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Mar 22
HST’s Nurse Clinician, Sr Thandeka Dladla, strives to save the lives of women and young girls through cervical cancer prevention in Zululand

By: Lunga Memela (HST Communications Engagement Lead)

Meet Sr Thandeka Dladla, who joined the Health Systems Trust's Cervical Cancer Prevention and Control (CCPAC) project as a Nurse Clinician in December 2022. She feels privileged to be channelling her knowledge and expertise in cervical cancer prevention to save the lives of local women and girls in Vryheid, Zululand.

Funded by the Bristol Myers Squibb Foundation and 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 CCPAC project is aimed at saving the lives of women and girls from cervical cancer – the only preventable cancer, according to the World Health Organization (WHO), and one which can be easily treated if it is detected early.

The vast majority of cervical cancer cases are linked to infection with the high-risk human papillomavirus (HPV), an extremely common virus transmitted through sexual contact, and associated with HIV infection. "The CCPAC project therefore addresses the alarming rate of sexually transmitted infections (STIs) – HPV and HIV – within the local communities," explains Dr Nompumelelo Ntshangase, HST's CCPAC Project Manager.

In the first quarter of every year (February to March), the South African National Department of Health (NDoH) runs an important nationwide campaign aimed at promoting HPV vaccination, especially among school-going youth for the prevention of cervical cancer. During this period of awareness, it was fitting for the Communications Team to have a chat with Sr Thandeka about her experience within the project.

Sr Thandeka's story

It is her warm personality coupled with being a loving and caring individual that landed Sr Thandeka in the nursing profession. "I always do justice when providing nursing care to my patients. I try my best to give each and every patient my all," she says. Sr Thandeka holds a Diploma in Nursing from the Kwazulu-Natal College of Nursing's Benedictine Campus in Nongoma Town, where she graduated in 2013.

She notes that, historically, cervical cancer screening has not been as highly prioritised as other health programmes. Because this needs careful monitoring and evaluation, Sr Thandeka feels that more nurses should be involved in screening a high number of women for cervical cancer, because its early detection always yields better patient outcomes.

Sr Thandeka finds it encouraging to see cervical cancer screening being increasingly integrated into Primary Health Care services, not only in facilities but also in communities during outreach interventions, offered in HST mobile vehicles.

"The involvement of nurses and other health professionals assists in process mapping of women in facilities," she explains, "by disseminating information through health education, screening of all eligible women for cervical cancer, and ensuring that all the women screened receive their results timeously and that their treatment is managed accordingly." Sr Thandeka believes in active referral systems, and also in all health professionals playing an active role in promoting prevention.

Addressing local misconceptions about cervical cancer

Sr Thandeka highlights that there is a prevalent misconception which must be dispelled immediately. "Cervical cancer has long been perceived, especially in rural communities, as a disease that occurs among elderly people, and so we must raise awareness that the condition affects all women of child-bearing age," she says. "Increased health education about the causes of cervical cancer and the factors contributing to its incidence are bound to raise critical awareness. It is also important to make the public aware that the choices they make now, particularly risky sexual behaviour, may expose them to cervical cancer in the future."

Bring women, young girls, men and young boys collectively into the picture

Sr Thandeka feels that men and young boys should also be educated about cervical cancer. "These are their partners, mothers, sisters and grannies who are infected. As men, they too are affected, and often continue to perpetuate the disease progression of HPV and HIV."

She says that unfortunately, local communities do not yet fully understand the association between HIV and HPV. "If they did, there would be as many individuals volunteering for cervical cancer screening as there is for HIV… but we're working on it! It will take added commitment from health professionals and more and more outreach initiatives that prioritise health education."

Sr Thandeka has set herself the ultimate goal of ensuring that all women of child-bearing age are screened for cervical cancer, that they receive their results, and that those whose results cause concern are managed accordingly. "My aspiration is to ensure that all the Pap smears I take align with best practices for endocervical smear evaluation."

When not focusing on CCPAC project work, she enjoys cooking, watching reality shows, and reading, but "doing Pap smears has also become my hobby," she chuckles.

Health Systems Strengthening Programme Manager, Joslyn Walker, observes that having people like Sr Thandeka on our project team is the 'X factor' at the root of HST's success. "Our people are passionate about their roles, and take project success personally," she says. "They are not just the face of our work, but at our heart."


Mar 15
Meet HST’s Psychosocial Advisor, Ntokozo Gumede, who champions holistic care for patients at their doorstep

By: Lunga Memela (HST Communications Engagement Lead)

Health Systems Trust's warm-hearted Psychosocial Advisor, Ntokozo Gumede, is a custodian of holistic care for all who need support through physical illness and social challenges.

In her work for HST's Delivery Optimisation for Antiretroviral Therapy (DO ART) Demonstration Project, Ntokozo exemplifies everything a compassionate social worker should be, especially for people living with HIV (PLHIV). She spared a moment with the Communications Unit to describe her commitment to improving the lives of people in eThekwini's Umlazi Township.   

Through a grant from the Bill & Melinda Gates Foundation, HST has built on the findings of a research study conducted by the Human Sciences Research Council (HSRC) and partners that provided community-based ART (CBA) initiation, monitoring and resupply to HIV-positive people in South Africa and Uganda to optimise delivery of HIV treatment through community-based services.

The goal of HST's DO ART Demonstration Project is to determine, within a real-world setting, the potential of CBA services for improving the numbers of ART-eligible clients being initiated on treatment, and their continuity of care towards viral suppression within six months.

The DO ART team has provided comprehensive screening services, ART initiation, and ongoing community-based management of patients on ART in eThekwini South and Nongoma Sub-districts in KwaZulu-Natal (KZN). 

Working in the DO ART project

"What I love the most about the DO ART project," says Ntokozo, "is that I get to bring about change in people's lives at their doorstep. Walking into someone's home to bring hope and giving them a better chance of overcoming their deep-rooted struggles brings me so much joy. Helping people to find themselves, heal, and realise that they are capable of developing themselves despite their challenges makes me love my job."

Ntokozo grew up exposed to social ills that burdened her community in Umzinto, on the South Coast of KwaZulu-Natal. She knew then that it was her calling to help other people, and she studied Social Work at the University of KwaZulu-Natal (UKZN), where she is currently pursuing her PhD. She has been a community worker since, and has never looked back.

Speaking about her typical work day, Ntokozo says: "As soon as I get to work, I call our patients to check their availability for scheduled appointments for the day. Then I head into the field to each and every one of them to deliver my services in the comfort of their homes."

During some of the home visits, she is accompanied by another healthcare worker and/or a Nurse Clinician, as well as a Driver Mobiliser. With the patient's consent, these team members are able to observe the intervention strategies, different counselling methods, and treatment adherence plans that Ntokozo develops with patients. "Having Nurse Clinicians present is helpful," she explains, "as we can consult each other on our respective specialist areas, allowing for continuous learning and merging of the clinical and psychosocial elements of our work. We prioritise confidentiality, and will share the patient's personal information with other healthcare workers only with the patient's consent."

This provides practical training for the project's healthcare workers. "It is also significantly beneficial for patients," adds Ntokozo, "because they can share their challenges in one sitting, as opposed to doing so with different healthcare workers. This reduces their risk of being re-victimised by having to repeat their stories of abuse and emotional trauma. Most of our patients are pleased with this approach, as it shows the care that the team has for them and their health."

"Throughout my career, I've worked in community-based projects," recalls Ntokozo, "and HST is one of the prestigious organisations within the province that provides different intervention models for health care. Having learnt about the DO ART project, I was attracted to the implementation of this outreach model, which prioritised bringing services to people instead of waiting for them to come to facilities ‒ this maximises their access to health care at a limited cost to them."

"The social issues faced by our patients are varied and very complex," she says. "Many of them are unemployed and rely on the social grant system, which results in a huge demand for nutritional support as they often run out of food before their next pay-date. We also come across people who do not have ID documents, which makes it difficult for them to secure employment or social grants," Ntokozo says. "Other issues they face are drug and alcohol abuse, homelessness, and domestic issues, such as non-disclosure of their HIV status and cases of gender-based violence. These are some of the social factors that directly and indirectly affect these patients' HIV treatment journeys and contribute to their viral load suppression challenges."

The importance of psychosocial advice for patients

"I believe that a holistic intervention strategy is beneficial for patients," notes Ntokozo. "South Africa's health system has done exceptionally well for HIV-infected patients, but in order to meet the 95-95-95 targets, a lot more than the clinical element of managing patients' health has to be considered. Advising and assisting patients to cope with their social needs is crucial for ensuring that they adhere to their medication and achieve viral load suppression. Interventions such as cognitive behavioural therapy, person-centred approaches, counselling and psychotherapy sessions are essential to support patients who are struggling with daily challenges."

"Some patients need to be linked with facilities, community-based organisations and government departments that have the specialised capacity to help solve some of their problems," she explains. "That is where I come in: linking patients to all the services they need outside of our health institutions. Intervention outcomes depend on the initial assessment of the patient. Some simply lack an appropriate support system, so sometimes just talking with them and building rapport, providing constant reassurance and affirmation, makes a huge difference to their emotional and psychological wellbeing."

Among the examples that Ntokozo shares is one of a patient whose family was selling and consuming alcohol in the same household. "He was virally suppressed at the time of his assessment," she says, "but he was concerned about not being able to maintain his treatment adherence in this home environment. With no alternative options for housing being available, we developed a plan to assist the whole family, and linked all of the household members with SANCA for ongoing specialist support; they have since embarked on their own interventions, and follow-ups are being made with the patient and family."

Another patient was addicted to substances and needed an ID because he had lost his when living on the streets. "The patient's family was traced in order to recover the details of the person who had applied for his ID," says Ntokozo. "We proceeded to Home Affairs to apply for a duplicate of his birth certificate, which would enable him to acquire his ID number and subsequently apply for a replacement ID. In turn, this made him eligible for registration on the Dablapmeds programme for easy collection of medication."

Ntokozo helped another patient with the same issue, who was able to start her ID application process and is waiting for an interview at Home Affairs. "When I first assessed her," she recalls, "her viral load was over 1 million copies, and she initially indicated that she saw no need to take treatment because she did not have an ID to secure employment – but the prospects of receiving assistance encouraged her to take her treatment, and she is currently virally suppressed."

The team followed the required processes for a patient who needed admission to a rehabilitation centre for help with overcoming his substance addiction, and he is currently on the waiting list of a free facility in Durban.

Towards a better future

Ntokozo did her Master of Social Science (Public Policy) degree at UKZN, scoring a Golden Key International Honour award. Her research focused on the analysis of laws and policies guiding the legal determents and businesses of funeral parlours in Durban. She is currently doing a PhD in Human Science: Public Policy, focusing on the bottlenecks of law and policy implementation in the South African justice system when handling crimes of gender-based violence.

In her spare time, Ntokozo enjoys travelling and exploring new places. "My bags are always packed and ready for an adventure," she says.

Mar 13
Collaborative effort by HST’s Unfinished Business outreach team, cervical cancer screening outreach team and the DoH to improve HIV case-finding in children and adolescents 0-19 years through school campaigns

By: Zandile Ngobese (Abaqulusi Sub-District UB Clinical Advisor), Philani Bhengu (UB Quality Improvement Manager) and Dr Nompumelelo Ntshangase (CCPAC Project Manager)

Members of the Abaqulusi UB Outreach Team together with local Community Caregivers and members of the Ntababomvu Clinic Team.

Two outreach teams from the Health Systems Trust (HST) collaborated to support an important Zululand Department of Health (ZDoH) school outreach initiative in February. The event was aimed at HIV case-finding in children and adolescents aged 0–19 years, all in an effort to fast-track ending AIDS by 2023 in line with the UNAIDS 95-95-95 targets.

The outreach teams were from HST's Unfinished Business for Adolescent and Paediatric HIV programme in KwaZulu-Natal (UB project), funded by the ELMA Philanthropies in a multi-year programme that is implemented in collaboration with the KwaZulu-Natal Department of Health (KZN DoH) and is part of a UB Consortium comprising CHAI (National Co-ordination), the ANOVA Health Institute and WITS RHI. Also from HST was an outreach team from the Cervical Cancer Prevention and Control Project (CCPAC) that 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 teams conducted school HIV Testing Services (HTS) at Gudu Primary which is situated in Zululand's AbaQulusi district. The campaign supported the local Ntababomvu Clinic, where the facility is struggling with HIV case-finding in children under 15.

Custodians of Adolescent and Youth Friendly Health Services (AYFS), HST's Abaqulusi Sub-District Clinical Advisor, Zandile Ngobese and UB Quality Improvement Manager, Philani Bhengu said that such school outreach initiatives are an effective way of reaching this key population. The in-school services provided are:

  • Health talks on sexually transmitted infections, pap smears, HTS, contraceptives and teenage pregnancy;
  • free HIV and TB screening services;
  • HTS specifically for under the age of 15, adolescents, and adults above the 19 years of age;
  • condom distribution; and
  • pregnancy testing.

On the day of the event, after the initial campaign, the team embarked on a further door-to-door campaign, offering free health services to eight families residing in the local Gudu community. None of the six children aged 15 and below tested HIV-positive. Four out of five children above the age of 15 had been lost to care and were linked back to care through contact tracing. The outreach teams also did nutritional screening, following up on health essentials such as clinic attendance, adherence to deworming and vitamin deficiency. For more information on these services, please contact UB's Clinical Advisor, Zandile Ngobese, via / 073 345 5167.

Mar 01
Funder, USAID impressed with ongoing ADAPT GlobalVax project in KZN

By: Lunga Memela (HST Communications Engagement Lead)

Happy smiles from USAID, HST and DramAidE partners during a Global VAX campaign site visit at Menzi High School in uMlazi Township's N Section.

The Health Systems Trust's (HST) project team that is subcontracted by Right to Care (RTC) for Accelerating Development Against Pandemic Threats (ADAPT) is proud to have participated in RTC's hosting of the U.S. Agency for International Development's (USAID) Global Health Security Officer, Karen Coldwell, joined by Alexis Olson, a Consultant at Panagora. They did a site visit at the end of February 2023 to uMlazi Township's N Section, where USAID's Global VAX campaign is being successfully rolled out.

In 2022, following the devastating impact of the COVID-19 pandemic, the United States committed to defeating the COVID-19 pandemic across the globe, introducing the Global VAX campaign: A new initiative for global vaccine access to accelerate U.S. vaccine delivery assistance around the world.

HST's ADAPT Acting Project Manager, Udaya Veeramachaneni (on the left next to the visitors, Karen Coldwell and Alexis Olson) said: "The aim of the project is to vaccinate 70% of the eligible population in identified provinces and districts. The program is multi-faceted and focuses on improving vaccine uptake through community mobilisation done in partnership with the University of KwaZulu-Natal's DramAidE. HST was subcontracted by Right to Care in October 2022 to provide direct service delivery (DsD) and technical assistance (TA) to the KwaZulu-Natal Department of Health (KZN DoH), particularly in the eThekwini South sub-district as well as in Zululand's Ulundi, Nongoma, Pongola and Abaqulusi sub-districts." 

The Global VAX campaign is significant in the local context as it aims to:

  • improve awareness and demand creation for vaccine services in the supported districts and sub-districts;
  • strengthen integration of vaccination services into DoH and Implementing Partners' mobile service delivery through direct service delivery (DsD);
  • strengthen vaccine supply chain management, management of adverse events, and pharmacovigilance; and
  • improve vaccination uptake through provision of technical assistance to high-volume Primary Health Care facilities in identified sub-districts.

The site visit kicked off at Menzi High School in uMlazi N section, which is situated next to Phila Ndwandwe N Clinic – a perfect vaccination site for vaccinating young people aged 12 to 17, and again, at the neighbouring sports ground, reaching out to community members aged 18-14, 35-49 and 50-59 through the mobilisation strategy. HST's ADAPT project team has also engaged several other schools such as Zwelihle Senior Secondary, where school-going youth can be vaccinated with consent from their parents.

HST's DO ART Community Co-ordinator, Dr Douglas Ngcobo (left) and HST's ADAPT Monitoring and Evaluation Officer, Siyabonga Pupuma (right) said there is a serious need to debunk myths and misconceptions associated with COVID-19 vaccines. The project team works in good synergy with partners and community leaders to ensure vaccine uptake. Ngcobo and Pupuma agreed that such outreach initiatives play a massive role in raising health awareness and promoting overall wellness for community members, young and old.

"Our teams are trained in social marketing, health promotion and facilitation skills," said Xoliswa Ngema and Nqobile Mthiyane (pictured above). "We love what we do. We mobilise the communities to come get vaccinated through loud-hailing, door-to-door activations, clinic talk, we do one-on-one motivations, school visits and promote the availability and access to integrated services, especially amongst the youth and the elderly. We do this at facility level, selected sites and via HST's mobile units. What is also important is to convince the youth that they should not think their immune system is strong enough to not get infected with COVID-19. The notion that they must receive incentives to get vaccinated is dangerous!"

HST Nurse-clinician, Sister Penelope Ngidi, talks the visiting delegation through the vaccination process at Menzi High School.

Coldwell said that it is impressive to see the innovative partnership that has emanated between Right to Care, DoH, HST and DramAidE. "Another highlight was seeing the synergy between schools, community leaders, and facilities in integrating immunisation with primary health care services. We come down to learn about any challenges faced by the teams, to adopt best practices, find ways of globalising support, and to brainstorm ways to strengthen the project. So far, so good!"

Feb 22
Meet Eddy Moyambo, the man overseeing HST’s clinic–laboratory interface in support of KZN communities testing for HIV

By: Lunga Memela (HST Communications Engagement Lead)

Consider the fact that, according to the Joint United Nations Programme on HIV/AIDS  (UNAIDS), South Africa's KwaZulu-Natal (KZN) Province has the highest prevalence of HIV infections globally.

The UNAIDS 95-95-95 mandate to accelerate action to end the AIDS epidemic by 2030 requires that people know their HIV status, start antiretroviral therapy (ART) if they test HIV-positive, and stay on treatment to achieve and maintain viral suppression.

Now consider how much co-ordination, meticulous attention to detail, and quality assurance is required to ensure that the province's HIV Testing Services (HTS) work seamlessly with laboratory services. This entails verifying the number of blood samples collected at local clinics and in community-based settings and test results, so that those found to be HIV-positive can be initiated on the ART regimen best suited for their viral load.

Humble and warm-hearted Eddy Moyambo (pictured above) is Health Systems Trust's (HST's) Co-ordinator responsible for optimising the clinic–laboratory interface (CLI) and ensuring that quality assurance support for HTS is provided to the KZN Provincial Department of Health at facility and community level.

Supporting four PEPFAR districts in KZN

Eddy's role is a vital one in HST's SA SURE PRO project, which is funded by the U.S. President's Emergency Fund for AIDS Relief (PEPFAR) programme through the Centers for Disease Control and Prevention (CDC). The project aims to strengthen and support local capacity to provide sustainable HIV and TB-related care and treatment service delivery in South Africa through technical assistance (training, mentoring, coaching) and supplemental support, including direct service delivery at four PEPFAR districts, namely eThekwini, uMgungundlovu, uThukela and Zululand.

He works collaboratively with the National Health Laboratory Service (NHLS) and the Department of Health to strengthen CLI in the supported districts, providing technical assistance to develop and implement quality improvement (QI) standards, systems and plans for HIV and TB programmes.

Working on the ground with Eddy

"Over time, the strategies for our HIV testing drive have evolved," explains Eddy. "To ensure that we test people as widely as possible, and to secure the necessary yield of results, we place special focus on hard-to-reach key populations such as children, adolescents, young women, and men, making sure that our approach is client-centred and brings the services to where they are."

The team of Clinical Laboratory Advisors (CLAs) ensures that key interventions to address programmatic gaps and data-related issues are implemented; for example: clearing bottlenecks in analysis of blood samples, fast-tracking of result reports, and improved capturing of test results at clinic level.

"With viral load (VL) suppression being the third and final key to epidemic control," says Eddy, "we must close gaps in VL programme performance at district and provincial level, and improve VL monitoring. So the CLA role involves supporting demand-creation activities for VL monitoring, and providing CLI training and capacity-development for staff in the four districts and for the Provincial DoH structures.

Eddy has been at HST for a full decade. He started as a Facility Mentor in 2013 and climbed the ladder in various roles, ending up in his current designation. He considers himself a humanitarian: "Working to improve the lives of ordinary citizens has a feel-good effect on me," he says.

Eddy's typical work-day demands high levels of co-ordination, liaising via phone and e-mail with the CLAs and Special Projects Co-ordinators in each of our supported districts, the National Institute for Communicable Diseases (NICD), the NHLS and HST Administrators. "I report to the SA SURE [PRO] Operations Manager and CDC Points of Contact, and participate in virtual and physical meetings to provide and discuss district and facility support."


Born and raised in the rural village of Muninginisi in Giyani, Limpopo Province, Eddy had wanted to become a professional football player. When he was working as a clinician within the mining industry, he realised the impending and ever-important need for private‒public partnerships to realise the aims of South Africa's National Health Insurance (NHI).

"I look forward to the day when the country and global community reaches the UNAIDS 95-95-95 targets, and more importantly, the sustainability of the gains," he says. "I long for a South African legacy where one day everyone can access quality health services, regardless of their social status."

During his spare time, Eddie enjoys historical literature, sports and music.

Feb 15
A day in the life of a Health Systems Trust Data Management Officer

By: Lunga Memela (HST Communications Engagement Lead)

Meet Rhulane Madale, the dedicated Health Systems Trust (HST) Data Management Officer  who has been serving the SA SURE PRO project in KwaZulu-Natal's uMgungundlovu District since October 2018. Her accurate and timeous reporting supports HST's Monitoring and Evaluation teams as well as district and sub-district levels of the Kwa-Zulu Natal Department of Health (KZN DoH) in strengthening local capacity for providing sustainable HIV and TB care and treatment in line with the UNAIDS 95-95-95 targets to end AIDS by 2030.

The need to report accurate data

Recording and reporting accurate data is critical for health systems strengthening, and that is why Madale views herself as being a watchman through the lens of data. Her performance agreement has a 'zero error' indicator. "Why? Because the data we collect on routine basis are about human beings, not just numbers," she said.

Madale's data analysis enables her to advise on campaign efforts, and to alert teams entering a red zone in terms of performance against targets. She explains that accurate reporting is the key to planning targeted interventions that respond correctly to the needs of the people residing in the communities served by HST. "This means that I need to be vigilant when I consolidate reports. If there is something wrong with my data reports, decisions are based on wrong information… I love this job, because it keeps my analytical skills and attention to detail intact."

Madale joined HST as a Researcher in 2009 and was appointed as a Senior Researcher in 2013.  She enjoyed developing training programmes that built capacity in HST-supported districts for the benefit of Primary Health Care Facility Managers and District Health Management Teams across provinces. She applied the skills that she acquired within HST's Health Systems Research Unit when she assumed the data management position. "I am able to scrutinise data and ask the right questions because of that scientific research background," she said.

Madale says that it has been rewarding to see increased uptake of HIV testing in uMgungundlovu over the years. This means that, in partnership with the DoH, the team can link more HIV-positive individuals to treatment and also work on improving viral load testing coverage. She stresses the importance of people being tested for TB and HIV regularly. "Our programme centres on the UNAIDS 95-95-95 strategy, so the data that we collect, consolidate and analyse on a routine basis address the HIV and TB care and treatment cascades."

The journey continues

Growing up, Madale wanted to become a psychologist. After her parents supported her Bachelor of Arts Degree, she pursed a Higher Education Diploma so that she could teach and do counselling at schools, while continuing to advance her career in Psychology. Ironically, five years after her graduation, she was appointed by the Department of Community Health at Mangkweng Hospital Complex in Polokwane to collect health data from local clinics for a Health Information Systems project.

Madale was fortunate to secure an internship, and later formal employment, at HST, where she believes she can make a meaningful contribution to people's lives. Today, she holds a Master's degree in Public Health, and uses her expertise to uplift others.

Madale is both analytical and creative: she loves singing and expressing her emotions through song, and when her head is not spinning with numbers and statistics, she spends her spare time dabbling in interior design.


Feb 10
Supporting the Department of Health’s outreach to former mineworkers eligible for occupational health injury compensation

By: Lunga Memela (HST Communications Engagement Lead)

Many South African households rely heavily on wages earned by hard-working employees in the country's mining industry. Reliance on such income is gravely compromised when the breadwinners are no longer able to put food on the table due to unforeseen circumstances such as closure of mines or injury at work.

The Health Systems Trust (HST) again joined forces with fellow District Support Partners (DSPs) to the Department of Health in KwaZulu-Natal (KZN DoH), this time in support of  a collaborative initiative by the DoH, Department of Employment and Labour and Department of Mineral Resources and Energy to track, trace and pay the former mine workers or their dependants who qualify for unclaimed social protection benefits from 1965 to 2019 in the form of compensation for illnesses, class action settlement funds and pension or provident funds. Many former mineworkers contracted tuberculosis (TB) or silicosis – an incurable lung disease caused by inhalation of dust that contains free crystalline silica.

Understanding the airborne nature of TB and silicosis in the global mining industry

It is common knowledge that TB is an airborne disease, meaning that it is spread through the air when people with lung TB cough, sneeze or spit. A person needs to inhale only a few germs to become infected. Also airborne, "Silica dust is made up of small particles that become airborne during work activities with materials that contain crystalline silica," explains the Centers for Disease Control and Prevention (CDC). The CDC warns that the respiratory systems of employees in a variety of industries including construction, mining, oil and gas extraction, stone countertop fabrication, foundries and other manufacturing settings, are exposed to crystalline silica.

The International Labour Organization says that: "Despite all efforts to prevent it, silicosis still afflicts tens of millions of workers in hazardous occupations and kills thousands of people every year, everywhere in the world. With its potential to cause progressive and permanent physical disability, silicosis continues to be one of the most important occupational health illnesses in the world."

KZN's compensation to former mineworkers

Towards the end of January 2023, the DoH announced that it would be embarking on a journey to compensate ex-mineworkers suffering from lung disease, starting in the deep rural northern parts of KZN, covering Vryheid, Ulundi, Nongoma and Pongola, where HST teams were stationed in the organisation's mobile units to support the initiative.

From 23 January to the first week of February, KZN claimants flocked to these sites, where they were offered free health screening, verified for their mining employment history, had medical examinations, and learnt about the payment of benefits to eligible members.

"We were proud to also play our part in offering critical health services," said HST's Area Co-ordinator for Pongola, Phindile Sangweni (pictured above). "Screening for as many ailments as possible is essential. Sometimes one comes across a patient who says their TB medication is not working, only to find that they have other co-infections, especially HIV," she said.

"We face a number of challenges in Pongola," Sangweni explained. "The sub-district is situated only 10 kilometres from the Eswatini border, so the local clinics and Outreach Teams see a lot of truck-drivers and migrant labourers, who are among hard-to-reach key populations. We try our best to link patients to care and to keep them in care, but they are always on the move because of work and other factors. The HST teams implement outreach sessions, delivering health services to the neighbouring farms so that we keep to our mandate for continuity of care. The local Gateway, Belgrade, Mkhwakhweni, Pongola and Ncotshane Clinics also service cross-border patients from Eswatini. It is a lot of work."

Also proud to be part of HST's Outreach Team during the initiative were Driver Mobiliser Siyanda Kunene and Nurse Clinician Slindile Khathi. They enjoyed interacting with more senior citizens in Pongola, a notable age difference from what Kunene is used to when servicing the KwaNongoma area.

"Our relationship with HST remains right on track," said iTshelejuba Hospital Chief Executive Officer, Mrs Thembisile Vilakazi (pictured above). She said that it had been a busy week for Pongola, with an impressive turnout of local citizens in response to the mobilisation that took place on radio and various other channels. "In addition to the purpose of the day, it was also good to see so many men attending, so that we could promote cancer screening for them," said Vilakazi. In an article posted by KZN DoH on 31 January 2023, KZN Health MEC Ms Nomagugu Simelane noted that the beginning of the year is a good time for men who are older than 50 to receive prostate cancer screening and testing.

The HST teams participating in the former mineworker initiative are employed under the organisation's SA SURE PRO project that strengthens local capacity to provide sustainable HIV and TB care and treatment services in South Africa's public health system. Funded by the CDC through the U.S President's Emergency Plan for AIDS Relief (PEPFAR), the project supports the provincial, district and health facility DoH staff and communities in four PEPFAR focus districts in KZN, namely eThekwini, uMgungundlovu, uThukela and Zululand. 


Feb 08
Inspiring chat with Dr Pam Ntshangase-Mpanza who speaks cervical cancer prevention on International Day of Women and Girls in Science and beyond

By: Lunga Memela (Communications Engagement Lead)

Every year, on 11 February, the United Nations (UN) celebrates the International Day of Women and Girls in Science. This is a significant commemoration as, according to the UN, even though women have made tremendous progress towards increasing their participation in higher education, they are still under-represented in the fields of science, technology, engineering and mathematics. The UN believes that gender equality and the empowerment of this key population will make a crucial contribution not only to global economic development, but to progress across all the goals and targets of the 2030 Agenda for Sustainable Development.

Similarly, when it comes to health promotion, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has long advocated that keeping girls in school reduces new HIV infections. UNAIDS confirms that, globally, HIV is still most prevalent in South Africa, and that the KwaZulu-Natal (KZN) Province records the highest number of HIV infections, with the majority being adolescent girls and young women. 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.

This year, in the spirit of promoting health, education and applauding the remarkable strides made by women and girls in science, the Health Systems Trust's Communications Unit interviewed Dr Nompumelelo Pamela Ntshangase-Mpanza – a gynaecologist by profession who was born in Durban's Inanda township, and who now serves as the Project Manager for HST's Cervical Cancer Prevention, Access and Control (CCPAC) programme in KZN's Zululand District in support of the Department of Health (KZN DoH).

Funded by the Bristol Myers Squibb Foundation and implemented under the auspices of a consortium comprising HST, the Zululand DoH, the Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU) of the University of KwaZulu-Natal (UKZN), and Genius Quality (GQ), the CCPAC 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. Dr Ntshangase-Mpanza joined the project in October 2022.

Q: So Doc, what makes you passionate about the work you do?

I love my work because it coincides with my passion for saving women and for cervical cancer prevention programmes. Previously, I worked in one of the biggest oncology units in eThekwini, as well as at Queen Nandi Regional Hospital in Empangeni. I saw the suffering of young females from disadvantaged backgrounds dying from cervical cancer and realised there is something I can do about it. It gave me great pleasure to join the CCPAC project.

Q: What did you want to be when you were young, and did you ever think that you would end up as a woman in the health space?

Yes! (chuckles) Although, I also wanted to be a pilot but my mother discouraged me due to fear of the plane crashing whilst training.

I developed the interest of becoming a doctor when I was in high school. I had malaria, and the nurse who was treating me gave me such bad service, shouting at me for no reason. As young as I was, I knew that it was not the way to be treating patients. I decided then that I was going to be a doctor when I grew up and do better. Fortunately, I was one of the top-performing students in my school, so my marks allowed the dream and the entry to medical school.

I also knew early that I wanted to work with women, even though at the time I didn't know in what way. It was when I did my gynaecological rotation at Baragwanath Hospital in my undergraduate training that I discovered that I enjoyed the subject. It also happened that one of my late distant uncles was also a gynaecologist, so that strengthened my love for the profession.

Q: Why is it important to attract more and more women into science, especially the health sciences?

Without sounding feminist, women suffer from a lot more health issues than men, and oftentimes it is easy to deal with someone relatable from the same sex. Patients are more comfortable to be treated by other women in the field of gynaecology because it is such a private and a very intimate exam.

We need more young women joining the industry, and also to do away with the mentality that women are only good to bear children and stay at home cooking and cleaning. This results in [a] lot of women being abused because they are completely dependent on their partners financially. Women need to know that they are capable and need to take up space in this previously male-dominated industry. Women did not always have these opportunities in the past and as the world is transforming, so we need to encourage this and also mentor the young ladies who aspire to be in the field.

Q: What was your motivation to end up becoming a woman in science?

I was born in Inanda Township, Durban. I moved to Manguzi just before high school, where my parents were teaching. Honestly, I think my greatest motivation was wanting to move away from poverty and I always knew that I was destined for greater things. I wanted to change the economic disposition of my family. I loved physical science in high school and did very well in the subject. My physics teacher, Miss Mavundla, also played an important role in motivating and encouraging me to do well. It was without a doubt that I would end up doing something in science.

Q: Why is science important in addressing today's problems, especially in the health sector?

If we are to address the problems the world is facing now (e.g. climate changes, food security), science is the only proven solution without which, there is no productivity. Look at COVID-19 for example; it put the whole world into a standstill and the solutions came from lessons learnt in science. Health is the one commodity we can't afford to not have; it drives the world's economy.

Q: Where would you like to see science go in terms of health systems research and health systems strengthening?

I think there is a great need for health systems strengthening, especially in Africa. Most solutions have come from other continents and sometimes are not always applicable to our context. We need to strengthen research of our own environment and people. There are medicines that have long been in use in Africa that can help to eradicate diseases that have devastated our people.

Most facilities or programmes also fail because of lack of mentorship and strengthening of systems. This would help bridge the gaps within the health systems, especially from guideline to implementation. If we focus on health systems strengthening and find sustainable evidence-based solutions, then the world would be a much better place for all.

Q: What are your goals and aspirations?

I'd say: To live my life to the fullest, travel the world, and conquer new territories. The next decade of my life focuses on discovering my true potential and making my mark in the women's space, especially in cervical cancer prevention. I am hoping to do my PhD soon and find solutions that will bring about change to our continent. I hope to inspire and mentor the youth, and young doctors who may be lost and discouraged out there.


Dr Ntshangase-Mpanza is a married mother of three children. She continues to thrive because of her good support system and faith in God. She loves going to church! When not out and about being a woman in science, she enjoys taking relaxing beach walks, watching movies, and going out with friends. 

Feb 01
Health Systems Trust promotes the uptake of men’s health services in uMgungundlovu

By: Lunga Memela (HST Communications Engagement Lead)

An HST mobile unit is seen stationed at the popular West Street taxi-rank in Pietermaritzburg where men's health services are made available, come rain or sunshine.

Local hostels, taxi ranks, taverns and sports fields are the hotspots being targeted by a dedicated team of Health Systems Trust (HST) MINA Men's Health Campaign champions who are set in their tracks to effectively support the KwaZulu-Natal Department of Health (KZN DoH) in accelerating the uptake of healthcare services among men in uMgungundlovu District and the greater province.

The Driver Mobilisers are employed by HST's flagship South Africa Sustainable Response to HIV/AIDS and TB (SA SURE PRO) project which is funded by the U.S. President's Emergency Fund for AIDS Relief (PEPFAR) programme through the Centers for Disease Control and Prevention (CDC) for sustaining HIV/TB epidemic control. On 25 January 2023, HST's Communications Unit paid a special site visit to uMgungundlovu to get a feel for how men as the key population are responding to the district's ongoing mobile men's health clinic being offered by the MINA Campaign team. 

Mobilising men to access health care

HST's uMgungundlovu District Men's Co-ordinator, Nhlanhla Zuma (pictured above), said that they are continuously working closely in collaboration with local Ward Councillors, chiefs, iziNduna, Community Policing Forum members, and non-profit organisations such as Inkunzi Isematholeni towards eradicating social ills, especially those affecting or perpetuated by males.

Zuma is 49 years old and while he considers himself a grown man, he says that he is equally relatable to boys, adolescents, young men and senior citizens who are much older than him when they meet in the men's health fora convened through the province's ongoing MINA Campaign, the Isibaya Samadoda movement, and the Amajita programme. 

Zuma explained that HST is dedicated to supporting such KZN DoH health initiatives because the team believes that addressing men's physical, mental, emotional and sexual health issues are important for addressing a plethora of biomedical and psychosocial challenges that are prevalent in uMgungundlovu and the province.

Zuma used the example of a patient being treated and healed from a sexually transmitted infection (STI) and then returning to the health facility/HST mobile unit a month or two down the line presenting with the same STI. "No!  That means we have failed to attend to the patient holistically," he said. Zuma emphasised that health education and health promotion are the best ways to encourage behaviour change, not only among men, but throughout society as a whole.

"There are only two mobile units dedicated to men's services in uMgungundlovu; however, there are seven sub-districts in total. Because men are warm and receptive to the services that we offer, the ideal situation would be to have one mobile unit supporting each sub-district," Zuma said.

The notion that men don't like going to the clinic is a misnomer

"Life is precious. There is a generational misconception that, no matter how ill, men despise going the clinic to access health services. That is incorrect," say members of HST's MINA campaign team, Sanele Hlongwane (Driver Mobiliser and Lay Counsellor), Nqobisizwe Ngubane (Lay Counsellor), Nhlakanipho Kunene (Lay Counsellor), Nqobani Zikhali (Nurse Clinician) and Mxolisi Nene (Nurse Clinician) – pictured above. 

The team said: "We view it in good light that HST mobile units have become synonymous with HIV testing. In this way, there is less stigma associated with people (men and women) approaching a mobile unit to be tested. All men, young and old, are welcome. It's completely free-of-charge, and we also offer an array of other services including TB screening and treatment for acute conditions and STIs. We offer pre- and post-exposure prophylaxis (PEP and PrEP), we advise on voluntary medical male circumcision (VMMC), male sexual and reproductive health problems, and mental health, and where necessary, we provide referral services for psychosocial, neurological and prostate cancer tests."

The team said that they are concerned about prevalent social ills including gender-based violence. They then strategise on outreach activities to mobilise men in the community to attend the mobile clinic where all societal health and wellness topics are addressed.

MINA Campaign champions Nqobani Zikhali (left) and Nhlakanipho Kunene (right) hold thumbs up with local community member, Sbusiso Mthembu (centre) after completing his health screening at an HST mobile unit.

"Testing should be a lifestyle," said Sbusiso Mthembu (36) from the Caluza suburb of Edendale, who was tested at a mobile clinic stationed at the busy West Street taxi-rank, where commuters travel from and to various parts of the province.

Mthembu encourages men to be tested whenever they come across an HST mobile clinic. He said he strongly believes in condom use. He and his partner were happy to have tested HIV-negative before they conceived their daughter. "Majita (a colloquial term for the word 'gents')! It is important to know your HIV status in order to lead a long and healthy life … Think about your kids. Think about your loved ones. We don't want to leave orphans behind."

HST Nurse Clinician, Sir Mxolisi Nene (pictured above), is a custodian for men's health services at uMgungundlovu's East Street Men's Hostel. His team renders health services targeting members of the public at a taxi-rank that is adjacent to the hostel from 14h00 to 17h00. They then move to a designated area inside the hostel to deliver services directly to hostel-dwellers from 18h00 to 20h00.

Nene said: "The hostel-dwellers find our services particularly beneficial as they no longer have to miss clinic visits and appointments because of the demands they face at work. Instead, now they return home from work to the hostel at their leisure, get a chance to freshen up, and then come down to access health services where we are good and ready to give them a listening ear."

"We, as health professionals, also get to learn from the men who attend the mobile clinic," said Nene. He said that working in the MINA Campaign has, for example, taught him not to think stereotypically about sex and sexuality. "Men do sleep with other men, and not all men who sleep with men present with feminine characteristics. What is important is for our team to educate all men about the dangers of risky sexual behaviour and to promote health holistically," he said.

Nene said that what society must understand is that men continue to bottle things up, and so the correct platforms must be created for men to speak openly about the health, emotional and mental issues they face. "Sometimes a man will approach you seemingly wanting to be screened for a minor ailment, only to find that they have been wanting so badly to talk about an STI that they have had for months, not knowing who to consult about it. The time has come for men to speak up, and to seek help without any associated stigma," Nene advised.

Jan 25
Protect yourself and your loved ones from UV rays even after the holiday season

By: Lunga Memela (HST Communications Engagement Lead)

Welcome to Sunny South Africa! We are completing the first month of 2023: parents and learners have returned to queuing traffic, and while the holiday season is finished, it is not yet time to abandon our hats, sunglasses, chilled water bottles and sunscreen. This is according to the Skin Cancer Foundation, advising that it remains critically important not to let down our guard from protecting ourselves and our loves ones against the sun's ultraviolet radiation (UVR), not just in summer but year-round.

Passionate about empowering people to take a proactive approach to daily sun protection and the early detection and treatment of skin cancer, the Skin Cancer Foundation issues a stern warning that all risks associated with skin cancer should be mitigated with serious intent. "Skin cancer is the cancer you can see. Unlike cancers that develop inside the body, skin cancers form on the outside and are usually visible. That's why skin exams, both at home and with a dermatologist, are especially vital... Early detection saves lives."

Always be mindful of your sun exposure risk. The UV index (illustrated above) is a measure of the level of UV radiation. Read more from WHO:

Confronting climate change

The United Nations (UN) note that global temperatures are rising and that no corner of the globe is immune from the devastating consequences of climate change. Goal 13 of the UN's Sustainable Development Goals is to take urgent action to combat climate change and its impacts. 

According to the UN, "Rising temperatures are fueling environmental degradation, natural disasters, weather extremes, food and water insecurity, economic disruption, conflict, and terrorism. Sea levels are rising, the Arctic is melting, coral reefs are dying, oceans are acidifying, and forests are burning. It is clear that business as usual is not good enough. As the infinite cost of climate change reaches irreversible highs, now is the time for bold collective action."

"The last four years were the four hottest on record. According to a September 2019 World Meteorological Organization (WMO) report, we are at least one degree Celsius above preindustrial levels and close to what scientists warn would be 'an unacceptable risk'," says the UN.

Understanding ultraviolet radiation (UVR)

With a clear aim to reduce the burden of disease resulting from exposure to UVR, the World Health Organization (WHO) advises that small amounts of UVR are beneficial to health and play an essential role in the production of vitamin D. "However, excessive exposure to UVR is associated with negative health consequences as UVR is carcinogenic (having the potential to cause cancer) to humans."

WHO highlights that skin cancers are caused primarily by exposure to ultraviolet radiation (UVR), either from the sun or from artificial sources such as sunbeds. Simple and effective prevention measures are said to be available, but what must also be noted is that UVR affects not only the skin as an organ but also the eyes. "Acute effects of UVR include photokeratitis and photoconjunctivitis (inflammation of the cornea and conjunctiva, respectively). These effects are reversible, easily prevented by protective eyewear and are not usually associated with any long-term damage but are painful and might require therapeutic intervention," says WHO.

WHO discourages the excessive sun exposure in children and adolescents as it may contribute to skin cancer in later life. "Sunburns in childhood lead to a higher risk of skin cancer in later life. Also, a larger amount of UVR can reach and damage their retina."

While WHO highlights that fair-skinned people suffer more from sunburn and have a higher risk of skin cancer than dark-skinned people, it also cautions that darker-skinned people develop skin cancers, and that consideration of eye damage is important for everyone. "Outdoor workers exposed occupationally to solar UVR levels face an increased risk of developing non-melanoma skin cancers."

Prevention is better than cure

WHO recommends the following measures to protect against excessive exposure to UVR:

  • Limit time in the midday sun.
  • Seek shade.
  • Wear protective clothing.
  • Wear a broad brimmed hat to protect the eyes, face, ears and neck.
  • Wear wraparound-style sunglasses that provide 99% to 100% UV-A and UV-B protection.
  • Use broad-spectrum sunscreen on skin areas that cannot be covered by clothes. Sun protection is best achieved by seeking shade and wearing clothes rather than applying sunscreens. Sunscreens should not be used for extending time spent in the sun.  
  • Avoid use of artificial tanning devices. Sunbed use increases the risk of developing skin cancers. Artificial tanning should never be considered as an option to achieve sufficient vitamin D status. Several countries have implemented legislation to ban or restrict the use of sunbeds.

A January 2023 infographic cautioning South Africans against heat stroke

Here is a link to the Extended 7-day UV Index Forecast Maps for Southern Africa.

Visit the South African Weather Service to stay informed about the latest weather warnings locally.

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