By: Lunga Memela (Communication Engagement Lead)
Life is precious. Life is short! Life is full many of twists and turns, but also with incredible moments that we cannot afford to miss out on if we have any control over living just a little longer, surrounded by our loved ones.
This is why when our health is riddled with any form of sickness – be it acute illness or any form of chronic condition – we ought to remember that there is hope! This hope lies purely in medical science, and patients on chronic medication who practise healthy living know very well that the benefits of taking their treatment as prescribed by the doctor results in much-desired longevity.
While there are hundreds of chronic conditions in the world, the most common in South Africa remain diabetes, high blood pressure, HIV/AIDS and TB. For HIV positive patients, for instance, there is clear evidence from this UNAIDS Undetectable = Untransmittable (U=U) explainer that if you take your chronic medications as prescribed, the health benefits are manifold. Health experts confirm that if you have a chronic condition, take the right medication, and lead a healthy lifestyle, with the correct care and support you can live a long and satisfying life.
Health Systems Trust (HST) staff have been hard at work supporting the Department of Health over the years registering individuals diagnosed with chronic conditions to the free and convenient service called CCMDD (Central Chronic Medicine Dispensing and Distribution) / dablapmeds or 'Get Checked. Go Collect' (GCGC). The mechanism allows you to collect your government-issued medication for free at convenient collection points across the province including the likes of Dis-Chem, Clicks, Sparkport, and Pick n Pay.
The net was cast wider when HST launched a series of CCMDD radio campaigns that raised awareness, especially amongst KwaZulu-Natal residents about the benefits of adherence to chronic mediation through CCMDD. The messaging intensified ahead of the December 2021 holidays where the gospel of adherence flashed across digital media platforms – HST's website, HST Facebook, HST Twitter, HST LinkedIn and GCGC Facebook – all lobbying for the renewal of chronic medication scripts and for the early collection of medicine parcels at 2 800 pick-up points (PuPs) across South Africa so that no patient would be found short of medication during the festive season.
Pandemic fatigue aside, it is now January 2022 and so we need to activate more ‘Adherence Custodians’ within our circles in order to promote return-to-care amongst those who might have missed taking their chronic medication over the festive season, and also to encourage those who qualify to register and benefit from the convenience of CCMDD.
The Deputy Director-General for Health Services in KwaZulu-Natal, Mr Mfowethu Zungu next to HST CEO, Dr Themba Moeti at a recent quality assurance, facility accreditation and licensing project progress briefing session.
The Deputy Director-General (DDG) for Health Services in KwaZulu-Natal (KZN), Mr Mfowethu Zungu, recently held a briefing session that was attended by the Health Systems Trust (HST) CEO, Dr Themba Moeti, in Ilembe Health District. The briefing highlighted the benefits of an ongoing quality assurance, facility accreditation and licensing project where HST has supported the provincial health department in the context of health systems strengthening for implementation of priority health programmes.
HST's Health Systems Strengthening (HSS) unit provides technical support to the Department of Health (DoH) through strategic use, analysis and distribution of information about health and related fields to enhance district-based services as well as health system performance, especially facilitating the scale-up of HIV and TB service delivery.
The DDG invited HST to a briefing attended by National Health Insurance (NHI) Support Project teams, together with the departmental NHI Unit team, where deliberations were held regarding the impressive progress made through the partnership in terms of quality assurance, facility accreditation and project licensing, and the application of technology to strengthen priority health programme efficiency and effectiveness.
The briefing reiterated that the primary objective of the NHI is to achieve universal access to quality healthcare services in South Africa, in accordance with Section 27 of the Constitution. This is based on the principle of social solidarity and where the comprehensive healthcare services provided by the NHI are bound by the philosophy of holistic approach to healthcare, spanning from preventative strategies all the way to convalescent and palliative care.
HST's support to the KZN's DoH has seen the successful implementation of a Synchronised National Communication in Health (SyNCH) system, which is improving access to medicines for patients with chronic diseases including HIV, TB and noncommunicable diseases such as diabetes and hypertension supporting prescribing and monitoring of patient medicine parcel collection electronically, as enshrined in the health department's NHI pledge.
SyNCH enables online patient registration on the CCMDD (Central Chronic Medicine Dispensing and Distribution) programme. It enables electronic submission of prescriptions to CCMDD service providers, scanning capability for medicine parcels issued to patients, and an automated reporting platform. The DoH now uses SyNCH for improving efficiency and management of the CCMDD programme.
DDG Zungu thanked HST for its unyielding support since the partnership's inception. In collaboration with the service provider, ASG Solutions, HST has effectively implemented and quality assured a performance management system and conducted standard operating procedure (SOP) training to the provincial NHI team. The highlights were presented at the briefing by the CEO of ASG Solutions, Dane Wilson, who said one of the most rewarding feelings of being part of the partnership is knowing that the work done is ultimately improving public health service delivery.
ASG Solutions CEO, Dane Wilson.
One of the highlights of the day was an early morning demonstration of how ASG Solutions, in partnership with HST and theDoH, and as part of application of information technology systems to strengthen programme delivery and improve patient access to health services has supported the implementation of an effective ambulance accreditation system at the health district level.
Discussions also included how to achieve universal health coverage (UHC) even better through innovation and strategic partnerships; taking advantage of digital platforms on e-Health; practical compliance with NHI regulations; the formalisation of work processes through SOPs; and managing and monitoring performance using transparent frameworks. Driving job satisfaction through innovation, the performance management system and on-time-monitoring and reporting was also covered.
Dr Moeti said although there is still a huge amount of work to be done, health systems strengthening is at the heart of the work done by HST in support of DoH initiatives. "To enable the programmes HST supports and to help build a stronger, more efficient and sustainable health service through appropriate deployment of technology inevitably enables the country to make progress towards its targets for HIV and TB service delivery and epidemic control, as well as improving universal access to quality health services," he said.
HST CEO, Dr Themba Moeti.
Dr Moeti said the long-term sustainability of programme investments is critical, and therefore health systems strengthening and quality improvement efforts need to take advantage of technology and its application. He applauded the DDG and his team for excellent work done and targets met. He said, amongst other TB and HIV service delivery targets, reaching the 95-95-95 targets for HIV and TB epidemic control, as part of the global effort to end the AIDS pandemic by 2030 required effective leveraging of programme investments towards health systems strengthening.
The scramble for COVID-19 vaccines: its production, supply and distribution, especially in developing countries, has highlighted the urgent need, once again, for universal health coverage (UHC). It was on 12 December 2012 that the United Nations (UN) General Assembly endorsed a resolution urging countries to accelerate progress toward UHC – the idea that everyone, everywhere should have access to quality, affordable healthcare.
On the day in 2017, the UN proclaimed 12 December as International UHC Day, calling on nations to demand action on UHC and calling on leaders to invest in health systems for all that leave no one behind as per the theme for 2021: Leave No One's Health Behind: Invest in health systems for all. "Our lives, livelihoods and futures depend on it," advises the UN.
What is Universal Health Coverage?
According to the World Health Organization (WHO), UHC means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
This YouTube clip on UHC from WHO emphasises that good health needs people, services, products, finances, policies and information; and it needs all of them to work together even in times of crisis. "Good health systems don't just treat sick people, they help to promote healthy living and prevent people from falling ill in the first place."
The Health Systems Trust lobbies for UHC in the South African context
The 15th edition of the District Health Barometer (DHB), a flagship publication of the Health Systems Trust (HST), provides information across a wide range of district health services and spans 30 indicators. The main focus of this edition was again on the Sustainable Development Goals and the UHC Index as an approach to measuring equity and progress with policy implementation. "The publication presents burden-of-disease data, coupled with the unprecedented impact of COVID-19, a chapter on the evolution of the COVID-19 pandemic and health system responses in South Africa, with an analysis of provincial data and lessons learnt from the Western Cape," said HST CEO, Dr Themba Moeti, upon its release.
Over the years the publication has provided policy-makers, healthcare workers, planners, researchers, academics and other consumers of national health system information with a unique overview of the performance of public health services in South Africa. The DHB plays an important role in providing information for district managers to benchmark their districts against others in the country and in strengthening the use of data for priority-setting and decision-making.
HST is a leading role-player in the South African public health arena, focusing on health systems strengthening, research, and strategic support to the implementation of priority health programmes. Its vision for 'Improved health equity in a healthier Africa' goes hand-in-hand with the very concept of making UHC a reality.
Access WHO Director-General, Tedros Ghebreyesus' keynote speech for International UHC Day 2021. Also see this short clip, a statement from the Director-General as UHC Champion.
By: Sphindile Magwaza and Lunga Memela
The Health Systems Trust (HST) backed public and private sector entities in support of the Departments of Health (DoH) and Social Development (DSD), District AIDS Councils, men's health fora, and the Office of the Mayor in eThekwini to promote a comprehensive 365 Days of Activism for No Violence against Women and Children. This call was made on 25 November 2021 during a launch of the global 16-day campaign hosted by the KwaZulu-Natal (KZN) Office of the Premier at the International Convention Centre in Durban.
The South African Police Service (SAPS) and the Health and Social Development Departments attest to local communities being overwhelmed by extremely high statistics of violence against women and children. They advise that victims of violence should experience no shame or stigma, and that women, girls, the LGBTQI+ community, boys and men should be encouraged to speak out if they ever fall victim to any form of violence.
The event was officially opened by KZN Premier Sihle Zikalala and attended by dignitaries who all said: Enough is enough!
In her opening remarks, Social Development Minister Lindiwe Zulu said: "I would like to join my colleagues and reiterate the salient point that any form of violence against women and children, be it physical, emotional or sexual, is an affront to our basic decency and humanity. It is a gross violation of women and children's fundamental human rights and there is no excuse for it. And that is why we are here today: because together, we have the power to do something about it, in our individual capacities, as a collective, and as a nation."
Minister Zulu explained that the 365 Days Child Protection Programme of Action is an initiative to strengthen the government's commitment and response to prevention of and protection for children against violence, abuse, neglect and exploitation. "The purpose is to scale up interventions geared towards promotion and protection of the rights of children during this difficult period of the COVID-19 pandemic and beyond. The campaign is integrated with the seven INSPIRE strategies for ending violence against children, which is a technical package for preventing and responding to violence against children. It is our plan to align the 365 days campaigns with the District Service Model so as to reach people on a local level for them to see the difference in the delivery of services."
The seven INSPIRE strategies are: implementation and enforcement of laws; norms and values; safe environments; parent and caregiver support; income and economic strengthening; response and support services; and education and life skills.
Zulu said that the DSD was committed to stimulating dialogue with men to identify challenges and pledge actions against violence as community leaders. She called for the participation of men, even boy children, to learn while young about valuing women, and for private and NGO partners to support government's efforts to prevent violence against children. She expressed hope that the prevalence of this violence in the country will decline.
The Premier's Office has subsequently launched a KZN Gender-based Violence and Femicide Strategy, which is underpinned by the following six pillars:
Pillar 1: Accountability, co-ordination and leadership
Pillar 2: Prevention and rebuilding social cohesion
Pillar 3: Justice, safety and protection
Pillar 4: Response, care, support and healing
Pillar 5: Economic power
Pillar 6: Research and information management
Team HST at the exhibition stand.
HST's involvement on the day
The Health Systems Trust hosted an exhibition stand at the ICC on the day, with collective representation from the SA SURE Project, the Unfinished Business for Paediatric and Adolescent HIV (UB) Project, the CCMDD/Dablapmeds programme, the MINA men's health campaign, as well as the Communications Unit.
Among the service-related activities and information presented by the HST teams at the event were:
The dignitaries and event organisers thanked the NGOs for showcasing their programmes that assist communities and families to mitigate all forms of violence − including hate crimes against non-binary and gender-diverse individuals – and to address the impact of gender-based violence and femicide.
We can't deny that the December 2020 festive season was terribly depressing with masks on every day, excessive hand-washing, sanitisers galore, and practicing social distancing as our primary protection against catching and spreading novel coronavirus (COVID-19). Apart from improved hygiene practices, the globe at large felt pretty gloomy. Hard lockdowns, travel restrictions, rising death tolls and not being able to visit our loved ones was unbearable. Trolling the media and reading about the increased number of ambulances roaming the streets in aid of the ill did, from a mental wellness perspective, not paint a pretty picture at all. It's now December 2021, the past few months have seen the discovery of new strains of COVID-19, but still, we dare to say there is HOPE! How so? The answer lies in the scientific evidence of vaccines.
In an article published by the Health Systems Trust at the end of October during Global Media and Information Literacy Week, readers were reminded of the World Health Organization's (WHO's) recording of numerous vaccine success stories, spanning across pandemics and diseases including measles, varicella, meningococcus, polio, tetanus, hepatitis, pertussis, influenza and diphtheria. We're all keen to queue up for the seasonal 'flu shot' at the beginning of every winter, so might our scepticism around the COVID-19 jab not soon be overridden by the reality that this new vaccine is soon becoming the only clinical preventative norm?
Vaccine hesitancy is stifling progress
Coupled with the outbreak of any pandemic in our day and age, is what WHO has coined an infodemic. An infodemic occurs when too much information, including false or misleading information in digital and physical environments, occurs during a disease outbreak. "It causes confusion and risk-taking behaviours that can harm health. It also leads to mistrust in health authorities and undermines the public health response."
Despite mass communication and unyielding public health advocacy by the National Department of Health (NDoH) through its SA Coronavirus portal, what could still cause members of society to remain vaccine hesitant when COVID-19 statistics and the tracking of SARS-CoV-2 variants by the National Institute for Communicable Diseases (NICD) are so alarming?
The NICD named the new variant of concern (VoC) B.1.1.529, Omicron. Its current earliest detection in South Africa was on 8 November in Gauteng, and Omicron has now been detected in 28 countries worldwide. Frequently asked questions for the B.1.1.529 mutated SARS-COV-2 lineage in South Africa are answered here.
The NICD advises that, "All viruses, including SARS-CoV-2, the virus that causes COVID-19, change over time. Most changes have little to no impact on the virus' properties. However, some changes may affect the virus's properties, such as how easily it spreads, the associated disease severity, or the performance of vaccines, therapeutic medicines, diagnostic tools, or other public health and social measures." The Network for Genomics Surveillance in South Africa (NGS-SA) continue to monitor and assess the evolution of SARS-CoV-2.
The above reasons are why all efforts should go towards promoting the NDoH's ongoing Vooma Campaign. If you love your family and friends, then shouldn't you be taking every precaution to protect them from COVID-19?
Let's support Vooma Vaccination Week
The NDoH has dubbed 3 to 10 December Vooma Vaccination Week – a campaign aimed at encouraging as many South Africans as possible to get vaccinated against COVID-19, especially as we enter this year's festive season. During this time, most people travel across provinces (sometimes crammed into public transport where social distancing is not always possible) to spend their holidays with loved ones, running the risk of catching and spreading COVID-19. Super spreader events and people congregating in shopping malls and on the beachfront and other recreational areas is also likely to increase the upsurge in the fourth wave.
Eyewitness News published an article warning that scientists on Monday stressed the characteristics of the COVID-19 pandemic's fourth wave are vastly different from what was experienced with previous surges. The article said there was now a far more rapid uptick in the number of new coronavirus cases being recorded daily when compared to the pandemic's third wave."
We are living in 'a new chapter in the COVID-19 pandemic' say University of KwaZulu-Natal scientists, Professors Salim and Quarraisha Abdool Karim in their journal article published in The Lancet, speaking about the new Omicron SARS-CoV-2 variant. The Abdool Karims say Omicron emerged in a COVID-19-weary world in which anger and frustration with the pandemic are rife amid widespread negative impacts on social, mental, and economic wellbeing.
"Although previous variants of concern (VoC) emerged in a world in which natural immunity from COVID-19 infections was common, this fifth VoC has emerged at a time when vaccine immunity is increasing in the world." In the case of COVID-19, the importance of timeous vaccine update and roll-out should not even be questioned.
Which part of the solution are you?
Are you an innovator, and early adopter, part of the early majority that took up the vaccine, the late majority or simply a laggard?
An illustration of Behavioural Change Theorist, Everett Rogers's Diffusion of Innovations theory.
"On Nov 25, 2021, about 23 months since the first reported case of COVID-19 and after a global estimated 260 million cases and 5.2 million deaths, a new SARS-CoV-2 VoC, Omicron, was reported. The emergence of the alpha, beta, and delta SARS-CoV-2 VoCs were associated with new waves of infections, sometimes across the entire world," say the Abdool Karims.
"One reason that Professor Salim Abdool Karim, Professor Shabir Madhi, Dr Glenda Gray, Professor Francois Venter, the amazing people at the National Institute for Communicable Diseases and a host of others are so valuable to our nation is that they help the public understand what's going on," said the Daily Maverick in a recent article: Sorting the real from the rubbish and challenging those who stir the Omicron pot of fear.
"Vaccine hesitancy will not be overcome with threats — we need to use behavioural science to convince the sceptics," says the Daily Maverick in another insightful article.
The debate around vaccine hesitancy may go on for a while, but we're humans first, and all we have is our health. Why not rather protect ourselves and our loved ones this festive season by simply taking the jab? Arm yourself with the scientifically-based information. It is readily available. Avoid social media groups that spread mis- and disinformation. If you're not sure of the veracity of a post consult the https://www.real411.org/.
Today is International Day of Persons with Disabilities (IDPD) and what better way to acknowledge this than to shine the spotlight on South Africa's stellar dancing sensation, Musa Motha. He is living proof that persons with disabilities are nothing short of amazing! His story was well captured by this CNN Style article, and it ushers us into celebrating persons and disabilities and commemorating IDPD befittingly. "After losing his leg, South Africa's Musa Motha is inspiring with every move," the article highlights.
The World Health Organization (WHO) says IDPD is about promoting the rights and well-being of persons with disabilities at every level of society and development, and to raise awareness of the situation of persons with disabilities in all aspects of political, social, economic, and cultural life. WHO joins the United Nations in observing this day each year, reinforcing the importance of securing the rights of people with disabilities, so they can participate fully, equally and effectively in society with others, and face no barriers in any aspects of their lives.
According to WHO, "More than 1 billion people experience disability, and this figure is predicted to rise, due in part to population ageing and an increase in the prevalence of noncommunicable diseases. Despite this, few countries have adequate mechanisms in place to respond fully to the health priorities and requirements of persons with disabilities".
The growing need to commemorate highlights these key messages:
Also lobbying for persons with disabilities are contributors to the Health Systems Trust's South African Health Review 2020 (SAHR) which was released under the theme: Access to health care for persons with disabilities in South Africa.
The Chairperson of HST's Board of Trustees, Dr Dumani Kula said, "Chapters in the Review provide information on the multitude of challenges associated with providing a seamless continuum of appropriate and adequate care for persons with disabilities in the public health sector.
"These challenges include human resource constraints, fragmented and under-resourced rehabilitation services, lack of appropriate assistive devices, and the adoption of an overwhelmingly medicalised approach to disability, all of which translate to poor availability, affordability and access to health services for persons living with disabilities. This results in many persons with disabilities being denied the opportunity to reach their full potential," he continued.
The United Nations does have a Disability Inclusion Strategy in place, which provides the foundation for sustainable and transformative progress on disability inclusion through all pillars of the work of the UN. Through the Strategy, the organisations of the UN system reaffirm that the full and complete realisation of the human rights of all persons with disabilities is an inalienable, integral and indivisible part of all human rights and fundamental freedoms.
Also read the Secretary-General's progress report on the implementation of the Strategy.
By: Judith King (Copy and Content Editor: SA SURE)
Thabo Nkosi – HST Lay Counsellor for the MINA programme in uThukela.
HST Lay Counsellor Thabo Nkosi serves the MINA programme for men's health at Ekuvukeni Clinic in Ladysmith, uThukela District. He works hand in hand with Department of Health Professional Nurse Thuthukani Mthembu, who conducts clinical screening, while Thabo conducts counselling to bring men into care.
"We are committed to reaching as many men as possible through routes such as community mobilisation of the MINA Campaign, and index contact testing to identify male partners of women diagnosed as HIV-positive," Thabo explains. "This man-to-man connection makes it easier for men to open up about their health concerns, and enables us to support our clients in realising that the responsibility for their own and their loved ones' wellbeing lies within them. We fast-track them for testing and treatment, and usher them through the journey of care."
This is not a rapid process, nor an easy one. Thabo encounters many instances of intimate partner and gender-based violence among all age groups, and has supported individual men and women, as well as couples, to free themselves from the cycle of physical, sexual, emotional, and even financial harm and exploitation.
"Behind each person's predicament − even as a perpetrator − there is always some form of deprivation, neglect and/or abuse that they have suffered," he says. "Improving their health requires building a rapport with them, and helping them to deal with various social dynamics and circumstances."
As a skilled communicator with strong experience in community engagement, he brings his academic background in Psychology and a passion for helping people to his counselling work. "This service opens the door to a new path of support, purpose and holistic health for clients," he shares. "It begins with the first counselling session, where − before probing for details − I reassure them that I see how they are struggling, and that here, they are safe, respected, and not judged. It's important to engage with them kindly and confidently."
When two partners test positive for HIV, a first session of couples' counselling typically descends into the man blaming the woman for his infection. In one such case, Thabo found that even though both partners were already on treatment, they were both unemployed and unable to afford food, which made adherence to medication difficult. They were not using condoms, and the male client was beating his girlfriend every day.
"The boyfriend felt disempowered," he explains, "and was taking this out on her, physically and emotionally." After giving the couple clear facts about their health needs and guidance for better communication between them, Thabo referred them to a Department of Social Development (DSD) Social Worker, who ensured that they received ongoing assistance with food supplies and more in-depth counselling. Thabo regularly follows up on their welfare, and they keep in touch with him. "They've told me that they recognise how much they needed this support," he says, "and they're doing well together now. One could sense that despite everything, they have a bond of love."
Thabo maintains a list of clients to prioritise for extensive counselling. One of these was a young transgender client who presented at the clinic with a sexually transmitted infection, and was emotionally 'shut down'. Alone in the world, he made a living through odd jobs and transactional sex (often being abused in the process), and was bullied by community members for being gay. "He felt more worthless every day," says Thabo, "but has slowly made progress since attending the clinic. He is now registered for a learnership and wants to do social work so that he can use his experience to help others. You see – we are all born for something good."
In Ekuvukeni, substance abuse is rife among men and women in the 19−35-year age group, which leads to a wretched life aggravated by the risk of numerous viral infections from needle-sharing among injecting drug-users, and sexual assault through disinhibition. "These clients have HIV and other STIs, but no relationships – and so the cycle of despair and illness continues," says Thabo. "While our clinic staff cannot provide all the services that they need, we partner with organisations like Families South Africa (FAMSA) to help them with professional counselling and rehabilitation support."
Nonetheless, Thabo goes above and beyond to be of use. To entrench the personal attention that men need for psychosocial support, he gives male clients his private phone number so that they can contact him at any time. "Sometimes they're reluctant to share everything about particularly sensitive topics during the counselling session – once home, they feel more comfortable with going into detail and asking further questions during a follow-up call." He also conducts counselling for the clinic's Adolescent- and Youth-friendly Services (AYFS) programme on Saturdays, so that he can support school-going boys through integration with the MINA Campaign.
Thabo sees a need for other targeted interventions, such as support groups, and urging community members through mobilisation and education to come forward when they witness gender-based abuse. "Through our outreach efforts, we receive 'hearsay' referrals, but we could address more of these cases were there a groundswell of awareness about how people can be linked to services."
By: Antoinette Stafford Cloete, Health Systems Trust Communications Manager
Nearly 1 in 3 women have been abused in their lifetime. Some have been abused multiple times by multiple perpetrators. During times of crisis such as wars and, currently, the COVID-19 pandemic, the situation worsens for women.
In 1979 the UN General Assembly adopted the Convention of the Elimination of All Forms of Discrimination Against Women (CEDAW), and in 2008 launched an initiative called UNiTE to End Violence against Women, but despite their endeavours, violence against women and girls remains pervasive.
Globally, many countries flout the policies of international bodies such as the United Nations by continuing to maintain practices that disadvantage female victims of abuse.
As in the past, the International Day for the Elimination of Violence Against Women, which starts on 25 November, launches 16 Days of Activism and concludes on 10 December, which is recognised as International Human Rights Day.
Orange the World
To raise awareness around the scourge of women abuse the theme, "Orange the World: End Violence Against Women Now" has been adopted as the theme for 2021. Orange is a colour representative of a brighter future, free of violence against women and girls.
The campaign has been led by the UN Secretary-General and UN Women since 2008 and aims to prevent and eliminate violence against women and girls globally by promoting advocacy, and creating awareness and opportunities for dialogue on solutions.
In 2017, the European Union (EU) and the UN launched the Spotlight Initiative, which aims to eliminate all forms of violence against women and girls by raising the awareness of this issue, in line with the 2030 Agenda for Sustainable Development.
Why is addressing gender-based violence such an important issue?
Violence in society affects us all.
Research conducted world-wide shows a direct correlation between violence against women and the weakening of social fabric, an increase in civil oppression, and the use of sexual oppression as a tool of war.
It doesn't have to be this way.
The right policies and programmes can work towards tackling the root causes of violence, thereby protecting the rights, bodies and minds of women and girls.
What about South Africa?
Unfortunately, enduring abuse is a reality for too many women and children in South Africa. The rights of women and children are fundamental human rights protected by our national Constitution. Gender-based and child violence, in all its different forms, devalues human dignity and the self-worth of the abused person and must be eliminated. For this to work we need to adopt a multi-fold strategy to deal with identifying abuse, supporting the victims, doing better at incarcerating and/or rehabilitating the perpetrators and educating society as a whole.
Why is this campaign important?
Creating awareness around the various forms of abuse and how it infringes on your human rights is important because many people undergo daily hardship at the hands of people, invariably, who are closest to them such as an intimate partner or father. Recognising abuse is a big step towards working towards eliminating it from society since many forms of abuse have become common-place and have remained unchecked over time.
What is abuse?
It can be described as any form of harm where someone or a group of people are:
No-one should have to live in such fear of reprisal because of another's need for control. That is why the campaign seeks to educate society about recognising the signs of abuse and what to do in situations where abuse is suspected via governmental, private sector, civil society, media, not-for-profit organisations and other entities.
It seeks to generate an increased level of awareness among all South Africans about violence against women and children and to empower society with information and support services that can help reduce the impact of abuse.
At the Health Systems Trust (HST) we run programmes such as The Unfinished Business for Adolescent and Paediatric HIV that works to support the health system in districts in the KwaZulu-Natal province with testing of the under-19 years of age group to get them on treatment. Adolescent girls and young women are particularly vulnerable to predators and are at risk of infection because of rape and transactional sex. These are issues that are also dealt with at health facilities through what is known as Adolescent Youth-friendly services.
HST's MINA programme
Men and boys, in particular, need to be engaged in the discourse around eradicating violence in our homes, communities and the workplace. Because most societies have historically been patriarchal, unequal ways of doing have developed over time that have entrenched ideologies that women are inferior, are property, should be home-based, have no voice, etcetera, even when living in countries that are constitutional democracies.
Big changes need to be made and will take the active participation of all levels of society.
What can you do?
Where to go for help?
You can contact the following organisations to report women and child abuse and to get more information:
We've all had to rely on medicinal drugs (antimicrobials) to feel better and recover from various health conditions. It is great to recover, but what if you cannot heal due to your body growing resistant to the very drugs meant to help you? Antimicrobials range from antibiotics, antivirals, antifungals and antiparasites.
In his opening message, the Director-General of the World Health Organization (WHO), Tedros Ghebreyesus put things into context saying, "Antimicrobial resistance is one of the greatest health threats humanity faces today. It occurs when bacteria, viruses, fungi and parasites change over time and antimicrobial medicines are no longer effective against them. Anyone, anyone, at any age can get a drug-resistant infection. This could mean longer treatment, hospital stays, higher health costs, lifelong disability, or even death."
He continued: "Antimicrobials including antibiotics, antivirals, antifungals and antiparasites are the backbone of modern medicine. They allow us to treat deadly infections successfully and make essential health services safer for everyone. However, the overuse and misuse of antimicrobials are the main drivers of drug-resistant pathogens. World Antimicrobial Awareness Week is an opportunity to draw attention to this urgent global challenge.
"We need as many people as possible to spread awareness to stop resistance. By practicing responsible use of antimicrobials and by following the advice of your health care providers, you can help preserve antimicrobials and prevent drug resistance. Help us spread awareness and play your part in our shared responsibility to keep these drugs working for everyone, everywhere. We are all in this together."
Spread the message:
What is antimicrobial resistance?
Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites that cause diseases stop responding to medicines. This makes infections harder to treat, increasing the risk of severe illness and even death. The correct use of antimicrobial drugs helps preserve the effectiveness of vital medical treatments.
Why is antimicrobial resistance increasing?
Overuse and misuse of antimicrobials is increasing drug resistance worldwide. Keep medicines working! How?: Don't share or use leftover antimicrobial medicines as this can cause resistance, and take your prescribed treatment in full, even after you start to feel better.
How can YOU prevent antimicrobial resistance?
People with chronic conditions suffer from a weaker immune system. This means that they are at higher risk of being infected with COVID-19 and other opportunistic diseases and, if this happens, they are at higher risk of becoming seriously ill.
People with chronic conditions who are not on treatment or who are not adhering to their treatment are also at greater risk of contracting the virus. For this reason, all such patients should ensure that their condition is well managed and that they adhere to their treatment. This is where HST comes in and supports the Department of Health with CCMDD (Central Chronic Medicine Dispensing and Distribution), or 'Get Checked. Go Collect', a free and convenient service, which allows you to collect your government-issued medication for free at convenient collection points.
The Get Checked. Go Collect website confirms: "Millions of South Africans have chronic conditions such as diabetes, high blood pressure or HIV. The best way to manage a chronic condition is by staying on your medication. To make access to your medicine supplies easier, you can register for the free and convenient service, CCMDD, which allows you to collect your government-issued medication for free at convenient collection points."
The CCMDD service is even more useful to reduce the spread of COVID-19, as it is important to avoid places where many people gather, especially as we approach the festive season.
Inanda Community Health Centre Facility Team Lead, Matron Thembelihle Ndimande; HST's SA SURE Project Programme Manager, Joslyn Walker, and OGAC Senior Advisor, Jirair Ratevosian during the visit.
The Health Systems Trust (HST) was privileged to host Jirair Ratevosian, the newly appointed Senior Advisor to the Office of the U.S. Global AIDS Coordinator and Health Diplomacy (OGAC), during his 16 November 2021 visit to eThekwini's Inanda Community Health Centre (CHC). HST has supported the facility since October 2020, successfully streamlining patient flow, improving the appointment system, and strengthening retention activities, particularly with a TB and HIV reduction focus.
A distinguished advocate for global health and human rights, Ratevosian was recently appointed by American President Joe Biden to serve in the senior advisory position where he is helping to oversee the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), HST's primary funder through the Centers for Disease Control and Prevention (CDC).
The visiting delegation, including the Director for CDC South Africa, Dr John Blandford, and CDC Quality Improvement Branch Chief, Jonathan Grund, was welcomed by the CEO of Inanda CHC, Dr Sethembiso Mncwango together with HST's Director of Health Systems Strengthening (HSS), Ronel Visser, and HSS's South Africa Sustainable Response to HIV/AIDS (SA SURE) Project Programme Manager, Joslyn Walker. The SA SURE Project supports the Department of Health (DoH) to provide sustainable HIV and TB-related care and treatment service delivery through training, mentoring, coaching and direct service delivery. The four health districts supported by the SA SURE project in KwaZulu-Natal are eThekwini, uMgungundlovu, uThukela and Zululand.
Inanda CHC CEO, Dr Sethembiso Mncwango, speaks
about the challenges and success stories of the facility.
Challenges in service delivery
Painting a picture of the work that happens on the ground, Mncwango highlighted that Inanda CHC is the second busiest health facility in eThekwini after KwaMashu CHC. It has nearly 10 600 patients on antiretroviral therapy, and it offers an array of health services to the greater Inanda Township despite the number of challenges including: space is severely constrained, extreme poverty, unemployment and substance abuse in the area.
The outbreak of COVID-19 certainly interrupted HIV service delivery and the provincial riots of July 2021 had a major impact on DoH's HST-supported Central Chronic Medicines Dispensing and Distribution (CCMDD) programme, Mncwango said. The looting and vandalisation of chronic medication pick-up points had a ripple effect on adherence, medical appointments, and the monitoring and evaluation of preventative interventions through the Synchronised National Communication in Health (SyNCH) programme.
How HST has assisted
HST Data Filing Clerk, Jessica Khanyile, walks the visiting delegation through the new and more effective filing system.
"We've got a footprint across the country," said HST's HSS Programme Manager, Joslyn Walker, when giving an overview of the organisation to the visiting delegation. Not only does HST's PEPFAR programme support the DoH at all levels of the health system (provincial, district, facility and community), HST has also grown to be CDC South Africa's largest and highest-performing district support partner.
One of the biggest highlights of HST's work at Inanda CHC has been the implementation of a highly effective case management approach, which has resulted in organised and functional filing rooms; effective appointment systems; and client-centred communication.
Whether tested in the community or at the facility, HIV testing personnel refer clients directly to clinicians for same-day initiation and immediate linkage to treatment. They trace patients who miss appointments within seven days – all efforts being a major win for HIV prevention, testing, treatment initiation, adherence, return to care and overall service delivery. "Case management starts with an effective appointment system. Improved filing systems really changed the patient flow," Walker explained.
Inanda CHC has also seen an impressive increase of the total number of clients remaining on ART (or TROA) from July 2020 to September 2021. With increased HIV testing, there has been an increase in case finding. ART optimisation improved consistently despite stock-outs, the July riots and the COVID-19 outbreak. The Men's Health Campaign (MINA) was successfully launched at Inanda CHC.
Also noteworthy, HST's case management approach has improved viral load management for clients, pinning a clear focus on the 95-95-95 goals with the objective to promote viral load suppression that results in HIV being undetectable and therefore untransmittable (U=U).
Walker reported that effective case management has resulted in the reduction of missed appointments, and that waiting times have been reduced by half at the facility. The same HIV case management approach has been adopted for managing TB. "TB-presumptive and TB-diagnosed clients are case-managed and followed up with closely for treatment initiation," Walker added.
The visiting delegation was taken on a walk-through of the facility, giving them a first-hand experience of service delivery at the facility. HST and Inanda CHC staff were present to answer questions and explain the day-to-day dealings of the facility.
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