| by Judith King – HST Copy and Content Editor 
Like many countries in Sub-Saharan Africa, South Africa's progress towards HIV and TB epidemic control has been dislodged by cuts in foreign aid, and several key aspects of our national response have been compromised – but this cannot thwart our efforts. As Winnie Byanyima (UNAIDS Executive Director) has urged, we "must choose transformation over retreat".1 In tandem with diversifying funding sources through international and bilateral agreements, we can build on what we know and have proved in the field as evidence-based, culturally appropriate interventions that have demonstrably saved lives. This will help to fulfil the World AIDS Day 2025 theme of 'overcoming disruption and transforming the AIDS response'.
Turning off the tap: HIV prevention The country's HIV prevention challenges are more pressing than ever, but hope has been catalysed by developments such as the planned national roll-out of lenacapavir pre-exposure prophylaxis (PrEP) in 2026, as part of our comprehensive HIV response. This highly effective, long-acting antiretroviral drug, delivered via injection twice a year, offers six months of continuous protection per dose. We must also do everything possible to address the decline in condom use and inconsistent uptake of oral PrEP.
With nearly 1 000 adolescent girls and young women in South Africa being infected with HIV each week2, the focus on reducing HIV risk among this vulnerable group must be intensified to protect their health and wellbeing, and that of future generations.
Fostering authentic partnerships with community forces  ![]()
At Health Systems Trust (HST), one of our greatest strengths is that we are embedded in communities, in the knowledge that mobilising and empowering communities to promote and take up critical lines of healthcare services will be central to success. Forging strong links between scientific knowledge and community engagement for action and practice enables individuals to make informed decisions about their health, own their future, and participate in developing and leading health system strengthening. As expressed by HIV and human rights activist Oziel Mdletshe3, "community advocacy must play a stronger role in closing the gap between science and the people". He calls for better platforms for community participation, ensuring that individuals are not only aware of biomedical solutions, but are also empowered to apply them in their daily lives. Innovation in HIV medication delivery through differentiated models of care – now a standard intervention – can be traced back to community-driven adherence groups and local actors making home deliveries.4 For this reason, the role of caregivers, community health promoters and grassroots organisations in this regard should be recognised, championed, capacitated and supported. Highly organised community-led monitoring of health service quality standards by networks of people living with HIV and activist partners across the nation was pioneered through the Ritshidze ('saving our lives' in the TshiVenda language) programme in 2019. The campaign's triangulated data are now institutionalised for improving public health clinics' health services.4
How HST's work has innovated good practice and promising models HST can attest to the value of community-orientated HIV services, based on our implementation of the DO ART Demonstration Project and related knowledge-transfer activities, and the work of our Outreach Teams in the Global Vax Project. Community-based HIV service delivery achieved through the DO ART Project was so successful that many community members wanted to join the project (beyond the quota of project participants), and those enrolled wanted the project to continue and expand.  The DO ART project undertook targeted community-based HIV case-finding and linkage to care, with implementation of the model yielding an impressive 12% positivity rate.
Through direct service delivery and technical assistance to improve uptake of COVID-19 vaccination among marginalised and under-served populations in six KwaZulu-Natal sub-districts, the Global Vax Project gained key insights on vaccine-related knowledge gaps and misinformation, attitudinal and cultural barriers, logistical and access barriers, and healthcare worker preparedness.  Community mobilisation for the Global Vax project in Mpofana Sub-district (left), and a project outreach team navigates rural terrain to reach community members (right).
Moreover, throughout the implementation of our SA SURE Project – funded for almost 15 years by the US President's Emergency Fund for AIDS Relief (PEPFAR) via the Centers for Disease Control and Prevention (CDC) – we have applied community-focused programming to bring services to where people are; worked with civil society organisations to layer service delivery; conducted community dialogues to ensure that community members inform and shape interventions; and spearheaded peer-led initiatives that foreground the role of knowledgeable and relatable 'expert patients'.
Leveraging digital health to make HIV treatment accessible As part of our contribution to the HIV response, HST plays a pivotal role in advancing digital health innovation in South Africa and the broader region, providing technical leadership, system development, and strategic guidance in collaboration with the national and provincial departments of health. HST supported the National Department of Health in the conceptualisation of SyNCH (Synchronised National Communication in Health) which is the core digital backbone of the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme. Currently, HST supports CCMDD in four districts and 378 facilities.
Community-based health services delivered by HST Outreach Teams 
Isibhedlela kubantu events are critical for community HIV literacy education, wellness advocacy and bringing services to hard-to-reach places. HST Outreach Teams' direct service delivery responds to community needs and synergises action with community partners. All clients receive general health literacy, screening and testing, and those diagnosed receive counselling and treatment literacy information, are initiated on treatment, and are linked to a facility convenient to them for lifelong care. The teams also trace patients with interrupted treatment, and test index contacts. Beyond this routine provision of comprehensive care, partnering with the Department of Health at commemorative events creates valuable opportunities to expand the reach of these services.  ![]() In a targeted intervention, 10 HST mobile clinics served as clinician-led pick-up points where patients could collect their medication to ensure continuity of care.
Community dialogues  ![]() Through focused listening, the community dialogue process enables communities and stakeholders to question and meaningfully discuss existing practices and their own thinking and behaviour regarding HIV treatment and support. Issues identified as challenges to community-based HIV treatment and support are discussed, and awareness can be built among stakeholders about how services can be adapted for success. The dialogues facilitate development of community-owned and community-driven action plans to address the key issues identified, and secure commitment and consensus from stakeholders on their contribution to sustainable activities. The approach recognises the cultural context of knowledge and social practices required to effect behaviour change, and fosters a shared identification with and empathy for each other's human reality, perspectives, traditions and life circumstances related to health care.
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HST has conducted multiple community dialogues under the auspices of various projects over many years, and included a 'how to' guide on running a community dialogue in a Community ART Services Desk Compendium and Toolkit produced in collaboration with the KwaZulu-Natal Department of Health as a comprehensive and easily accessible suite of resources and guidance that healthcare workers can use for optimal delivery of patient-centred care.
Peer-led initiatives: leveraging the skills and positioning of 'expert patients' to support fellow community members In partnership with the Zululand Department of Health, the SA SURE project trained and placed nine Youth Peer Mentors in eight facilities in the district to provide case-management services to pregnant youth between the ages of 10 and 24 years. These services entailed providing education on pregnancy and the importance of early antenatal booking, treatment and care; issuing appointment reminders and following up on missed appointments; providing psychosocial support and adherence counselling, based on the Peer Mentors' previous experience; forming facility-based support groups to assist with disclosure, stigma and diagnosis acceptance; and mapping of community services as referral points for youth requiring additional support. The Mentors were given tools for collection of data on HIV testing, linkage to care, viral load monitoring, and early infant diagnosis. Post intervention, the linkage rate improved from 88% to 100% in the eight clinics, and there was a noticeable decrease in positive PCR results among babies borne of these young mothers. To strengthen male health services and to increase demand for and continuity of HIV treatment among men, HST implemented the Coach Mpilo, MINA for Men's Health, and Phila Ndoda campaigns as part of SA SURE programming.  HST's MINA Campaign champions promote health among men in uMgungundlovu.
The Coach Mpilo case manager model offers interventions co-crafted by men to provide male patients with knowledge about HIV and the importance and benefits of treatment adherence, and to support disclosure of their HIV status to partners, family and friends. HIV-positive men who are stable on treatment are assigned as 'Coaches' of newly diagnosed men and those who have returned to care after a treatment interruption. The MINA campaign – led by the Department of Health, with support from PEPFAR and the US Agency for International Development (USAID) – publicises and provides links to the clinic-based Coach Mpilo services. It offers direct links to clinicians, access to support groups, and education on men's health topics, while sharing the stories of men who are successfully living with HIV and creating spaces where men can support each other through friendship and a sense of community. MINA-supported districts and facilities have seen strong growth in HIV testing and linkage to treatment, and improved continuity of care. Phila Ndoda is a movement focused on restoring positive male figures in society and fostering healthier communities through men protecting themselves and their loved ones from infectious diseases and other health conditions. In 2019, HST instituted a Phila Ndoda men-friendly mobile clinic in Zululand, attached to Queen Nolonolo Clinic in Nongoma Sub-district. Men's health services were delivered by an all-male team in spaces where men congregate, such as hostels, taxi-ranks, taverns and sports fields, with HST's male Driver Mobiliser rallying community members through a loud-hailer. Following increased demand for this mobile service point, it operated five days a week. The median number of men tested for HIV per quarter more than doubled, and was sustained above 800 tests per quarter by March 2021.
Youth Ambassadors From 2018 to 2020, SA SURE Youth Ambassadors (YAs) formed part of the district teams supporting the Department of Health's Adolescent and Youth-friendly Services (AYFS). Their role was to engage with youth in Youth Care Clubs, run activities in facility-based Youth Zones, mobilise HIV Testing Services, distribute condoms, and educate groups about teenage pregnancy, gender-based violence and general health issues. When young clients in need were identified, the YAs facilitated their access to health and social services through referrals to the clinic and relevant government departments, and recruited them for support groups and psychosocial advice where necessary. Youth Ambassadors were given daily targets to elicit HIV testing among children younger than 15 in facility Youth Zones. YAs were employed in three KwaZulu-Natal districts and were supported with technical assistance by HST's AYFS Co-ordinators during frequent site visits.  ![]() While running a holiday programme at the end of 2019 in eThekwini, the YAs found additional ways to relieve the plight of several orphaned and vulnerable youngsters – donating their own funds to do so.
Stakeholder engagement
Stakeholder engagement requires an understanding of the contextual dynamics of each district to ensure community entry, and familiarity with all stakeholders implementing services that feed into our project workplan. Knowing which structures are functioning and how they operate enables prioritisation of key collaborators to improve performance, avoid duplication, and close any gaps in the various programmes.
"It's time to move ownership into the communities so that they lead initiatives. We should capacitate them so that they have the skills and confidence to teach other community members. You will notice a difference when you promote communities' self-mobilisation. As they lead, so they come to own the initiatives. Whenever we want to implement a programme, consultation with the community is very important because that will guide us on what their needs are. We all need each other, one way or another, and in the end, we win through partnership."
Primrose Sithole: HST Cross-site Stakeholder Liaison Specialist for Zululand and eThekwini
People are at the centre of change. Science tells us how, but not why. It is people – with our insights, activism, hope and ingenuity – who will ground scientific knowledge to infuse it with meaning. Community actors as partners generate jointly formulated solutions and ensure accountability. Achieving the resilience and sustainability of South Africa's HIV response demands that collectively, we rise again, draw on the knowledge we have and the lessons learnt, and maintain momentum towards eliminating HIV as a major public health challenge.
References Byanyima W. Overcoming disruption, transforming the AIDS response – World AIDS Day 2025. URL: https://www.unaids.org/en/2025-world-aids-day
Githuku-Shongwe A, Kiwango E. The link to schooling and HIV infection rate is clear – and teenage girls are most vulnerable. Geneva: United Nations Children's Fund (UNICEF); 2024. URL: https://southafrica.un.org/en/271962-link-schooling-and-hiv-infection-rate-clear-%E2%80%93-and-teenage-girls-are-most-vulnerable
Mdletshe O. Bridging the gap between science and community in the HIV response. Daily News, 14 October 2024. URL: https://dailynews.co.za/opinion/2024-10-15-bridging-the-gap-between-science-and-community-in-hiv-response/
UNAIDS: Let Communities Lead. World AIDS Day Report 2023. URL: https://www.unaids.org/sites/default/files/media_asset/2023WADreport_en.pdf
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| by Roma Ramphal – Provincial Differentiated Care
1 August 2025 was a truly exciting and meaningful day as I joined my HST colleagues: Lethukuthula Shabalala (Sub-District Co-ordinator: South), Shahzadhee Yakoob (Roving Pharmacist: South), and Ayanda Zungu (Clinical Advisor) in supporting the Cato Manor Community Health Centre (CHC) launch of six-month multi-month dispensing (6MMD) for patients who are clinically stable on medicine for chronic conditions. It was an honour to be part of this milestone moment that marks a bold step forward in enhancing patient care in eThekwini and KwaZulu-Natal. I had the opportunity to present to the prescribing team, taking them through the benefits of 6MMD not only for patients, but also for the facility itself. I highlighted that 6MMD is more than a dispensing model; it is another opportunity to give patients choices that empower them to select a care model that works best for their lives. We discussed patient eligibility in detail, with an important emphasis on assessing the social factors of patients' circumstances, not merely their clinical stability. I reminded the team that before transitioning a patient to 6MMD, we must consider issues such as sex-based violence, substance use and social support, all of which can have a negative impact on treatment adherence. Every patient deserves to be assessed holistically and offered a model of care that truly supports their context. We also spoke about the clinician's obligations and the importance of obtaining the patient's commitment to their treatment journey, ensuring that they understand their role in taking their medicines daily, storing them safely, and returning for their viral load testing on time. Ayanda Zungu took the team through the eligibility lists, the benefits of file-flagging, and reporting on the TIER.Net system as we prepare to initiate patients. The day was made even more special through the support and enthusiasm of the facility team. Sister Malinga, the Acting Operations Manager at Cato Manor CHC, captured the spirit of the day beautifully. She said: "6MMD will assist patients and benefit them as another option to collect their meds. This will also to help the facility to decongest even more. Previously, for registration on the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme, patients needed an ID or passport. Now, we can offer 6MMD to eligible patients who don't have a unique identifier. Nurses will have more time to focus on unstable patients, which is exactly what we need."
In a symbolic and empowering moment, Acting Operational Manager of Cato Manor CHC, Sister Malinga, holds a 6MMD medicine supply. This launch marks a revolutionary moment in Primary Health Care service delivery in KwaZulu-Natal, and is a reminder of what's possible when we come together with purpose to put patients first and ensure that the systems we design truly serve the communities that we support.
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| By Siyabonga Gema (HST Communications Officer)
As the world grapples with the far-reaching effects of climate change, its impacts are increasingly visible not only in environmental degradation but also in human health, particularly in vulnerable regions such as South Africa. Rising temperatures, shifting weather patterns, and extreme weather events are placing an added strain on the country's already burdened healthcare system, disproportionately affecting low-income communities and exacerbating existing inequalities. In this article, we unpack the effects of climate change in health, a topic covered in detail in the District Health Barometer 2023/24. Found in Section A, chapter 5, the topic was authored by Caradee Y Wright, Thandi Kapwata, Natasha Naidoo, et al. South Africa is particularly vulnerable to climate change due to its geographic location, water scarcity, and socio-economic challenges. The health impacts of climate change in the region are both direct, such as injuries from extreme weather events, and indirect, including the increased prevalence of infectious diseases and food insecurity. As average temperatures rise, heat waves have become more frequent and severe. This leads to an increased risk of heatstroke, dehydration, and exacerbation of cardiovascular and respiratory diseases. The elderly, children, and those with pre-existing health conditions are especially at risk. South Africa faces chronic water scarcity, which is likely to worsen with prolonged droughts and reduced rainfall linked to climate change. This increases the risk of water contamination and outbreaks of diseases like cholera, typhoid, and diarrhoea, particularly in informal settlements lacking adequate sanitation infrastructure. Climate change disrupts agriculture by reducing crop yields and increasing the unpredictability of food production. As food prices rise and availability drops, poor communities face higher rates of malnutrition, especially among children. This has long-term consequences for physical and cognitive development. The psychological burden of climate-related disasters such as floods, wildfires, and droughts can lead to increased cases of anxiety, depression, and post-traumatic stress disorder (PTSD). In rural and low-resource areas, access to mental health services remains limited, compounding the problem. South Africa has deep socio-economic divides, with many underprivileged communities living in informal housing with poor infrastructure. These communities are often located in flood-prone or drought-stricken areas, with limited access to healthcare, clean water, or air conditioning. This structural inequality makes them especially vulnerable to the health impacts of climate change. Climate change is not a distant threat—it is a present reality that is already affecting the health and well-being of South Africans. While the challenges are immense, proactive policies, public engagement, and international support can help South Africa build a resilient and healthier future in the face of climate uncertainty. The District Health Barometer (DHB) is a vital statistical and analytical resource that provides an overall view of district health performance on key health systems indicators in South Africa. To view more editions, click here: https://shorturl.at/amP7y
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| By Willemien Jansen (HST Copy and Content Editor)
Mental Illness Awareness Month, commemorated in South African in July each year, is a time dedicated to raising public understanding of mental health conditions and reducing the stigma surrounding them. This month serves as a powerful reminder that mental health is just as important as physical health, and that millions of people are affected by mental illness every year. Through education, open conversations, and community support, Mental Illness Awareness Month encourages individuals to seek help, support one another, and advocate for better mental health resources and policies. At the Health Systems Trust (HST), our vision of "Improved health access and outcomes in South Africa and beyond" extends to ensuring equitable and inclusive mental healthcare. Central to this vision is our strong community focus, which recognises that lasting health improvements are achieved when services are accessible, culturally relevant, and integrated into the everyday lives of the people we serve. Community mental health is about more than just providing services; it's about creating inclusive, supportive environments where people feel safe, valued, and connected. When mental healthcare is embedded within communities, it becomes more accessible, culturally relevant, and responsive to the unique needs of diverse populations. By focusing on access and inclusion, this year's observance calls for stronger mental health infrastructure at the community level, reduced stigma, and equitable resources for all. It's a reminder that mental health is a shared responsibility and that strong, healthy communities are the foundation of individual and collective well-being.
We talked to HST Senior Researcher Michael Burnett, who holds a Master's degree in Psychology and is a Registered Mental Healthcare Practitioner (HPCSA), about his work in mental health. Can you tell us about your background and work in the field of mental health? I hold both a bachelor's and a master's degree in psychology, and I have been registered with the HPCSA as a mental healthcare practitioner since 2008. Throughout my career, I have integrated my knowledge of psychology and mental health into the work of HST, applying my expertise as much as the project allows. My background and experience in the field profoundly influence my approach, guiding the way I support and collaborate on projects. I am dedicated to leveraging my skills to contribute effectively to promoting mental well-being and advancing the objectives of our work. What does mental illness look like? Mental illness can look different for every person, and it may not always be "visible". It can involve emotional changes such as consistent sadness, irritability, or mood swings, or behavioural changes such as withdrawal from friends and activities, difficulty concentrating, or changes in sleeping and eating habits. Some people may appear anxious, or tired, while others might appear unusually energetic or detached. Physical symptoms such as headaches or unexplained aches can also be signs that a person is struggling with a mental illness. It is important to remember that mental illness isn't always noticeable. A person may appear fine on the outside but can be struggling internally.
Why is Mental Illness Awareness Month important to you personally and professionally? Mental Illness Awareness Month is important to me both personally and professionally because it serves as a vital reminder of the importance of reducing stigma, increasing understanding, and promoting compassion around mental health issues. On a personal level, it inspires me to continue advocating for those struggling with mental illness and to contribute to creating a more inclusive and supportive environment. We all know someone who is struggling with mental illness, even if we are not always able to clearly identify it. According to research, up to 26% of South Africans struggle with some level of depression, and 18% with some level of anxiety. Professionally, it underscores the importance of education, prevention, early intervention, and accessible mental healthcare, all of which are essential for improving outcomes and fostering mental health resilience. Recognising this month motivates me to stay engaged in this work and to raise awareness about the importance of mental health for overall well-being. What are some of the biggest barriers people face when trying to access mental healthcare in their communities? Accessing mental healthcare remains a significant challenge for many individuals due to a combination of barriers. In South Africa, there is a severe shortage of mental healthcare professionals, with only 0.97 Psychologists and 0.31 Psychiatrists per 100 000 people, in the public sector. This shortage leads to long waiting lists and limited access, especially in rural communities. Stigma surrounding mental illness further aggravates the situation. In many communities, mental illness is misunderstood, often viewed as personal weaknesses or attributed to other causes, discouraging individuals from seeking help. Economic factors also play a crucial role. The high cost of private mental health services makes it inaccessible to many, while public services are often underfunded and overburdened, leading to inadequate care. Addressing these barriers requires a multifaceted approach, including increasing the number of trained professionals, reducing stigma through education, improving funding for public services, and leveraging technology to reach underserved areas. Can you share an example of a successful community mental health initiative that HST has been part of? The Research and Implementation Science Unit is working on a project to improve the mental health needs to healthcare workers. It is envisioned that by improving the mental health of nurses and community healthcare workers, they in turn will be better equipped to support the mental health needs of the communities they serve.
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| By Willemien Jansen (HST Copy and Content Editor)   Mental health in the workplace directly affects productivity, employee satisfaction, and overall company success. When organisations prioritise mental well-being, they reduce absenteeism and create a more positive working environment. Supporting mental health at work is essential for maintaining a healthy, engaged, and efficient workforce.
Employees who experience stress or mental health challenges often struggle to perform at their best. Recognising and addressing these issues benefits not only individuals but also the wider team. It enables better communication, collaboration, and resilience in facing everyday challenges. Many businesses are now realising that investing in mental health support is no longer optional but necessary for sustainable growth. Understanding its importance can help employers create strategies that foster a supportive culture, improving outcomes for everyone involved. Defining Mental Health in the Workplace Mental health in the workplace involves both the emotional well-being and psychological state of employees. It affects their ability to perform tasks, interact with colleagues, and cope with daily pressures at work. Understanding Mental Health Mental health at work refers to how individuals manage stress, maintain focus, and maintain a balance between professional and personal demands. It includes a range of conditions such as anxiety, depression, and stress-related disorders. Good mental health enables employees to be productive, adaptable, and resilient. Poor mental health can lead to absenteeism, reduced engagement, and lower job satisfaction. Employers need to recognise that mental health is a critical component of overall workplace health. Prevalence of Mental Health Issues at Work Mental health problems affect a significant portion of the workforce globally. Studies show that 15% of working-age adults were estimated to have a mental disorder in 2019. Workplace factors such as workload, lack of control, and job insecurity contribute to these problems. For example, high-pressure environments are linked to increased stress and burnout. Mental health conditions are a leading cause of long-term illness, highlighting the need for proactive support. Why Mental Health Matters in Professional Settings Mental health significantly impacts an employee's performance and the overall workplace environment. Addressing mental wellbeing can reduce absenteeism and enhance team dynamics, leading to better organisational outcomes. Link Between Mental Wellbeing and Productivity Employees with good mental health tend to have higher concentration and make fewer errors. Stress and anxiety can reduce cognitive function, causing delays and diminished work quality. Organisations that support mental health see improved engagement and innovation. Positive mental wellbeing is linked to increased motivation and lower turnover rates. Providing resources such as counselling, flexible working hours, or stress management training can directly influence productivity. These measures create a stable workplace where employees can perform at their best. Recognising Signs of Poor Mental Health at Work Identifying poor mental health in the workplace requires attention to specific behaviours, organisational indicators, and the impact of stigma. These elements often interact and affect both employees and company performance. Behavioural Indicators in Employees Employees experiencing poor mental health may show changes in routine work habits. These can include frequent errors, missed deadlines, or reduced productivity. Other signs include withdrawal from colleagues, increased irritability, or a lack of motivation. Physical symptoms like fatigue or headaches may also be present but are less obvious. Sudden changes in attendance patterns, such as frequent absences or lateness, can be a clear warning sign. It is important for managers to observe these behaviours without jumping to conclusions. Organisational Warning Signs High turnover rates and increased absenteeism can signal widespread mental health issues within an organisation. When multiple employees show signs of stress or burnout, the workplace environment may be contributing to poor mental health. Low morale, conflicts, and poor communication are also indicators. These affect team cohesion and overall effectiveness. Workplaces with little support for mental health or poor work-life balance policies often see an increase in these warning signs. Data like employee surveys and performance reviews can help highlight problems early. Stigma and Its Effects Stigma around mental health can prevent employees from seeking help. Fear of being judged or losing their job often discourages open communication. This silence leads to untreated conditions, worsening performance and wellbeing. Stigma also affects team dynamics by creating misunderstanding or exclusion. Employers must actively work to reduce stigma through education and clear policies. Encouraging conversations and normalising mental health support improves access to resources and fosters a safer workspace. Workplace Factors Affecting Mental Wellbeing Several elements within the work environment directly influence employees' mental health. These include pressures related to job demands, the behaviour and support of leadership, and how well individuals can maintain a balance between work and personal life. Workplace Stressors Workplace stressors such as excessive workloads, tight deadlines, and unclear job expectations significantly impact mental wellbeing. Continuous exposure to these factors can lead to anxiety, burnout, and decreased productivity. Physical work conditions also matter: poor lighting, excessive noise, and uncomfortable workspaces contribute to stress and distraction. Additionally, interpersonal conflicts and lack of social support increase emotional strain. Organisations that identify and minimise these stressors help maintain healthier, more engaged staff. Regular assessments of job demands and employee feedback are key to managing stress effectively. Role of Management and Leadership Leadership style strongly shapes workplace mental health. Supportive managers who communicate clearly, demonstrate empathy, and provide regular feedback foster a positive work atmosphere. Conversely, inconsistent or overly critical leadership can cause confusion and low morale. Employees need trust and clarity from management to feel secure and valued. Training managers in mental health awareness and communication skills can equip them to recognise early signs of distress and to respond appropriately. Strong leadership creates a culture where mental health is openly discussed and prioritised. Work-Life Balance Considerations An imbalance between professional responsibilities and personal life increases stress and potential mental health issues. Long working hours, unpredictable schedules, and inadequate time off reduce recovery opportunities. Flexible working arrangements, such as remote work or adjustable hours, support employees in managing their responsibilities more effectively. Encouraging regular breaks and respecting boundaries between work and personal time also protects wellbeing. Employers benefit from implementing policies that promote balance. Staff with an adequate work-life balance tend to show greater commitment, reduced absenteeism, and improved mental health. Building a Healthier, More Resilient Workforce Through Mental Wellbeing Mental health is a vital component of a productive and successful workplace. When organisations prioritise mental wellbeing, they reduce absenteeism, improve employee engagement, and foster a positive work environment. Poor mental health, on the other hand, leads to reduced performance, low morale, and increased staff turnover. Recognising early signs of mental distress, addressing workplace stressors, and encouraging open communication are key to supporting employee wellbeing. Effective leadership, flexible work arrangements, and clear mental health policies help create a supportive culture where employees feel valued and understood. Investing in mental health is not just an ethical responsibility—it also enhances productivity, retention, and overall organisational success. By placing mental wellbeing at the core of workplace strategy, companies can ensure sustainable growth and a healthier, more resilient workforce.
For more information on mental health, or assistance please go to: Websites National Department of Health: Mental Health Masiviwe SADAG
SA Federation for Mental Health
List of helplines Mental Health Information Line: 0800 567 567 LifeLine National Counselling Line: 0861 322 322 Suicide Crisis Helpline: 0800 567 567 Healthcare Workers Care Network Helpline: 0800 21 21 21, SMS 43001 SADAG: 011 234 4837 List of Whatsapp helplines Cipla Mental Health: 076 882 2775 Maybelline BraveTogether: 087 163 2030 Ke Moja Substance Abuse: 087 163 2025 Have Hope Chat Line: 087 163 2050
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| by R Ramphal Health Systems Trust: KZN Provincial Manager – Differentiated Models of Care 
In South Africa, millions of parcels containing medicine bottles are dispensed every year through the Central Chronic Medicine Dispensing and Distribution (CCMDD) Programme. Typically, these containers have been seen as simple vessels for life-saving pills. But what if they could do more? What if – alongside supporting a patient's adherence to chronic medicine – they could quietly offer hope and safety to women navigating not only illness, but also sex-based violence (SBV)? The 'Beyond the Box' initiative challenges pharmaceutical companies to embrace this vision: transforming every medicine bottle into a medium for both health and compassion. Inspired by the Access to Medicine Foundation's Through Her Lens campaign1, this approach recognises that health is never merely about the body: it is about dignity, safety, and community support. Globally, only about 50% of patients with chronic conditions take their medicines as prescribed, with even lower adherence rates in developing countries.2 In South Africa, this crisis is particularly acute due to the high burden of HIV, hypertension, diabetes, and mental health conditions. The CCMDD Programme was designed to address this by making chronic medicines more accessible, reducing the need for frequent clinic visits and minimising congestion in public health facilities. However, access alone is not enough. As the country moves towards six-month dispensing (6MMD) for antiretroviral therapy (ART), and mobilises the National Department of Health's '1.1 Million Close the Gap' campaign to bring more people into HIV care3,4, the challenge of adherence becomes even more critical. If we want to be HIV-free, we must address every barrier to taking medicine as prescribed, including those that are hidden, such as violence and fear. Research shows that sex-based violence is a major, often overlooked barrier to medicine adherence. A landmark study by Lopez, et al. found that women experiencing intimate partner violence had 59% lower odds of optimal ART adherence.5 Cluver, et al. showed that adolescents facing both intimate partner violence and sexual abuse had only a 38% probability of adhering to their medicine, compared to 72% for those not exposed to violence.6 In Kenya, Biomndo, et al. found that violence directly undermines a woman's ability to prioritise her treatment when her safety is at risk.7 This is not just an HIV issue. Bagherzadeh, et al. found that among women with chronic illnesses, intimate partner violence was significantly linked to poor adherence across conditions.8 A 2024 study conducted by South Africa's Human Sciences Research Council revealed that more than one in three women (36%) reported experiencing physical or sexual violence, with 24% experiencing violence from an intimate partner – a reality that has a direct impact on their health behaviours and outcomes.9 Why CCMDD parcels are a unique opportunity For many women, collecting a CCMDD parcel might be the only moment of privacy in their day. In homes where partners are controlling or abusive, or where HIV-related stigma is high, this brief interaction with the health system is a rare chance for patients to access information safely. By including discreet SBV support information, such as helpline numbers on medicine parcels or bottles, we can offer a lifeline to those in distress.10,11 This isn't just theory. Cohen and Saran demonstrated in Uganda that simple, targeted messages on malaria medicine packaging increased adherence by 9% and reduced untaken pills by 29%.10 The most effective message was direct and supportive: "Malaria is NOT gone until ALL tablets are finished." Imagine the impact if, alongside such messages, we included information on where to get help for violence or abuse. The CCMDD Programme's focus is on improving access and adherence, but health does not exist in isolation. When survival is uncertain, adherence becomes harder. As healthcare workers, we see that patients are more than just their chronic conditions. They are mothers, daughters, sisters, people whose health is shaped by the safety and stability of their environment. Including SBV messaging in chronic medicine programmes allows us to do more than dispense medicine; it enables us to dispense compassion, solidarity and safety. Even if this intervention helps only one woman, it is worth it. The social impact of integrating SBV support into chronic medicine programmes extends well beyond individual patients. With millions of CCMDD parcels distributed annually, even small improvements in help-seeking behaviour could connect thousands of women with potentially life-saving services. The NDoH Command Centre that deals with SBV (0800 428 428)12 and other helplines provide 24-hour support that could be accessed through discreet contact information on the medicine parcel.
A call to action: The role of Pharma and policy The evidence is clear: simple packaging interventions can significantly improve medicine adherence while providing critical support to vulnerable populations.8,10 Regulation 10 of the South African Health Products Regulatory Authority (SAHPRA) allows for the inclusion of special information on medicine labels, so the regulatory pathway exists.13 The technology is available. The business case is compelling. Pharmaceutical companies now have an unprecedented opportunity to show that their commitment to health equity is more than a slogan. Every medicine bottle offers a platform to improve lives, not only through the pills inside, but through the hope, support and empowerment it can provide through information on SBV services. The question is not whether pharmaceutical companies can make this transformation, but whether they will choose to lead this revolutionary approach to patient care. The answer lies in seeing patients not merely as consumers, but as whole human beings deserving of comprehensive support in their journey toward health and safety. As South Africa's Close the Gap campaign and six-month dispensing policies expand, let's ensure that every step forward in access is matched by a step forward in compassion and safety. The 'Beyond the Box' initiative challenges the industry to lead this change. The time for action is now. To achieve an HIV-free society, we must try to solve every adherence challenge, even if it helps only one woman. That is enough. That is everything. References 1. Access to Medicine Foundation. Health Equity Through Her Lens. Amsterdam, 2025. URL: https://accesstomedicinefoundation.org/health-equity-through-her-lens 2. Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. 2018. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open, 2018; 8:1, e016982. 3. Joint United Nations Programme on HIV/AIDS (UNAIDS). Bold new initiative to put an additional 1.1 million people living with HIV on treatment. Geneva: UNAIDS; 2025. URL: https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2025/february/20250225_1-1-million-people-treatment-south-africa 4. World Health Organization. South Africa launches 1.1 million HIV campaign to close treatment gap. Geneva: WHO; 2025. URL: https://www.afro.who.int/countries/south-africa/news/south-africa-launches-11-million-hiv-campaign-close-treatment-gap-0 5. Lopez EJ, Jones DL, Villar-Loubet OM, Arheart KL, Weiss SM. 2010. Violence, coping, and consistent medication adherence in HIV-positive couples. AIDS Educ Prev, 2010; 22:1, 61─68. 6. Cluver LD, Zhou S, Orkin M, Rudgard W, Meinck F, Langwenya N, Vicari M, Edun O, Sherr L, Toska E. Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa. AIDS, 2023; 37:3, 503─511. 7. Biomndo BC, Bergmann A, Lahmann N, Atwoli L. Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV-positive women: Evidence from government facilities in Kenya. PLoS One, 2021; 16:4, e0249813. DOI: 10.1371/journal.pone.0249813. 8. Bagherzadeh R, Sayad Nik A, Gharibi T, Vahedparast H. The predictive role of intimate partner violence in treatment adherence among women with chronic illness: A cross-sectional study. Chronic Illn, 2024; 20:1, 76─85. 9. Human Rights Watch. Confronting South Africa's Crisis of Gender-Based Violence. 2024. URL: https://www.hrw.org/news/2024/11/25/confronting-south-africas-crisis-gender-based-violence 10. Cohen J, Saran I. The impact of packaging and messaging on adherence to malaria treatment: evidence from a randomized controlled trial in Uganda. J Dev Econ, 2018; 134, 68─95. 11. 1000 Women Trust. Gender-based violence resources and support. Cape Town, 2024. URL: https://www.1000women.co.za 12. Department of Justice and Constitutional Development. Gender-based Violence Command Centre (GBVCC): Emergency Line number – 0800 428 428. URL: https://www.justice.gov.za/vg/GBV.html 13. South African Health Products Regulatory Authority (SAHPRA). Medicines and Related Substances Act 101 of 1965: General Regulations, Regulation 10: Labelling of medicines intended for human use. 2017. URL: https://www.sahpra.org.za/wp-content/uploads/2022/07/General-Regulations-Medicines-and-Related-Substances-Act-25-Aug-2017-Gazetted.pdf
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| By Siyabonga Gema (HST Communications Officer) 
June is Men's Health Month, and it's more than just a calendar reminder — it's a call to action. Around the world, men face higher rates of heart disease, suicide, liver disease, and certain cancers, often due to a combination of biological, behavioural, and societal factors. Yet, far too many men delay or avoid medical care, leading to preventable complications and premature death. It's time to change that narrative. Men's health isn't just about hitting the gym or skipping the extra slice of pizza — it's about taking proactive steps to improve overall well-being: physically, mentally, and emotionally. Top Health Concerns for Men - Heart Disease
- Heart disease is the leading cause of death among men. High blood pressure, high cholesterol, smoking, and poor diet all contribute to the risk.
- Prevention tip: Regular check-ups, blood pressure monitoring, a heart-healthy diet, and exercise.
- Cancer
- Prostate cancer is the second most common cancer in men, followed by lung and colorectal cancers.
- Prevention tip: Regular screenings (especially after age 50), avoiding tobacco, and knowing your family history.
- Mental Health and Suicide
- Men are less likely to seek help for depression or anxiety and are more likely to die by suicide.
- Prevention tip: Talk openly about mental health, seek therapy or counselling, and support others doing the same.
- Diabetes
- Type 2 diabetes is often undiagnosed until complications arise.
- Prevention tip: Maintain a healthy weight, eat balanced meals, and get regular screenings if you're at risk.
- Liver Disease and Substance Abuse
- Excessive alcohol use and hepatitis are major contributors.
- Prevention tip: Limit alcohol consumption and get vaccinated for hepatitis B.
The Power of Preventive Care Preventive health care is one of the most underutilised tools for men. Annual check-ups, blood tests, vaccinations, and cancer screenings can catch issues early, often before symptoms appear. Key annual check-ups include: - Blood pressure and cholesterol levels
- Blood glucose levels
- Testicular and prostate exams
- Skin checks for melanoma
- Mental health screenings
Start the Conversation Men's health awareness starts with you. Whether you're a father, son, partner, or friend, your health matters — not just for you, but for the people who count on you. Talk to your doctor. Support the men in your life. Share resources. Break the silence. Healthy men build strong families, strong communities, and stronger futures. For resources on men's health visit the Men's Health Network.
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| By Mandisa Dlamini (Communications Assistant) 
Each year on 16 June, South Africa honours the brave students of 1976 who marched against apartheid and Bantu education, sparking a movement for freedom and justice. Launch of Youth Month 2025 On 3 June 2025, the National Youth Development Agency (NYDA), together with the Department of Women, Youth and Persons with Disabilities and the Department of Sport, Arts and Culture, officially launched Youth Month at the Hector Pieterson Memorial in Soweto. Under the theme "Skills for the Changing World – Empowering Youth for Meaningful Economic Participation", this year's programme focuses on job skills, entrepreneurship, and supporting young people's physical and mental wellbeing. Building Youth Power Through Health The South African Department of Health (DoH) recognises that without robust health systems and preventative care, youth empowerment remains incomplete. In early 2025, the DoH rolled out its nationwide Human Papillomavirus (HPV) vaccination campaign scheduled from 3 February to 28 March to protect adolescent girls against cervical cancer, a leading cause of mortality among South African women. This initiative carried out in collaboration with the Cancer Association of South Africa (CANSA), reflects a preventative approach that promises long-term benefits for community health. Shining a Spotlight on South African Health Systems The Health Systems Trust (HST) continues to play a vital role in building the foundations for a healthier, more equitable future. Through initiatives like the District Health Barometer, HST empowers young people, researchers, and decision-makers with access to critical health data that drives real-world change. HST launched the 17th edition of its District Health Barometer for 2023/24, complete with an enhanced online interactive dashboard that highlights performance across districts and provinces equipping young activists and policy-makers with the data they need to champion stronger, more equitable care. Call to Action: Invest in Youth, Invest in the Future As we honour the courage of the 1976 youth, let us match their legacy with action. Whether you're a policymaker, educator, health worker, researcher, or young leader now is the time to invest in youth wellbeing, leadership, and opportunity. Youth Day 2025 is a tribute to past sacrifice and a call to invest in the future by strengthening health systems, empowering young leaders, and ensuring all youth can thrive in a changing world. To learn more about the Department of Health's youth health programmes, visit the South African Department of Health.
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| By Willemien Jansen (HST Copy and Content Editor) 
How long have you been with HST and which position/s have you occupied? I started working for HST as a Psychosocial Advisor in February 2017, so it has been eight years. Please share some information about what your current role entails. I support the psychosocial services that drive progress in the 95-95-95 strategy, particularly for children and adolescents aged 0 to 24. I facilitate age-appropriate disclosure counseling, ensuring that children and adolescents on ART receive the guidance they need in a way that aligns with their developmental stage. I work closely with healthcare workers, mentoring them on both adherence and disclosure strategies, equipping them to handle complex cases—especially those involving clients with unsuppressed viral loads. When I encounter a client with an unsuppressed viral load, I make sure enhanced adherence counseling is promptly provided. If a viral load test is due, I ensure it's repeated without delay. I also focus on capacitating facility staff by walking them through adherence and disclosure guidelines. Part of my routine includes conducting file audits. These help me verify that documentation related to adherence and disclosure tools is not only present but also accurately maintained. I conduct onsite mentorship with Peer Mentors and Lay Counsellors, closely observing how they deliver adherence counseling to newly diagnosed clients or those who have missed appointments. My aim is always to improve the quality of service delivery. I also support HAST Co-ordinators as they implement adherence and disclosure support groups within the facility. For children who test PCR positive, I make sure they are followed up consistently and their cases are updated on the RfA dashboard. Finally, I work to strengthen the relationship between the Department of Health and other key stakeholders. Together, we ensure efficient case referral systems that prioritise client care and continuity. What influenced your decision to be in the development/NGO sector? I was seeking personal growth and the opportunity to develop my skills further. I wanted to gain experience working within the private sector and to understand how collaboration and partnerships between government and private organisations contribute to effective service delivery. Additionally, I aimed to apply and expand my expertise as a Psychosocial Advisor in a private sector setting. How do you spend your time away from work? I attend church and go shopping with my family. I also enjoy watching television, particularly educational programs, news, and reality shows. What gives you motivation? I like feeling like my work is making a positive impact, whether on a small scale or large one. I am motivated by the opportunity to make a difference in the lives of our clients. I am also motivated by team work. What is the best advice you've ever received in your life? (personal or professional) Personal advice: Be yourself: don't be afraid to try new things. Professional advice: Be committed: through commitment you can gain motivation.
Any future aspirations? I am focused on advancing my career, achieving personal growth, learning new skills, and taking on leadership roles. What are you reading at the moment? I am reading a book called The prison letters of Nelson Mandela. The book is about letters the late president Nelson Mandela wrote to his family, friends, and comrades while he was in prison. The book is edited by Sahm Venter.
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| By Mandisa Dlamini (HST Communications Assistant)
From 29 May to 5 June 2025, South Africa observes National Child Protection Week, a significant initiative aimed at raising awareness about children's rights as set out in the Constitution of the Republic of South Africa and the Children's Act (Act No. 38 of 2005). Child Protection Week has been celebrated since 1997, emphasising our shared responsibility to protect the well-being and safety of all children in the country. The Department of Social Development (DSD) has launched a nationwide child protection programme to combat child abuse, following alarming statistics revealing that more than 26 000 cases of child abuse and neglect were reported in the 2024/25 financial year. Preventing Child Abuse: National Efforts Childline South Africa offers a 24-hour toll-free helpline (116) for children and families in distress. Child Welfare South Africa provides support and services to vulnerable children and families. Contact them at 0861 4 CHILD (24453) or via email at info@childwelfaresa.org.za. Save the Children South Africa carries out programmes to avoid violence by strengthening the ability of schools and community-based organisations, reaching thousands of adults and children through projects like the Vikela Nwana project. The Teddy Bear Foundation offers holistic, integrated services to children that have been abused, including victim support services, prevention and early intervention, a teen mom programme and community outreach. Immunisations: Protecting Children's Health Immunisation is a critical component of child health, protecting against diseases like polio, measles, hepatitis B, tuberculosis (TB), and meningitis. In South Africa, immunisations are available free at state clinics, with the first vaccines given at birth. Timely vaccination is crucial for children's health and well-being. Early Childhood Development: Building a Strong Foundation Early Childhood Development (ECD) is important for children's mental, emotional, and social growth. Quality ECD programmes improve school readiness, academic achievement, and lifelong well-being, particularly for children from disadvantaged backgrounds. Supporting Child Protection: How You Can Help - Report Abuse: If you suspect a child is being abused or neglected, contact Childline South Africa at 116 or Child Welfare South Africa at 0861 4 CHILD (24453).
- Stay Informed: Educate yourself about children's rights and protection measures.
- Get Involved: Support organisations working towards child protection and ECD through donations or volunteering.
- Promote Awareness: Engage in conversations about child protection within your community to foster a culture of safety and care.
By participating in Child Protection Week and supporting ongoing initiatives, we can collectively ensure a safer and healthier environment for all children in South Africa. For more information, Go to: the South African Government's official page.
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