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HST Blog

May 24
Celebrating Africa Month: A Continent of Diversity and Growth

By Mandisa Dlamini (HST Communications Assistant)

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The month of May is recognised as Africa month – a time when the continent of Africa commemorates the founding of the Organisation of African Unity (OAU). This year's celebration reflects on the progress made by the OAU in enhancing the lives of the African population. The theme of the 10th edition of Africa Month is Celebrating 30 Years of Freedom: Building a Better Africa and a Better World

Africa Month is celebrated to honour the rich cultural legacy, diversity, and historical accomplishments of the African continent and is an opportunity to reflect on the continent's progress, challenges, and goals. In 2024, the focus includes a number of important health projects that will improve public health and wellbeing across Africa.  

The World Health Organization Africa Region has introduced a comprehensive plan of action and targeted programmes aimed at addressing health challenges in Africa over the period 2023 to 2030. These efforts prioritise tackling health issues like TB, cervical cancer via HPV vaccination, and enhancing mental health services. They also emphasise the importance of resilient health systems capable of responding to both existing and new health risks.

A major effort is the African Health Initiative funded by the Doris Duke Charitable Foundation. Under this programme, sub-Saharan African healthcare systems are supported by the development of partnerships and the application of comprehensive models of integrated primary healthcare. It highlights local ownership of health solutions, continuous learning processes, and local ownership of health solutions. To ensure long-lasting improvements to health, this calls for co-operation between regional administrations, academic institutions, and international funders.

Leading the way in research, strategic assistance for the execution of key health programmes, and building health systems are the main areas of concentration for the Health Systems Trust (HST), an organisation supporting the South African public health sector. HST has been crucial to the development of the country's healthcare system as the following projects illustrate; the Cervical Cancer (CCPAC) Project is a three-year Cervical Cancer Prevention, Access, and Control project in the Zululand District funded by the U.S Centers for Disease Control and Prevention (CDC). It facilitates  access to early screening, diagnostic procedures, treatment, and palliative care services within the district. The DO ART Demonstration Project offers comprehensive screening services, initiates ART (Antiretroviral Therapy), and provides continuous community-based management for ART patients in the eThekwini South and Nongoma Sub-districts of KwaZulu-Natal. The organisation's goal is to make Africa healthier and more equitable in terms of health.

Africa Month also features activities designed to enhance the appreciation for arts and culture, indirectly benefiting mental health by fostering community unity and cultural pride. The celebration includes events that showcase the continent's rich cultural heritage.

The health related activities during Africa Month 2024 highlight a comprehensive approach to improving health outcomes, strengthening health systems and addressing specific diseases to promoting mental health and cultural well-being.

Read more on Africa Month.

 





May 21
World Malaria Day, 25 April 2024, “Accelerating the fight against malaria for a more equitable world”

​By Antoinette Stafford Cloete (Health Systems Trust Communications Manager)

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World Malaria Day was instituted at the World Health Assembly in 2007 and draws attention to the necessity of ongoing financial support as well as a genuine political commitment to the prevention and control of malaria.

Progress with regards to decreasing the incidence or prevalence of malaria with most cases (94%) found in the Africa region has been sub-optimal. The World Health Organization (WHO) estimates that there were approximately 608 000 deaths caused by malaria in 2022 and more than 249 million new cases. It is an astounding number for one geographical area. The WHO for the African Region argues that this threat to human life is fuelled by a brutal cycle of inequity and a long list of social determinants related to poverty. The most vulnerable in the region are impacted: newborns, children younger than five years of age, expectant mothers, internally displaced people, refugees and migrants all bear the brunt of the disease.

Rural areas are affected to a greater extent than urban settings due to a lack of ready access to health services, including mobile clinics. A lack of poor treatment and prevention roll out in the form of health promotion and health education efforts to assist people with better understanding the causes, effects and preventive measures is also a contributing factor. Many people are unable to obtain the necessary protective measures such as mosquito nets and repellent as a starting point. Non-governmental organisations like Goodbye Malaria, funded by the Global fund, attempts to close the gap that government cannot fill by running awareness programmes on malaria and making the preventive material mentioned more readily available for consumers under the banner "Save a life in your sleep". It is a community development effort to promote small business and job-creation efforts that aims to create employment around sorely needed life-saving products, saving lives and alleviating poverty in the process in South Africa, Eswatini and Mozambique.

Efforts to roll back malaria were already in place in 1998 when four of the biggest health orgnisations in the world, the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and the World Health Organization (WHO), joined forces to launch a campaign to fight malaria. The programme, "Roll Back Malaria", sought to reduce the human suffering and economic losses due to one of the world's costliest diseases.

The then WHO Director-General, Dr Gro Harlem Brundtland, said that, "Malaria is the number one health priority of people and leaders in affected communities and countries, but their voices have not been heard … The human suffering is unacceptable and so is the economic burden and impediment to progress. Africa and other regions with malaria are responding and we must answer their call".

Almost three decades have passed since that statement and too many lives are still being lost to malaria because levels of political commitment, private sector engagement (the exception would be the Bill & Melinda Gates Foundation) and much-needed community involvement are still not optimal.

For more information:

The Malaria Consortium

Speak Up Africa

 

 

 

 

 



May 17
A day in the life of Thandeka Mzulwini, HST’s Pharmacist for uMgungundlovu District

​by Siyabonga Gema - HST Communications Officer

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As the country progresses towards universal health coverage as envisaged by the World Health Organization (WHO), the role of primary health care and, in particular, pharmacists as a first point of contact with people seeking medical advice, couldn't be more crucial.

At the Health Systems Trust (HST), our high calibre of pharmacy professionals places us centrally in providing the necessary support in human and technical resources to the Department of Health in pursuit of equitable health for all.

Thandeka Mzulwini, HST's Pharmacist based in uMgungundlovu District, had a brief chat with the Communications Unit and gave us a glimpse of her professional and personal life.

Why did you choose a career in Pharmacy?

I wanted to provide clients with an incomparable service in the healthcare field by ensuring the safe and effective use of medication, providing health advice and pharmacy-initiated therapy to the community without being consulted by a nurse or doctor, especially in this economic landscape. The pharmacy field offers diverse opportunities and is not limited to community or hospital work; it also opens doors to research and development, academia, regulatory affairs, and industrial and clinical pharmacy.

What qualities does one need to thrive in this field?

One has to be passionate about helping others with their health needs; you must have patience, be non-judgemental, impartial, compassionate, and eager to learn every day for continuous self-development.

Do you think people understand the important role that Pharmacists play in health care?

At the National Department of Health, it is not well represented, and within the institutions, we still observe health decisions taken without pharmacy input. Pharmacists should be heading the anti-microbial stewardship programmes combatting microbial resistance, heading Central Chronic Medicines Dispensing and Distribution (CCMDD) strategies, and should give inputs in the transportation of medicines from other countries to maintain the cold chain and medicine stability. So many gaps exist, and this should be addressed.

The general public is familiar with doctors and nurses, but they are not fully aware of what pharmacists do and some do not consider pharmacy as part of the healthcare sector. In some instances, people may use community pharmacies as a shortcut to get medication if they cannot afford consultations.

How do you stay up to date with new medical trends and information?

I attend health training sessions and do lots of reading on Department of Health guidelines, research articles, and package leaflets of generic drugs. In my field, doing research on new conditions or diseases and always reading public health websites is a crucial part of a Pharmacist's professional development. The benefit is that it creates self-confidence.

What's your biggest career highlight thus far?

After completing my Honours Degree in Pharmacy, I was unsure which field to choose within pharmacy. Working for a non-governmental organisation has assisted in directing me to aspire to further my studies. I have developed an interest in HIV/AIDS and TB management as the leading disease burden in our country. I am currently doing my Master's degree to gain more insight into public health challenges and how to overcome challenges in my current role as a Pharmacist working for HST. 

Take us through a typical day at work

My work involves data interpretation in the Dablapmeds programme / differentiated care model as a vehicle for medicine accessibility and adherence. I support the uMgungundlovu District's facilities and Dablapmeds external pick-up points in ensuring service delivery, capacitating prescribers in utilising the available systems, and following standard operating procedures guided by DoH guidelines. I also support HST's Mobile Pharmacy services and Pelebox innovations, and attend to patient queries at the district level.

What's your take on ethical behaviour in your field?

An individual decides to maintain professional responsibility in adhering to ethical standards of pharmacy and upholding the code of conduct and regulations. Prioritising patients' needs and interests should be top of mind, treating all patients fairly, with integrity, and reserving judgements and personal beliefs.

How do you spend time away from work?

As a family-orientated person, I believe in quality time with my family and church. But this year, I have a lot of studying which is taking up most of my time. However, when I do get the time, you will find me out and about with my family or in church.

What inspires you?

Waking up every day to fight for a better future.  Achieving set goals and overcoming obstacles. Doing good in people's lives and staying true to myself.

How would you advise someone who wants to pursue a career in pharmacy?

They must work to obtain good results in Matric. Competition for university entry is very high, so it's in their best interest to work extra hard. They must do research about pharmacy before applying, and decide if they have a passion to become a Pharmacist and, mostly, they must fall in love with the career. The academic context is huge, but manageable if you put in the extra effort. It is also important to do research on approved institutions which offer pharmacy.

 


May 09
HIV ends with me – integrating U=U evidence into HIV service delivery

by Willemien Jansen and Judith King – Copy and Content Editors, and Siyabonga Gema – Communications Officer


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Being diagnosed as HIV-positive is no longer a death sentence.

In fact – with adherence to modern antiretroviral therapy (ART) – it is regarded as a chronic medical condition that can be well controlled, and it is possible for a person's viral load to be so low that HIV cannot be transmitted to someone else.

Based on several studies showing that there is no risk of HIV transmission from virally suppressed patients to HIV-negative partners, the global concept of sustained viral suppression is known as 'Undetectable = Untransmittable' or 'U=U'.

What is viral load?

Viral load is the amount of HIV found in a person's blood. This can be checked by doing a viral load test. Viral load is measured by testing the number of viral particles – or 'copies' ‒ in each millilitre (copies/ml) of a small sample of blood. Taking ART medication correctly every day lowers the viral load to the point where it cannot cause harm to the patient and it cannot be passed on to anyone else. This is known as viral load suppression.

What is undetectable?

When the results of two consecutive viral load tests taken over a period of six months show that a person has 50 copies/ml or less of HIV in their blood, their viral load is defined as undetectable. This can be achieved by taking one's treatment every day as prescribed, because the medication is so effective that the virus cannot reproduce to infect new cells in the body. It may take a little longer for some people to reach this level, but it is possible to achieve an undetectable viral load within six months.

It is important to remember that the virally suppressed person is still HIV-positive, as ART cannot cure HIV altogether. 'Resting' or latent HIV cells remain in the body, and the virus will begin to reproduce itself again if the person stops taking ART. This is why it is essential for a person living with HIV to remain on ART for life, so that sustained viral suppression keeps their immune system strong, and they can live as long as someone who is HIV-negative. 

What is 'untransmittable'?

'Untransmittable' means that virus cannot be passed on to another person or unborn baby through blood or sexual fluids. HIV is still present in a person's body, but there is too little of it for onward transmission.

Focusing on the proven option of treatment as prevention and the science of U=U can reduce HIV-related fear and stigma, make disclosure of one's HIV-positive status easier, and move us towards achieving HIV epidemic control.

HST's programming supports U=U as a public health campaign

Through the SA SURE PRO project and in partnership with the Department of Health, HST is supporting implementation of the U=U approach as a feature of all stages of HIV service provision and related technical assistance for case management.

Planning for this implementation began in mid-2021, and was built around the project's key objectives of ensuring optimal HIV case-finding and treatment enrolment, ART adherence, and continuity of care to achieve and maintain viral suppression.

At that point, data from the Ritshidze Project indicated that no more than 65% of patients understood the relevance of viral load suppression to HIV transmission, so the team also centred on ways to support patient and provider literacy, with healthcare workers using the U=U messaging as a powerful counselling tool to encourage treatment adherence and create demand for regular viral load monitoring among couples and individuals.

Based on diligent record-keeping and data analysis, and through collaboration with pharmacy staff and community caregivers, our teams working in facilities and communities are continuously tracking and tracing patients who have missed their clinical appointments and medication collection, which flags the risk of treatment interruption. Various return-to-care interventions ‒ such as the 'Welcome Back' strategy, enhanced adherence counselling, and intensified application of the Case Management Model II ‒ are deployed as needed.

Rigorous data reporting on sites needing urgent action for retention of patients on ART is undertaken to ensure that return-to-care targets are met in all four of the project's supported districts.

Our training and post-training mentorship programme, along with site support provided jointly by pharmacy, case management and clinic‒laboratory interface teams, incorporates multiple modules for every aspect of patient-centred HIV care.

SA SURE PRO project teams are partnering with civil society to actively disseminate accurate U=U information and contextually appropriate messaging. In so doing, they caution virally suppressed patients that although condomless sex will not result in HIV transmission, having an undetectable viral load does not provide protection from other sexually transmitted infections or pregnancy.

As a PEPFAR Implementing Partner, HST is committed to contributing to the rapid and widespread uptake of U=U, which has generated a new momentum for South Africa's HIV response and an improved quality of life for people living with HIV.

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Dr Thembisile Xulu – Chief Executive Officer of the South African National AIDS Council (SANAC) – reiterated at the national U=U launch that if an HIV-positive person adheres to treatment, they can achieve and maintain viral load suppression and not transmit the virus.

The National Minister of Health, Dr Joe Phaahla, led the official national U=U launch on Tuesday, 7 May 2024 in the uThukela District of KwaZulu-Natal. The launch saw representatives of national and provincial government, civil society organisations and the People Living with HIV sector come together to rally behind the science-based message that a person with HIV who adheres to treatment achieves an undetectable viral load and cannot transmit HIV sexually.

At the launch, the community of KwaDlamini in Ward 12 of Ntabamhlophe, Estcourt, interacted with health professionals from the Department of Health and non-governmental organisations who engaged them on the importance of knowing their HIV status, starting treatment if diagnosed as HIV-positive, and remaining on treatment.

In her address to the audience, Dr Xulu rebutted the popular notion that people who are HIV-positive are responsible for the spread of HIV. She explained that it is those who do not know their status, and are not aware that they need to be on HIV treatment, who run the risk of transmitting the virus through unprotected sex. Importantly, she pointed out that U=U is not only a tool to help lower the rate of HIV infections, but also to address the issue of stigma.

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A multisectoral response saw HST Outreach Teams joining other community-based providers offering HIV literacy, health education and HIV testing and counselling services at the launch.

Apart from encouraging community members to know their status, part of the launch engagement entailed educating the public that despite being on HIV treatment, people still need to use protection as a preventative measure for sexually transmitted infections (STIs).

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The U=U launch was preceded by the launch of 'Zikhala Kanjani' on 26 April 2024 in Richmond, uMgungundlovu District. This national communications campaign aims to increase the reach and quality of HIV prevention services for young people.



May 08
Mental illness stems from abuse in women

​By Willemien Jansen (HST Copy and Content Editor)

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Both men and women suffer from mental illness, but the reasons are very different.

Even though men are more likely to die by suicide due to unemployment, occupational issues, divorce and adverse childhood experiences, women are more likely to suffer from mental health issues due to abuse.

South Africa has the greatest number of reported incidences of violence against women worldwide; approximately one every six hours. One in four men have committed sexual offenses, while 40% have physically abused their partners. Violence against women is on the rise, with up to one in four women reporting that they have been beaten or subjected to abuse, even if only 2% of cases result in charges being brought. According to a study conducted by the Royal College of Psychiatrists, psychiatrists in the UK feel that, in large part because of their experience treating patients, violence and abuse are the main causes of mental illness in women and girls.

The majority of respondents (59%) say violence and abuse are contributing to mental illness in their female patients. This was closely followed by relationship issues (49%), often caused by coercive behaviour, and home and family pressures (48%), which also cause significant harm. Another issue that was mentioned as a frequent problem for female patients was isolation or loneliness (24%). Feelings of loneliness are a common problem for many persons with mental illnesses, but they are made much worse if they are being abused.

Women are not just abused physically, but also sexually and emotionally. "Not all abuse is physical – psychological abuse also causes extreme harm and casts a long shadow over victims. We need to identify and respond to trauma if we are to reduce the likelihood of women and girls developing mental illness," says the study. Dr Katherine Durkin, joint presidential lead for women and mental health at the Royal College of Psychiatrists, goes on to say that "sexual violence impacts on mental health in all genders. But these experiences are unfortunately much more common in girls and this plausibly contributes to higher rates of mental health difficulties in girls and women." Emotional abuse is harder to recognise than physical abuse because there are no physical scars, but the effects can be just as profound. Tactics of emotional abuse include gaslighting and shaming, which can leave the victim feeling helpless, hopeless and powerless.

Emotional abuse has serious effects on the victim's mental health. These include:

Short-term effects

  • isolation and loneliness
  • self-doubt
  • shame
  • confusion
  •  low self-esteem
  • fear when interacting with others
  • avoidance of activities related to the incident
  • feelings of powerlessness


Long-term effects

  • mental health conditions
  • neuroticism, or the tendency toward low mood and negative emotions like anger
  • chronic stress
  • physical health challenges like body aches and heart palpitations
  • attachment challenges
  • emotional disconnect or apathy.


Abuse can cause a range of different mental illnesses, including anxiety, depression, substance use disorder, eating disorders and post-traumatic stress disorder (PTSD). Symptoms can be even more serious: "Tragically, it is not uncommon for female patients to experience long-term abuse that causes serious symptoms, including suicidal ideation or symptoms of psychosis," said Dr Durkin.

To reduce mental illness in women, we need to reduce the abuse that they suffer. According to the United Nations there are 10 things that everyone can do to help reduce abuse amongst women. These are:

  1. Listen and believe survivors
  2. Teach the next generation and learn from them
  3. Call for responses and services fit for purpose
  4. Understand consent
  5. Learn the signs of abuse and how you can help
  6. Start a conversation
  7. Stand against rape culture
  8. Fund women's organisations
  9. Hold each other accountable
  10. Know the data and demand more of it


If you or someone you know is being abused, call the Stop Gender Violence Hotline on 0800 150 150 or visit the Life Line website at https://lifelinesa.co.za/



May 08
OPINION: Women’s Health: The Right to Proper Health Care

By Antoinette Stafford Cloete (Health Systems Trust: Communications Manager) and Siyabonga Gema (Health Systems Trust: Communications Officer)

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Photo credit: UN/Photo (Sylvain Lietchti)

Over the next few weeks we will examine a variety of health-related topics in a series on women's health, including menopause, puberty, pregnancy and childbirth, cancers that affect women, violence against women, and the potential applications of artificial intelligence in improving the health of women at a human rights interface.

As we close out Human Rights month in South Africa we reflect on how far we have come with regards to human rights in health.

The COVID-19 pandemic certainly confirmed what was long known, but never adequately addressed: women's health concerns are not as important as those of men. Caroline Criado Perez compiled a number of statistics in her book "Invisible Women: Exposing Data Bias in a World Designed for Men" that demonstrate the unequal treatment of women. She has argued that the data shows that "healthcare is systematically discriminating against women, leaving them chronically misunderstood and misdiagnosed".

In a paper presented at the International Conference on Reproductive Health in Mumbai, India, in 1998, jointly organised by the Indian Society for the Study of Reproduction and Fertility and the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, the author Dr Carmel Shadev outlines a departure from previous models of healthcare for women where they were merely tools without agency with regards to population development to a distinct emphasis on women's empowerment and individual needs, as well as the development of a growing body of knowledge regarding the relationship between health and human rights that connects novel ideas about health to the fight for social justice and respect for human dignity.

The United Nations Sustainable Development Goal 5: Achiev[ing] gender equality and empower[ing] all women and girls sets a number of targets towards creating gender equality by 2030 which they now admit may not be met, but hope to create inroads. These are to:

  • end all forms of discrimination against all women and girls everywhere;
  • eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation;
  • eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation;
  • recognise and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate;
  • ensure women's full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic and public life;
  • ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences;
  • undertake reforms to give women equal rights to economic resources, as well as access to ownership and control over land and other forms of property, financial services, inheritance and natural resources, in accordance with national laws;
  • enhance the use of enabling technology, in particular information and communications technology, to promote the empowerment of women; and
  • adopt and strengthen sound policies and enforceable legislation for the promotion of gender equality and the empowerment of all women and girls at all levels.


In South Africa, the right to quality healthcare is enshrined in our constitution and stipulates that it is a basic human right accorded to all citizens of this country with further emphasis placed on sexual and reproductive health rights in Section 27. The provision of health services, especially for women, is therefore a crucial enabler in recognising and upholding the South African Constitution.

We can thus see that the conversation around women's health and their right to access has been ongoing, at least since the first public health conference held in 1978 in Alma Ata (in Kazakhstan) which didn't explicitly state the rights of women vis-à-vis access to healthcare, but does mention in the Declaration that resulted from this gathering that "people have a right and duty to participate individually and collectively in the planning and implementation of their health care".

A quick Google search for [women's health] will surface the more current debates raging around women's access to health care and the disparities that exist between investments in men's health against that of women.

Over the next few weeks we will look more closely at these issues and will include information on the work we do as an organisation to be enablers of health equity through our various health programmes that support women, in particular.

For comments or questions do email us at: communications@hst.org.za




May 08
Securing a child’s future through ART treatment and support

by Apiwe Nightingale ‒ HST Cross-site Paediatric and Adolescent Co-ordinator, and Siyabonga Gema – HST Communications Officer

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The HIV response in South Africa has achieved great milestones since the early 90s when the country faced what seemed to be ever-increasing HIV infections. Among the gains made is the ground-breaking research that led to the successful prevention of mother-to-child HIV transmission through offering antiretroviral therapy (ART) to pregnant women. Another shift was the introduction of ART for children living with HIV.

Many South Africans still remember the image of a young and brave Nkosi Johnson, who publicly spoke about his HIV status and was widely regarded as a symbol of hope. A lot of work has been done since then to ramp up access to treatment and care for children and adolescents living with HIV (C/ALHIV), although challenges persist and there is still room for major change.

HST's Cross-site Paediatric and Adolescent Co-ordinator, Apiwe Nightingale, sheds light on paediatric ART interventions.

Why is there a need for a programmatic paediatric ART intervention in our communities? Is this need urgent?

South Africa launched the world's largest ART programme in April 2004, offered to all people as soon as possible after their HIV-positive diagnosis.

It's been 20 years since the introduction of the ART programme, but children and adolescents living with HIV (C/ALHIV) have been left behind in case-finding, treatment initiation and viral load suppression to reach the UNAIDS 95-95-95 targets, especially when compared with the adult HIV care continuum in Kwazulu-Natal, and the country as a whole.

Reaching children in clinics and hospitals is still a challenge, as many parents and caregivers do not bring their children for scheduled immunisation visits, and when children are brought to the facility, staff may miss testing or checking their HIV status for initiation or re-initiation on ART.

Among other reasons for children aged five years and older not coming to the clinics during weekdays are that they are attending school, or the child is no longer staying with the parent and the caregiver is not aware of the child's HIV status. This leads to poor continuity of care, which hinders viral suppression.

Please share some background on Health Systems Trust (HST)'s involvement in providing paediatric ART services

Since the start of the SA SURE programme in 2012, HST has been supporting HIV services for children and adults in the facilities. In previous years, HST employed Paediatric Case Managers, whose responsibility was to provide direct services in the facilities. Our support approach then changed, as we prioritised the need to capacitate facility staff through technical assistance to ensure sustainability of paediatric HIV services by the Department of Health (DoH) beyond the life of the project.

We have seconded a team to support the Provincial Department of Health in policy development for improved paediatric and adolescent HIV services. Through our pharmaceutical programme, we have provided extensive support in driving the new mandate of transitioning children and adolescents to the new Dolutegravir (DTG)-based regimen.

Currently, HST provides comprehensive support for the Paediatric ART programme, rendered at various levels of the health system.

At facility and community level, the DREAMS programme for adolescents and young people promotes integrated prevention of teenage pregnancy and HIV. Our SA SURE and Unfinished Business project teams provide technical assistance through training, supervision and mentoring for facility clinicians on disclosure, psychosocial support and caregiver support.

Our Peer Mentors, employed under the Youth Employment Services (YES) programme, are allocated to facilities to establish and facilitate support groups for teenage mothers, and liaise with the facility/community teams for HIV testing of children through index contact testing services. In high-burden facilities, staff such as Nurse Clinicians and Data Capturers are allocated to provide direct service delivery for the Paediatric ART programme.

At district and provincial levels, HST staff work closely with the DoH and other stakeholders on implementing paediatric HIV care and treatment, including psychosocial support. I am one of SA SURE PRO's two Cross-site Paediatric and Adolescent Co-ordinators, and we are part of the technical team serving the UNAIDS Global Alliance to End AIDS in Children. The main objective of the Global Alliance is to work closely with the District and Provincial DoH to ensure that four intervention pillars are implemented:

  • early testing,
  • diagnosis and treatment;
  • optimising and continuing treatment for pregnant and breastfeeding women, and preventing and detecting HIV among this group;
  • and more broadly, addressing rights, gender equality, and the social and structural barriers that hinder access to HIV services.

Through the US Centers for Disease Control and Prevention (CDC), President's Emergency Plan for AIDS Relief (PEPFAR) has provided HST with an additional grant for the Livelihood & Food Security Technical Assistance (LIFT) programme, which focuses on children and adolescents living with HIV. The grant was awarded in October 2023, and from January to February 2024, we set about drafting our LIFT workplan. Since our implementation of LIFT activities began in March, we have seen improvements in facilities.

Do you generally find that ART programmes for children are widely supported or are there still gaps?

Although the ART programme for children is well supported, there are some gaps and challenges that have been identified jointly by the SA SURE PRO and DoH teams.

Because of legal and ethical safeguards relating to HIV testing and counselling for children and adolescents, they depend on their caregivers or parents for access to HIV testing and treatment engagement. For children younger than 12 years, informed consent must be provided by a parent, caregiver or a provincial head of the Department of Social Development. However, in real-life situations, facility staff find that some parents are not staying with their children, and the caregivers are unaware of the child's HIV status and therefore cannot provide the required consent for HIV testing.

Some caregivers relocate to other provinces to seek or take up work opportunities, which means that they do not visit the facilities to collect their children's medication and for the child's clinical review. This has a severe impact on the child's continuity of care and overall health.

Many children are unaware of their own HIV status, and parents and caregivers are not equipped to disclose it to their children. Our Psychosocial Advisors have special skills for guiding HIV disclosure.

What gains have been made in providing ART to children?

In KwaZulu-Natal, we have not reached the UNAIDS target for ART coverage among children, but our data show a positive performance in the HIV care and treatment cascade for children.

Through capacity-building in our four supported districts, we have supervised, mentored and trained clinic and hospital staff in the management of C/ALHIV.

Critically, there has been a marked increase of paediatric DTG uptake over the past six months, with more than 60% of children having been transitioned to this treatment regimen. This is impressive, because it has been achieved despite stock-outs of Paediatric DTG for several days.

Take us through some of the challenges in this programme. What, in your view, causes these challenges?

The challenges in implementing the Maternal and Child Health programme are not different from those affecting the Adult ART programme. Currently, the most dominant one for children are low case-finding rates.

With children not coming to the facilities, and implementation of the index contact testing approach not yielding optimal results, HIV testing in schools would be a helpful intervention, but the legal guidelines for implementers prohibit this. Another opportunity would be through integration of HIV testing within the immunisation schedule, but this is currently not in place.

The causes of these challenges are dynamic and relate to individual circumstances, but the major factors that I have observed since I started in the programme are structural, such as clients having to travel long distances to health facilities, treatment shortages, and the HIV disclosure issues; and in communities, there is a lack of social mobilisation for C/ALHIV, and limited or no mobile services focusing on HIV testing and care for children and adolescents.

How can we empower communities to be actively involved and thereby support the work that you do?

Our stakeholder engagement assists in empowering the communities to be involved and actively support the programme for C/ALHIV. Involving community leaders in outreach campaigns like the School Health programme is also beneficial. Community members and organisations can rally support for increased uptake of paediatric DTG. It's also important to ensure that we maintain strong links with the Department of Social Development's Social Workers so that children and adolescents receive the psychosocial care that they need.

What role does credible information-sharing play in promoting the community's buy-in and raising awareness?

Sharing reliable information through health education and health promotion plays a very big role in securing community buy-in, and in turn, improved knowledge empowers individuals and families in taking responsibility for their health and wellbeing. Awareness campaigns centred on various key health topics encourage the community to participate in targeted activities, and the information they receive via social media, dialogues and other communication platforms must be accurate and readable.

For more information on paediatric and adolescent HIV testing and treatment, please visit the Health Systems Trust website at www.hst.org.zaSA SURE PRO and www.hst.org.zaUnfinished Business or e-mail us on hst@hst.org.za.




May 08
Navigating the Immunisation Landscape

​By Mandisa Dlamini (Communications Assistant)

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In a world where diseases can quickly spread and become pandemics, vaccines offer hope and strength. Vaccination efforts are crucial for protecting public health. In the face of ongoing health challenges, including the persistent threat of infectious diseases, vaccinations have never been more important. Vaccination is a crucial tool to control the spread of a virus and reducing its impact. Through concerted efforts and sustained investment in immunisation programmes, we have the power to protect the most vulnerable among us, strengthen health systems, and advance towards a healthier, more resilient future for all.

"Vaccinated communities, Healthy communities" is the over-arching slogan of this year's African Vaccination Week. African Vaccination Week is primarily concerned with strengthening national immunisation initiatives in the African Region. Vaccination is particularly crucial for women and children as they are often more vulnerable to vaccine-preventable diseases. The health of mothers directly affects the health outcomes of their children, demonstrating the close relationship between maternal and child health.

Challenges and Innovations

In an effort to stop a virus's spread and safeguard their populations, nations all over the world have launched massive immunisation campaigns However, many challenges have slowed down progress. African Vaccination faces a number of difficulties, including restricted access to vaccines, vaccine hesitancy, a shortage of medical professionals, and financial limitations. However, innovative solutions are emerging. These include the use of mobile health technologies for vaccine tracking and education; the deployment of community health workers to underprivileged populations; the promotion of public-private partnerships for resource mobilisation; investigating drone-based decentralised vaccination distribution models or mobile clinics; the improvement of data analytics for targeted interventions; and the support of local vaccine development and manufacturing.

Impact of Vaccination on African Communities

Vaccination significantly impacts on African communities by helping to prevent the spread of deadly diseases, saving lives, and improving overall public health. By immunising individuals against diseases like measles, polio, and  tetanus, vaccination programmes reduce the burden of illness and disability, allowing communities to thrive.

African Vaccination Week serves as a powerful reminder of the importance of immunisation in maintaining public health. The goal is to create a world in which every individual has the chance to lead a healthy and satisfying life by removing obstacles to vaccination access and encouraging innovation. In honour of African Vaccination Week 2024, let us unite in our efforts to empower communities, protect lives, and ensure a healthier future for all.

For more information visit: https://www.afro.who.int/health-topics/immunization-and-vaccines-development/african-vaccination-week/faqs

 

 



May 07
World Hand Hygiene Day: Clean hands protect from disease

​By Siyabonga Gema – HST Communications Officer

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This week, on 5 May, the World Health Organization (WHO) led a worldwide campaign to observe World Hand Hygiene Day. Annually, this day is used to raise awareness about the importance of knowledge and learning about hand hygiene to prevent infectious diseases. The "Save Lives: Clean Your Hands" global campaign was launched by the WHO in 2009. The 2024 theme is "Promoting knowledge and capacity building of health and care workers through innovative and impactful training and education, on infection prevention and control, including hand hygiene".

One of the most crucial things we can do to prevent getting sick and infecting others is to wash our hands frequently. Not washing hands with soap and clean, running water can lead to the spread of many illnesses and ailments. Proper hand washing came into the spotlight in recent years when the world was hit by the COVID-19 pandemic, however, this has always been a key aspect of infection control and prevention. The public health sector holds regularl activations in schools and in public spaces educating the public on hand hygiene and the proper way of washing your hands. The recent spread of pink eye (Conjunctivitis) in the province of KwaZulu-Natal again brought to the fore the importance of hand hygiene in preventing the spread of unwanted diseases and bacteria. There is a range of reasons why proper hand hygiene is important in preventing the spread of diseases. Let's look at a few:

  • People frequently touch their eyes, nose, and mouth without even realising it. Germs can get into the body through the eyes, nose and mouth and make us sick.

  • Germs from unwashed hands can get into foods and drinks while people prepare or consume them. Germs can multiply in some types of foods or drinks, under certain conditions, and make people sick.

  • Germs from unwashed hands can be transferred to other objects, like handrails, table tops, or toys, and then transferred to another person's hands.

  • Removing germs through handwashing therefore helps prevent diarrhoea and respiratory infections and may even help prevent skin and eye infections.

According to the U.S.  Centers for Disease and Control and Prevention (CDC), about 1.8 million children under the age of 5 die each year from diarrheal diseases and pneumonia, the top two killers of young children around the world. Handwashing with soap can protect one out of every three young children who get sick with diarrhoea and 1 out of 5 young children with respiratory infections like pneumonia. Healthcare workers are also encouraged to practice proper handwashing, as they are at a greater risk of contracting diseases due to exposure. They are trained in using the 5-step hand wash procedure, but despite this the WHO estimates that roughly 70% of healthcare workers do not follow the proper hand hygiene procedures.

For caregivers, this day is a significant reminder to teach children about the importance of proper hand hygiene and to take the necessary steps to limit children's exposure to germs and diseases both at home and school. The use of hand sanitiser with a high enough alcohol factor (60% and upwards) is encouraged as an additional protective measure.

For more information: World Health Organization: https://www.who.int/


Mar 20
Health care as a human right

​By Willemien Jansen -  HST Copy and Content Editor

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South Africans celebrate Human Rights Day yearly on 21 March. This date is historically linked to 21 March 1960, the day that 69 people died and 180 were wounded at Sharpville, when police fired on a crowd that gathered peacefully in protest against the Pass laws. This year's theme for Human Rights Month is "Three Decades of Respect for and Promotion of Human Rights". As set out in our constitution, human rights in South Africa include the rights to equality, human dignity, freedom of movement and residence, language and culture, and life.

The right to equal, quality health care is encompassed in these human rights. The South African Human Rights Commission states that "Section 27 of the Constitution provides that everyone has the right to have access to health care services, including reproductive health care services and no one may be refused emergency medical treatment." However, South Africa is an unequal society with available healthcare services being greatly influence by socio-economic standing. The reality is that equal and quality healthcare is not available to all.

In recent years the South African government has undertaken a journey to provide better quality healthcare for all through the initiative of the National Health Insurance (NHI). The NHI is a fund that the government uses to purchase healthcare services for South Africans from both public and private healthcare providers. By lowering healthcare costs overall, the NHI will lower the cost of healthcare. It serves as a kind of universal health insurance, and every South African will contribute to the fund in accordance with their ability to do so through taxes and other payments. It will guarantee that everyone has access to free medical care when they require it. The fund will pay for the costs of care, so there won't be any admission fees. The NHI Bill was passed by the National Assembly in June 2023 and this is seen as a "key milestone that paves the way for ensuring better collaboration between our private and public health systems, guaranteeing universal and comprehensive quality health coverage for all."

There are many pros and cons to the suggested NHI and only time will tell whether or not it is a realistic healthcare model for South Africa. What is clear, is that an overhaul of the healthcare system is necessary to provide all citizen with the health care they deserve. In the meantime, NGOs and NPOs like Health Systems Trust (HST) do their best to support the National Department of Health (NDoH) in bringing healthcare services to communities. HST's vision is "Improved health access and outcomes in South Africa and beyond". The organisation is involved in a range of different programmes that support interventions in the areas of HIV, TB, cervical cancer, reproductive health, vaccine awareness and others. HST relies on the NDoH and other funders to roll out its programmes and continue with the good work its doing in communities.

This Human Rights Day, let us reflect on health care as a basic human right and think of how we as South Africans can play a part in improving quality health care for all.


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