HST Projects

The ‘Programmatic implementation and technical assistance (TA) for HIV/AIDS and tuberculosis (TB) prevention, care and treatment services throughout the health system in South Africa’ (SA SURE Plus) project strengthens and supports local capacity to provide sustainable HIV and TB-related care and treatment service delivery in South Africa through technical assistance (training, mentoring, coaching) and seconded direct service delivery.The ‘Plus’ at the end of the project name denotes the changed focus linked to the second round of funding.

Currently, the project focuses at all levels of the health system – provincial, district, facility and community – to support Department of Health (DoH) facilities in four PEPFAR focus districts in KwaZulu-Natal (KZN) Province: eThekwini, uMgungundlovu, uThukela, and Zululand.

Implementation of RoR scale-up began on 2 February 2015 in Lejweleputswa District, Free State Province. The aim of the project is to reduce the existing number of registers used in primary health care (PHC) facilities to a maximum of six standardised registers, namely:
• PHC Daily Tick Register plus Headcount Register
• TB Registers (for ETR.Net)
• ART Register (for TIER.Net)
• Delivery Register
• Theatre Register (for medical male circumcision [MMC] and TOPs)
• Midnight Census Register

The scale-up component of the RoR Project paved the way for full implementation of the six rationalised registers across the Free State, Eastern Cape, North West, Northern Cape, Mpumalanga and Limpopo Provinces; Gauteng and KwaZulu-Natal will be involved in the scale-up once the finalisation of each of these provinces’ Provincial Indicator Data Set (PIDS) has been incorporated into the registers.



Monitoring the compliance of facilities in the use of the six rationalised registers is being conducted in Northern Cape Province. Ultimately, compliance monitoring will be implemented nationally.

The Quality Improvement Co-ordination Project focuses on the provision of technical assistance for co-ordination and learning, enabling: the National Department of Health (NDoH) and the Office of Health Standards Compliance (OHSC) to conduct visits to the provinces; the co-ordination of meetings on behalf of the NDoH; the development of OHSC video material; and the documentation of relevant resources and good practices.



Health Systems Trust has documented and analysed the outcomes of a series of district and provincial workshops where QI and core standards work was discussed, and challenges and potential solutions identified. A workshop was held to review all activities conducted by the participant non-governmental organisations (NGOs).

Developed by HST in collaboration with the National Department of Health (NDoH), the National Health Research Database (NHRD) is a web-based tool for use by the National Health Research Committee (PHRC) to monitor and track health research being conducted in South Africa. In the last financial year (2014/15), HST consolidated refinements to the database and piloted it in three provinces, namely KwaZulu-Natal, Western Cape and Free State. The official launch took place on 29 October 2015; since then, the database has been used nationally by the Provincial Health Research Committees.



Through ongoing funding in the 2015/16 financial year, HST will continue to train PHRC administrators and maintain the database whilst preparing for the next phase of NHRD development for use by National Health Research Ethics Committees (NHRCs).



An evaluation of the NHRD has been concluded with the analysis of the findings being written into a report.

In July 2013, the Ideal Clinic Realisation and Maintenance (ICRM) initiative was launched as a way of systematically improving the deficiencies in South Africa’s public sector primary health care (PHC) clinics. The Ideal Clinic is envisaged to offer a comprehensive range of integrated diagnostic, curative, rehabilitative and palliative services. Using existing clinic functions and staff duties in a different and systematic manner, the goal of this initiative is to ensure universally available high-quality PHC services.



To transition clinics from their current state to an ‘ideal’ state, a set of almost 200 items needed to be improved to an acceptable level of functionality. Progress within these 200 items is monitored through the Ideal Clinic Dashboard which scores the item as either Green (achieved), Amber (partially achieved) or Red (not achieved). Identification of the standards and indicators helps to convey a sense of what is required, but does little to support and catalyse the change necessary to transition clinics from their current state to the envisaged ideal state.



Various change and/or Lean Management models are currently implemented within the public health sector. Some health facilities are supported by development partners that use different Change and/or Lean Management models. Ensuring that there is understanding of the National Department of Health (NDoH) standards for health service delivery and compliance to protocol across the entire health system is critical.



Health Systems Trust (HST) serves as the co-ordinating body for the development and implementation of the Change Management model that would facilitate the success of the ICRM initiative.

The Eastern Cape Department of Health (ECDoH) requested Health Systems Trust (HST) through the SA SURE project to provide support with quality improvement initiatives at two district hospitals in OR Tambo.  In collaboration with ECDoH Epidemiology and Research Directorate, the HST SA SURE Evaluations Unit will principally provide evaluation support to assess the quality of maternal and child health services rendered in two of the hospitals.

uMzinyathi Health District in KwaZulu-Natal, as an NHI pilot district implemented the Benguela Referral method since January 2013, in an effort to strengthen the PHC approach in the district and to realize the outputs of the Department of Health’s (DoH) Negotiated Service Delivery Agreement (NSDA) and to meet its Millennium Development Goals (MDGs). The District’s aim to strengthen the referral system within the district, in line with the Primary Health care re-engineering framework, is part of its NHI planned activities to improve service provision through ensuring that all residents of the district have access to appropriate, efficient and quality health services. It is envisaged that the strengthened referral system will result in improved access to quality healthcare services.



This project aims to qualitatively assess the referral system at district level for equity, accessibility, efficiency and effectiveness.

Since 2010, HST has led work in the area of competency assessments focusing on sub-district and PHC facility managers. The Assessment of the General Management and Public Health Competencies of Facility and other Sub-district Managers was concluded in 2012/13; this study revealed gaps in leadership and management capacity-building in the country, as well as the need to enhance competency assessment techniques and processes and extend this to other categories of staff working within the district health system. HST has been working closely with the National Department of Health (NDoH) and the US Centers for Disease Control and Prevention (CDC) in pursuit of expanding this work. The study now continues as a CDC-funded project aimed at honing the competency assessment tools and up-scaling competency assessments in additional HST-supported districts using refined competency assessment techniques.

The National Department of Health has funded Health Systems Trust’s research activities for many years and since 2011, there has been a renewed commitment to fund our research outputs, including the District Health Barometer and the South African Health Review. This has enabled HST’s Health Systems Research (HSR) Unit to conduct a number of key studies generating a strong body of evidence relating to all health system building blocks that can inform policymaking. 



An assessment of these efforts and outputs will demonstrate how Health Systems Trust has established a unique and important contributory presence in priority research fields through stipulating and supporting innovative programmes to address research priorities. The project will synthesise key research findings and determine how our investigations have helped to inform the development of policies and strategies, and the implementation thereof.



Collection of data on the various projects and research activities included collation and extraction of relevant documents and consultations with authors. The synthesis project database has been developed and updated with key documents. Using a research methodology framework, data have been extracted from all project-related documents. Authors (project managers and researchers) have been consulted to validate extracted data elements for data analysis.



Data analysis and report-writing are underway. The synthesis project report will document key research findings and evidence across the building blocks of the health system, highlighting information on research efforts and expertise for policy implementation, whilst indicating cross-cutting issues and trends that provide insight to national health strategies.

The Soul City Institute of Health and Development Communication (Soul City Institute) is a social change project which uses mass media combined with social mobilisation and advocacy to bring about social change and improved health outcomes.

The Soul City Institute was awarded a grant to develop programme interventions to strengthen the demand for quality health services by the South African population in order to increase access to improved quality health care.

A literature review on the Revitalisation of Primary Health Care was commissioned, with a key focus on the role of communities in strengthening PHC and improving quality of care.  This literature review will contribute towards the development of the Soul City series 12, and the Soul  Buddyz Clubs. The purpose of the drama series is to model greater engagement of  communities with PHC delivery, and to promote accountability.

Through the support of the Millennium Challenge Account, the Lesotho Ministry of Health and Social Welfare (MOHSW) has engaged a Health Systems Strengthening (HSS) firm to augment the Ministry’s efforts in implementing the ongoing National Health Sector Reform Programme. The design of the HSS-Technical Assistance serves to mitigate the negative economic impacts of poor maternal health, HIV and AIDS, Tuberculosis, and other diseases by substantially strengthening the country’s health-care infrastructure and its ability to deliver quality health services to the Basotho.