By: Lunga Memela (Communications Engagement Lead)
(Left) HST's Area Co-ordinator for Nongoma Sub-district, Sifiso Mdletshe, and (right) HST Nurse Clinician, Muziwakhe Ndima, reflect on positive outcomes yielded by the Phila Ndoda campaign in Zululand.
The narrative that South African men refuse to attend their nearest clinic for medical attention, even when they are ill, is slowly being dispelled. Instead, there are other factors to be considered. This is visible in KwaZulu-Natal's Zululand District where the Department of Health's (DoH) Phila Ndoda campaign is making a considerable difference! The campaign is an increasingly well-received men-friendly clinic designed to address men's health issues, with the main focus being on HIV, TB, sexually transmitted infections (STIs) and non-communicable diseases (NCDs).
In an article published in July 2021, the Health Systems Trust (HST) highlighted an upsurge of healthcare services attended by men young and old in Zululand, thanks to Phila Ndoda – an isiZulu term which, in itself, prompts men to be accountable for their health, thereby fostering healthier communities through men protecting themselves and their loved ones from infectious diseases and other health conditions.
The success of the campaign was also featured in a Spotlights Compendium that was recently launched in May 2022 by the University of California San Francisco's (UCSF) Optimizing Performance by Improving Quality (OPIQ) Project in efforts towards better management of TB and HIV in South Africa. The publication comprises 20 'spotlight stories' of health service quality improvement, which offer clear, concise and useful guidance on good practice, designed to help health professionals provide optimal care to clients.
The Phila Ndoda campaign is strongly supported by HST's SA SURE Project which is funded by the United States President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC).
SA SURE Project Operations Manager, Felicity Basson (pictured above) describes how HST works closely with the Health Department to promote health and wellness for all people ̶ regardless of gender, culture, religious beliefs or socio-economic backgrounds ̶ and in line with the UNAIDS 95-95-95 targets for fast-tracking HIV epidemic control by 2030.
HST's Nurse Clinician, Muziwakhe Ndima, spoke about his joyful experience at HST and within the Phila Ndoda initiative.
The good news about the status of the campaign was shared by HST's Nurse Clinician, Muziwakhe Ndima, who was radiant when narrating his journey with Phila Ndoda. Not only did he grow up knowing that he would one day become of a nurse by profession because of his caring nature, kindness and compassion ̶ he also knew and felt that there was pressing need for more intense promotion of men's health issues. "Previously, men didn't really speak about their emotions, let alone matters pertaining to their health," he explained. Today, Muziwakhe is living his dream through the work that he does at HST and within Phila Ndoda.
HST's Area Co-ordinator for Nongoma Sub-district, Sifiso Mdletshe, with Queen Nolonolo Clinic's Facility Operational Manager, Sister Nomusa Zungu.
The programme was adopted and initiated in 2019 at Queen Nolonolo Clinic, Nongoma, where Ndima works under the stewardship of HST's now District Quality Improvement Co-ordinator, Siyabonga Gwala. The Facility's Operational Manager, Sister Nomusa Zungu, confirms that while there have been staffing challenges, the overall impact of the campaign is very successful.
From the initial idea of taking a mobile clinic to the local Nongoma taxi-rank in order to provide targeted men's health services to clients once a week, the clinic now operates five days a week and, among other achievements, the clinic staff are able to quickly find new HIV cases, link clients into care, and improve the tracking and tracing of patients whose treatment has been interrupted, including chronic medication. "It's an integrated service approach that really works. We work with HST and other District Support Partners (DSPs) to improve the overall health of the community," said Sr Zungu. "When it began, we used loudhailers and worked with Community Mobilisers for encouraging men to attend the launch of the campaign."
Contextualising the real challenge
According to Sr Zungu, DoH and HST colleagues, male clients do want to access healthcare services – they simply hate standing in long queues at the clinic, as this often results in taxi drivers (for instance) missing opportunities to put food on the table because of long waiting periods when they come to seek medical attention at the facilities. Male clients are also not comfortable with discussing their health issues with female nurses, and in the presence of other female clients at clinics and hospitals.
The need for the Phila Ndoda mobile clinic sited at the taxi-rank was informed by a 2019 clinic survey, the results of which showed how difficult it was to meet the UNAIDS 90-90-90 targets when male clients struggled to either schedule and/or wait for clinic appointment dates and times. The clients also felt that there had to be a better way to talk about health issues comfortably in a private setting shielded from on-lookers. This is also why there is a desperate need for the appointment of more male healthcare workers, who can tailor-make services that will appeal to and attract male attendance for healthcare. The community needs more male Nurse Clinicians and Lay Counsellors to speed up health service delivery in the Zululand District. The isiZulu idiom 'Okuhlula amadoda kuyabikwa!' maintains that men must not hold back from talking about challenges that they may experience as overwhelming.
Amplifying the critical need for men's health services in Zululand and beyond
A true community builder is Men's Health Champion in Zululand, Mr (uBaba) Solomon Kunene.
Only a few men in Zululand have not heard the pearls of wisdom shared by uBaba Solomon Kunene (or uMtimande as often referred to by clan name). As a former Councillor and priest, he is a staunch believer in men's health and building healthy families and communities. As young people would say it: He loves dropping knowledge!
Through his community standing and facilitation skills, Ubaba uKunene has enabled Queen Nolonolo Clinic and HST staff to drive into KwaNongoma taxi-rank and make Phila Ndoda services effective and accessible to local male clients. He firmly believes that every individual, family and household should be deeply rooted in health consciousness and understanding that 'your health is your wealth'. He said: "You could own 100 cattle, but if your health is compromised then all will be lost at your demise." He sits with izinduna, and is Chief of the local taxi association, a father, a loving husband, and an exemplary beacon of hope to many.
Ubaba uKunene does not understand why people do not take active care of their health, and he wants this to stop. That is why he firmly believes in Phila Ndoda and the invaluable work performed by the Queen Nolonolo Clinic staff and HST colleagues based at the facility. While on air at the local community radio station, Nongoma FM, and lauding the Phila Ndoda campaign and its implementers, he was happy to mention that more and more taxi drivers are starting to understand that one cannot presume to know one's HIV status, for instance, only by virtue of one's partner having been tested.
There is much more work to be done. South Africa remains the epicentre of the global HIV pandemic, with KwaZulu-Natal Province having the highest HIV prevalence in the country. Facing this challenge requires strengthening and intensifying all interventions, especially in the light of TB co-infection, the growing burden of NCDs, the impact of the recent COVID-19 pandemic, barriers to healthcare access, and a multitude of socio-economic factors that underlie HIV transmission and general vulnerability to illness.
Nurse Clinician, Sibusiso Ntshangase, (pictured above) will not rest until levels of sexually transmitted infections (STIs) decline, when more if not all men go for voluntary medical male circumcision, and substance abuse subsides.
HST's Area Co-ordinator for KwaNongoma Sub-district, Sifiso Mdletshe, shared the isiZulu expression: 'Ukuphila kwendoda ukuphila kwesizwe sonke' ̶ loosely interpreted and understood in the local Zululand context as meaning: No nation will thrive in the absence of quality men's health.
Youngsters enjoying soccer amongst other games that were played on the day.
Saturday, 18 June 2022, will be a day to remember for quite a while amongst eThekwini Metro's Department of Health (DoH) staff, the Health Systems Trust (HST), collaborating District Support Partners (DSPs) and especially the youngsters residing in New Germany as well as the neighbouring Clermont and KwaDabeka townships following a fun-filled sports and entertainment event that was held at Solomon Mahlangu Hall in commemoration of Youth Day.
It wasn't merely the music, dancing, soccer, netball, indigenous games, cultural activities and the variety of free health screening services available on site that made the day one of sheer joy, but also the safe space created for the promotion and integration of the DoH's Adolescent and Youth Friendly Services (AYFS) into the community.
HST's Health Systems Strengthening Manager, Rakshika Bhana, recently explained that HST's Unfinished Business for Adolescent and Paediatric HIV programme in KwaZulu-Natal (UB project), funded by the ELMA Philanthropies, is implemented in three health districts in KwaZulu-Natal, namely eThekwini, uMgungundlovu and Zululand, and seeks to improve outcomes for the age group 0–19 years across the HIV 90-90-90 cascade.
Hard-working and passionate about the youth: HST's Psycosocial Advisor (UB) Nonhle Maphumulo; New Germany Clinic's Nursing Services Manager, Sameer Rajah; and HST's Clinical Advisor (UB) Phumzile Matolo.
The Youth Day event was nothing short of a dream come true for New Germany Clinic's Nursing Services Manager, Sameer Rajah, who said the clinic was excited to introduce AYFS into the facility for the benefit of the youth in the community and its surrounding areas. For him, the Youth Day event was a reminder of how the COVID-19 pandemic has interrupted optimal healthcare service delivery in eThekwini, especially access to healthcare, adherence to chronic medication and adequate health screening, importantly in the prevention of TB, HIV and other non-communicable diseases (NCDs).
"The young ones are close to our hearts," Rajah said. "We have to groom them because the world is their oyster." He said the New Germany facility has been longing to do a youth intervention. Launching AYFS at the facility was a big win, and so the Youth Day event was just a bonus. "We want to have more such youth interventions, but sometimes resources are a limitation."
"AYFS is a platform for us to fast engage with youth, to know the concerns straight from the horse's mouth. We are concerned about the prevalence of teenage pregnancy, STIs, new HIV infections, and alcohol and drug abuse that has been on the rise." Healthcare has always been his passion, and he said that as DoH colleagues, they are blessed to be supported by dedicated HST staff.
Colleagues turned into friends Nonhle Maphumulo and Phumzile Matolo have both been at HST for over three years and are still going strong. They enjoy working under the UB project because it deals directly with young people. "The youth is our future so if we can groom them as early as possible that is key," said Matolo.
Maphumulo said it was sad to see young people being infected with HIV, "and so the idea is to provide as much care, support and health education as possible."
The day's activities included COVID-19 vaccine promotion, voluntary medical male circumcision (VMMC) and free health screening for an array of illnesses, which was done in partnership with other DSPs that were present on the day.
HST and DoH staff happy to be of service at the Youth Day event.
By: Nandipha Jacobs (Project Manager UB eThekwini) and Rakshika Bhana (Programme Manager: Health Systems Strengthening)
Addington Hospital – HAST Unit, discussion on patient case management
The Unfinished Business for Adolescent and Paediatric HIV programme in KwaZulu-Natal (UB project), funded by the ELMA Philanthropies, is implemented in three districts, namely eThekwini, uMgungundlovu and Zululand, and seeks to improve outcomes for the age group 0–19 years across the HIV 90-90-90 cascade. This multi-year programme is implemented in collaboration with the KwaZulu-Natal Department of Health (DoH) and is part of a UB Consortium comprising CHAI (National Co-ordination), ANOVA Health Institute, WITS RHI and the Health Systems Trust (HST).
A delegation from ANOVA Health Institute led by Dr Carol Tait (Project Advisor: Paediatric and Adolescent Scale-up Project) and Dr Nomcebo Nene (Project Manager: Paediatric and Adolescent Scale-up Project) visited the Unfinished Business project in eThekwini district for a benchmarking visit on 26 and 27 May 2022. The purpose of the visit was to look at, and assess HST strategies and interventions targeting the 15 to 19-year-old age groups. This visit took place over two days comprising of health facility visits at selected facilities, a presentation by HST's community case management partner Cindi Network and a debriefing session.
Three facilities in eThekwini district were selected for the facility visits. These were Addington Hospital, Chesterville Clinic and Sivananda Clinic. These facilities were selected based on their HIV performance cascade targets, the resources mix, UB strategies implemented at the different facilities and different institutional arrangements that exist in each, for example, Chesterville Clinic is a municipal clinic.
Some of the key lessons learnt from the visit as captured from the debriefing session included:
HST's Health Systems Strengthening Manager, Rakshika Bhana said: "HST is passionate about promoting AYFS that are tailored to the needs of youth, and at the same time ensuring that the quality of service standards are met."
Bhambayi and Phoenix township residents benefit from free health services offered by the Department of Health and its District Support Partners as part of the 'Isibhedlela Kubantu' outreach initiative at Fernham Sports Ground.
KwaZulu-Natal's Provincial Department of Health (KZN DoH) is making good progress in promoting COVID-19 vaccine uptake and mobilising communities to take charge of their health through its Isibhedlela kubantu initiative. In isiZulu, this Nguni term refers to continued efforts by the KZN DoH to take critical hospital services closer to where the people live.
The province still faces high poverty rates, youth unemployment, and a variety of socio-economic ills. Many households are led by the elderly who rely solely on social grants to survive, and who themselves are often physically challenged to travel and reach the province's health facilities.
While KZN has no shortage of clinics and hospitals, one of the issues addressed by Isibhedlela kubantu is the pressing challenge of access. Although clinic services offer a good range of critical Primary Health Care (PHC) services, hospitals offer a much broader bouquet. This was explained by the Deputy Director for eThekwini Health District's North West Service Area, Nonhlanhla Masondo, when she welcomed residents flocking in from the neighbouring Phoenix and Bhambayi townships to Isibhedlela kubantu, which was held at Fernham Sports Ground on 3 June 2022, coinciding with Child Protection Week.
Deputy Director Nonhlanhla Masondo (centre) with HST and DoH staff at one of HST's mobile units during the event.
Deputy Director Masondo was thrilled to announce that entire families could be screened and treated for a variety of ailments at the various stations in which KZN DoH District Support Partners (DSPs) such as the Health Systems Trust (HST) were staffed on the field. She said: "Isibhedlela kubantu is our way of showing you that we care. Through this initiative, our DSPs drive in with their mobile units to help us to give you the very best of healthcare services."
As with the recent DoH Phuthuma Week that promoted COVID-19 vaccine uptake and integrated services at community level across KZN, locals were attended to holistically during Isibhedlela Kubantu in Phoenix.
Isibhedlela kubantu is a one-stop-shop health promotion approach, with KZN DoH personnel teaming up with DSP staff to offer free health screening for tuberculosis (TB), HIV, non-communicable diseases (NCDs) and more. Deputy Director Masondo explained: "Through this initiative, we aim to give our clients a 'real life' hospital experience, and are also offering X-rays, Pap smears, eye and dental care services, voluntary medical male circumcision, nurse-initiated management of antiretroviral treatment (NIMART), assistive devices for the elderly … the works!"
Both working in eThekwini's Phoenix Cluster, HST's Lay Counsellor, Thulani Mdluli (left) and Nurse Clinician Sister Lorraine Nzimande (right) say that they are passionate about community outreach and helping other people in general. They provided HIV testing services at the event.
"I love working with people. Being of help and service is in my nature," said Mdluli from KwaMashu, who also said that men should always be encouraged to take good care of their health and wellbeing. "My mother was a caregiver and I think I got it from her."
"The day is going great," said Bongani Mbatha, HST's Area Co-ordinator (Phoenix Cluster). He works closely with HST's Phoenix Cluster Facility Team Lead, Noluvuyo Sibisi. They agreed on the importance of bringing services to the people, stressing the need for promoting TB and HIV testing, treatment initiation, and ensuring that patients whose treatment for chronic conditions has been interrupted are brought back into care.
By: Joslyn Walker (HST's Health Systems Strengthening Programme Manager: SA SURE Project)
HST's Driver Mobiliser, Lungile Mngadi, engages the national Minister of Health, Dr Joe Phaahla, together with KwaZulu-Natal's provincial Health MEC, Nomagugu Simelane-Zulu, flagging the critical TB and HIV services that the Health Systems Trust supports the department with in addition to COVID-19 prevention initiatives.
Health Systems Trust (HST) was a proud participant in the launch of the Global Vax campaign on 3 June 2022 by the South African Minister of Health, Dr Joe Phaahla, and the United States (US) Chargé d'Affaires, Heather Merritt.
The event centred on grassroots community engagement and highlighted the availability of integrated treatment and care services at Caluza Sports Centre in Pietermaritzburg, KwaZulu-Natal, encouraging community members to access these services in their communities.
In South Africa, the Global Vax campaign is run as a joint partnership between the US Government, the National Department of Health, and implementing partners funded through the U.S President's Emergency Fund for AIDS Relief (PEPFAR), such as HST.
The launch event provided an opportunity for community members to not only receive their COVID-19 vaccination jab, but also a variety of additional services, including HIV and tuberculosis (TB) testing and treatment, pre-exposure prophylaxis (PrEP) initiation, referrals for medical male circumcision, eye testing, dental services, and pap smears.
Community members and dignitaries attending the launch.
As part of the proceedings, HST showcased its programme for community-based antiretroviral therapy (ART) support through offering HIV and TB testing and treatment initiation, the availability of mobile units as community outreach points for chronic medicine collection through the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme, and nurse-managed pick-up points that provide ongoing ART services and support in the community.
The Minister, Chargé d'Affaires and other dignitaries met the HST team on the ground and learnt about the work that we do in communities to strengthen health services aimed at epidemic control.
Through the Global Vax campaign, the South African government has set a target to vaccinate 70% of the population by December 2022 against COVID-19.
At the launch, Minister Phaahla was pleased to announce that the country had reached the milestone of 50% of the population receiving at least one dose of the vaccine. Emphasising that the COVID-19 pandemic is not over, and that vaccination is the only way to prevent further outbreaks and reduce the incidence of serious hospitalisation and death from the virus, he reported that over 36 million doses of vaccine have been administered, and more than 22 million people − including children − have been vaccinated. More than 70% of people older than 60 have received at least one COVID-19 vaccine dose, meaning that the most vulnerable groups are receiving preventative treatment.
The campaign is designed with the aim of closing the gap to vaccine coverage, which represents approximately 13 million people in South Africa alone. "Our biggest challenge is to convince the youth between the ages of 18 and 34 years who are not coming in numbers. The majority of them are in universities and colleges, and only 6.6 million … have been vaccinated" said Minister Phaahla. "This approach builds on the extraordinary commitment that US President Joe Biden has made to donate more than 1.2 million vaccine doses by the end of 2022, and this intensifies our efforts to get 'shots in arms'," he explained.
The Global Vax campaign augments the bilateral efforts between South Africa and the US government to strengthen the country's health system; these comprise a wide range of programmes, including HST's HIV and TB Care and Treatment Programme funded through the U.S Centers for Disease Control and Prevention (CDC), implemented in KwaZulu-Natal and conducted in partnership with the Provincial Department of Health. Minister Phaahla referred to this partnership in his speech, noting that the Global Vax campaign "would add to our work to enhance partnership between the two countries in strengthening health pandemic responses and the health system."
Global Vax is implemented through a mechanism called 'Accelerating Development Against Pandemic Threats,' and is being managed by the non-governmental organisation Right to Care in support of South Africa's National and Provincial Departments of Health.
Low COVID-19 vaccine demand, linked to poor dissemination of information on where people can be vaccinated was a focus addressed during the launch event. The web-based 'Find My Jab' app (www.findmyjab.co.za) was demonstrated to show that anyone with a smart phone can access the system to find their nearest permanent and pop-up vaccination site.
It is hoped that this innovative technology and accompanying community-based demand-creation campaign will appeal to those in the 35−49-year age group, among whom vaccination rates are lowest nationally. Minister Phaahla noted that vaccine hesitancy is particularly marked within this age group, largely influenced by the negativity and vaccine misinformation messages spread mainly through social media platforms. "Through these collaborative efforts," the Minister explained, "we aim to contribute to closing the gap, through demand creation, information and education.
As a leading organisation and knowledge broker specialising in integrated care and health systems strengthening, HST is rising to the challenge laid down by the Health Minister to use effective communication and community engagement to 'get more jabs in arms.'
By: Lunga Memela (Communications Engagement Lead)
HST and KwaZulu-Natal's Department of Health (DoH) partners offer free health screening services to residents at the remote Sivule Community in uPhongolo, which is situated on the border of Zululand and eSwatini during the DoH's Phuthuma Week.
Meet Magugu Nxumalo. The soft-spoken and warm-hearted mother of two was thrilled when she and fellow community members heard the news that the provincial Department of Health (DoH) in partnership with the Health Systems Trust would be visiting their local Sivule Community in rural Zululand's uPhongolo Local Municipality during Phuthuma Week. She and her sons received free health screening at the outreach event.
Phuthuma is an isiZulu word that means 'hurry', and the DoH identified this particular week for the implementation of a strategy to regain the losses suffered by health services in the province as a result of the negative impact of a multitude of factors in the last two years: including the COVID-19 pandemic, the July 2021 civil unrest, the devastating April 2022 floods, as well as the unprecedented negative impact of misinformation and disinformation about vaccines in general. When the DoH sent out a directorate for local health districts to prioritise Phuthuma Week in the province from May 15 to 22, Health Systems Trust (HST) as its district support partner was present to play an active role in rolling out the strategy.
HST's Communications Unit supported the organisation's District Co-ordinator for Zululand, Makhosazana Khoza, during Phuthuma Week, where two community sites and a school were visited. Makhosi, as she is known as, is employed under HST's South Africa Sustainable Response to HIV/AIDS (SA SURE) Project, which is funded by the Centers for Disease Control and Prevention (CDC) through the United States President's Emergency Plan for AIDS Relief (PEPFAR).
Honing in on Zululand
UPhongolo Local Municipality is fortunate enough to have a few clinics as well as a district rural hospital (iTshelejuba Hospital), however, transport issues coupled with a number of socio-economic factors in the iTshelejuba community and its surrounds prevent residents from accessing the health facilities as often as they would like to.
The overall picture was painted by Mrs Thembisile Vilakazi, a Nurse by profession and Chief Executive Officer of iTshelejuba Hospital and its clinic. Community outreach has always been at the heart of what she does. Her passion is helping people, but the community faces several challenges. "Poverty and other social determinants mean we are far from our clients. What I like to do is show[ing] up at the communities to understand the challenges faced by healthcare workers and understand how best to support them as well as the community members. HST plays a huge role in helping us reach out to communities."
Mrs Vilakazi said Phuthuma Week highlighted what has always been needed: integrated services at community level. Phuthuma Week encouraged the establishment of vaccination centres at all chronic (PHC) clinics to reach the elderly, persons with co-morbidities and persons classified as immunocompromised. It was also an opportunity for school health facilitated vaccinations to reach learners and surrounding communities; for Occupational Health clinics to promote vaccine uptake and booster shots; and going back to SASSA and Post Office pay points to reach the elderly in efforts to help shield them and vulnerable individuals from severe COVID-19 through up-to-date vaccinations.
Despite the ongoing social ills and challenges, including teenage pregnancy; drug abuse; gangsterism; constantly migrating farm workers; cellphone network issues sometimes preventing cross-border client tracing; and (especially) cancer clients showing up to the hospital and clinic almost too late in the disease progression spectrum; clients still do want to access health services. Mrs Vilakazi and her team were pleased to see community members showing up in their numbers to receive free health screening services for TB, HIV, acute and minor illnesses during Phuthuma Week. Services included medical male circumcision and screening for prostate cancer; eye-care services and Pap smears offered in the mobile units; and assistive devices such as walking sticks were personalised and issued to the elderly.
Bringing health services to the people: HST's Area Co-ordinator for Zululand, Phindile Sangweni, consults with an elderly community member inside a mobile unit during Phuthuma Week.
Identified by the DoH as one of the best schools in the district, Mchitheki High School in KwaNgoma, Zululand, vaccinated an impressive 520 learners for COVID-19 on its first day of the Phuthuma Week drive. This was in line with the DoH strategy to increase the number of youngsters (aged 12–17) vaccinated against the pandemic. The school established a Vaccine Committee, led by one of the teachers, Mr Siyabonga Khumalo, in January 2022. Khumalo said managing the virus is critical. The committee has prioritised sourcing reliable information to share with the learners and the surrounding community. The learners are sanitised and screened daily, and the schools encourage them to wear masks and maintain social distancing.
The school principal, Mr Xolani Mthethwa said they were thrilled to be making a valuable contribution to the community. "We are a school operating within the community and so we have to play our part. It's great that the Department of Health will see that a school in the 'bundus' can make a difference – we like to be a candle lit in the community." The school was touched by the recent floods in Durban. They responded with a donation of over R5000 to the Durban Mayor's Office. The money was raised by teachers, learners and parents. Principal Mthethwa said it was great to see the parents supporting the vaccine drive at the school.
The Zululand visit concluded in Ngenetsheni Community, situated in Vryheid's Emahhokweni area that is serviced by the neighbouring Ikhambi Clinic in the Abaqulusi District. We spoke to Sister Daisy Ndebe who lauded HST's support, especially the outreach into remote communities. As primary healthcare professionals, they would also like to see more integrated services becoming more available in the area. To this end, they work closely with HST's Area Co-ordinator in Vryheid's Abaqulusi District, Cebo Ngobese.
Working hard to deliver health services in Vryheid: Cebo Ngobese, Zandile Mtshali and Sister Daisy Ndebe.
Together with the local Community Health Worker, Zandile Mtshali, Sister Ndebe explained that residents in the community identified for the Phuthuma Week outreach often feel neglected. There is a single taxi that leaves for the clinic each day. If the client misses that taxi, they will miss out on critical healthcare services. They said the Get Checked. Go Collect Campaign has really helped with increasing pick-up points for chronic medication patients.
Other challenges in the community include community members not having Identity Documents (IDs) and birth certificates. "This makes it extremely difficult to on-board clients to the health system and CCMDD. We need to establish strong interdepartmental referral pathways between the DoH and the Departments of Social Development and Home Affairs.
Trained by the HSTi, HST's Driver Mobilisor, Mondli Shelembe offers HIV testing services (HTS) in a mobile unit in Vryheid during Phuthuma Week.
Partners offering integrated services in Zululand during Phuthuma Week.
Colleagues from UCSF OPIQ, the Department of Health and HST celebrating the launch of the new health resources.
The University of California San Francisco's (UCSF) Optimizing Performance by Improving Quality (OPIQ) Project has launched a Spotlights Compendium together with an HIV Tracing and Recall Script (TRS) User Guide to better manage TB and HIV, with a strong focus on reaching the UNAIDS 95-95-95 Fast-Track Targets aimed at ending the AIDS epidemic as a public health threat by 2030.
These new resources which can be downloaded online (Spotlights and TRS) were developed within two years in 12 health districts situated within South Africa's Eastern Cape, Gauteng, KwaZulu-Natal and North West provinces from a corporative agreement between OPIQ and four Department of Health (DoH) District Support Partners (DSPs) – Health Systems Trust, TB HIV Care, The Aurum Institute and Wits RHI.
Funded by the Centers for Disease Control and Prevention (CDC) through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) the Spotlights Compendium and TRS User Guide were launched at the Capital Pearls Hotel in Umhlanga Rocks on 24 May 2022, announcing the remarkable development of 20 quality improvement Spotlights which are a clear, concise and useful guide designed to help health professionals provide improved care to clients. The Spotlights cover a range of topics, giving guidance on case finding, decanting, records management, retention, TLD (tenofovir, lamivudine and dolutegravir) implementation, Mycobacterium tuberculosis (TB) and viral load monitoring.
OPIQ also worked with the DSPs to develop a TRS User Guide that forms part of the tools to be used during the implementation of the Department of Health's Welcome Back Campaign Strategy which seeks to support re-engagement and retention of people living with HIV who were diagnosed, but never initiated on antiretroviral therapy (ART) and those who were initiated on treatment and interrupted ART or missed ART appointments. It was stressed at the event that the TRS is to be used in a manner that is non-accusatory and non-judgemental, but rather that seeks to make the client feel supported and welcomed back at the health facility.
The TRS User Guide will be used in conjunction with the 8th standard operating procedure of the National Adherence Guidelines of HIV, TB and non-Communicable Diseases (NCDs) of March 2020. The document is available in eight of South Africa's 11 official languages, which is an impressive feat that truly enables access to information. The guide can also be used for both the telephonic and physical tracing of clients. The TRS is aimed at guiding messaging/language around tracing and recall of clients who were unable to return to the facility within 7 calendar days of their scheduled appointments including:
Jaqui Ngozo (KZN DoH Director of the Tuberculosis Control Programme, HIV and STI); Dr Hloniphile Mabuza (UCSF OPIQ Technical Director); HST's SA SURE Project Operations Manager, Felicity Basson; Dr Diane Morof (Associate Director of Programmes KwaZulu-Natal, Division of Global HIV & TB: U.S. Centres for Disease Control and Prevention); and Dr Gugu Mona (Senior Clinical Advisor, Quality Improvement, Division of Global HIV & TB: U.S. Centres for Disease Control and Prevention) unboxing the Spotlights Compendium and Tracing and Recall Script User Guide at the event.
The event was attended by Dr Diane Morof (Associate Director of Programmes KwaZulu-Natal, Division of Global HIV & TB: U.S. Centres for Disease Control and Prevention), who applauded HST's collaboration with OPIQ and the DoH, saying it was a positive move towards the desired epidemic control. She said such partnerships were essential for establishing best practices and creating a real impact in turning the tide against the HIV pandemic.
HST's SA SURE Project Operations Manager, Felicity Basson.
HST's SA SURE Project Operations Manager, Felicity Basson, said the occasion celebrates an enriching and important journey of translating innovative practice into knowledge. "In all of our programme and project work over the past 30 years, HST has been committed to knowledge-sharing. This entails documenting our data-driven implementation experiences from the field, and compiling accessible accounts of promising models and change ideals for effective health service delivery. The Spotlight stories demonstrate the value of these efforts."
Basson said the continued partnership with OPIQ has brought expertise in data visualisation, informatics and implementation science to our implementers. "All colleagues benefit from the capacity-building in data literacy and writing skills, and the professional growth that they will gain through authorship of the final outputs." She said it was critical for all health professionals to gain access to both the Spotlights Compendium and the TRS User Guide.
Dr Hloniphile Mabuza (UCSF OPIQ Technical Director); CDC Associate Director (Programmes) Dr Diane Morof; and Jaqui Ngozo (KZN DoH Director: TB Control Programme, HIV and STI).
UCSF OPIQ Technical Director, Dr Hloniphile Mabuza applauded HST and the other DSPs for their hands-on contribution in the development of both resources. She said the products are evidence that collaboration, and not competition, are what will foster resilient health system quality improvement as a continuous process. She said it is envisaged that the two publications will improve the quality of services in the health sector.
Mabuza stressed that quality improvement is a continuous process. "It is the combined unceasing efforts of everyone to make the changes that will lead to better patient outcomes, better system performance and better professional development." Mabuza said the launch was a celebration, but also an indication that a lot is still to be done. She said it was critical for South Africa to reach epidemic control, and that everybody must play their part.
The Project Director for the UCSF OPIQ Project, Thulani Mbatha, said "We are indebted to your [HST's] support to the OPIQ project team. Especially as we continue to work with HST and eThekwini Health District in providing technical assistance, evidence-based Quality Improvement methodologies to foster a data-driven approach to improve HIV and HIV/TB program performance in the province. OPIQ is committed to address QI performance gaps of DOH by working jointly with HST."
In the spirit of Ubuntu and full recognition of their commitment and dedication to saving the lives of others, the Health Systems Trust (HST) would like to say to nurses all over the world, thank you!
The global community observes International Nurses Day annually on 12 May, a day commemorating the anniversary of Florence Nightingale's birth (1820-1910). This world icon's work and training of nurses helped transform hospitals from death houses to sanctuaries of care. This year, representatives from HST's Communications Unit and SA SURE Project spent the day visiting nurses from five clinics based in some of eThekwini's communities hardest hit by the recent floods to hear the voices of nurses employed in the organisation and try to fathom how they continue to shine, despite the recent crises, disasters and pandemics that have shaken KwaZulu-Natal.
Funded by the U.S Centers for Disease Control and Prevention (CDC) through the United States President's Emergency Plan for AIDS Relief (PEPFAR) the South Africa Sustainable Response to HIV/AIDS (SA SURE) Project strengthens and supports local capacity. This provides sustainable HIV and TB-related care and treatment service delivery in seven districts (including over 600 facilities) spread over three provinces (Eastern Cape, Free State and KwaZulu-Natal) through training, mentoring, coaching and direct service delivery. Some of the nurses visited on International Nurses Day form part of the SA SURE Project.
Care and compassion drives it all
Facility Team Lead, Ntombentsha Sigam
The first stop was at Chesterville Clinic where we spoke to warm-hearted Facility Team Lead, Ntombentsha Sigam who joined the nursing profession in 2007 and HST in 2019. It was their caring nature, professionalism and crisp white uniforms that attracted Nurse Sigam to the profession. "When you're a nurse, you are also a teacher, an advocate and counsellor," she expressed. "I find joy and much reward in helping others," she said.
Nurse Sigam said COVID-19 was a definite blow for healthcare workers, patients and overall service delivery. "We lost a lot of clients. The clinic could only take a certain number of clients at a time. We experienced shortage of staff. Some of us had to go into isolation. There was a general fear of coming to work due to the nature of the pandemic, but we still came through because we really love what we do and genuinely care about the health and well-being of our clients. The recent floods also affected us badly, the healthcare workers as well as our clients. "Some staff couldn't come to work due to damaged roads, some lost their houses and had to relocate. It was to the extent that some phoned in asking for transfer letters. Access to work was limited and also detrimental was that tracing staff couldn't go out to reach patients."
Other challenges the facility faces are that the Chesterville community is home to many informal settlements, meaning that clients do not have actual addresses, they are lost to tracking and tracing, plus due to immigration, some clients have language barriers; they speak neither English nor isiZulu; making communication and service delivery a serious challenge. The facility did a mop up of the situation in March where many dwellers in the informal settlement tested positive for Mycobacterium tuberculosis (TB). "There is a high pregnancy rate. One positive though is that the CCMDD Peleboxes are really helping in terms of clients being able to collect chronic medication at their convenience."
Nurse Clinician, Nomcebo Khumalo
The situation was slightly better at New Germany Clinic where we met Nurse Clinician, Nomcebo Khumalo, who qualified as a professional nurse in 2009. She loves nursing! "The reward is seeing a patient coming in ill and walking out smiling. It keeps me going every day!"
Nurse Khumalo lost her grandfather to COVID-19 and says these two years of the pandemic have been surreal. New Germany Clinic services several neighbouring communities and one of the challenges the facility faces from at the onset was distinguishing whether the symptoms some of the clients showed were of COVID-19, TB or asthma. It has been a challenging time but she wouldn't trade her profession for the world.
Mpola Clinic Nursing Services Manager, Mrs Wendy Ncube and Facility Team Lead, Patrick Koli
Mrs Wendy Ncube, Mpola Clinic's Nursing Services Manager in the Pinetown vicinity, complimented HST Facility Team Lead, Patrick Koli, for his work ethic and professionalism. Not only an all-rounder at the clinic, but also for his dedication to boosting and promoting men's health services through the MINA Campaign at the facility, nurse Koli has always loved helping people, and he said he has been fortunate to work for non-governmental organisations that have mostly a strong HIV and TB focus since he joined the profession in 2009.
They work closely with a COVID-19 Mobiliser and other healthcare providers from the Department of Health to provide integrated services at the Mpola community's Ward 15, especially since the outbreak of COVID-19 and for people with comorbidities. It was deeply saddening to learn that over 80 families are currently housed at the local Mpola Hall, with over 40 families at the local Sthundule Hall – all as a result of the recent floods that destroyed many parts of the province.
Roads damaged by the recent floods in the Mpola community.
Nurse Koli said COVID-19 screening is critical because it's flu season and people present with symptoms that could either be of flu, TB or COVID-19 alike. "We make sure that we fast track patients with flu symptoms, those on chronic medications, and of course, children and the elderly. A great win at the facility is the establishment of specific consultation rooms tailored for specific integrated services: MINA for Men, Adolescent Youth friendly Services (AYFs), and CCMDD for clients on chronic medication. Campaign Agents also work HST's Outreach Team and Community Healthcare Workers on HIV testing, case management, the tracking and tracing of clients, as well as on the Department of Health's Expanded Program on Immunization (EPI).
There is hope!
Nurse Samkelisiwe Gwala at Reservoir Hills Clinic
We also met Samkelisiwe Gwala (25), HST's Nurse Clinician whose middle name, 'Hope', which spells exactly what she exudes when clients walk through her door at Reservoir Hills Clinic. "I love helping people. Growing up, my church would make you go to bed at night asking yourself, 'How many people have you helped today?' That school of thought has never left me. You must allow God to use you to help other people. This is what I love; I wouldn't want to do anything else."
Like all the nurses we met on the day, Nurse Gwala believes that a critical part of being a nurse is spending time to educate your clients about the importance of adhering to medication, as preached by the CCMDD campaign. She wears her heart on her sleeve. She said the floods were bad: not only could most staff not show up for work on the first day, but on the second day they arrived at work and the facility itself was flooded. "Patients open up to us about how dire the impact of the floods have been. Their stories motivated us to give donations. The Outreach Team has played an important role in delivering medication to clients that could not make it to the clinic due to the impact of the floods. We are still trying to recover. There are shacks nearby and some families who lost their homes have had to be housed at a neighbouring fall for a roof over their heads. Despite all of this, clients are persevering and still coming to collect their medication and receive treatment. That is impressive!"
A way forward
At birth, near-death experiences, illness, trauma, medical advice and sheer generosity, we have all experienced care in many forms from nurses. Let's do our best to respect, protect and preserve the profession.
A message from the CEO
"On international nurses Day 2022, we say a heartfelt thank you to all the nurses in HST for the wonderful work you do, and for having played a key role in HST's ability to continue to provide services over the past two difficult years. You've led from the front!" - Dr Themba Moeti .
A message to all nurses in isiZulu from the provincial Department of Health
Nurses from Kwadabeka Clinic in eThekwini.
By: Judith King (Copy and Content Editor: Health Systems Strengthening)
HST CEO, Dr Themba Moeti, introduces the SAHR 2021 at the launch event.
Photo: Lunga Memela
In partnership with the University of KwaZulu-Natal's Health Economic and HIV/AIDS Research Division (HEARD), Health Systems Trust (HST) launched its 24th edition of the South African Health Review (SAHR) on 22 April 2021.
Exploring a broad range of specialist perspectives on South Africa's experience of addressing COVID-19 under the theme 'What have we learnt?' the content of this SAHR edition offers knowledge that strengthens the scientific advisory process for COVID-19 where no model exists for what is predictable and will be manageable for healthcare provision.
The following reflective view on the scenarios and recommendations presented in the publication was published in the Daily Maverick on 27 April 2022. Please access the article via this link.
To read the full 2021 South African Health Review, click here and for Chapters-at-a glance, click here.
Health Minister Joe Phaahla receives the publication from the Chair of HST's Board of Trustees, Dr Dumani Kula. Equally excited by the handover: SAHR Guest Editor from HEARD, Professor Gavin George; SAHR Managing Editor, Ms Ashnie Padarath; and HST CEO and Co-editor, Dr Themba Moeti.
The Health Systems Trust (HST) together with its collaborator, the University of KwaZulu-Natal's Health Economics and HIV and AIDS Research Division (HEARD), were thrilled to present the Minister of Health, Dr Joe Phaahla, with a copy of the 24th South African Health Review (SAHR) – one of HST's flagship publications – that was produced this time as a special edition funded by the Johnson & Johnson Foundation. The publication focuses on health sector responses to COVID-19 and what has been learnt, two years into the pandemic.
The much-anticipated journal was officially presented to the National Department of Health (NDoH) at an event that took place at the Southern Sun Hotel in Pretoria on Friday, 22 April 2022. It was a hybrid event, attended in person and also virtually by a diverse group, including the members of HST's Board of Trustees, the authors, co-editors, funders, media houses and other contributors that made the publication and its launch a tremendous success.
SAHR Managing Editor, Ms Ashnie Padarath and Guest Editor from HEARD, Professor Gavin George addressing the auditorium at the launch.
About the theme: Health Sector responses to COVID-19, what have we learnt?
Conceptualising the theme for this special edition, the editors (HST's Ashnie Padarath and Dr Themba Moeti together with Professors Kaymarlin Govender and Gavin George from HEARD) agreed that when it comes to service delivery and access in both the public and private health sectors, COVID-19 has put everything to the test. They reiterated that the pandemic has demonstrated how central public health security is to health and livelihoods, and how pandemic health emergencies expose the weaknesses and vulnerabilities of health systems, costing lives and causing immeasurable damage to economies. That is why this edition considers the government and broader health sector's response to COVID-19: it explores the current challenges facing the health system at this unprecedented time, and reflects on lessons learnt for future for public health emergencies.
"The chapters offer information on, inter alia, the challenges of balancing lives with livelihoods, and the impact of COVID-19 on different cadres of healthcare workers, especially Community Health Workers who found themselves at the forefront of our COVID-19 response. Other areas covered include the impact of COVID-19 on vulnerable populations like children, persons with disabilities, farmworkers, migrants, and the poorest in our society," the speakers highlighted at the event.
As per the SAHR standard, the journal comprises of 29 peer-reviewed chapters with over 100 contributors, most of whom are established experts in the health sector, and whose topics thematically capture both the impact of COVID-19 and the health sector's response. It also provides recommendations for building a stronger and more resilient health system.
The significance of the publication is effectively captured in a video that was played at the launch, making it clear that this edition of the SAHR will be not only be a national, but also global, resource. The full publication can be downloaded in PDF format from HST's website. Chapters at a Glance can also be accessed on HST's website.
South African Minister of Health, Dr Joe PhaahlaIn his keynote address, Minister Phaala said he would like to convey the deep appreciation of Government and the DoH for the tremendous contribution all its partners have made to the fight against COVID-19, the maintenance of key health services in these difficult times and their support for the continuing development of our health system. He said: "Many of you are sitting in this room today and the journal we are launching in many ways documents the work that you have done in collaboration with our health system in the fight against this pandemic. We would not be where we are today without your support, and I believe we will all take the lessons documented in this journal this evening and apply them to make our health system better prepared for and more resilient to the challenges of pandemics and emerging health challenges such as COVID-19."
Minister Phaahla congratulated HST on its 30th anniversary. "They [HST] have played a critical role in helping build and strengthen the health system in the 28 years of our democracy and remain a valued partner. May they grow from strength to strength and leave a lasting impression on our health system," said the Minister.
HST CEO, Dr Themba Moeti and UKZN's Deputy Vice Chancellor of Research and Innovation, Professor Mosa Moshabela applauding the page turner SAHR 2021 at the launch
HST's CEO, Dr Themba Moeti, served as programme director at the launch. All the speakers took a moment to acknowledge the lives lost and terrible impact of recent floods in KwaZulu-Natal, communities in which both HST and UKZN operate.
Ms Laura Nel, Johnson & Johnson’s Director for Global Community Impact, representing the funder of the publication, also addressed the audience. She said the Foundation was incredibly proud to be associated with a publication of this stature. “It gives an important voice for frontline workers during the COVID-19 pandemic.” She wished HST a happy 30th anniversary.
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