HST Blog

​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.