By: Lunga Memela (Communications Officer)
There is increased dialogue, hope and a positive outlook on adherence to chronic medication amongst KwaZulu-Natal (KZN) residents, thanks to the successful launch of the Health Systems Trust's (HST) 2021 Get Checked. Go Collect radio campaign promoting the Department of Health's National Health Insurance initiative, CCMDD (Central Chronic Medication Dispensing and Distribution) / Dablapmeds.
A sequel to previous CCMDD radio campaigns, this year's 10-week campaign kick-started with a live radio interview on the popular Gagasi FM evening show, Indaba with Alex Mthiyane, who interviewed HST's Roving Pharmacist and Radio Champion, Charity Mchunu, recapping on 'what is CCMDD and who qualifies for this free service'?
Topics have included important information about Pelebox smart lockers and CCMDD pick-up-points which include local pharmacies, and shops like Dis-Chem, Clicks, Sparkport, and Pick 'n Pay. The best part is that the shows span across KZN's regional and community radio stations – Gagasi, Imbokodo, Inanda, Izwi LoMzansi and Vibe FM – enabling wide reach and proactive engagement about CCMDD, especially the time of COVID-19.
HST explains that CCMDD is even more useful during the COVID-19 pandemic when it is important to avoid long queues and crowded places to reduce the spread of the coronavirus. By registering for this service, stable patients on chronic medication can avoid busy government clinics and collect medication at over 200 collection points in eThekwini.
Promoting adherence will remain an ongoing endeavour. Further radio topics are scheduled to cover CCMDD and COVID-19, debunking COVID-19 and vaccine myths, adherence and the benefits thereof, healthy living, as well as mental wellness as a chronic condition.
It is common knowledge that millions of South Africans have chronic conditions such as diabetes, high blood pressure or HIV. HST affirms that best way to manage a chronic condition is by staying on your prescribed medication and that patients who are stable on their medication can register for CCMDD.
HST's KZN CCMDD Provincial Co-ordinator, Roma Ramphal confirmed that the organisation's radio champions are not only knowledgeable and passionate about promoting adherence to chronic medication, but also that they strongly believe that CCMDD/Dablapmeds can effectively prolong life and livelihoods, ease the disease burden within the local communities and curb the spread of COVID-19. Kudos to our radio campaign champions: Charity Mcunu, Nolwazi Mpithi, Noni Sithole and Thulisile Bekwa together with HST health experts: Drs Nkosingiphile Gama, Tinyiko Khosa and Mbalenhle Nxele.
Don't forget to visit and Like the Get Checked. Go Collect. Facebook page.
By: Judith King (Copy and Content Editor: SA SURE )
Tidying the contents of a filing room might not strike one as being a task that could enhance patients' experience of service delivery and health outcomes − but the work done by HST's SA SURE team at Phoenix Community Health Centre (CHC) in eThekwini proves otherwise.
Prior to October 2020, Phoenix CHC faced the challenge of a disorganised filing system, with congested shelves, torn folders, and high numbers of missing files that resulted in the creation of duplicates.
To support technical analysis of the problem, Health Systems Trust's (HST's) Sr Noluvuyo Sibisi (Facility Team Lead) conducted a file retrieval efficiency assessment using a CDC scorecard. For this test, 20 patients' names were identified from an appointment list generated by Data Capturers. Two Filing Clerks were each given 10 patient names whose files were to be retrieved, each within five minutes. Any file that was not found within this time failed the assessment, and the percentage of files found was calculated against the 20 names on the list. Because of the disarray in the filing room making retrieval difficult, the facility scored 40%.
This situation contributed not only to poor data availability, quality and management, but also to longer queues and waiting times for patients, and a negative effect on their continuum of clinical care through delays in service delivery.
With the supportive engagement of Mr BT Zwane (the facility's Assistant Director of Systems), the SA SURE team − led by Sr Sibisi, Area Co-ordinator Philani Bhengu, and Area M&E Co-ordinator Bonginkosi Ndlovu − devised an intervention plan to strengthen the CHC's filing system.
From left: Mr BT Zwane (DoH); Mr B Ndlovu (HST); Sr N Sibisi (HST) and Mr P Bhengu (HST).
This entailed the deployment of a Filing Clerk Team Lead and an Assistant Filing Clerk Team Lead with eight temporary Filing Clerks to rationalise and re-archive approximately 16 800 files – covering HIV/AIDS, STI and TB patients, as well as general patients.
Sr Sibisi, Mr Bhengu and Mr Ndlovu designed a set of tools to monitor implementation of the intervention, comprising Daily Tally Sheets, a Daily Reporting Tool, a Missing Files Register, and a list of identified dormant and duplicate files.
From 28 December 2020 to 15 January 2021, each member of the Filing Clerk squad worked through the holiday season and on weekends to sort 150 files in sequence per day, and to:
The team's unwavering commitment ensured that each member sorted 200 files per day. By close-out of the intervention, they had sequenced a total of 82 938 files, de-duplicated 2 461 files, repaired 11 859 files, and transformed the filing room into a haven of order. The CHC scored 90% in a post-intervention retrieval efficiency assessment.
patient files before and after the intervention.
patient files before and after the intervention.
Commenting on the revamped filing room, Mr Zwane noted that an accomplishment of this nature could not have been completed without the assistance of the HST team. "I am grateful for their wonderful work and continued guidance and support, as well as mentorship throughout the project."
In turn, Sr Sibisi paid tribute to Mr Zwane and the Filing Clerk team: "It always seems impossible until it is done with good team spirit. Consistent hard work ensured the success of the project. The Systems Manager was very supportive and provided the resources required to materialise the intervention."
Our partner's ownership of a project of this calibre is paramount to ensure sustainability of the gains," said Mr Bhengu. "Hopefully, this collaboration will also be cascaded to the lower levels where the actual work is done." Mr Ndlovu agreed: "Continuous collaboration between the DoH and HST teams can envision a health fraternity that serves our community at its best. The filing project was a success because of the dedicated team and commitment they have shown."
Mr S Chuma, HST Filing Clerk Team Lead, noted that “with togetherness, everyone achieves more. We worked very hard as a team and managed to overcome all the challenges encountered.”
"Team work is a vehicle for success," said HST Filing Clerk, Mr Nhlakanipho Parkies. We thank the HST and Phoenix CHC management for affording us as temporary staff an opportunity to work in this facility. We have learnt a lot. The experience and skills we gained from this project will help us to implement the same intervention in other facilities where we will provide support."
By: Judith King (Copy and Content Editor: SA SURE)
Outreach activities for HIV Testing Services (HTS) are designed to reach people who cannot visit a clinic. In communities, there are patients on treatment who require a similar outreach approach.
Patients who are stable on their antiretroviral medication can register on the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme to collect their medicine parcels from conveniently located external pick-up points and adherence clubs, at times that suit them.
However, patients who are not yet stable on their medication, and those who do not meet the criteria for differentiated care, cannot benefit from this option − yet they come from the same disadvantaged circumstances as those who do qualify for CCMDD registration.
"While extended clinic hours and case management have served some of these patients well," says Nomvula Radebe (the SA SURE Project's District Co-ordinator for uMgungundlovu District in KwaZulu-Natal Province), "there are many other patients who struggle with visiting a clinic because of unchanging barriers − even with a properly negotiated adherence plan having been agreed to at the start of their treatment."
Nomvula Radebe, SA SURE uMgungundlovu District Co-ordinator.
In January 2020 − before the COVID-19 pandemic took hold in South Africa − the SA SURE team in uMgungungdlovu launched an innovative solution to improve clinical service delivery for such patients. This intervention strategy entails establishing facility-serviced, Nurse-led outreach pick-up points, as well as home medicine delivery once a month.
A standard operating procedure for the intervention was developed and endorsed by the Department of Health, and the roll-out has been expanded to serve both Spaced Fast Lane CCMDD and non-CCMDD patients at designated community sites that are convenient for them to access, or at workplaces and households.
As the year progressed and we entered 2021, the lockdown restrictions on physical movement and proximity have heightened the need for community-based HIV and other health services, especially in the district's hard-to-reach areas. Clinician-led pick-up points support COVID-19 prevention and control measures by reducing the numbers of people travelling to clinics and decongesting the facilities.
The Nurse Clinicians work with the team's Case Managers and Linkage Officer to ensure that patients – especially those who have missed their scheduled appointments – are returned to care and can make appointments for clinical services in the community.
The Clinicians take the CCMDD patients' medicines that are kept at the facility and deliver them to the outreach pick-up points. Facility-based patients are clustered geographically, registered in an appointment system, and traced via telephone call or SMS. These patients then meet the Nurse at a centralised point in the community, where the patient's medication is issued and other service elements such as HIV Testing Services including index case contact testing, initiation on antiretroviral therapy (ART), viral load monitoring, and script renewal, are provided.
The Nurse Clinician confirms the next appointment date for the patient and documents this on the patient's appointment card and file. The patient's file is updated with details of all services rendered during the visit by the facility's Data Capturer, and this information is recorded in the Health Patient Registration System (HPRS) and TIER.Net – a data management system that is used to capture patients' HIV and TB information at facility level, and which is also integrated with the District Health Information System (DHIS) for reporting various programme data from sub-district to national levels.
“We recommend using of a special register containing notes on the Clinician−patient interaction during the visit,” explains Radebe. “This provides a valuable resource for facility staff to review when seeking to understand the reasons for missed appointments and where new pick-up points can be strategically located – which then guides the identification of stakeholders with whom to engage for establishment of sites.”
A patient is attended to by Linkage Officer
Nhlanhla Dlamini and Campaign Agents Thabisile Dlamini and Gloria Makhonza.
By the end of May 2020, four of the project's 15 Siyenza facilities were implementing this modality for continuation of care, and Impilwenhle Clinic in Edendale (which was the first facility to offer this option), had 12 pick-up points serving an average of 28 patients per site. East Boom Community Health Centre in Pietermaritzburg (a non-Siyenza site) had 207 active patients registered for Nurse-led pick-up points. Siyenza facilities are named after the SA SURE Project’s plan of action called Siyenza (‘We do’).
SA SURE Facility Team Leader Sr Phungula leads the Impilwenhle team that provides services to workers at Steddy Farm, who − along with the farm-owner − have expressed their delight with receiving these services at their workplace.
Productivity is no longer affected by workers having to take a day's leave to attend the clinic, meaning minimal financial loss for the farm, and because they need not spend money on travelling to a clinic, none for the workers.
"We are proud to have seen great improvements since we started this service," says Sr Phungula. "Our patients are stable on treatment; some are virally suppressed and have been registered on CCMDD."
Sr Phungula in the mobile pick-up point.
SA SURE Nurse Clinician Sibongile Hadebe shares her experience of setting up a Nurse-led pick-up point while supporting the Khan Road Clinic in Pietermaritzburg:
"We established an outreach pick-up point at uMsilinga Primary School, and one of the patients I attended to there was grateful to be re-initiated on treatment. She knew several people who had been unable to collect new supplies of their medication because they risked being robbed while walking alone to the facility. She said that she would spread the word about our new, convenient service-point, and was true to her word: 12 patients came to the school pick-up point for our services."
Driver Mobiliser Gracious Dlamini tells of Zandile* whom he knew from Sobantu and now resides at France location. Zandile was a patient whose treatment had been interrupted and was re-initiated on ART by the team. She mobilised more patients who had stopped taking their treatment or had shared their medication in the community to attend the Nurse-led pick-up point for return to care. The site has been named after this patient and its user profile continues to grow. (*Not her real name)
Driver Mobiliser Gracious Dlamini.
By June 2020, the number of sites had increased by 138% from 13 to 32, tripling the number of patients provided with community-based clinical services. By October 2020, 17 000 medicine parcels had been issued through this modality.
The goal is to scale up this service option by at least 100% − from 32 to 59 sites in uMgungundlovu – so that more patients can benefit from its clinical and financial advantages.
The success of this intervention has inspired another implementation project that will help to establish community-based ART services as a standard of care: through the DO ART Demonstration Study, comprehensive HIV screening services, treatment initiation and ongoing community-based management of patients on ART will be delivered in eThekwini and Zululand Districts. The SA SURE Plus project offers ARVs and other chronic medication to clients registered for CCMDD in the eThekwini, Umgungudlovu, Uthukela and Zululand districts.
By: Ms Ashnie Padarath (SAHR Editor-in- Chief)
Looking back at how we started
The first edition of the South African Health Review (SAHR) was launched on 4 October 1995. Comprising 18 chapters and over 30 authors, The Star newspaper described it "as the first of what is to be expected to become the standard annual reference work on the health sector." Twenty-five years later, the SAHR has lived up to this prediction and continues to chronicle the progress and challenges in transforming the health system.
The SAHR is recognised as one of the most authoritative sources of commentary on the South African health system. It is widely used in teaching public health at undergraduate and postgraduate level in South Africa, and by scholars, donors, journalists, policy makers and policy implementers at various levels of the health system.
The origins of the SAHR can be traced back to a meeting held in the modest setting of an orphanage on the south coast of KwaZulu-Natal in August 1994 where a group of thought leaders in the health field identified the need to document the transformation of the health system in a democratic South Africa. Now in its 23rd edition, the aims of the Review are to advance the sharing of knowledge, to feature critical commentary on policy implementation, and to offer empirical understanding towards improving South Africa's health system.
Chapters in the Review comprise a mix of specifically commissioned work reflecting on core health systems' issues as well as current issues of particular importance and findings from topical research. Chapters go through a rigorous peer-reviewed process and each edition is guided by an Editorial Advisory Committee consisting of wide range of leaders in their respective fields.
The Wonder Years: 1995–1999
Earlier editions of the Review reflected the national optimism pervading the country at the time and focused on the need for policy development and a gathering of evidence that would be needed to inform policy-making. During this period chapters in the Review were consistent and focused on imperatives for health systems reform. Some of the key issues flagged were the need to revisit the recommendations of the Gluckman Commission with regards to universal coverage, the development of human resources for health, the development of a National Health Insurance Scheme (NHIS), quality assurance, and the need for comprehensive health care for people living with HIV and AIDS.
Reality Check: 2000–2004
The turn of the century brought with it a change in the political milieu with a new President and new Minister of Health. Chapters in the Review started to move away from broad principles and began to provide an analysis of implementation – looking at issues as diverse as community service, quality and patient rights. Chapters also become wider in their scope and begin to interrogate how the private-for-profit sector, religious communities and traditional healers interact and intersect with the health system. Reviews begin to address the growing burden of disease and attendant decline in life expectancy and the perspectives of people interacting and working within a health system undergoing a prolonged period of transformation.
Growing Pains: 2005–2009
The 10th edition of the SAHR in 2005 marked the beginning of a thematic approach to the publication. While cross-cutting health system issues such as legislation and financing and health and related indicators were still featured in the Review, the lion's share of the publication was devoted to specific thematic issues. The Reviews were produced against the backdrop of the promulgation of the National Health Act, the introduction of antiretroviral (ARV) programmes, the publication of the TB strategic plan and the reports of the Integrated Support Team. These sparked a series of policy reforms and government's commitment to strengthen health systems and reduce inequities which the Review then sought to cover.
Winds of Change: 2010–2014
Material in the Review reflected the wide scope of topics that characterised the terrain of health systems strengthening and began to locate health systems development in within a broader international public health agenda. The 2010 edition entitled Reflections on the MDG's and Perspectives on a National Health Insurance focused on universal health coverage as articulated in the 2010 World Health Report and SA's progress towards meeting the Millenium Development Goals. The 2011 edition focused on the Negotiated Service Delivery Agreement and health systems strengthening using the World Health Organization's six building blocks framework.
In 2012, HST introduced the Emerging Public Health Practitioner Award in recognition of the best article submitted by a young and emerging public health professional for inclusion in the SAHR. This capacity building initiative was followed the introduction of the Healthcare Workers Writing Programme, which offers writing skills training and ongoing coaching throughout the publication process for identified first time authors.
The profile of the SAHR was significantly raised in 2014 when it was officially accredited as a peer-reviewed publication by the Department of Higher Education and Training. This had the effect of broadening the pool of potential contributors and introducing more robust and refined work flow processes.
Leaving no-one behind: 2015–2020
Following the adoption of the Sustainable Development Goals and the release of South Africa's White Paper on National Health Insurance in 2015, chapters in the Review began to reflect on key challenges in implementing universal health coverage and the development of an equitable and inclusive national health system that leaves no-one behind. Data-driven chapters capturing the complexities and possibilities of measuring progress in the implementation of NHI towards UHC became more frequent and provided insight into the calculation of a South African UHC service coverage index. Chapters also foregrounded the country's burden of non-communicable diseases and the health system responses to long-term acute and chronic conditions and diseases.
Building back better: 2020 and onwards
Ensuring that persons with disabilities are not left behind in the country's progression to universal health coverage is addressed in the 2020 edition of the Review. Which provides critical insights into barriers and facilitators, good practices, and successful service delivery models for disability inclusion and rehabilitation. Chapters also reflect the need for South Africans to move away from an overwhelmingly medicalised and individualised approach to disability which focuses on fixing impairments, to a rehabilitation service-delivery model that facilitates the development of holistic well-being and greater socio-economic inclusion for persons with disabilities.
As 2020 draws to a close, the challenge facing South Africans is to reflect on how we can 'build back better' and best use the experience, lessons, and innovations of responses to COVID-19 to build a stronger and more resilient health service. The 2021 edition of the Review is dedicated to unpacking this issue and will consider the impact of Covid-19 on existing health services and programmes; the impact of socio-economic disparities on prevention and treatment; the rationing of health care services, emergence of innovative collaborations and partnerships and the impact of measures taken to balance saving lives with saving livelihoods.
The past 23 editions of the Review highlight and provide a timely analysis of key issues and challenges that must be addressed if the vision of equitable and sustainable access to quality health services is to be realised, in a manner that eliminates current disparities in access, and that overcomes the inefficiencies and challenges of the current health system.
Congratulations to Natasha Esau from HST's Health Systems Research Unit for her recent publication in the BMC Health Services Research journal. She completed her Master of Public Health (M.PH) degree at the University of Cape Town (UCT) in 2018. As part of her M.PH thesis she conducted a study evaluating a 'training-of-trainers programme for clinic committees' in a South African district, and was supervised by Professors René English (Stellenbosch University) and Maylene Shung-King (University of Cape Town).
The National Health Act (2003) mandates provincial health departments to establish clinic committees to provide governance oversight at Primary Health Care (PHC) facilities. This study evaluated a training programme called the 'PHC Facility Governance Structures Trainer-of-Facilitator (ToF) Learning Programme'. The ToF learning programme was a collaboration between HST and the National Department of Health (NDoH) aimed at capacitating clinic committees in order to fulfil this role.
The study assessed whether the intended aims of the training programme were clearly conveyed by the trainers, and how participants understood and subsequently conveyed the training programme intentions' to the clinic committees.
The study found that despite the different perceptions and understandings of the ToF Learning Programme, its overall aims were achieved. The capacity of the trainees was confirmed to have been strengthened, and the clinic committees were trained accordingly. The study concludes that "the training programme holds promise for possible national scale-up. The high quality of the interactive posters can be considered equally valuable as a training tool as the training manuals."
Supervisors: René English and Maylene Shung-King
By: Naomi Massyn (Project Manager: District Health
The first District Health Barometer (DHB) was published in 2005 and the 2019/20 DHB is the Health Systems Trust's (HST's) 15th edition! Naomi Massyn has been the main editor since the third publication. She is a health professional with post-graduate training in nursing administration, nursing education, public administration and health management and has been with the HST for more than 18 years. With more than 44 years of experience in different fields and at all levels of the South African health care system as professional nurse, administrator, educator, facilitator, consultant and manager she also has extensive experience in health service management at various levels and is skilled in training and capacity building methodologies. In addition to the DHB she also manages several other projects, including having provided providing quality assurance at each step of the Health Facility Audit in Namibia and Eswatini and verifying the quality of the sampling, data collection, analysis and reporting of the Health Facility Audit. She has also managed several other projects.
Naomi works closely closely with Candy Day who has been responsible for the creation of the datafile, league and maps since the 2009/10 publication. Candy originally trained as a pharmacist but has spent the past twenty years as a data analyst in support of the HST's publications. Candy was involved in the conceptualisation of the Barometer from the beginning, together with Fiorenza Monticelli. She has been involved in the production of each edition, including co-editing most editions and being co-author of a variety of chapters as well as data management, analysis and visualisation. Selected methods and findings from the DHB have been presented nationally and globally and collaborations with the World Health Organization and the Countdown to 2030 initiatives to improve the use of routine health facility data in low- and middle-income countries around the world have taken place. Candy's current position is technical specialist and has been working with HST for the past 24 years!
The team was joined in 2018 by Noluthando Ndlovu who took over the creation of the maps. Noluthando is also an integral part of data management and has also co-authored and edited in some editions. Each year another person from HST joins the team to assist with the first round of editing before the chapters are edited by public health specialists and for the 2019-20 edition it was Thesandree Padayachee, Senior Programme Manager in Health Systems Research.
The publication is also enhanced by the contribution of Dr Peter Barron who has done specialist editing since the first publication in 2005. Dr Barron is a leading public health specialist and was with the National Department of Health for many years including setting up the mHealth-based MomConnect used by over 1.5 million women in South Africa during pregnancy. The DHB was his brain child and he worked for the HST since the establishment of the organisation. When he left HST he became a specialist advisor for Dr Yogan Pillay – a past Deputy Director-General at the National Department of Health. He retired at the end of last year at age 70, but is still involved with the DHB even after retirement. He was co-author of several papers in several journals and was Naomi's mentor over the years.
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. This annual publication continues to provide policy-makers, healthcare workers, planners, researchers, academics and other consumers of national health system information a unique overview of the performance of public health services in South Africa. The publication seeks to highlight inequities in health outcomes and health-resource allocation and delivery, and to track the efficiency of health processes across all provinces and districts.
Compilation of the 2019/20 DHB was guided by a technical working group made up of key people from HST as well as eight Public Health specialists. Data are drawn from the District Health Information Software (WebDHIS), the Ideal Clinic Realisation and Maintenance system, Statistics South Africa (Stats SA) surveys, the National Treasury Basic Accounting System (BAS), the Personnel Administration System (PERSAL), the Three Integrated Electronic Registers (TIER.Net) for tuberculosis (TB) and antiretroviral therapy (ART) data, the Electronic Drug-resistant Tuberculosis Register (EDRWeb), the National Income Dynamics Study (NiDS) and other National Department of Health information systems.
The main focus of the 2019/20 edition is on the Sustainable Development Goals (SDG's) and Universal Health Coverage (UHC) index. The district chapters in the DHB contain trend graphs of the indicators included in Section A: Indicator Comparisons per programme, as well as additional indicators [Health indicators are quantifiable characteristics of a population which researchers use as supporting evidence for describing the health of a population.] aligned with the District Health Plan template of the National Department of Health. The district chapters also include the burden of disease (BOD) profiles for 2012−2017. The BOD profiles cover the percentage of deaths by broad cause; deaths are classified into four groups, namely: (i) injuries; (ii) non-communicable diseases; (iii) HIV and TB; and (iv) communicable diseases together with maternal, perinatal and nutritional conditions. Data are presented by gender and age group as well as the 10 leading single causes of death within each age group and by gender.
The DHB is a compilation of health data that takes many months to pull together. It takes a team of dedicated specialists who know that the work that they do plays a critical role in terms of creating insights into the public health system that can assist with enhancing and improving how services are delivered as well as received.
By: Lunga Memela (Communications Officer)
It's the final countdown to the official release of the South African Health Review (SAHR), a flagship publication produced by the Health Systems Trust (HST) addressing key health issues that affect South Africans collectively in the public and private health sectors. One of the publication's focal areas in this 2020 edition is improving access to healthcare and the overall quality of life for persons with disabilities so look out for the hashtag: #SAHR2020onDisability
Yesterday, the world commemorated International Day of Persons with Disabilities (IDPD) and Thesandree Padayachee, HST's Programme Manager for Health Systems Research who is also a Ph.D candidate in Disability Studies at the University of Cape Town, contributed an in-depth blog article that mapped out the importance of raising disability awareness.
In HST's continuous efforts to make the world a better place for all by lobbying for unyielding health promotion, we interviewed the humble and ever compassionate University of KwaZulu-Natal's Optometry Professor Khathutshelo Percy Mashige who introduced himself as a quadriplegic, "…[m]eaning that I have total loss of function and feeling in all four limbs. I use a wheelchair for mobility and a caregiver/attendant to assist with activities of daily living," he said.
Lessons learnt from HST's interview with Prof Mashige
"People with disabilities have feelings, dreams and aspirations like anyone else. However, they still face cultural, physical, social and other barriers that limit them from accessing opportunities for employment, reasonable accommodation and public transport. They still face challenges of discrimination and ignorance." Prof Mashige expressed.
Society may sometimes be ignorant to the fact, but the Prof highlighted that there are a number of emotional and mental challenges faced by persons with disabilities and their families and caregivers based on a number of unfair social statements and judgements by other people. "These things couple[d] with other challenges associated [with] quadriplegia, (and) can often lead to depression." Now imagine all of these challenges manifesting in today's unprecedented circumstances of COVID-19?
A positive outlook
Not so long ago, Mashige was a young and aspiring academic in the field of optometry. Today, he finds himself a professor in the discipline, affiliated with the Community Self Mastery Coaching Institute, the Global Institute for Entrepreneurship and Ethics and an active member of the Health Professions Council of South Africa. He cares about helping people and making an impact which he feels his line of work allows him to do. He intends to start a business, travel, finish writing his books and getting them published!
Our call to action
While the Prof is grateful and fortunate to have had his family, especially his mother, brothers and sisters to care and support him during his journey to success, all persons with disability need and deserve the same love, care, support, sensitivity, to feel understood, and definitely to have easy access healthcare, especially chronic medication where necessary.
HST's way forward: The South African context
HST, together with Inclusive Practices Africa, a research group of the Faculty of Health and Rehabilitation Sciences affiliated to the University of Cape Town, are due to release the findings of its latest South African Health Review the week of 7 December, timed to overlap with the International Day for Persons with Disabilities, under the theme of 2020, "not all disabilities are visible." https://www.hst.org.za/media/Pages/International-Day-For-Persons-With-Disabilities.aspx
HST's newly appointed Employment Equity Committee is holding several meetings, one of the key topics being disability inclusion.
By: Thesandree Padayachee (Programme Manager for Health Systems Research at the Health Systems Trust and PhD candidate in Disability Studies at the University of Cape Town)
The year 2020 will forever be etched in our memories as a year of challenge and extreme change. A year that compelled us to reassess the values and priorities that guide all aspects of our lives and reflect on the merits of how we operate as a society. How we value and respond to the needs of the most vulnerable and marginalised, such as persons with disabilities, can often serve as the barometer of our progress as a society. Disability inclusion, is a virtuous societal imperative with global support and reach that remains a poorly understood and under-prioritised issue across many development sectors, including health.
The global commitment to address marginalised and vulnerable populations such as persons with disabilities is clear and if the public health community has been slow to respond to the call, chances are they will have very little choice going forward. Article 25 of the United Nations Convention on the Rights of Persons with Disabilities is an important statement for public health professionals to reflect on. It recognises that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. Similarly our public health drive to achieve Universal Health Coverage (UHC) is the cornerstone of the global health agenda, and an important target of the Sustainable Development Goals. Public health practitioners, researchers and health service implementers are, therefore, key actors who play a pivotal role in driving this development agenda within the heath sector, ensuring that even at its point of greatest weakness and strain, our health system upholds the value of "leaving no one behind."
Persons with disabilities are at higher risk for poor health outcomes. There are those who will require specialist healthcare services as well as rehabilitation, however; persons with disabilities also have basic healthcare needs much like everyone else and have the same right as you and I do of accessing preventative, promotive and curative healthcare services that offer the best chance of leading a healthy and fulfilling life. During the course of 2020; the world witnessed first-hand how the COVID-19 pandemic exposed the dire effect that our health system weaknesses have on vulnerable populations. Locally, the well-documented, fragmented nature of our healthcare services in South Africa have only served to deepen inequities relating to the availability, affordability and access to health services for people with disabilities, and during times of crises this gap widens with disastrous consequences. The situation is further exacerbated by stigma and discrimination often experienced by persons with disabilities when accessing public health services.
The disappointment that stigma still exists around disability isn't surprising, but the awkwardness and discomfort that the topic brings to public health conversations is quite a different matter and one that needs to be well understood and addressed. Barring the exceptions, many public health professionals avoid engaging in disability-related issues despite the fact that a large part of public health is promoting healthcare equity, quality and accessibility. What is it about the term "disability" and all things disability-related that makes us feel so out of touch with our humanity? Perhaps it is our lack of understanding and the relative invisibility of persons with disabilities that fuels our fear? People who are not seen are not understood. Bringing disability out of the shadows and into the centre of all debates around public health policy and service delivery plans is one way to address this. But this depends on the key players having the willingness to make the shift and see disability inclusion as a core value of public health and a way of thinking and being. Keeping disability on our public health agenda by constantly and actively reflecting on how the system can be strengthened to address the needs of persons with disabilities is what we all must do. It is needed to not just to address the invisibility of disability but also to reignite our connectedness to what it means to be vulnerable and have unmet needs. It is through this understanding that we will be better equipped to problem solve our way towards the creation of inclusive health systems.
Beyond the individual shift that is required, the department of health and the many partner organisations, non-profit organisations and academic institutions must drive change at strategic and operational levels of the health system. These entities need to take a deep dive into their own priorities, policies and workplace culture to identify key levers of change and activate them with urgency. Employment Equity Committees, for instance, serve an important function in driving the change towards a more equitable and inclusive workplace, but also in ensuring that persons with disabilities are well represented in the workforce that is striving for change and inclusion.
Today is the International Day for Persons with Disabilities with the theme: Building Back Better: toward a disability-inclusive, accessible and sustainable post COVID-19 World. My call to all HST staff, public health professionals and others is to overcome your fear of the unknown and embrace your important role in making healthy lives a reality for the most vulnerable in our society. The global call to the public health community is loud and crystal clear; we are the change that is needed.
Please also read the Secretary-General's report on the implementation of the UN Disability Inclusion Strategy:
It's aslo the final countdown to the official release of the South African Health Review (SAHR) 2020, a flagship publication produced by the Health Systems Trust (HST) and addressing key health issues that affect South Africans collectively in the public and private health sectors. One of the publication's focal areas in this edition is improving access to healthcare and the overall quality of life for persons with disabilities, and accordingly, this blog article reminds us not only to count our blessings one-by-one, but also sit up and take note that every individual can play their part in raising awareness.
By: Lunga Memela (Communications Officer)
Imagine falling ill with an infection, your health practitioner prescribes the best medication to cure you, you take it diligently – for added benefit you also adjust your diet and lifestyle but, over time, it becomes apparent that the bacteria in your body has become resistant to the antibiotic. What then?
This has been the sad reality for many individuals diagnosed with Tuberculosis (TB), for example, and subsequently multidrug-resistant TB (MDR TB) which at times results in extensively drug resistant TB (XDR TB). The challenge is heightened in countries like South Africa, for instance, where the past few decades has seen a dreadful number of cases of TB and HIV co-infection, with many-a-citizen having limited access to the relevant treatment.
A soaring number of people are contracting drug-resistant infections globally, and this why there is an urgent mandate for the pharmaceutical industry, private and public health sectors to join forces in eradicating the problem and to speak in unison beyond 18–24 November, which is World Antimicrobial Awareness Week (WAAW). This annual event aims to increase awareness of global antimicrobial resistance (AMR) by encouraging best practices among the general public, health workers and policy makers to avoid the further emergence and spread of drug-resistant infections.
In the spirit of promoting expert opinions and finding innovative ways to raise health awareness, Health Systems Trust spoke to Professor Sabiha Essack, the South African Research Chair in Antibiotic Resistance & One Health, a Professor of Pharmaceutical Sciences and the Director of the University of KwaZulu-Natal's Antimicrobial Research Unit. She is a prolific researcher and Vice-President and General Secretary of the Academy of Science of South Africa (ASSAf).
Essack said in order to raise antimicrobial awareness, it is important to understand that, "Antimicrobial resistance occurs when a micro-organism can survive or continue to thrive in the presence of an antimicrobial medicine that previously killed the micro-organism." Micro-organisms or microbes are microscopic organisms that are not visible to the naked eye; they are made up of viruses, bacteria, fungi and other parasites.
She explained that AMR is an overarching term that encompasses resistance to anti-viral, anti-bacterial, anti-fungal and anti-parasitic medicines. In particular, she described antibiotic resistance as specific to bacteria that occurs when bacteria no longer respond to antibiotics that previously killed the bacteria and cured infection.
Essack said AMR is evident in both community- and hospital-acquired infections and, of concern, is the fact that resistance to broad-spectrum antibiotics is escalating at community level. AMR exists and is escalating in South Africa as it is in other parts of the world. "South Africa, like other countries around the world, has reported resistance to every single antibiotic in clinical and veterinary practice, even the last resort antibiotics for 'difficult-to-treat' infections, but the nature, extent and sequalae is unquantified because we are yet to put into place comprehensive surveillance systems. Surveillance in human health is most advanced in blood stream infections from the public and private sector, surveillance in food animals is in its infancy, while surveillance in the environment is limited to research projects at academic institutions," she explained.
South Africa's commitment to combatting AMR
There is hope! According to Essack, AMR has been prominent on the global public health and political agendas since 2015 (although it was recognised as a public health threat since 1998) when the World Health Organization published its Global Action Plan on AMR. "All countries have committed to develop[ing] National Action Plans on AMR as signatories of the World Health Assembly Resolution and the United Nations General Assembly Political Declaration on AMR.
According to Essack the Global Action Plan has five strategic objectives, the first being improving awareness of AMR through communication, education and training. The vast majority of countries have instituted AMR awareness campaigns, particularly during World Antimicrobial Awareness Week. South Africa has also launched the Antibiotic Guardian Campaign where everyone from government ministers to civil society can pledge to use antibiotics correctly to ensure their efficacy for future generations.
Understanding AMR in the time of COVID-19
Although it goes unnoticed by many, AMR is the slow-moving pandemic that is adversely affecting humans, animals, crops, the environment, and their various interfaces and ecologies. "AMR is a One Health issue and its impact is so much more far-reaching than COVID-19," said Essack. "COVID-19 highlighted the lack of preparedness of health systems to deal with pandemics and it is imperative that our health, agricultural and environmental health systems are capacitated to prevent, contain and mitigate AMR as a matter of urgent priority, especially as AMR surveillance stewardship appears to be deprioritised as resources were channelled to deal with COVID-19."
The slogan for WAAW 2020 is "Antimicrobials: handle with care" applicable to all sectors, as declared by the World Health Organization. The theme for the human health sector for WAAW 2020 is "United to preserve antimicrobials".
Because millions of South Africans live with chronic conditions such as diabetes, high blood pressure or HIV, HST encourages patients on chronic medication to register for a free and convenient service called CCMDD (Central Chronic Medicine Dispensing and Distribution) – the National Department of Health's programme which dispenses and distributes medicine from a central point to patients with a chronic condition who are stable on their medication. To find out more about it you have to visit the HST-managed website for the CCMDD campaign funded by the Centers for Disease Control and Prevention called Get checked. Go collect..
Just like cattle need to graze; birds to fly; the sun to shine; as well as jets need their fuel, service and safety measures; so do humans need to feed their bodies and souls. The basic human right of sustaining mental and physical wellness through the supply of regular nutritious meals in order to perform optimally is not, unfortunately, possible for a significant segment of the world's population.
The National Department of Health and the African continent at large, observes Africa Food and Nutrition Security Day and uses the opportunity to remind us that many communities still live below the poverty line. The geographical, psycho-social, psycho-physical and psycho-economic disparities presented by food (in)security amongst some of the communities situated in the most marginalised contexts, especially during the COVID-19 pandemic, spells hunger! The written word and philanthropy can draw attention to this other "pandemic", but witnessing it with the naked eye really brings home the plight of many right on our door step.
It was a humble gesture for Health Systems Trust (HST) employees to reach out on 30 October to commemorate Africa Food and Nutrition Security Day by donating food parcels – mainly toiletries, non-perishable goods, face masks and hand sanitisers – to Uthando Home-Based Care (a non-profit organisation based in Verulam, eThekwini) for distribution amongst families in desperate need of food during the COVID-19 pandemic that has left many without.
HST was thankful to its Stakeholder Engagement affiliate, Simamisa Mkhize, for his help with identifying an entity that would be suitable to distribute its donated goods fairly on this day. On the day HST delivered the donation it became clear that the charity and community it serves still needs so much, as do many others. If you are keen to help them please contact email@example.com.
It was Beth Bechdol, the Deputy Director-General of the United Nations' (UN) Food and Agriculture Organization (FAO), who said these words in her opening remarks of a recent podcast:
"The number of food insecure people in the world prior to the COVID-19 pandemic was already surprisingly high, and unfortunately, trends in trying to eliminate hunger around the world and in the most vulnerable countries are not good trends… We've got more work to do! And so, when you add the COVID-19 pandemic to that and add the economic implications: soaring unemployment rates, income losses, rising food costs – all of these begin to jeopardise food access in both developed and developing countries."
FAO mentions in its article, Impact of COVID-19 on people's livelihoods, their health and our food systems, that the economic and social disruption caused by the pandemic is devastating: tens of millions of people are at risk of falling into extreme poverty, while the number of undernourished people, currently estimated at nearly 690 million, could increase by up to 132 million by the end of the year.
A report published by FAO in July 2020, The State of Food Security and Nutrition in the World 2020: Transforming food systems for affordable healthy diets, highlights that the burden of malnutrition in all its forms continues to be a challenge. The report complements the usual assessment of food security and nutrition with projections of what the world may look like in 2030, if trends of the last decade continue. The World Health Organization expanded on the matter, publishing a stimulating article headlined: As more go hungry and malnutrition persists, achieving Zero Hunger by 2030 in doubt, UN report warns.
As part of its 75th anniversary and the 5th anniversary of the adoption of the Sustainable Development Goals, the UN declared Goal 2 of these as #ZeroHunger. The biggest question is: Is the world on track to achieve Zero Hunger by 2030? The Sustainable Development Goals are the blueprint to achieve a better and more sustainable future for all. They address the global challenges we face, including poverty, inequality, climate change, environmental degradation, peace and justice.
The reality is that no nation will thrive to reach its full potential until we open our hearts and take collective action to make a difference.
Why Global Citizens Should Care?
"Food insecurity is the state of not having reliable access to sufficient food, and is one of the leading causes of chronic hunger in Africa. The United Nations' Global Goal 2 calls for an end to world hunger, and also aims to achieve food security and promote sustainable agriculture. This goal can only be obtained if Africa has reliable and consistent access to food. Join the movement and take action on this issue here."
HST remains committed to taking action to address the influence of the social determinants of health on the burden of disease.
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