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HST Blog

Dec 01

​How effective HIV care and treatment management helps sero-discordant couples and patients co-infected with HIV and TB

by Sanele Mvelase – Cross-site Facilitator: Health Promotion and Primrose Sithole - Special Project Co-ordinator: Zululand District

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The Health Systems Trust (HST) has been receiving funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) since 2012. We work in partnership with the Department of Health in four districts in KwaZulu-Natal, where we provide technical assistance for TB and HIV programmes, and have placed supplemental staff in facilities to provide direct services to patients.

In the course of this work, we hear many stories from patients ‒ some motivating us to do more, some helping us improve our patient-centred approaches, and some that demonstrate the difference that our work makes in people's lives through PEPFAR's commitment to the dual pandemics of HIV and TB in South Africa.

This article touches on the stories of three patients who are partners in sero-discordant couples, and a patient with TB and HIV co-infection. These patients have shared their experiences with us in order to inspire others to seek treatment and dispel myths that contribute to the stigmatisation of people living with HIV. We also speak to the clinicians responsible for helping patients to remain on life-saving treatment.

Msizi Zikalala (not his real name) is from Zwelisha in Estcourt, a farming town in the uThukela District of KwaZulu-Natal, where he and his three siblings were raised by his mother. Now 32 years old, he is an informal vendor selling snacks, sweets and cigarettes at a local taxi-rank.

When his partner was pregnant, she was not feeling well and they decided to visit the Zwelisha Clinic, where they both consented to be tested for HIV. During the consultation, the healthcare worker asked them whether they would accept whatever the test results showed, even if their status was not the same; they agreed to accept the results and support each other as a couple.

"I know that there are other couples out there with other health conditions, like one partner has diabetes and the other does not," says Msizi. "Such couples do not give up on each other but continue with support and love for one another. It's the same with HIV, so I believe couples should support each other if one is HIV-positive and the other is not."

When the test results showed that Msizi's partner was HIV-positive and he was HIV-negative, the nurse assured them that the situation could be managed, and that many couples in a similar situation were healthy, happy and still in love.

Because they received their test results together, they spoke about their sero-discordant status immediately during the consultation. "My partner was emotional and crying," recalls Msizi. "I comforted her, and assured her that everything would be fine. I still love her and will not leave her. We are in this together and we will conquer. I believe that it's important to stay loyal to your partner and never allow anything to come between you. Another man might have moved on to another partner, only to find that that person is HIV-positive as well."

"The nurse offered me PrEP tablets (pre-exposure prophylaxis), which she explained would help to keep me HIV-negative, and my partner received antiretroviral therapy (ART)," says Msizi. "I have gone for repeat medication twice, and each time my vital signs are checked and I am re-tested for HIV."

To support each other on their treatment journey, the couple aligned their joint appointment dates, and ensured that they each receive the same number of months' medication supply, so that they return to the clinic together on the same day. The couple is grateful for the health services they receive. "The most important advice we were given was about me taking PrEP to stay healthy and HIV-negative, and my partner adhering to the treatment she needs," says Msizi.

Before learning about his negative HIV status, Msizi's greatest fear was his partner's reaction if his test result was HIV-positive. "Of course, now we wish that we were both HIV-negative, but the nurse helped me by explaining exactly what this diagnosis would mean, and the importance of accepting our results. She advised us on what we can do together to have a healthy life, and gave us leaflets containing more information."

Once diagnosed, Msizi committed to always being there for his partner so that if she falls pregnant again, she will have his support. "My partner had a miscarriage, and we don't have a child yet," he explains. "I hope to be a successful business man and run a proper tuck-shop so that we can build for our future."

Msizi's advice for other couples is to visit the clinic and be tested for HIV, so that they can receive either PrEP or ART, depending on their status, to stay healthy by taking treatment as required, and align their appointment dates to support each other.


A 22-year-old woman, who lives with her mother and five-year-old daughter, sells fruit and vegetables at a local taxi-rank. When she had 'flu and breast tenderness, she asked her partner to accompany her to the clinic, where they were both tested for HIV and found to be HIV-negative. She also had a pregnancy test and was confirmed as expecting, so she enrolled in antenatal care.

The following month, the couple had a second HIV test; this time, she was HIV-positive and her partner tested negative. "I was scared that my partner would change and leave me, but he has been supportive and requested to take PrEP which was offered by our counsellor. I also did not understand what to do now that I was positive, but our counsellor explained HIV to me and the importance of adherence to treatment."

The nurse explained that she could still live a healthy life if she took her ART medication as required. "At first I could not remember everything we were told, since I was still confused about testing positive and my partner testing negative," says the patient. "We had been having unprotected sex for more than two years, and the nurse advised us that this can happen, which was a big lesson for us."

The patient made important life decisions after the couple's consultation. "I told myself that even though I will have to take treatment every day, I want to live a long life, grow my business and provide for my family. While I don't want to lose my partner, I also want to be independent, so I take my pills every day," she explains.

"We received proper counselling and support from the clinic, but we'd like the staff to create groups for people who have experienced the same thing ‒ people of our age group with whom we can speak freely," she says.

"My advice to others is that when you test HIV-positive, you must take your treatment and have one partner. If you test negative, you should take PrEP and use condoms to protect your partner. You can live a healthy life if you take your treatment, and it is easy if your partner is supportive. We even request the same dates for our clinic appointments, and also for blood collection."


At Pongola Fixed Clinic in Zululand, a 17-year-old HIV-positive patient describes her experience as a partner in a sero-discordant couple.

"I have one child and am not working, as I'm still at school doing Grade 11. When I became pregnant, I tested positive for HIV. For a month, I could not tell my partner about my diagnosis. Then one day, when we were fighting over his many girlfriends, I told him that I was HIV-positive and that I thought it was his mistake. We then both went to the clinic and when his test was negative, he was put on PrEP."

This patient's greatest fear was that she would be visibly ill and that people in her community would judge her and stigmatise her for being HIV-positive. "Then the counsellor assisted me by telling me that if I take my medication properly, the virus will be supressed and neither my partner nor my unborn child will be infected with HIV. The counsellor explained that I have to love my medication, exercise regularly, eat healthily and protect myself with a condom when I'm with my partner."

"My goal is to take my medication and practise safe sex so that I won't infect my child and I can live a long, healthy life. I've learnt that when you are still sexually active, protection is very important. My advice to others is that even if you are young and HIV-positive, treatment will keep you healthy, and if you are HIV-negative, you can still protect yourself by using PrEP."


A clinician describes how a sero-discordant couple is counselled to inform the pair fully about their diagnosis and allay any fears:

"As clinicians, we counsel a discordant couple by firstly explaining what it means to be in a relationship with a discordant partner. They can both live a healthy and happy life without the fear of infecting one another if the HIV-positive partner takes ART as instructed, because an undetectable viral load means that the virus is untransmittable. The HIV-negative partner should use PrEP. The couple can join a support group for discordant couples, and should they have questions about the guidance, they have access to the clinic via phone at any time."


Mlungisi Zakwe (not his real name) is 55 years old. He has three sons from his late first wife, and now lives with his second wife but they have no children.

"I used to work at an industrial firm around Durban," says Mlungisi. "I stopped working when my first wife got sick to come and take care of her and she died. My two sons are working and the last one is looking for a job."

He decided to have an HIV test because he believes that it is important to know yourself as a person.

"I learnt about my TB infection about a month ago," explains Mlungisi. "I was working in Dundee and fell ill, coughing a lot. I lost my appetite and couldn't eat or sleep at night, sweating and feeling cold at the same time. I was weak, couldn't walk properly, and couldn't carry on with my duties at work, so I was sent away to seek medical attention. I consulted two different doctors and both told me I was well – but I was feeling sick."

He then decided to visit his local clinic where they took a sputum test and discovered that had TB infection. "They explained what this meant and the importance of starting TB treatment immediately, as I was very ill. After starting the treatment, I was able to sleep."

Mlungisi says that he'd like to write to the newspaper about the care he has received from the clinic.

"Without that help, I wouldn't be alive today as I saw that my days were numbered. At first, I was concerned to know that I have two diseases inside me – HIV and TB – but then I was happy to find out exactly what was wrong, as the doctors I'd seen previously could not help me. The nurse was kind and explained both conditions to me, advising me on what the treatment journey involves. Now I understand that I can fight both diseases with the medication I'm given."

Mlungisi's greatest challenge in managing his treatment adherence was dealing with side-effects of the medication, especially during the first two weeks of TB treatment. "At first, I was not able to walk or be active in the yard. But when I go for return visits to the clinic, a health worker takes my vital signs and the nurse discusses my treatment experience with me, helping me to deal with the side-effects and re-assuring me that I will be fine. She also gave me a leaflet to refer to for more information, but I am also welcome to go to the clinic for any reason, even if it's to ask for more guidance. I know now that I should not procrastinate in seeking medical attention."

Mlungisi's wife has been very supportive, taking two weeks' leave to look after him when he first started to take his medication. "It was not easy," he recalls. "I don't know how I can thank her for everything she's done for me."

His advice to others who suspect that they may have TB is that they should visit the nearest clinic without delay. "Using myself as an example, the clinic will do proper screening and tests," he says.


A healthcare provider describes the challenges faced by TB patients, especially those who are co-infected with HIV, and the clinician's role in supporting them through their treatment:

The pill burden is demanding, as co-infected patients have to take numerous tablets at the same time, and side-effects (especially those arising from TB treatment) affect their adherence.

Patients have to attend multiple appointments if their TB and HIV visit dates are not aligned (this happens mostly in the first month of TB treatment).

Most patients, particularly men, adhere to TB treatment but interrupt ART once they have completed their TB medication. By using campaigns such as MINA and peer education, we are working to improve adherence rates in men.

Offering treatment literacy and advanced adherence counselling, including a personalised adherence plan and careful management of side-effects, is of great help to such patients, as is ongoing counselling and psychosocial support during every visit. 

Disclosure to loved ones can also affect adherence, so on initiation of treatment, we link these patients with a Community Health Worker for home visits and support, and we encourage them to join support groups for easy communication and peer support.

Nov 29
Empowering Change: 16 Days of Activism Against Gender-Based Violence

​By Mandisa Dlamini, HST Communications Intern

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16 Days of Activism Against Gender-Based Violence is an annual global campaign that commences on 25 November, the International Day for the Elimination of Violence Against Women, and concludes on 10 December, Human Rights Day. In 2023, this period of activism holds even greater significance as the world unites to address and eradicate gender-based violence. In 1991, activists kicked off the campaign at the Women's Global Leadership Institute inauguration. Since then, people worldwide have adopted it as a strategy to rally against violence towards women and girls, aiming for prevention and elimination.

The theme

This year, the UNiTE campaign theme of the 16 Days is: Invest to Prevent Violence against Women & Girls. Violence against women and girls remains the most penetrating human rights violation around the world. In general terms, it appears in physical, sexual, and psychological manifestations, encompassing:

  • intimate partner violence (battering, psychological abuse, marital rape, femicide);
  • sexual violence and harassment (rape, forced sexual acts, unwanted sexual advances, child sexual abuse, forced marriage, street harassment, stalking, cyber-harassment);
  • human trafficking (slavery, sexual exploitation);
  • female genital mutilation; and
  • child marriage.

In order to put an end to violence against women, it is crucial that we address and challenge the attitudes that perpetuate, rationalise, and normalise such acts. We must also vehemently reject any denial of women's fundamental right to safety. The goal of Parliament is to make society fair and just by promoting democracy and protecting human rights, including those of women and children. Parliament has taken steps by passing laws to address and stop these problems in society.

16 Days of Activism Against Gender-Based Violence in 2023 is a crucial moment for global solidarity and collective action. By shedding light on the challenges, celebrating successes, and emphasising the importance of continued efforts, we can strive towards a world free from all forms of gender-based violence. Let's unite and take meaningful actions to support the 16 Days of Activism Against Gender-Based Violence campaign. Together, we can make a difference and contribute to creating a safer and more respectful world for everyone. Organisations such as POWA, Sonke Gender Justice, South African National AIDS Council, Ilitha Labantu, and TEARS Foundation actively participate in the fight against gender-based violence.

For more information visit:

Nov 22
A Day in the Life of HST’s Monitoring and Evaluation Technical Advisor, Silindile Mnembe.

By Siyabonga Gema, HST Communications Officer

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Meet Silindile Mnembe, HST's Monitoring and Evaluation (M&E) Technical Advisor for eThekwini District, who says that the most rewarding part about her job is her ability to make a meaningful impact and contribute to positive change. Those who work closely with Silindile know her for her commitment to delivering a high-quality standard of work, but there is more to her than what meets the eye. We had a brief chat with Silindile to get to know her better.   

Briefly outline what your role at HST entails

I support the M&E Manager in ensuring the effectiveness and efficiency of programmes and projects within an organisation by scoping, piloting and implementing electronic M&E and other systems that aim to improve availability and utilisation of evidence-based information. I am involved in designing and implementing monitoring and evaluation systems tailored to specific projects or programs

 What made you decide to get into the health sector?

I was drawn to the health sector by a genuine desire to make a positive impact on people's lives. The opportunity to contribute to the well-being and health of others can be a powerful motivator.

 What's the most rewarding part of your job?

The most rewarding part of my job is the ability to make a meaningful impact and contribute to positive change.

 What sets HST apart from other organisations?

Investment of the organisation in people's futures and career development. Even though HST is positioned in a fast-paced environment, the organisation excels at adapting to dynamic challenges, leveraging innovation, and maintaining a steadfast commitment to achieving its goals.

 How does your typical day at work look like?

My days are not the same, some are more hectic than others but I still manage. I start my day by checking emails and communications for any updates, queries, or requests related to monitoring and evaluation. Throughout the day, I co-ordinate with the various Project Managers and stakeholders to address any emerging issues or provide the necessary support. I set aside time to provide technical assistance to colleagues or partners who may need support in understanding or implementing M&E processes.

 What are your interests and hobbies outside of work?

My family comes first, so I love spending time with them, otherwise I do charity work.

 What advice would you give to someone starting a new career?

Embrace a mindset of continuous learning. Stay curious, seek out new knowledge, and be open to acquiring new skills throughout your career.

Describe yourself in three words

Determined, passionate and caring

 What's next for Silindile?

I am currently wrapping my studies in Masters in Public Health and will be enrolling for a Post Graduate Diploma in 2024, to explore new opportunities within the organisation.

Nov 15
A Day in the Life of Office Administrator Thabo Komape

By Siyabonga Gema, HST Communications Officer

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HST's Durban-based Office Administrator, Thabo Komape, exudes positive energy with a touch of modesty. Thabo's role at HST entails providing comprehensive administrative support to project staff and management in order to ensure that projects within the organisation operate smoothly and efficiently. In his role, Thabo is in charge of processing travel, accommodation and conferencing requests, fleet management, replenishing consumables, processing expenses claims, managing car wash accounts and advances, and managing the asset database for various project amongst many other duties entailed in his role. We recently had a chat with Thabo to get to know him better.


How did you hear about HST and what made you want to join this organisation?

I was introduced to HST via various social media platforms when I was in search for an organisation that had internship opportunities available. I join HST because I wanted exposure and experience in the field I had studied. Being a part of the great work that HST does was also a motivating factor.

What has been the highlight/s of your career at HST?

Working with the various stakeholders in pursuit of ensuring that staff are upskilled will always remain a highlight in my career as contributing to the growth of people fulfils me. The opportunity to work on the Border Health project was also a highlight for me as that is where I was exposed to most of HST processes and I got the opportunity to travel.

How have you grown within your role at HST?

I started my career at HST as a HR/Training Intern and growth began when I was absorbed as an administrator in the training unit (Health Systems Training Institute) where I gained extensive experience in the training and development field. I am currently an office administrator and I work on a number projects which I believe has given me more exposure and experience, which translates to growth.

What is the one thing that people don't know about you?

I might come across as a reserved person, however I absolute love working people and that is probably the reason I love the work that I do.

What inspires you?

Individuals that overcome adversity inspire me because life will always have challenges and seeing people overcome these challenges gives encouragement to keep trying.

Name one vital skill that one must possess to excel in a role like to yours.

Office Administrators provide the critical function of ensuring that organisations run smoothly and a vital skill that I feel is critical to excel in this role is great customer service as we work with a variety of stakeholders that need to be dealt with professionally.

The best advice you've ever received?

In relation to the professional environment the best advice I've received was that one needs to always remember why you are at work and the most important thing is to do your work to the best of your ability. In my personal life the best advice I have ever received is that one should never give up on your dreams no matter the circumstances and I ensure that I put God first in everything I do.

What are your future aspirations?

My future aspirations are to become a leader in roles I will occupy in the future and make a meaningful impact in society.


Nov 08
Diversity includes Disability: Disability rights awareness

By Siyabonga Gema, HST Communications Officer


Each year from 3 November to 3 December, South Africa celebrates National Disability Rights Awareness Month, with 3 December being the International Day of Persons with Disabilities, also celebrated as National Disability Rights Awareness Day. The theme: A Day for All, reflects a growing understanding that disability is part of the human condition, and represents a call to society to recognise that people with disabilities are equal citizens who should enjoy all basic human rights. The Convention on the Rights of Persons with Disabilities (CRPD) defines persons with disabilities to include those who have long-term physical, mental, intellectual or sensory impairments which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis.

Statistics South Africa released a report that provides statistical evidence relating to the prevalence of disability and characteristics of people with disabilities at both individual and household levels in South Africa. The report indicated that the national disability prevalence rate is 7,5% in South Africa. Disability is more prevalent among females compared to males (8,3% and 6,5% respectively). Persons with disabilities increase with age. More than half (53,2%) of persons aged 85+ reported having a disability. According to the report, households headed by persons with disabilities have less access to basic services compared to households headed by persons without disabilities. Taking into consideration the inequality gap in South Africa, the disparities extend further in underprivileged communities.

According to the Human Rights Commission of South Africa (SAHRC), people with disabilities may face the following challenges in accessing their rights:

  • Social barriers such as lack of awareness on the different types of disabilities amongst society, which results in lack of acceptance of persons with disabilities within communities; negative attitudes resulting from ignorance, misunderstanding and prejudice which keeps society from appreciating and experiencing the full potential persons with disabilities can achieve.

  • Psychological barriers which are mainly informed by fears for their personal safety.
  • Structural barriers such as accessibility to facilities and infrastructure, the lack of support services or technology, the lack of availability of information in accessible formats and the lack of reasonable accommodation in schools and work places.

In recognising these and other prevalent challenges, the South African government has taken steps to ensure that the rights of people living with disabilities are upheld and protected as enshrined in the Constitution. Section 9 of the Constitution provides that everyone is equal before the law and has equal protection and benefit of the law. It further states that no person, including the State and private companies may unfairly discriminate directly or indirectly on one or more grounds against any person on one or more grounds including race, gender, colour, age or disability.

Legislative measures to improve the lives of persons with disabilities such as The White Paper on Rights of People Living with Disabilities that was adopted by the South African Government in 2015, and the Employment Equity Act - which prohibits unfair discrimination against employees on the grounds of disability or illness - are part of a commitment by the State to protect the rights of disabled people in all sectors of society, including in the workplace. In a bid to further promote equal opportunities for all disabled people, the Disability Rights Charter of South Africa; a document which asserts the right of all disabled people to live independently in a safe environment and in a society free from all forms of discrimination, exploitation and abuse was adopted in South Africa.

Society has an important role to play in ensuring that everyone, including people living with disabilities are treated equally, and continue to have equal opportunity to participate in the continued growth and upliftment of the country. A wide range of information is readily available to the public in order to educate themselves on issues relating to the protection of the rights of people living with disabilities.

For more information, please visit;



Oct 26
Nomcebo Mtimkulu’s journey with HST: A Journey of Growth

by Siyabonga Gema, HST Communications Officer


HST prides itself on the calibre of talent it attracts, which in turn benefits the communities that we serve in partnership with the Department of Health (DoH). This is evident from the depth of knowledge and skills our colleagues possess, setting us apart from other organisations within the health sector. One such talent, HST's Clinical Advisor Nomcebo Mtimkulu, recently spoke to the Communications Unit and gave us insight into her professional and personal life.

What is your designation and when did you join HST?

 I joined HST in October 2016. I joined as a Nurse Clinician and transitioned into the role of Adolescent and Youth Friendly Services (AYFS) Co-ordinator. Thereafter, I took up the position of Special Projects Co-ordinator. During this time, I briefly fulfilled the role of Acting HTS Co-ordinator. I recently took on the role of Clinical Advisor in UMgungundlovu district.

 In your view, what sets HST apart from other organisations?

HST's longevity in the health system, our publications that keep people in the Public Health system updated, and the numerous projects that we embark on that are able to respond to and align to the needs of our client, the DoH, and the funders. Most importantly is our ability to find innovative ways to assist and support the communities we serve.

 What do you think it would take to improve health service delivery?

Advocating for our patients, treating people with dignity, and executing our duty with integrity. Also being accountable to ourselves, each other, and the communities we serve. Involving our communities in decision making, especially when it comes to the services we render will also improve health service delivery. We should also work together as stakeholders to provide holistic care to our people. HST has adopted the approach to empower the stakeholders that we support with sustainable strategies aimed at improving every pillar of the HIV cascade for adults, adolescents, and paediatrics.

 What gives you fulfilment in your role at HST?

The autonomy with which I am able to carry out my duties and deliver on my mandate gives me great fulfilment. It gives me great satisfaction to work with such a dynamic and innovative team. This translates into improved health outcomes for the clients accessing the services.

 How do you strike the work-life balance?

My work life flows seamlessly into my home life, and it's true what they say, "when you love what you do, you never have to work a day in your life".

 What's next for Nomcebo?

I am planning to further my studies, to enhance my skills and knowledge base in Public health. The following quote by Pele is a fitting description of my work journey: "Success is no accident. It is hard work, perseverance, learning, studying, sacrifice and most of all, love of what you are doing or learning to do".

Oct 20
HIV case management in uMgungundlovu facilities boosts trust in health services

by Siyabonga Gema, HST Communications Officer and Judith King, HSS Copy and Content Editor


Department of Health and HST staff working on case management at Eastwood Clinic in Pietermaritzburg.

Batho Pele / People First – which was conceived with the intention of transforming service delivery in the public sector – is founded on the principle that good service delivery leads to happy customers and employee satisfaction.

This is especially true in the health facilities based in uMgungundlovu District that have implemented Health Systems Trust's Case Management Model II (CMM2) ‒ a patient-centred model that assigns individual patients with chronic medical conditions to a single Clinician supported by members of the multi-functional facility team.  

The mission of case management

Case management is a practice focused on delivering personalised, holistic and high-quality health care, so as to achieve the desired health outcomes, reduce patients' unmet needs, enhance a positive experience of health care, and foster involvement of patients in their health care. The CMM2 also motivates and inspires healthcare providers and contributes to sustainable health service delivery systems.

Benefits of case management

This modality ensures that patients feel well-supported.

  • It promotes a positive patient‒clinician relationship based on efficient and responsive service delivery, thereby creating mutual trust.
  • Healthcare workers are confident and fulfilled in their work environment.
  • Healthcare providers are empowered with leadership and data management and analysis skills.
  • Overcrowding, long queues and long waiting times are radically reduced.

Case management has particular benefits for continuity of care among patients on antiretroviral therapy (ART), through close viral load management to the point of suppression and transitioning patients to differentiated models of care (DMoC) once they are clinically stable. Applying this modality also ensures that patients in DMoC remain supported, so that they have unbroken access to medication and guidance to avoid treatment interruption.

The model strengthens linkage to care through tracing, tracking and close follow-up of patients, helps to sustain them through their treatment journey through adherence counselling, appointment reminders, and referrals when necessary for other supportive services.

CMM2 implementation also facilitates care continuity for hospitalised patients, and improved tracing and testing of contacts of patients admitted with tuberculosis (TB).

CMM2 implementation in facilities

Patients in the Chronic Stream (whether they are living with HIV, TB, and/or a non-communicable disease) follow a colour-coded signage route to their Case Manager and related care-provision team.. The Clinicians are trained to analyse their own data, and to present on the CMM2 Dashboard content for discussion. Each team leader is concerned about poor results and strives to excel, with a clear goal of progressing their patients to stable viral suppression and transition to DMoC. They present data at weekly Nerve Centre meetings, and all staff understand what the data mean; everyone works together on quality improvement strategies. The real-time data updates and clean-up ensure that no gap is missed. This leads to strong accountability for individual and team performance, and growth of broader skills, so that the model constitutes an instrument for contextual understanding of a facility's service profile and its catchment area.

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This is a joint venture, where HST provides technical support and monitoring, and the Department of Health is the driver of the system in facilities.

Visiting two CMM2-implementing facilities in uMgungundlovu

On 5 and 6 October 2023, the uMgungundlovu SA SURE PRO project team was joined by members of HST's communications and training units in visiting two of the implementing facilities: Eastwood Clinic in Pietermaritzburg and Richmond Clinic in Richmond. The group aimed to benchmark and package good practice in CMM2 implementation for replication in other facilities.

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A briefing in Richmond Clinic's Chronic Stream

Clinicians from Eastwood and Richmond Clinics took the delegation through the process flow, and the various stages followed by each case-managed patient. The group observed the progress made, and brainstormed strategies for communicating and promoting the impressive work being carried out by the dedicated health professionals involved in the roll-out of the model.

Sr Nhlebela, Operational Manager for Richmond Clinic, gave the background of case management implementation in the facility. "Case Management was first introduced in October 2022. At first, there was some reluctance among staff, but this was quickly overcome after the HST implementing team explained the benefits of the system and the facility decided to adopt it.''

Eastwood Clinic was the first in the district to implement the CMM2 protocols for file flow. Pre-retrieval of patient files and staff being responsible for movement of the files from point to point during the patient's visit have ensured file security, and shortened waiting times through increased efficiency.

During the visit to Eastwood Clinic, the Communications Unit engaged with Clinicians and patients to get a sense of how case management has improved service delivery and experience of care, respectively.

One of the patients who has received care at Eastwood Clinic since 2010, says that service delivery has improved drastically, pointing out that she spends less time in the facility due to the smooth process flow. Patient waiting times have been shortened from five to three hours (from arrival to departure). Another point that emerged from the interviews was that patients are happy to have one clinician who sees them at every visit, and with whom they have developed a relationship. An improved patient satisfaction score had been demonstrated through an externally conducted survey.

District DoH endorsement and support

The Medical Manager of Richmond Hospital, Dr Bulelane Gebashe, who had joined the visit to Richmond Clinic, observed that the CMM2 has changed ways of working to significantly ease the burden on staff and patients, and that the positive performance results for all indicators – including data management – can be attributed to CMM2 implementation. "It is clear to see how fulfilled and motivated the staff members are," he said. As he was in charge of monitoring patients' complaints and compliments, he emphasised how important the shorter waiting time is for patients – sharing that his own home helper "raves about Richmond Clinic".

The Operational Manager of the Clinic, Sr Nhlebela, reported that many patients call their Clinician "mother", and feel supported in their knowledge of the clinic process, referring to "my green chair", for example.

Dr Gebashe noted that the CMM2 has led to integration for a fully functional facility. The team structure shows how important each member is, and the model instils an ethos in which every person, whether a provider or a patient, is valued, which in turn makes the community feel valued, as expressed by the clinic committee members.

Clients from other areas (such as Ndaleni, which is 30 minutes' drive away) are coming to Richmond Clinic because of its reputation. This is a considerable achievement for a clinic that serves approximately 8 000 people per month, and he thanked HST for leading the facility to innovation.

"Hope is that thing inside us that insists ‒ despite all evidence to the contrary ‒ that something better awaits us if we have the courage to reach for it, work for it, and fight for it."

                    Former US President, Barack Obama


Oct 11
Mental Health Awareness Month – Taking care of your mental health

​By Willemien Jansen (HST Copy and Content Editor)

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Anxiety, depression, burn-out. This late in the year, with minimal leave available and most people being overworked on top of pressing family and social commitments, most of us are left feeling overwhelmed. The world is also still recovering from the Covid-19 pandemic, which took a huge toll on our mental health. Mental Health Awareness Month, commemorated in October each year, is therefore a good time to stop and reflect on our mental health.

But what are we talking about when we refer to mental health? The U.S Centers for Disease Control and Prevention (CDC) explains that mental health includes our emotional, psychological and social well-being. It affects how we think, feel and act, and helps determine how we handle stress, relate to others and make healthy choices. Often we focus more on immediate physical health issues and forget that we need to take care of our mental health too. As the saying goes, you can't pour from an empty cup. As many as a quarter of the South African works force suffers from depression, resulting in massive losses in productivity. It is therefore important that companies invest in wellness programmes to help their employees deal with work and life stresses.

Self-care is an important way to make sure you take care of yourself by doing things that will help to improve both your mental and physical health. The National Institute of Mental Health highlights a number of self-care strategies that you can follow to take care of your health:

  • Regular exercise. As little as 30 minutes of physical activity every day can boost your mood and improve your health.
  • Eat healthy, regular meals and stay hydrated. A balanced diet and plenty of water can improve your energy and focus throughout the day.
  • Make sleep a priority. Stick to a schedule, and make sure you're getting enough sleep.
  • Try a relaxing activity. Explore relaxation or wellness programmes or apps, which may incorporate meditation, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy activities you enjoy, like journalling, reading, or even playing with your pets.
  • Set goals and priorities. Decide what must get done now and what can wait. Learn to say "no" to new tasks if you start to feel like you're taking on too much. Try to be mindful of what you have accomplished at the end of the day, not what you have been unable to do.
  • Practice gratitude. Remind yourself daily of things you are grateful for. Be specific. Write them down at night, or replay them in your mind.
  • Stay connected. Reach out to your friends or family members who can provide emotional support and practical help.
  • Ask for help. Don't be ashamed to contact a professional if you feel like you're not coping. Getting help early can avoid bigger problems down the line.

Let's use Mental Health Awareness Month to reset and focus on our mental health so we can remain happy, productive, and balanced human beings for the rest of the year.


  • Government Mental Health Helpline - 0800 12 13 14
  • Suicide Helpline - 0800 567 567
  • 24 hour Cipla Mental Health Helpline - 0800 456 789
  • 24 hour Substance Abuse Helpline - 0800 12 13 14 SMS 31393
  • Website


  • Dr Reddy's Help Helpline - 0800 21 22 23
  • Pharmadynamics Police &Trauma Helpline - 0800 20 50 26
  • Adcock Ingram Depression and Anxiety Helpline - 0800 70 80 90
  • Destiny Helpline for Youth & Students - 0800 41 42 43
  • ADHD Helpline - 0800 55 44 33
  • 24hr Department of Social Development Substance Abuse helpline - 0800 12 13 14 SMS 32312
  • 24hr Suicide Crisis Helpline - 0800 567 567
  • 24hr Cipla Mental Health Helpline - 0800 456 789
  • 24hr University of Cape Town Student Helpline 0800 24 25 26
  • 24hr University of Pretoria Student Careline - 0800 747 747
  • University of the Western Cape after hours Student Helpline - 0800 222 333
  • 24hr Discovery Medical Student Helpline - 0800 323 323
  • Tshwane University of Technology after hours Student Helpline - 0800 687 888


  • Youthline for counselling services and youth mentoring programmes: Free call 0800 376 633
  • Contact the Childline services and speak to counsellors: +27 (0) 31 201 2059
  • SA Federation For Mental Health: +27 (0) 11 781 1852; +27 (0) 86 558 6909

Oct 05
A Day in the Life of HST’s Senior Researcher, Michael Burnett

​by Siyabonga Gema, HST Communications Officer

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Health Systems Trust's Senior Researcher, Michael Burnett holds a Master's Degree in Psychology and has more than 15 years' experience working within the South African public health and social care settings across all three levels of government (National, Provincial and District levels) focusing on public health programmes, initiatives, and research. He has extensive experience in operational and financial management of projects. Over the course of his eight years at HST, he has contributed to a variety of projects and is also a published author in various prestigious journals. Michael had a brief chat with the Communications team where he shared some interesting facts about himself and his career.

How would you describe the public health landscape and how do you propose the gaps can be closed?

The South African public health landscape is extremely complicated. While our system appears fragile at times, there is an underlying strength and resilience which stems from the resilience of our people. The National Health Insurance (NHI) will be one component needed to address the current gaps we have in the public health landscape. Just as crucial is the economic growth and development of South Africa in general in order to assist with the funding of the NHI.

What do you think are your most significant research accomplishments?

I am particularly proud of the work we did on two major projects: TREATS, and GP Contracting, and the subsequent publications in order to share our results with the broader scientific community. These are:

  • Klinkenberg E, Floyd S, Shanaube K, Mureithi L, Gachie T, de Haas P, Kosloff B, Dodd PJ, Ruperez M, Wapamesa C, Burnett JM, Kalisvaart N, Kasese N (2023) Tuberculosis prevalence after 4 years of population-wide systematic TB symptom screening and universal testing and treatment for HIV in the HPTN 071 (PopART) community-randomised trial in Zambia and South Africa: A cross-sectional survey (TREATS). PLOS Medicine 20(9): e1004278.
  • Mureithi, L., Burnett, JM., Bertscher, A., & English, R (2018). Emergence of three general practitioners contracting-in models in South Africa: a qualitative multi-case study. International Journal for Equity in Health, 17(107).

What gives you fulfilment in your role at HST?

While I enjoy most of the work we do, there are three elements that gives me a lot of fulfilment: (1) helping to guide less experienced researchers and watching them develop new skills and confidence,  (2) publication of articles in order to share findings, and (3) attending conference to learn and share ideas with peers in the field.

What does innovation in research mean to you?

Pushing the boundaries in terms of the research approaches and methods that we utilise.

When/how did the research bug bite?

In my third year (2004) at Stellenbosch University I had a research course as part of my undergraduate studies in Psychology. I enjoyed the course so much, that when it came time to choose my Master's Degree, I switched from Clinical Psychology to Research Psychology.

Why HST?

My very first job was as a Research Assistant at the MRC Depression and Anxiety Unit at Tygerberg Hospital. One of the main sources we would use as part of our literature reviews for projects was the District Health Barometer and the South African Health Review. As a young researcher I was extremely impressed with the publications and the organisation that published it (HST) and I knew I wanted to someday work for HST. At my second job I attended a CDC Funding Training and at the training I got to interact with staff from HST. These interactions were so positive that it further cemented my desire to work for HST. In 2014 I finally got the opportunity to work for HST, and here I still am, almost a decade later.

How do you spend your time away from work?

While spending time with family is very important to me, I also enjoy reading (particularly historical fiction) and travelling. I also belong to a Lego club and we do Lego exhibitions quarterly. Here are two of my recent displays that I designed and built myself.

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Any future aspirations?

The future is unpredictable and while it is important to plan ahead, we also sometimes have to take life one day at a time and enjoy the here and now. I would like to one day go back to University and complete my PhD.

Sep 27
Heart Awareness Month: Information on the heartbeat of society’s health

By Siyabonga Gema, HST Communications Officer

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September is earmarked as Heart Awareness Month, a health campaign that is driven by the Heart and Stroke Foundation South Africa (HSFSA) dedicated to raising awareness about heart disease and its risk factors in South Africa. Heart Awareness Month then culminates in World Heart Day on 29 September. During this month, people are encouraged to protect themselves from heart disease by following a healthy diet, keeping active, and being aware of risk factors such as smoking, drinking, taking drugs, high blood pressure, high cholesterol, obesity and stress.   

In South Africa, about 33 people die daily of a heart attack, while about 60 die daily from a stroke. For every woman who dies of a heart attack, two men die. About 37 people die per day from heart failure. More than half the deaths caused by chronic diseases, including heart disease, occur before the age of 65 years. The glaring number of deaths reflects the dire need for intervention from health providers as well as health-centred organisations in educating the public and sharing information. A concerning aspect of these statistics is the early age at which patients succumb to heart disease. Premature deaths caused by Cardiovascular disease (CVD) in people of working age (35-64 years) are expected to increase by 41% between 2000 and 2030, having massive economic implications. In an already dwindling economy, with high levels of inequality and poverty in many communities, these premature deaths cause massive income gaps.

 What are some risk factors?

1.      Socio-demographic risk factors

  • The risk of CVD is more prevalent in persons with a history of CVD in their families, where some family members have been affected by CVD in the past.
  • Men are known to be at a greater risk of developing CVD than women.
  • Those with low levels of education in middle-income countries like South Africa have a significantly higher risk of major CVD events compared to those with high incomes. People with low education may not have access to the right health care to detect and treat diseases, including CVD.

2.      Cigarette smoking

  • Smoking is a major cause of cardiovascular disease (CVD) and causes approximately one of every four deaths from CVD, according to the 2014 Surgeon General's Report on smoking and Health.
  • Toxins in cigarettes may also damage the blood vessels very quickly, but good news is that the damage is repaired quickly for most smokers who quit smoking.

3.      Obesity

  • Excess weight can lead to fatty material building up in the blood vessels, causing them to get damaged and clogged, which could lead to a heart attack.
  • If this happens in the arteries that carry blood to the brain, it could lead to a stroke or vascular dementia.
  • Obesity is associated with an increased risk for type 2 diabetes, insulin resistance, cancer, stroke, and hypertension.

These and many more risk factors are linked to one's behaviour and lifestyle, which is why it's critically important for those armed with credible information to share it and educate the public. The Heart Awareness campaign is just one of an array of ways that society can play a role in protecting people from heart-related diseases.

For more information on the Heart Awareness campaign, visit  

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