentor because I understand very well how challenging it is being a mother with such experiences in life, and being a Social Worker by a profession, I will help them conquer their personal issues. It also helps me to improve my skills because I like to work with people. I know that people are unique and it's easy to understand their behaviour in a non-judgemental way.

Peer mentorship improves the quality of health services to PLHIV because I teach them about me as I am HIV-positive, and that makes them feel free to share their experiences with me because we are at the same threshold of health status and we can listen to each other.

It makes me feel so happy to be the one who is responsible in my clinic and as a member of the community. Those who are on treatment are responding so well to their medication. Peer mentoring decreases the number of patients with interrupted treatment because I teach them the importance of taking medication on time, using condoms, and family planning. Patients who are orphaned, survivors of rape and abuse, poor and angry are able to verbalise their concerns to me, and I can refer them to Social Workers for additional support.

One teenager had declined to take treatment but after I counselled her, she enrolled in treatment. Patients who have missed appointments need my assistance and counselling and they are returned to treatment, as I go with the outreach team to trace them. 


Thandeka Mchunu

Peer mentor

I wanted to be a Peer Mentor because I am passionate about empowering adolescent girls and young women by giving them knowledge about services for mental health, STIs, gender-based violence, preventive interventions, nutritional counselling, and contraception.

Being a Peer Mentor makes me happy because I am helping AGYW with health services and improving their self-belief. I make sure I teach them about how to manage peer pressure via counselling and offer them life skills during Youth Zone sessions in the facility and during health talks.

Being a Peer Mentor improves the quality of health services for PLHIV, and counselling adolescent girls reduces the rate of teenage pregnancy.

I had a postnatal patient who is currently on antiretroviral therapy (ART), but she had interrupted treatment, was addicted to drugs due to an abusive relationship, and had dropped out of high school. Peer mentoring does not end at the facility. I had a one-on-one session with her after she was re-initiated and her file was referred to me as a Peer Mentor. After the initial, session I stayed in contact with her over the phone, offering to talk to her whenever she needed. She then opened up about her past struggles with her abusive partner and her battle with drug addiction. After continued sessions, she is now keeping up with clinic appointment dates and is virally suppressed. She has gone back to school and overcome her drug habit. She managed to stand up to her abusive partner and leave the relationship. In our last session, she revealed that it was the relationship she had built with me as someone to just listen and not judge her, that helped her. She is now advising others who are in a similar situation to seek help before it's too late.

Having a friendly face and an ear to listen to you in your time of distress helps. All of this was facilitated by the Peer Mentor Programme. 


Peer mentorship through the Coach Mpilo Programme is another means of reaching out to men living with HIV. This programme assigns men who are living openly with HIV as coaches for encouraging men to disclose their status and guiding them through the challenges of HIV diagnosis, adherence and treatment. It recognises that men fear their diagnosis, and while they want to be healthy, they do not always have the tools at their disposal to achieve this. Coach Mpilo is currently implemented by the SA SURE Pro project in uMgungundlovu and uThukela, where it is making a substantial difference in the way we engage men and is improving integration of HIV-positive male mentors into health service delivery. 

Nqobisizwe Ngubane

Peer Mentor – Coach Mpilo


​I wanted to be a coach because I want to help people to understand and know about their status, and to gain self-confidence as I have. I want to show people that and HIV diagnosis is not the end of the world. I inspire men to be survivors by taking their medication correctly. I give a step up on treatment adherence by empowering men with knowledge.
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My name is Thobani Shabangu and I am 28 years old. My main reason for becoming a Coach was to try to eradicate the spread and stigma of HIV, and to educate and enlighten people in the community with emphasis on men about health education. What I enjoy most about my job is that I bring new hope to men who have lost all hope with their lives. I love seeing my players rise from the ground up, regaining their confidence and giving them a different and positive view of life and their health. 
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My name is Thembalihle Cedrick Khumalo. I’m 36 years old and the reason I wanted to be a Coach is because I want to educate people, mostly males, about HIV and how positively you can live, and also how you should present yourself in a respectful manner in the community and be a responsible individual living with the virus. I live openly with my status and I am not afraid of disclosing. I am able to tell my story without fear, helping other people to open up and be comfortable with themselves. I tell them that living with HIV is not death sentence. The world is a beautiful and wonderful place to be in, so make every moment count. What I like most about my role in the men’s health programme is the gratitude shown by my players and the men I interact with, telling me that they now can see light at the end of a dark tunnel. 
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I am Siyamukela Shange and am 40 years of age. I'm a Men’s Coach at Bergville Clinic. I wanted to be a Coach because I want to be a part of making a change in our country, and to help men who are living with HIV, by giving them hope and assuring them that being HIV- positive is not a death sentence but a condition that requires you to take care of yourself. And if you adhere to your treatment, you can live a normal life. I also want to help men who are HIV-negative to stay uninfected. I believe my strongest trait is my attention to detail, which has helped me tremendously as a Coach. As a man living with HIV, I find it easier to point out the challenges that my players are facing, and because of my observations it’s easier to find solutions. I see myself as an inspiration to men who are struggling with treatment adherence because when they see how healthy I am and how I live a normal life, they get inspired to adhere to their treatment. My message is: We are here for you in this HIV journey, you won't be alone. Start your treatment today.
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My name is Justice Sithembiso Khanyile, and I am 41 years old. I wanted to change the lives of people living with HIV and give them the hope and encouragement before taking their treatment. l see myself playing a big role and providing ongoing guidance and support for their own personal experience of living with HIV, and above all, I see myself as an important tool for helping them to live a healthy life. 
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My name is Zakhele Zwane, greetings. I am 35 years old. I wanted to be a Coach after I found out about my status in August this year. I was very shocked to hear about my status, but when I was asked about initiating treatment, I agreed immediately because I was thinking about my dream in life and the things I want to achieve. I love to be a Coach. It works for me and my community. As a man living with HIV, I always give hope to myself first. Without hope, I don’t think we will make it. So before leaving a client, I make sure he understands me very well, in order to make him gain strength through hope. It is so exciting to see a player recovered from illness and come around and ask for you by name, just so he can show you that he is getting better.
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I am Ndumiso Ndlovu, aged 30 years. Men's health is important, but men find it is not easy to attend, as they do not want to attend clinics like a woman. I wanted to be a Coach so that I can encourage all men to go to the clinic. I tell them that I'm living with HIV but I'm still the same. They can live their life the way they want to if they do things right. Adherence is important. This pill is like a spring: if you put something which is heavy on it, it goes down. Once you remove that thing, it rises up again. You will be in danger. The thing I like about being a Coach is that I see many men coming back to the clinic, looking for me to help them. I see them coming to do HIV testing, consulting, others coming to collect their medications, without any shame. I see myself as a life-saver. 
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My name is Mntungwa Derrick Khumalo. I am an example of how being HIV-positive is not the end of the world. Always I inspire men by telling them about my status and the way I am free about it and also how acceptance makes the treatment work on your system. This helps our players to be honest to us and open to our friendship with them. What I like the most about my programme is that players now are my friends. Always they want my help every time they arrive in our facility; the only thing they ask is for me, and that makes me feel great because I love to help people and to know people, and also to see people happy, knowing that I am the reason for that. 
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My name is Sanele Gwala and I am 32 years old. The reason I wanted to be a Coach is because we as men are not aware of the importance of our health. The strength that I bring to case management as a man living with HIV is unique. Every time that I speak with my players, they understand me very well because I always start by referring to myself first, which makes it easier for them to receive the information because no one is judging and we are living the same life. We are sharing in this because as much as I am helping them, they are helping me as well. I see myself as an inspiration to men who are struggling with adherence because we share a lot and come up with many different strategies. Every player is facing different challenges when it comes to adherence. Most of my players have a problem with alcohol so that they forget to take their medication, so we find the most suitable time for them to take their medication. I would like to say to men and women who already know their status but are not yet taking their medication that sometimes it is not about us but the next person that we care about, and giving the next generation the chance for a better life and future. 

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Coach Zanele Zwane reaches out to guide and support his player.
​Thembelihle Cedric Khumalo gathers his players for a coaching session.

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Coaches run group sessions for their players.

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​Coaches speak to their players on their level
​Siyamukela Shange demonstrates viral load with the ‘B-OK’ bottles of beads.
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​Justice Sithembiso Khanyile is an advocate for men’s health. By sharing his experiences, he becomes a tool in their lives
​Ndumiso Ndlovu showing men that even though he has HIV, he is still the same strong and proud man he always was
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​The B-OK bottles are a great aid for explaining how the virus and medication interact
​Coach Mntungwa Khumalo using the B-OK bottles for adherence classes.


Nhlakanipho Kunene

Peer Mentor – Coach Mpilo

​Since my childhood, I've longed to work as a Health Worker. I saw the stats for the level of health services rendered and the outcomes of people needing care. For various reasons, there are fewer men seeking health care. Given the opportunity to change that, I took it because I understand how it feels like to be a man living with HIV. I know what advice and help are needed by men, whether HIV-positive or HIV-negative. I believe I am living proof that even if I'm HIV-positive, I can still live a healthy life, by first accepting my status, asking for help if I need it, and reminding myself that by taking care of others and taking my treatment I'm not only taking care of myself, I'm also protecting others from being infected. I tell men who are not on treatment the history of how hectic it was when the ART programme started; I take them through the improvements in medication, and about the advantages and disadvantages of taking or not taking treatment.


Whether as Coaches, Peer Mentors, Case Managers or a Managers working with the district to develop strategies for more inclusive health services, we are all working towards more equitable and integrated health systems to make treatment more accessible for and more widespread among people living with HIV. Together, we can do more. 


Nov 28
HOMii Lifestyle event skilfully targets men’s health and men’s mental health issues

By: Lunga Memela (HST Communications Engagement Lead)

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It goes without saying that women and children's health are a priority if we want to secure a bright future for all, especially in South Africa where cervical cancer, HIV and various non-communicable diseases remain a fundamental public health threat. Equally so, a dangerous gap exists where men's health and men's mental wellness are issues ignored or overlooked, compromising health efforts overall. 

Not addressing men's health issues has often been labelled as the cause, for instance, for movements such as the global 16 Days of Activism for No Violence against Women and Children Campaign.

The Health Systems Trust (HST) was again invited to participate as a guest speaker at a critical event hosted by urban apartment dwelling enabler HOMii, honing in on the health and mental health issues faced by young men in support of National Men's Health Awareness Month. 

Casual and informal in its setting, the #HOMiiMensConference aimed to dismantle stigma by raising awareness through normalising the conversation and changing the narratives that may be holding men back from taking charge of their own health. 

HOMii invited guest speakers to spark conversations around finance in relationships, how men ignore the signs of depression, coping with stress and disease, black tax, and an array of other topics that were open for participation from the floor through roving microphones. 

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The only woman invited to the event was Amanda Khomo, a motivational speaker and author of two books: Losing A Loved On Through Death and Breakup, and Isodoma ne Gomora. She went into the heart of why men need to reconcile with their emotions to be able to express themselves and feel understood within their communities. Attendees were proud to hear a woman speak so positively about men and how men too need support.

As HST's Communications Engagement Lead, I highlighted some of the work the organisation has supported the Department of Health in rolling out and implementing. These include a MINA Men's Health Campaign and the province's impressive PhilaNdoda Campaign and Izibaya Zamadoda – all of which are encouraging men to take holistic charge of their health, thereby also protecting their loved ones. I also covered other topics including the importance of taking care of one's mental health, raising STI awareness and removing the stigma from visiting healthcare facilities and taking chronic medication as prescribed.

The event was attended by eThekwini Mayoral Affairs Health Promotion Officer for the South Sub-District, Simamisa Mkhize, who commended HOMii for hosting such an event and for promoting health amongst young men. He was happy to respond and advise on the many social ills faced by attendees during the proceedings.

The event was lauded for its targeted approach to these critical topics. 


Nov 21
The Health Systems Trust supports Disability Rights Awareness Month 2022

By: Lunga Memela (HST Communications Engagement Lead)

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The theme for this year's National Disability Rights Awareness Month, commemorated from 3 November until the United Nations International Day of Persons with Disabilities on 3 December, is "Empowering Persons with Disabilities through resourceful, sustainable and safe environments."

Prioritising disability rights and promoting disability awareness has always been high on the Health Systems Trust (HST) agenda. The 23rd annual South African Health Review (SAHR) – one of HST's flagship publications – was themed: Access to health care for persons with disabilities in South Africa. The publication provided critical insight into barriers and facilitators, good practices, and successful service-delivery models for disability inclusion and rehabilitation. The journal's chapters furnished the reader with information on the multitude of challenges associated with providing a seamless continuum of appropriate and adequate care for persons with disabilities in the public health sector.

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Similarly, the 2021 special edition of the SAHR titled Health sector responses to COVID-19, what have we learnt? dedicated a chapter to disability where the authors documented experiences of vulnerability of people with disabilities during COVID-19 in South Africa. They felt that people with disabilities are often left behind in emergencies, and that this was a risk during the COVID-19 pandemic.

"With approximately 3.8 million people living with disabilities in South Africa, it is not clear how they were considered during the initial and ongoing stages of strict lockdown," said the authors. "Emerging lessons reveal that the right to health of people with disabilities should be protected during the COVID-19 pandemic and similar emergencies. Additional efforts are needed to ensure that pandemic responses are disability inclusive from the planning stage."

Continued commitment from HST 

HST joins the rest of the world in commemorating Disability Rights Awareness Month 2022. As health leaders advise, what people need to remember is that disability may be present from birth, or occur during a person's lifetime – that is to say, every person is susceptible to becoming disabled at any given point in their life. We need to always spare a thought for persons with disability, their families and caregivers.

The SAHR Managing Editor Ashnie Padarath reminded people that not all disabilities are visible. "There are two immediate challenges facing the health sector. The first is to move from [an] overwhelmingly medicalised and individualised approach to disability focused on fixing impairments, to a rehabilitation service-delivery model located at community level. The second challenge is ensuring that persons with disabilities are consulted, included and considered in the ongoing rollout of NHI," she said.

For more information on disability in South Africa, please visit: https://disabilityconnect.co.za/


Nov 18
Rotary event encourages KwaMashu residents to remain health-focused while recovering from KZN’s recent tragedies

By: Lunga Memela (HST Communications Engagement Lead)

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The National Department of Health (NDoH), together with Rotary International, hosted a Rotary Family Health Day on 15 November 2022 at KwaMashu Sportsfield in eThekwini. This event harnessed key stakeholders and partners to bring services to people at community level, as part of the South African Government's strategy for delivering equitable and integrated health care.

Lead partners at the event included the South African National AIDS Council (SANAC), the KwaZulu-Natal Department of Health (KZN DoH), the eThekwini Municipal Health Unit, the Health Systems Trust's (HST) SA SURE Pro project, and a number of community-based organisations. The event was funded by the international Rotary Action Group for Family Health & AIDS Prevention (RFHAP), paying homage to communities and individuals gravely affected by the province's recent floods, public unrest, and COVID-19.  

The Rotary Family Health Days (RFHD) campaign is a public‒private partnership between government, SANAC, Rotary International and various organisations aimed at bringing a comprehensive package of free primary and specialised health services to identified underserved communities across the country on three consecutive days during the month of November every year.

The event was addressed by the Deputy Minister of Health, Dr Sibongiseni Dhlomo, who praised the organisers' collaboration and the turnout from the community, noting how important it was to ensure that health care is more accessible to all.

He also used this platform to officially launch the theme for #WorldAIDSDay on 1 December 2022: Equalise and Integrate to End AIDS. The annual World AIDS Day Campaign serves to unite people in controlling the HIV epidemic, to show support for people living with HIV, and to honour those who have died from an AIDS-related illness. 

Deputy Health Minister Dhlomo said it was heart-breaking to learn that the country's youngest mother in 2022 is 10 years of age. All constituencies present at the event, including civil society, were confronted with the reality that children are sexually active, be it consensually or not. With the 16 Days of Activism for No Violence Against Women and Children campaign commencing on 25 November, it goes without saying that more must be done to protect women, children and especially young girls from all forms of violence, including sexual violation ‒ not only as a human rights issue, but also in an effort to stop the spread of HIV and other sexually transmitted infections.

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Deputy Minister Dhlomo, along with KZN DoH Head of Department Dr Sandile Shabalala, called on people to take advantage of community-based services to improve their health outcomes.

Dr Diane Morof, Associate Director of Programmes for the Centres for Disease Control and Prevention (CDC South Africa), addressed the gathering by saying that the past two years had not been easy for the people of KwaZulu-Natal. "We were one of the provinces worst affected by the COVID-19 pandemic. While recovering from COVID-19, we experienced social unrest that claimed many lives. As we tried to rebuild our province, we experienced devastating floods that left hundreds of people dead and displaced hundreds of thousands more," Dr Morof (pictured below) reflected. 

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"All these unfortunate incidents disrupted lives and reversed TB and HIV care and treatment gains. The treatment disruptions were particularly felt in eThekwini Metro and surrounding districts. The floods destroyed homes and washed away people's identification documents, clinic cards, and much-needed treatment. The roads leading to the clinics were also affected, making it difficult for people to access public health facilities. All these difficulties caused people to miss their clinic appointments and for some, treatment was interrupted," Dr Morof explained.

HST's SA SURE Pro project staffers were present at the event in mobile units, providing HIV testing and counselling services. Funded by the United States President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. CDC, the project supports the DoH in providing community- and facility-based services delivering life-saving antiretroviral therapy (ART) for people living with HIV, and works with community leadership to improve access to treatment and a better life for all. 

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A community member receiving voluntary HIV testing and counselling from HST at the event.

Key insights from Rotary CEO at the event

The CEO of RFHAP, Ms Sue Paget, said that our post-COVID-19 world shows how the pandemic has disproportionately impacted the people most affected by diseases – "the poor, the marginalised, those living without access to health care, those living in informal settlements, farmworkers, and those in this area so affected by the devastating floods."

Rotary's President Elect, Mr Gordon McInally, also conveyed his message of support virtually at the event.

Ms Paget explained that the organisation had learnt key lessons from its first pilot in Uganda in 2011. These were that:

  • community-specific health interventions are needed;
  • integrated preventative health screenings enable people from the communities to come forward for testing without the stigma that is associated with singular screening;
  • the people using these interventions believe Rotary to be a non-partisan or neutral, and therefore trustworthy, organisation;
  • driven by service leadership and volunteerism, Rotarians are happiest when working together for common cause, directly benefitting their country and the communities in which they live and serve.


"Through effective collaboration with the private sector and government," said Ms Paget, "Rotary Family Health Days play a part in building and strengthening health care. We do this in communities through education, through governance, through empowerment and leadership, to respond to local and global health challenges that face our country but also our continent… Good health affects not only the individual, it affects all of us. It has a good spin-off at community, family, corporate, government and country levels."

Polio and measles vaccination

Deputy Minister Dhlomo also reiterated one of the main objectives of the day, which was to promote the nationwide call to action for measles vaccination roll-out. Polio and measles are currently a major public health threat in the country and across the African continent, calling for urgent intervention, especially immunisation. 

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Other health priorities

In addition to promoting women and children's health at the event, speakers also flagged men's health and men's mental health as a priority. Integrated services offered to the KwaMashu community on the day included family planning, immunisation, TB and HIV testing, Pap smears, dental screening, an eye clinic, screening for minor ailments and chronic diseases, a children's clinic, as well as a clinic for the elderly where those in need were issued with new walking sticks. 

One of the final key messages emphasised to attendees was the importance of adherence to chronic medication. They were reminded that the DoH has made it possible for government-issued medication to be collected for free at convenient collection points after registering for a free service called CCMDD (Central Chronic Medicine Dispensing and Distribution) or 'Dablapmeds', which HST continues to promote through its online communications channels.

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HST's Acting Area Co-ordinator for KwaMashu, Nokzola Mqholiwe, takes dignitaries through the process for HIV testing services at the event. 


Nov 03
Southern African Development Community commemorates Malaria Day 2022

By Mandisa Dlamini (Health Systems Trust Communications Intern)

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The Southern African Development Community (SADC) commemorates Malaria Day on 6 November every year. Government explains that the purpose of this day is to mobilise communities through health education to recognise signs and symptoms of malaria, provide more home-based treatment, encourage people to seek treatment when they become ill and to make people aware of personal protective measures.


What is malaria?

Malaria is a disease caused by a parasite. The parasite is spread to humans through the bites of infected mosquitoes. People who have malaria usually feel very sick with a high fever and shaking chills. While the disease is uncommon in temperate climates, malaria is still common in tropical and subtropical countries.

Each year nearly 290 million people are infected with malaria, and more than 400,000 people die of the disease. Malaria is therefore a serious illness that needs to be combated by any means necessary.


Where can you contract malaria?

Malaria is prevalent in subtropical areas like sub-Saharan Africa, South and Southeast Asia, the Pacific Islands, Central America and northern South America.


What are the symptoms of malaria?

Signs and symptoms of malaria may include:

  • Chills
  • Fever
  • General feeling of discomfort
  • Headache
  • Nausea and vomiting
  • Diarrhea
  • Abdominal pain
  • Muscle or joint pain
  • Fatigue
  • Rapid breathing
  • Rapid heart rate
  • Cough


Some people who have malaria experience cycles of malaria "attacks". An attack usually starts with shivering and chills, followed by a high fever, followed by sweating and a return to normal temperature. Malaria signs and symptoms typically begin within a few weeks after being bitten by an infected mosquito. However, some types of malaria parasites can lie dormant in your body for up to a year.


How can malaria be prevented?

  • If you live in or are traveling to an area where malaria is common, take steps to avoid mosquito bites. Mosquitoes are most active between dusk and dawn.

  • To protect yourself from mosquito bites, cover your skin, wear pants and long-sleeved shirts, tuck in your shirt and tuck pant legs into socks.

  • Apply insect repellent to skin. Use an insect repellent registered with the Environmental Protection Agency on any exposed skin and apply repellent to clothing. Sprays containing permethrin are safe to apply to clothing.

  • Sleep under a net. Bed nets, particularly those treated with insecticides, such as permethrin, help prevent mosquito bites while you are sleeping.

  • If you'll be traveling to a location where malaria is common, talk to your doctor a few months ahead of time about whether you should take drugs before, during and after your trip to help protect you from malaria parasites. In general, the drugs taken to prevent malaria are the same drugs used to treat the disease. What drug you take depends on where and how long you are traveling and your own health.


Can I get vaccinated for malaria?

According to The Conversation, developing a vaccine for malaria has proved to be a far more difficult task than developing one for Covid-19, and research has been conducted to find a suitable vaccine for years. What makes it so challenging is that a parasite such as malaria can take on different forms in different hosts and is ever evolving to escape the human immune system. The first malaria vaccine, Mosquirix by GSK, was approved by the WHO after 30 years of research and numerous clinical trials. This ground breaking vaccine received prequalification from the WHO in September 2022. Receiving prequalification from the WHO is a mandatory prerequisite for United Nation (UN) agencies like UNICEF to produce a vaccine in partnership with GAVI, the Vaccine Alliance, and eligible countries. The World Health Organization has recommended a malaria vaccine for use in children who live in countries with high numbers of malaria cases.

Huge strides have been made in the prevention and combatting of malaria, and the Mosquirix vaccine is a major breakthrough that should alleviate much suffering in vulnerable countries. By continuing to spread awareness about the prevention and control of this deadly disease, malaria can hopefully be brought under control.

 


Oct 26
Bone marrow donation is easier than you think

By Willemien Jansen (Health Systems Trust Copy and Content Editor)

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Every year thousands of South Africans with blood cancers or immune disorders find themselves in need of a bone marrow transplant.

Most people don't find bone marrow matches within their own family and rely on a donation from a stranger who exactly matches their type of bone marrow tissue. Unfortunately, the odds of finding a match is just 1 in 100 000, and this is why signing up to become a bone marrow donor is so important. People of colour represent only 30% of current donors, and since donors are usually found within one's own ethnic group, this presents a huge problem for many South Africans who can't find a match. Having more donors will improve the odds of surviving a blood cancer or immune disorder where a bone marrow transplant is necessary.

What is a bone marrow transplant?

Red blood cells, white blood cells and blood platelets are produced in the bone marrow tissue. White blood cells fight infection, red blood cells carry oxygen and blood platelets prevent bleeding. Bone marrow doesn't produce healthy blood cells in those suffering from blood cancers and certain immune disorders, and the only way to fix this is by undergoing a bone marrow transplant. The procedure is fairly simple and similar to a blood transfusion. The unhealthy bone marrow is replaced with healthy bone marrow stem cells so that the body can start producing healthy blood. Sixty percent of bone marrow transplants successfully cure the recipient.

How do I become a bone marrow donor?

Getting registered as a potential donor is a very easy process and does not require a person to undergo any kind of procedure or pay any money. To be added to the register you can complete the online form either on the South African Bone Marrow Registry (SABMR) or the DKMS websites. You have to be between the ages of 16 and 45 to donate. South Africa became the second country in the world to allow people aged 16 to become donors. When completing the form, you will be asked a few questions to make sure that you would be healthy enough to donate. You will then receive a cheek swab by courier that you should send back to the provider. All this is paid for by the provider. As easy as that, you will be added to the register. You will not be required to do anything else until you are matched with someone.

What happens if I am a match?

The organisation you registered with will contact you if you are a match to anyone who needs a transplant. They will walk you through the process and support you every step of the way. They will also cover all the costs of the donation. Over 90% of donations are done through peripheral stem cell collection, where an IV-line is run through the arm, much like donating blood. DKMS explains that the blood passes through a small tube into a machine that collects the blood stem cells, and then returns the rest of the blood to the body. The collection takes a few hours and the person can usually go home when it is done.

What if I can't register as a donor?

There are certain criteria that might exclude some people from becoming donors based on their overall health. If for some reason you cannot register to become a donor, there are other ways to get involved and spread awareness. Registering people on the donor lists is an expensive process and so both SABMR and DKMS accept donations. If you are between the ages of 16 and 35, you can sign up to become an SABMR volunteer.

Registering to become a stem cell donor is a free and easy process. Sign up today to potentially save a life!


Oct 21
CDC applauds eThekwini's top-performing clinics in HIV treatment and care

By: Lunga Memela (HST Communications Engagement Lead)

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CDC, PEPFAR and HST colleagues celebrate eThekwini's top-performing clinics at a certification ceremony.

The Centers for Disease Control and Prevention in South Africa (CDC-SA) was thrilled to issue certificates of appreciation to six eThekwini public health clinics in recognition of their outstanding performance meeting key HIV indicators in the district.

The certification ceremony was held at the Health Systems Trust's (HST) Durban office with the eThekwini District Department of Health (DoH) and the eThekwini Municipality Health Unit in attendance, where the facilities' Operational Managers and staff representatives were all smiles to receive the awards.

Ottawa Clinic and Caneside Clinic were recognised for achievement in viral load coverage, Lamontville Clinic and Savannah Park Clinic for patients' continuity of care, KwaMakhutha Clinic for HIV case-finding, and Addington Gateway Clinic for strong performance in both case-finding and viral load coverage.

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"It's more than the performance. It's about saving lives," said the CDC's Public Health Specialist for Counselling and Testing, Sego Debeila, who saluted the clinic staff as well as the Provincial structures for strong leadership and for working hand-in-hand with HST to make significant strides in HIV management. HST's Programmatic Implementation for HIV/AIDS and TB Prevention, Care, and Treatment Services – known as the SA SURE Pro project –  is funded by the United States President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S CDC. The project supports the DoH in line with the Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track strategy to end the AIDS epidemic by 2030.

The key indicators for which the clinics were recognised by the CDC are important. In addition to providing free HIV Testing Services (HTS) within eThekwini, encouraging people living with HIV (PLHIV) to adhere to antiretroviral therapy (ART) is as critical. The proven benefit of HIV being undetectable in the blood system of PLHIV is a major win, as it then becomes untransmittable. This message, also known as U=U, is supported by UNAIDS to confirm that PLHIV who have an undetectable viral load cannot transmit HIV sexually.

The event was attended by PEPFAR's Provincial Liaison, Baphiwe Nxumalo, who said it was joyful to see that the DoH–HST partnership is being strengthened and producing such results. "It's the community and the people we serve who are really benefitting," she said.

The clinic staff commended HST for enhancing community outreach, especially to the district's hard-to-reach areas, where residents often find it difficult to travel to the facilities for medical attention.  HST's Outreach Teams, comprising Driver Mobilisers, Nurse Clinicians, Lay Counsellors, Campaign Agents and Linkage Officers, take community-based HIV and other health services deep into these communities.

"It's about teamwork and team spirit," reported the clinic staff members at the certification ceremony. Working hard to meet and exceed HIV treatment targets, they can share good practices on targeting key populations such as adolescents, truck and taxi drivers, and men who have sex with men for HIV service provision. The aim is that every individual who visits the clinic must be tested for HIV, regardless of whatever ailment brings them to the facility. 

The recipients were grateful and inspired to receive recognition from CDC. "The work that we do is blessed. We are fortunate to have chosen the profession that chose us."

HST's SA SURE Pro Operations Manager, Felicity Basson, and SA SURE Pro Project Manager for eThekwini, Ntombifuthi Shezi, also congratulated the clinic staff. "A heartfelt thank you and appreciation from us as HST, for accepting our staff into your facility teams as colleagues working closely with shared commitment and passion to ensure the success of our TB and HIV programmes."

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From left: SA SURE Pro Project Manager for eThekwini, Ntombifuthi Shezi; CDC Public Health Specialist for Counselling and Testing, Sego Debeila; PEPFAR's Provincial Liaison, Baphiwe Nxumalo; and SA SURE Pro Operations Manager, Felicity Basson.


Oct 19
Don’t you forget about me: Women and ADHD

By: Antoinette Stafford Cloete (Health Systems Trust Communication Manager)

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October is Attention Deficit Hyperactivity Disorder (ADHD) Month in South Africa. According to a South Coast Herald article published in September 2018 the condition affects approximately 1 in 20 children and over 1 million adults. These figures may be grossly underestimated since many argue that the condition may be severely mis- or under-diagnosed.

Drs Renata Schoeman and Rykie Liebenberg are experts in the field and have developed guidelines to assist with a proper diagnosis. Dr Schoeman, the convenor of the ADHD Special Interest Group (SIG), part of the South African Society of Psychiatrists (SASOP) says it is critical that we 'shed light on this condition which [can] hamper sufferers' educational performance, self-esteem, relationships and work productivity.'

A correct diagnosis by a properly qualified clinician such as a paediatrician or psychiatrist is thus key and takes an effective multi-modal treatment plan, which may include drug- and psychotherapy, into account.

ADHD Symptoms

ADHD is usually characterised by a core triad of symptoms: 

  • Inattentiveness: being easily distracted or forgetful, failing to follow instructions or finish tasks, lack of attention to detail or careless mistakes, being disorganised, procrastinating.
  • Hyperactivity: fidgeting, tapping, talkativeness.
  • Impulsivity: has difficulty waiting their turn, often intrudes on others or butts into conversations; short temper or low tolerance for frustration; makes snap decisions without considering consequences; addictive behaviour. 


These symptoms must be viewed in conjunction with other conditions such as anxiety- and mood disorders and usually over time (about six months).

For many years the focus has also been on children and adolescents, but increasingly research and treatment has shifted to adults since it has become widely accepted that children don't necessarily outgrow ADHD.

What exactly is ADHD?

'Mental restlessness' was first described by Sir Alexander Crichton in 1798, while 'Fidgety Philip' (a popular storybook character and now also an allegory for children with attention-deficit/hyperactivity disorder [ADHD]) was created by Heinrich Hoffmann in 1844. Sir George Still's Goulstonian Lectures, describing children with restlessness, inattention and impulsiveness, can be considered the starting point of the description 'attention-deficit/hyperactivity disorder' (ADHD) as we know it. (From The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder).

For many years (until the 1990s) ADHD was considered a childhood disorder, but longitudinal studies and public awareness highlighted the presence of ongoing symptoms in adult patients. Adult ADHD is now a recognised condition. It is a costly chronic disorder since many adults who suffer from it also have comorbid medical and psychiatric disorders such as unplanned pregnancies, sexually transmitted diseases, substance abuse disorders, mood disorders, anxiety disorders and behavioural disorders.

Untreated ADHD is a huge problem in that many people end up spiralling out of control because of substance abuse, accidents, and inability to cope with life and work demands, which is caused by lowered self-esteem, and the lack of support friends and family would bring.

Paying for ADHD is costly and probably the largest expense for private patients.

Access to healthcare and treatment is a challenge for those wishing to do so through the public health system due to the 'identification and treatment of common mental disorders at primary healthcare level and limited access to specialist resources with a service delivery and treatment gap of up to 75%. Medication options are also often limited … [and] the majority of South Africans currently utilise the public healthcare sector and may not have access to treatment options referred to in these guidelines' (as set out by Schoeman and Liebenberg).

However, with the launch of the ADHD SIG in 2015 the objective was to make the overall 'basket of care' more readily available to patients with ADHD wishing to access treatment and care via the public sector.

The sex difference when it comes to ADHD

Keath Low, a Therapist and Clinical Scientist at the Carolina Institute for Developmental Disabilities at the University of North Carolina focuses specifically on women at the ADHD interface. She offers a number of insights into what ADHD looks like in women to help them get a proper diagnosis and treatment. She argues that women tend to live with undiagnosed ADHD mainly because this was traditionally thought of as a condition that affects mainly boys/men because women do not necessarily manifest the same way men do.

How Symptoms Differ in Women and Men

​ADHD in Women
ADHD in Men
  • ​Less likely to be diagnosed
  • Low self-esteem and anxiety
  • More symptoms of inattention
  • Verbal aggression

  • ​More likely to be diagnosed
  • Disruptive behaviours and acting out
  • More hyperactivity and impulsiveness
  • Physical aggression


Why ADHD in Women Is Often Misdiagnosed

ADHD symptoms in girls are often viewed as character traits rather than symptoms of a condition. For example, a girl might be described as spacey, forgetful, or chatty. Later in life, a woman might reach out for help for her symptoms, only to be diagnosed with depression or anxiety instead.

According to Low, 'Women with ADHD face the same feelings of being overwhelmed and exhausted as men with ADHD commonly feel … Our culture commonly expects women to fill the caretaker role. When things feel out of control and it's difficult to organize and plan because of ADHD, taking care of others can feel nearly impossible. This societal pressure also may greatly increase a woman's feelings of inadequacy.'

What are Common Signs of ADHD in Women?

Relationships: You may wish you were able to be a better friend, partner, or mom, and that you could do the things that other people do. Because you're not able to do the things that society expects women to do, people may think you don't care.

Social Life: While you may be talkative, you may dislike going to parties and other social gatherings because they make you feel overwhelmed and shy. Your mind drifts during conversations unless you're the one talking or it's a topic you find very interesting.

Work: Being at the office feels difficult. The noise and people make it hard to get work done. Your desk at work is piled high with papers. Even when you make a big effort to tidy it, it only stays clear for a day or two.

Daily Life: With ADHD, it may feel like each day is spent responding to requests and limiting disasters rather than moving forward with your goals. You may feel crushing sadness and frustration that you haven't met your potential.

Relaxing is often difficult for people with ADHD. Little things can push you over the top and you may become emotional.

Where to get help?

You could reach out to ADHASA, a registered non-profit organisation (Section 21) that has been assisting people living with and/or affected by ADHD for over 20 years. They offer information, advice, support and guidance as well as referrals to other professionals to further assist you.

T: +27-11-8887655

Website Address: http://www.adhasa.co.za



Oct 13
Let’s maintain the habit of handwashing and sanitising post-COVID-19

By: Lunga Memela (HST Communications Engagement Lead) and Mandisa Dlamini (HST Communications Intern)

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Most people grow up acquiring good manners. We know how to say "please" and "thank you" and most of us have relatively good hand hygiene; washing hands with soap and water before eating and after using the bathroom. What became very clear during the pandemic regarding good hand hygiene is that some people do not adhere to it, becoming a catalyst in the spread of disease. Having ridden the very rough wave of the COVID-19 pandemic, it is crucial, now more than ever, that we continue to focus on proper hand hygiene as part of our fight against the spread of bacteria and viruses.

Think about how many surfaces you touch daily? Your desk at home or school, your laptop, pen, handbag, shopping bag, a trip into the mall and its many shops, that coffee shop for your regular latte …

Global Handwashing Day on 15 October dovetails with the World Health Organization's (WHO) observance of World Hand Hygiene Day, reminding us of the benefits of handwashing. The U.S Centers for Disease Control and Prevention (CDC) reiterates that: "One of the most effective ways to stop the spread of germs and stay healthy is also one of the simplest – handwashing with soap and water. Keeping hands clean can prevent 1 in 3 diarrheal illnesses and 1 in 5 respiratory infections, such as a cold or the flu." The CDC recommends cleaning hands in a specific way to avoid getting sick and spreading germs to others:

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The CDC is happy to show you the science behind how germs get onto hands and make people sick.

Global Handwashing Partnership

Working actively to save children's lives and improve health by promoting handwashing with soap, the coalition, Global Handwashing Partnership, encourages everyone across the world to unite for universal hand hygiene. They say Global Handwashing Day is an opportunity to design, test, and replicate creative ways to encourage people to wash their hands with soap at critical times. "Leveraging the learnings from recent years, the time to accelerate hand hygiene progress is now – and it requires a collective effort to enact real change. As the world moves beyond COVID-19 to our new normal, we must unite for universal hand hygiene."

The coalition was pleased to announce on 10 October 2022 that their Handwashing Handbook is now available in six languages: (initially) English, (and today) Arabic, Chinese, French, Portuguese, and Spanish – ensuring more people have access to the critical content the handbook provides.

Reiterating the message

"Yes, washing our hands really can help curb the spread of coronavirus," said the South African Medical Research Council during the devastating outbreak of COVID-19. At the moment, October 2022, South Africans are concerned about the increase of COVID-19 cases in the Western Cape. Are we in any position to risk not taking precautionary measures?

In an article published by the open-access medical and life science hub, News-Medical Life Sciences, Dr Priyom Bose, reminds healthcare workers and professions that it is extremely important to prevent the spread of germs, especially, in hospital settings, healthcare-related facilities, such as dialysis centres, nursing homes, and general public places. "According to a recent report, thousands of people across the world die from infections acquired while receiving healthcare. Hygiene is one of the easiest, nonetheless, an important means to reduce the spread of diseases and infection," she says.

The take home message is that hand hygiene is critical for everyone across the globe: children, adults, healthcare professions, the food industry – everyone!

Download WHO Africa Region's brochure: Hand Hygiene: Why, How & When?



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