Tag: South Africa

Categories : Mental HealthTags :

Analysis: SA’s New Mental Health Plan and the Problem of Stigma

On By ModernMedia
Photo by Alex Green on Pexels

By Nthusang Lefafa for Spotlight

Before being diagnosed with bipolar disorder Type 1, Sifiso Mkhasibe says he was often labelled as the “black sheep” of the family and he did not know where to go for help. He was often dismissed as crazy and told that this is a white man’s illness.

“My immediate family did not know how to help or support me,” he says. “I was always labelled the black sheep of my family. I was told that I was crazy, bewitched and that I was just pretending to be sick. I was told to be strong and to get over myself and that this disease is a white man’s illness and black people do not have such things.”

Mkhasibe says his family thought it was a cultural thing and that he had an ancestral calling to become a traditional healer. He did not agree.

The South African Federation of Mental Health (SAFMH) defines stigma as “an attribute, quality, or condition that severely restricts or diminishes a person’s sense of self, damaging their self-worth, social connections, and sense of belonging”.

The challenge of getting help

“It was extremely challenging to get help and support from my family. They played a big role in stigmatising me,” Mkhasibe tells Spotlight.

A delay in accessing mental healthcare services led to Mkhasibe’s condition deteriorating. He says some of his symptoms were racing thoughts, impulsive spending, hearing voices, and insomnia. “I was always high on life with extreme energy levels. Things became worse, whereby I became violent and aggressive. I was eventually admitted to Chris Hani Baragwanath Hospital in 2007 and later transferred to Sterkfontein Psychiatric Hospital in Krugersdorp.”

“I was never informed about my diagnosis. What it was and how to manage it. I had no idea what to do when I was diagnosed. The challenge was that I was not educated about my mental illness,” he says.

Mkhasibe says he was in Sterkfontein Hospital until 2011. By then, he was estranged from his family and moved around a lot staying with cousins, aunts, and his late grandmother.

“I was at Sterkfontein for four years. My family did not want me back home. I moved from one ward to the other during that time. Now I’m close to my sister and mother again but it took a while to mend those bridges.”

He says his experience with the illness prompted him in 2011 after he was discharged from hospital, to start volunteering and creating awareness on mental health conditions. Mkhasibe is now 39 years old and was until recently a project leader for mental health at the SAFMH. He started at the organisation in 2017. On leaving the organisation, he says he has learned a lot but now has a newborn son and wants to spend time with him. Mkhasibe describes himself as a family man. He is married and has two children.

Stigma and seeking care

Ashleigh Craig, a clinical psychologist who runs a Johannesburg-based private practice and has also worked in the public sector, says beliefs around mental health contribute to stigma because there are negative connotations surrounding mental illness.

“People seeking care are often called names such as bewitched or crazy. This prevents people from seeking out care,” says Craig. “This results in people seeking care when their condition is acute and recovery will take much longer. Stigma can often lead to people completely stopping to take treatment.”

Claire Hart, a post-doctoral fellow at Wits University’s Developmental Pathways for Health Research Unit (DPHRU), says the label of any mental illness is often also associated with a mark of social disgrace or stigma. This has been shown in South African communities, where studies revealed high levels of stigmatisation towards individuals with mental disorders. The label of having a “mental illness” is socially stigmatised and constitutes negative external perceptions, which may, in turn, be internalised and negatively impact an individual’s internal sense of self.

“As a result, these individuals may avoid using existing mental health care services in fear of being labelled even when experiencing severe psychological distress. Thus, both having a mental illness and seeking help may be viewed as undesirable,” says Hart.

Under-funded, under-resourced

Hart says fighting stigma requires a two-fold approach that involves education and providing adequate resources. “People with a lived experience can help in terms of fighting mental health stigma and raising awareness. However, mental health is underfunded and there is a shortage of psychologists in the country. To become a registered psychologist, you need a Masters degree and most universities only take six to 12 Masters candidates per year,” says Hart.

Craig says people in the public sector can wait up to four months just to see a psychologist. She says private psychologists are very expensive and in the public sector most mental health services are only available at tertiary hospitals.

According to South Africa’s new National Mental Health Policy Framework and Strategic Plan 2023 – 2030 (the mental health framework,) the country has less than one psychologist for every 100 000 people. This is among the reasons why there are limited mental health services in the public health sector, especially in rural areas.

“At present, mental healthcare in rural areas, preventive and promotive aspects of mental health, and the provision of services to children, adolescents and those with anxiety, mood, and other non-psychotic disorders remain under-resourced and underdeveloped. Furthermore, primary healthcare workers are under considerable strain due to high caseloads and have minimal training in mental health, resulting in patients receiving inadequate mental health care,” says Hart.

The social and economic costs

Data in the mental health framework indicates that about 5% of the total public health budget was allocated to public mental health expenditure in 2016/2017. Provincial public health budget allocations towards mental health showed marked inequality, ranging from 2.1 to 7.7% across provinces.

According to the mental health framework, social costs of mental illness can include disrupted families and social networks, stigma, discrimination, loss of future opportunities, marginalisation, and decreased quality of life.

Mental illnesses such as depression and anxiety have been estimated to cost the economy more than R61.2 billion in lost earnings, according to the mental health framework. It states that at a societal level, lost income associated with mental illness far exceeds public sector expenditure on mental health care. In other words, it costs South Africa more to not treat mental illness than to treat it.

What to do?

Although the mental health framework goes to great lengths to stress the impact of stigma on mental health, its plans to address this are relatively low in detail. According to the framework, all health staff working in health settings will receive basic mental health training, inclusive of anti-stigma training, and ongoing routine supervision and mentoring. Provincial departments of health are meant to look at expanding their mental health workforce.

The framework also sets out to strengthen mental health promotion, prevention and advocacy. “Currently, however, no concerted national programme exists,” the framework states. “In 2024, a national public education programme for mental health will be established, including knowledge of mental health and illness; stigma and discrimination against people with lived experience of mental illness.” This, according to the policy framework, will be steered by the national health department and provincial health departments. Other relevant government departments, including Employment and Labour, Education, and Social Development will, among others, introduce mental health literacy programmes into curriculums or workplace policies and decrease stigma.

But according to Michel’le Donnelly, a project leader for advocacy and awareness at the SAFMH, there is no clear outline for any anti-stigma programming in the mental health policy framework. “As the SAFMH we hold the view that the South African government needs to actively ensure that there is sufficient funding targeted for anti-stigma programming. Monitoring, evaluation, and implementation of these programmes should be done in collaboration with people with lived experience of mental health conditions and NGOs working in the sector. These programmes should include contact-based education as part of governments intended activities because, through evidence and research, this has proven to be a way of ending stigma.”

Mkhasibe agrees that we need more support to make people aware of mental health services and how to fight stigma. ”We need more community engagement in terms of mental health education and awareness. People all over South Africa need to know that mental health is more prevalent than we think. Businesses and organisations need to instil mental health training as a culture in the office,” he says.

“Schools, colleges, and universities should make mental health a priority within education. Awareness campaigns should be done at churches, malls, taxi ranks, airports, and bus stations. Basically, everywhere where people gather,” he says.

Republished from Spotlight under a Creative Commons Licence.

Source: Spotlight

Categories : Medical IndustryTags :

Boehringer Ingelheim Appoints César Nieto as General Manager and Head of Human Pharma, Southern Africa

On By ModernMedia

Boehringer Ingelheim, one of the world’s leading bio-pharmaceutical companies, appointed César Nieto as General Manager and Head of Human Pharma for the Southern Africa region. As part of his responsibilities, Cesar will manage the Southern Africa region which includes South Africa and Sub-Saharan Africa countries.

A qualified physician, César has previously held senior leadership positions with the company in North and Central America, Caribbean, United Arab Emirates, and the company’s headquarters in Germany.

Mohammed Tawil, Regional Managing Director and Head of Human Pharma for Boehringer Ingelheim’s India, Middle East, Turkey and Africa (IMETA) region, said, “César has a proven track record of success in driving growth for Boehringer Ingelheim. His diverse experience will be key to our ability to drive sustainable growth and we are confident that he will help us fulfil our purpose of transforming lives for generations by bringing innovative healthcare solutions to address areas of unmet medical needs in the region.”

Commenting on his appointment, Cesar Nieto said, “Through strong partnerships with our stakeholders and Boehringer Ingelheim team, I’m confident that we can positively impact the patients and communities and contribute to healthcare innovation.” 

César was previously the Regional Cardiovascular Therapeutic Area Lead at Boehringer Ingelheim IMETA, where he played a key role in the transformation of the company’s cardiovascular and stroke portfolio. His strategy in this role served as a blueprint for other regions such as Brazil, Mexico, UK and Ireland, and led to an increase in profitability in IMETA.

Boehringer Ingelheim has been in the South African market since 1962 and later grew the network into Namibia and Botswana. Recently, the regional headquarters has extended its representation to the Sub-Sharan African region.

Categories : HIVTags :

Traditional Healers in Rural Mpumalanga Help Diagnose HIV

On By ModernMedia
Photo by Sergey Mikheev on Unsplash

An initiative of Wits University’s MRC/Wits Agincourt Research Unit, the Traditional Healers Project convened two ‘open houses’ at local primary healthcare facilities – Rolle Clinic and Thulamahashe Community Health Centre in rural Bushbuckridge, Mpumalanga – in March 2023.

An ‘open house’ is a community and stakeholder gathering hosted at a public health facility in partnership with the Department of Health.

The aim of these sessions is to build on the relationship that the MRC/Wits Agincourt Research Unit has established between local traditional healers, community members, and healthcare facility staff to support the end of HIV through regular HIV counselling and testing.

Traditional healers in public health

The sessions supplement research that began almost a decade ago, which focuses on the role of traditional healers in healthcare access and delivery.

Specifically, this research aims to determine:

  • whether traditional healers can conduct HIV counselling and testing (HCT)
  • whether the patients of traditional healers are willing to undergo HCT that is administered by a traditional healer
  • whether traditional healers and biomedical healthcare workers can work together to help link patients to HIV/AIDS diagnosis and care.

The open house sessions form part of this research and provide a platform where traditional healers and biomedical healthcare workers can come together and build mutual understanding and trust, with a view to linking those who test positive for HIV with healthcare providers who can then administer lifesaving antiretroviral treatment (ART) and care.

15 traditional healers certified HIV counsellors and testers

The open houses drew an audience of more than 150 participants, including 15 traditional healers, local indunas [tribal chiefs], community healthcare workers (CHWs), community members, and representatives from Right to Care (a local collaborating partner on HIV) and the Department of Health.

Mr Wonderful Mabuza, Project Manager at the MRC/Wits Agincourt Research Unit, oversees the open houses and says that the successes to date have far surpassed expectations:

“It is exciting to be part of the group that is doing this work, knowing that we have a lot of people who visit traditional healers in our communities. It’s groundbreaking to have traditional healers trained to provide HIV counselling and testing – and amazing to see community members respond, with some never having tested previously.”

Gogo Singabeni, one of the 15 traditional healers who has completed the programme, says: “I was very excited to be invited to the HIV training, and that we would be certified in HIV testing and counselling. It’s important to show people proof that I am certified to do HIV testing.”

She adds: “The first day of testing [a patient] was very difficult for me. I was even shaking as I was conducting the test. I started with the first client, although I was shaking, and I managed to complete the process according to how we were trained. After the client left, I drew strength in seeing that I am able to do it.”

Partnerships imperative

Dr Ryan Wagner, Senior Research Fellow at the MRC/Wits Agincourt Research Unit, leads the traditional healers programme known collectively as Ntirhisano (Shangaan for ‘working together’).

He emphasises the importance of the Ntirhisano team, traditional healers, community healthcare workers, and the Department of Health collaborating to strengthen the referral system. 

“In order to expand coverage and increase uptake of HIV testing – and thereby contribute to ending new HIV cases – we need to embrace innovative approaches, such as traditional healer-initiated HIV counselling and testing,” says Wagner.

“We have recruited and trained 15 traditional healers in the Thulamahashe/Rolle area who, for the past six months, have been successfully testing their patients for HIV/AIDS. Those who tested positive have been referred to a local clinic or community healthcare worker.”

The Department of Health’s Primary Healthcare Supervisor, Sister Mariah Mkhari, says: “The Department of Health alone cannot do it, but with such collaborations between MRC/Wits and other stakeholders we will be able to conquer HIV. We welcome the initiative, and we hope Wits can expand to other areas in Bushbuckridge and train all traditional healers to test for HIV.”

Categories : Healthcare Politics and RegulationsTags :

Opinion: There are Paths to Quality Universal Healthcare Besides NHI

On By ModernMedia
One of the most damaging aspects of our public discourse on National Health Insurance (NHI) is the mistaken notion in some quarters that the only two options are NHI and the status quo. PHOTO: Rosetta Msimango/Spotlight

By Marcus Low for Spotlight

One of the most damaging aspects of our public discourse on National Health Insurance (NHI) is the mistaken notion that the only two options are NHI and the status quo. Often implicitly, sometimes explicitly, defenders of NHI suggest that any argument against NHI is one for maintaining the current system. Since the current system doesn’t work very well for most people, this line of argument gets some purchase, even though it is based on a false premise.

In his book “Which country has the world’s best health care?”, oncologist and bioethicist Ezekiel Emanuel outlines the key features of healthcare systems in 11 different countries. Two things that stand out are that health systems differ substantially between countries and that most systems are the relatively messy products of complex histories and political and other compromises. This latter point about the path-dependency of healthcare systems is an important point we will return to.

Many varieties

South Africa’s proposed NHI system is sometimes clumped together with systems in other countries such as Canada, the United Kingdom, and Thailand. At times this is fair, at times it skims over important differences.

For example, NHI will be a single-payer system, which is to say, the NHI fund will be responsible for almost all purchasing of healthcare services in the country. In some respects, Canada has a similar system, except that rather than one system for the whole country, they in effect have 13 single-payer systems for each of their provinces and territories. Even Thailand, at times referred to as an example of NHI, technically has three funds rather than one, although it resembles South Africa’s NHI plans in several other respects. In principle, a large single-payer should be able to negotiate better deals than several smaller payers, but on the other hand, having Canada-style provincial funds would be more closely aligned with South Africa’s current governance arrangements and in some provinces, like the Western Cape, chances are people would have more trust in a fund run by the province than in one run nationally.

Another thing that quickly becomes apparent when looking at the variety of healthcare systems out there, is that a simplistic dichotomy between NHI and private healthcare is a false one. Countries like the Netherlands and Germany have achieved excellent health outcomes with systems that are neither NHI-style systems nor examples of the private sector running riot. Though the details are significantly more complicated than this, you can think of the Netherlands and Germany roughly as having many strictly regulated medical schemes (called sickness funds in Germany) with scheme/fund membership being compulsory (with some exceptions). The German system is progressive in that people with higher incomes contribute more than people with lower incomes – an important difference from South Africa’s medical schemes.

Funds in the Netherlands are also not primarily funded directly, as with our medical schemes, but receive funding from a central fund via a risk adjustment process. Both the German and Dutch systems have significant social solidarity built-in in the way it institutionalises the cross-subsidising of the poor by the wealthy.

In South Africa, such a system could, for example, be implemented by dramatically tightening up the regulation of medical schemes, putting in place a progressive mechanism for cross-subsidisation between schemes, making scheme membership compulsory for those who can afford it, and, over time, using tax revenue to pay for scheme membership for the unemployed (although this last element, like NHI, does come with a big question mark on affordability. Those with long enough memories might remember that a system roughly along such lines was on the cards in South Africa around the turn of the century. (see for example the Taylor report of 2002 and this interesting paper.)

Getting to there from here

One striking thing about NHI in South Africa is that for all the column inches, submissions to Parliament, and oral hearings across the country and in Parliament, hardly anyone seems to have shifted their positions in the last decade and there has been very little serious consideration of alternative paths to universal healthcare.

Photo by Hush Naidoo on Unsplash

One reason for this is the sense that the design choices behind the NHI Bill were essentially decided on by a relatively small group of people in the National Health Department and the African National Congress (ANC) around 10 or 15 or so years ago. What followed since then often felt like an attempt at co-opting rather than meaningful engagement. This was particularly apparent in the way some members of the Portfolio Committee on Health continuously pushed people on whether they are for or against NHI, rather than engaging with the substance of people’s submissions. Though the boxes for public engagement were ticked, the reality was often a parody of what such engagement is meant to be.

We could have gone a different route. It would have been entirely feasible to have a process for NHI akin to the much more meaningful set of engagements we had for the Competition Commission’s Health Market Inquiry into the private healthcare sector. In that case, people could make submissions, be heard by the panel, and crucially, one never got the sense that the outcome was preordained. Such a process may in some respects have given government officials and members of Parliament a few more headaches, but it would also have built trust and understanding of the technical issues, and for major reforms like NHI trust and public understanding is half the battle.

Republished from Spotlight under a Creative Commons Licence.

Source: Spotlight

Categories : COVID Healthcare Politics and RegulationsTags :

Supreme Court of Appeal Rejects Appeal Over COVID Vaccine Sale Restriction

On By ModernMedia

The Supreme Court of Appeal has dismissed an application for leave to appeal by Solidarity and Afriforum over a 2021 court case where they challenged a condition by South African Health Products Regulatory Authority (SAHPRA) that the Johnson & Johnson vaccine be restricted to the government. SAHPRA said that this was not a condition that they had imposed.

On 26 July 2023, the Supreme Court of Appeal (SCA) dismissed an application for leave to appeal filed by Solidarity and Afriforum (the Applicants) on the grounds that there is no reasonable prospect of success.

The Pretoria High Court struck Solidarity and AfriForum’s application from the court roll on the grounds of an alleged lack of urgency, and the court also ordered them to pay SAHPRA’s legal costs which was filed in June 2021 by the Applicants, wherein they alleged that when SAHPRA approved and registered the J&J vaccine, SAHPRA imposed a condition that the sale of the J&J vaccine is restricted to the National Government. The applicants argued that SAHPRA was not mandated to stipulate the condition that only the government may purchase the J&J vaccine and questioned the legality of such a condition.

SAHPRA refuted this claim because this is not a condition that SAHPRA had imposed. Subsequently, the applicants proceeded to lodge an application for leave to appeal with the SCA . SAHPRA CEO, Dr Boitumelo Semete-Makokotlela said, “This court ruling indicates that SAHPRA is judicious in adhering to its mandate responsibly. We welcome the outcome of this judgement.”

Categories : HospitalsTags :

Mixed Responses to Gauteng Health’s Latest Security Plans

On By ModernMedia
Photo by Maxim Hopman on Unsplash

By Thabo Molelekwa for Spotlight

Following reports of healthcare workers who have been bitten, punched, hit in the face, robbed, assaulted, or even killed in healthcare facilities in Gauteng, the province’s health department announced that healthcare workers will now be trained in handling patients who become violent.

The initiative was recently announced by Motalatale Modiba, spokesperson for the Gauteng Department of Health, on social media.

A lack of security at public healthcare facilities is not a new problem. A previous series of Spotlight articles highlighted security challenges in public health facilities in several provinces – including Gauteng – and reports of robberies and assaults at some facilities. Last year, there was a fatal shooting of a nurse at Tembisa Hospital which sparked an outcry among health worker unions over the safety of their members.

The departments’ announcement prompted questions by organised labour and an opposition politician about whether the authorities have lost trust in the multi-million rand security measures already in place in health facilities to protect both workers and patients, with some arguing that security guards, rather than healthcare workers, should be responsible for safety.

However, according to Modiba, the training of staff has nothing to do with the security contracts of security companies.

“Security personnel are non-medical personnel, therefore, their presence in facilities does not substitute the need to ensure that our staff is empowered with techniques to know how to handle difficult patients,” he told Spotlight.

‘Just a tick-box exercise’

The training plans, however, have inspired little confidence among healthcare workers.

According to the nurses’ union Denosa’s Gauteng Provincial Secretary, Bongani Mazibuko, the training does not address the safety concerns that exist in the facilities. “It’s just a tick-box exercise to say the employer is trying to do something. The root cause of these attacks is the influx of mental health patients and the mixing of mental health patients with medical patients,” he told Spotlight.

The department in a statement in April said many of the incidents were reported at Weskoppies Psychiatric Hospital with 21 cases since January last year. At Carletonville Hospital there were nine safety incidents, nine incidents at the Far East Rand Hospital, seven at Chris Hani Baragwanath Academic Hospital, four at Thelle Mogoerane Hospital, and three at Kopanong Hospital. There were also reports of some isolated incidents at other facilities.

Mazibuko said that from the reports they received from their members working in Gauteng public health facilities, the training has also not yet taken place. “We would like the department to tell us which institutions they have provided the training to so that we can confirm with our members if they received the training or not.”

Modiba, however, did not respond to Spotlight’s questions about where training had taken place so far, how many healthcare workers have been trained, or the impact this is having.

Explaining aspects of the plan, however, Modiba said that the department training staff to know how to protect themselves is a practical step that shows that they are conscious of the environment they operate in. According to him, training on how to manage a violent mental healthcare user is generic to the training of doctors and psychiatric nurses as regulated by the Health Professions Council of South Africa, which is a statutory body established in terms of the Health Professions Act. “A special course on management of violent mental healthcare users is planned to be rolled out from the second quarter of the 2023-2024 financial year. It is based on a similar course attended by one of the healthcare workers in the UK. He will be working in one of our Specialist Psychiatric hospitals, Sterkfontein Hospital. He will be the main facilitator and will be working with other employees from the Regional Training Centres, the Office of Health Standards Compliance (OHSC), and Wellness Practitioners,” said Modiba. He said the department is also working with the police.

But Mazibuko said Denosa has had many talks with the department on healthcare workers’ safety concerns and the need to create a safe working environment. “This was part of our demands when we marched last year. Even on International Nurses Day, we were vocal about our concerns about the safety of our members at the workplace.”

He said the union had previously presented its safety campaign to the department.

SAMA ‘deeply concerned’

Meanwhile, following a scoping review study, the South African Medical Association (SAMA) recently published a report outlining the nature and extent of violence against healthcare workers between 2012 and 2022. The study found an increase in violent acts targeting healthcare workers, with the most affected being doctors, nurses, and paramedics. The study found that female healthcare workers were disproportionately affected compared to their male counterparts and most of the incidents were reported in Gauteng.

In an interview with Spotlight, SAMA Chairperson Dr Mvuyisi Mzukwa said they are “deeply concerned” about the safety of healthcare professionals. He said they appreciate efforts that can realistically improve the safety of healthcare workers in the workplace.

“SAMA has shared an interim report [based on the study findings] on violence targeting healthcare workers with DENOSA and the media. This report was designed to sensitise all stakeholders about crime targeting healthcare workers and to prime the stakeholders, including the National Department of Health, to initiate intersectoral solutions to limit and prevent safety threats in the workplace against all healthcare workers in the country,” Mzukwa said.

SAMA’s report found eight murders of healthcare workers reported in the media, “with six of the deaths (or 75%) occurring among doctors”. One nurse and one paramedic were also murdered in the set period the report found. “Of all the 45 media reports examined, only 17 arrests (38%) were reported, with only two resulting in successful prosecution.”

According to Mzukwa, SAMA had recommended that a multi-sectorial strategy for the security of healthcare workers to protect them from targeted crime be developed and implemented.

“Without this intervention, healthcare in itself continues being further jeopardised and more doctors will feel threatened and seek safer refuge in foreign countries, taking with them critical skills and expertise that are in dire need locally. Law enforcement agencies should also act swiftly in dealing with crime and to ensure the safety of both patients and healthcare providers,” Mzukwa said.

61 safety incidents

Speaking in the Gauteng Legislature in April, MEC for Health and Wellness, Nomantu Nkomo-Ralehoko said there were 61 incidents reported in health facilities between January 2022 and April 2023. She told MPLs that most of these incidents were attributed to mental healthcare users, while others relate to patients’ anger towards staff for various reasons, such as refusal to buy them items or patients trying to escape, as well as angry relatives and patients linked to criminal activities.

Nkomo-Ralehoko said that staff training in responding to aggression and violence in the affected institutions is one element of their intervention. She said the department will be installing CCTV cameras at strategic locations for monitoring purposes.

“Our goal is to minimise – if not eradicate – such incidents in our facilities. We have to work with healthcare workers and other stakeholders such as hospital boards, clinic committees, and the patients themselves to curb incidents of attacks inside our facilities,” she said.

But security concerns in Gauteng’s public health facilities are also fuelled by systemic and contract management issues – something the MEC vowed to address. In March, responding to concerns over these multi-million rand security contracts that are rolled over year on year without a proper tender, Nkomo-Ralehoko acknowledged that the situation is unacceptable. The department is spending over R59 million on month-to-month security contracts at its facilities.

“The security contracts are rolled over irregularly as there is currently no contract in place; only service level agreements are used to manage the contracts,” she said.

Responding to a question from Spotlight on the progress with the new security tender, Modiba said that the tender was advertised and has since closed. “The evaluation committee has been appointed and will now go through the evaluation process to assess the various bids that have been received. We are still on course to complete the process within this financial year,” Modiba said.

But according to Denosa’s Mazibuko, in-sourcing security services, separating mental health patients from other patients, and ensuring that mental health patients are only admitted to where the institutions can commit them, will help the department and the healthcare workers work in a safe space.

He said that the fact that there have been years of year-on-year security contracts, shows that the department is not in touch with the challenges on the ground. “In-sourcing of security will help as well since it will address the issue of security withholding their services as they have not been paid and security being given proper gear for work,” he said.

According to Jack Bloom, the Democratic Alliance’s health spokesperson in Gauteng, the department is failing in its basic responsibility to provide a safe working environment for staff and patients in public hospitals.

“A huge amount of money is spent on security companies that don’t do their job, and it is high time that new security contracts are awarded to competent providers,” he said.

Bloom said that healthcare providers should not have to defend themselves against attacks because that is what security guards are supposed to do. “There needs to be a complete overhaul of security arrangements at our hospitals, with a professional assessment of what should be provided at a reasonable cost,” he said.

Republished from Spotlight under a Creative Commons Licence.

Source: Spotlight

Categories : Diet and Nutrition Healthcare Politics and RegulationsTags :

Health Activists Make Over 12 000 Submissions on Draft Food Labelling Regulations

On By ModernMedia
These are examples of the proposed new black and white warning labels on food packaging. Photo: supplied

By Mary-Anne Gontsana

Over 12 000 submissions have been collected by Community Media Trust and the Healthy Living Alliance (HEALA) in response to the Department of Health’s draft Regulations Relating to the Labelling and Advertising of Foodstuffs.

The draft regulations were gazetted in January and consumers had until 21 July to comment. These regulations, among other things, propose the mandatory use of new and bolder warning labels on unhealthy food which include items high in salt, sugar, saturated fats and items containing artificial sweeteners.

Community Media Trust (CMT) is a not-for-profit company, mainly focused on health and human rights and has partnered with the Healthy Living Alliance (HEALA), a coalition of organisations focused on nutrition.

In February, CMT and HEALA staged a flash mob as part of the “Less Sugar, More Life” campaign in Cape Town ahead of the Finance Minister’s Budget Speech, advocating for an increase in the sugary drinks tax. They were disappointed by the announcement that the tax would be frozen for two years.

Following a massive media campaign on the draft regulations, CMT and HEALA successfully collected thousands of submissions.

CMT’s co-director Lucilla Blankenberg said the warning labels had been tested with audiences and researchers. If you’re a diabetic shopping for food and there was a clear warning label saying, ‘high in sugar’, the consumer won’t have to spend time trying to work it out because the message is simple.

The proposed warning labels are black and white triangles and would clearly indicate when food is high in sugar, salt and fat or contains artificial sweeteners.

“The reason the food industry is fighting back is because if food has a warning label, it cannot be marketed directly to children. Which means cartoons and animation that will attract children cannot be used to market a food item that has a warning label. If a pack has a warning label they can’t make any health claims whatsoever,” said Blankenberg.

“We won’t see the results immediately, but it will happen over time, especially for the children. With warning labels, it will be easier for parents to avoid buying certain food,” said Blankenberg.

HEALA’s communications manager Zukiswa Zimela said conversations proposing front of pack warning labels started in 2016.

Zimela said research for the campaign was initially done by the University of Western Cape to determine which foods qualify to have front of pack warning labels. She said the research gave more insight into what consumers thought of the current information on packaging as well as what the new warnings should look like.

“We started the campaign in May and went to eight provinces, mainly to educate and inform communities about the importance of front of pack warning labels and the food they were eating,” said Zimela. She said they found that many consumers agreed that they did not understand the nutritional information on food packaging.

She said the food industry had used scare tactics like saying warning labels would cause job losses which was “completely untrue”.

“This is not something new, warning labels have been done in other countries like Chile, Mexico, Peru and Columbia and there has been no evidence that jobs have been lost because of it. This is just undermining the government’s plan to get people to eat better.”

Zimela said HEALA will be monitoring the responses to the regulations. “Should the regulations be implemented, we need to make sure that they are not watered down or seen as useless.”

Sugar industry warns against “demonising sugar”

The South African Sugar Association (SASA) told GroundUp it had also submitted comments on the draft regulations, and that the front of pack warning labelling system was of particular concern to the industry.

SASA executive director, Trix Trikam, said: “The objective of this system is to encourage the reduction of energy/calorie intake, saturated fat and salt to prevent obesity and non-communicable diseases.

“It is well known and there is evidence that sugar is not the sole contributor of kilojoules to the diet and should therefore not be singled out in a regrettable out-of-context manner,” he said.

He said the warning labels should not be done in a sensationalist or alarmist manner “which seeks to demonise sugar” because that would have “a significant adverse impact on the sugar industry”.

Trikman suggested that the warning labels should instead reflect the calories in a food product. “SASA is also not convinced that the perceived cut-off values for sugar is evidence-based. A possible solution to that would be to use the perceived cut-off values based on percentage of energy value and not the amount of sugar per volume of product,” said Trikam.

“The draft regulations make it mandatory for a warning symbol to be placed on the front of pack labels for foods that exceed a perceived cut-off value for sugar. In order to avoid the warning symbol for sugar, food manufacturers will seek to find ways of removing sugar from their products. This will lead to a decrease in the demand for sugar and will ultimately negatively impact the livelihoods of those dependent on the sugar industry in the deeply rural areas of KwaZulu-Natal and Mpumalanga.”

Trikam said SASA is concerned about the obesity rates in South Africa but added that the solutions should be evidence-based.

Disclosure: GroundUp was once a project of, and still has a close relationship with, Community Media Trust.

Republished from GroundUp under a Creative Commons Licence.

Source: GroundUp

Categories : Gender HIVTags :

Feature: The Complexities of Traditional and Medical Circumcision in the Eastern Cape

On By ModernMedia
Circumcision rates in South Africa have increased dramatically over the last decade with 62.5% of males aged 15 to 49 who were circumcised as of 2022. PHOTO: Rodger Bosch

By Siyabonga Kamnqa for Spotlight

There is compelling scientific evidence that Voluntary Male Medical Circumcision (VMMC) is both safe and significantly reduces a man’s risk of becoming infected with HIV. While there can also be some protection from traditional circumcision, the protective effect of medical circumcision is thought to be much greater. The World Health Organization (WHO) has recommended medical circumcision for HIV prevention since 2007.

Circumcision rates in South Africa have increased dramatically over the last decade. According to estimates from Thembisa, the leading mathematical model of HIV in South Africa, 62.5% of males aged 15 to 49 were circumcised as of 2022. In 2012, this number stood at 38.8%. Experts ascribe some of the reduction in the country’s rate of new HIV infections to the massive circumcision drive over the last decade.

But the choice between medical, traditional, or no circumcision is often about much more than HIV risk. For one thing, traditional circumcision has great cultural meaning for some groups.

‘From boyhood to manhood’

Spotlight visited Lwazi Mfeka* at his ibhoma (traditional hut) during his last week at an initiate school in the Eastern Cape this winter. The first-year Walter Sisulu University student asked to remain anonymous for fear of victimisation, as talking openly about initiation is taboo in many rural communities.

He said leaving his ibhoma on the last day of his tenure as an initiate is a moment that will forever be etched in his mind. Not only did this signal the end of a “challenging” three-week period at the school, but it was also a symbolic moment where he says he has graduated from boyhood to manhood.

Mfeka said he was supposed to have undergone the ritual in December last year, but due to a bereavement in his family, he couldn’t. “At varsity, I was often mocked and isolated because I was still a ‘boy’. This bothered me a lot and I couldn’t wait to come here (to the mountain) and finally become a man,” he said.

He admits he was gripped by fear in the months leading up to his initiation.

“For starters, many young boys die while undergoing the custom and I didn’t want to add to the numbers. But, fortunately, my dad chose an ingcibi (traditional surgeon) with a good track record. I first had to go and get tested by a doctor for chronic illnesses such as HIV and TB as I had to present a medical certificate to the ingcibi before being circumcised. At the initiation school, everything was done according to the rules. After each cut, the spear gets sanitised to avoid any spread of infections,” Mfeka said.

Botched circumcisions

Mfeka’s fears are not without merit. In recent years, traditional male circumcision has often made headlines for all the wrong reasons, with the lives of young men lost due to botched or unhygienic circumcisions.

According to Mamnkeli Ngam, spokesperson for the Eastern Cape Department of Cooperative Governance and Traditional Affairs, in the 2022 winter initiation season, 11 of 10 794 boys who underwent traditional circumcision in the province died, while in the summer initiation season, 23  of 51 601 died. Ngam says around 20 000 boys went into the mountains to undergo traditional circumcision this winter (2023).

He told Spotlight that some fly-by-night ingcibis, desperate to make a quick buck, are the ones giving the custom a bad name. He says that assisted by the local chiefs and the police, they have been clamping down on illegal initiation schools and arresting bogus traditional surgeons.

“During the period between 1 June to 20 July, nine bogus traditional surgeons have been arrested in the Eastern Cape,” Ngam said.” We have been conducting safety campaigns ahead of the winter circumcision season to educate communities. Circumcising boys without parental consent [and] not having undergone medical examination to perform the procedure is against the law.”

Nkosi Mpumalanga Gwadiso, the Eastern Cape House of Traditional and Khoisan Leaders’ chair, told Spotlight that parents need to be involved throughout the process. “Often, parents leave everything to the amakhankatha (traditional nurses). That’s where things go wrong. As chiefs, we always emphasise the importance of parental involvement from day one until the initiates come back home safely. Some traditional nurses are the reason things go wrong because they neglect the initiates and go drinking. It is therefore the responsibility of the fathers to ensure that they visit the initiation schools regularly and monitor everything,” Gwadiso said.

While numbers vary widely and we haven’t been able to get a full picture, we understand that initiation schools can admit around 100 initiates during each of the winter and summer circumcision seasons. Our informal survey of several initiation camps in the former Transkei suggests the cost is typically around R300.

The medical alternative

While medical male circumcision is a generally available alternative to traditional circumcision, its provision in the Eastern Cape is influenced by cultural factors. For example, according to Eastern Cape Provincial Health Department spokesperson, Yonela Dekeda, the department does not conduct open marketing or demand creation in the communities/public “due to cultural dynamics within the province”.

“Medical Male Circumcision services are actually confined within the health facility level. Therefore, intake depends on the walk-ins, not on demand creation or promoting of the MMC services,” Dekeda said. “MMC is the choice of individual families. However, as the department, we are ensuring that all the designated MMC sites are well equipped with necessary MMC equipment, including training of clinicians such as medical doctors, clinical associates, and professional nurses to provide quality voluntary medical male circumcision services.”

Despite the lack of promotion, some young men, such as Bandile Macetywa*, have opted to go the medical route. He asked that we not use his real name for fear of victimisation from people who disapprove of his decision not to be circumcised in the traditional manner.

Speaking to Spotlight, the 20-year-old from Cofimvaba in the Eastern Cape said he pleaded with his parents, who are staunch traditionalists, to do the custom the medical way. “I know I disappointed my parents, especially my father, but at the end of the day, it was about my safety. I was happy when they respected my decision,” he said.

However, Mecatywa says he is all too aware of the discrimination that awaits him in society. “There are already naysayers. But I’m just glad the whole process went well. For Pete’s sake, we are in 2023. People are free to choose where they get circumcised. Some people had the guts to tell me to my face that I deserved to be abducted and circumcised again the traditional way?” he said.

Mecetywa believes many lives will be saved if rural communities can be educated to accept medical male circumcision. “It is much safer with [fewer] risks of getting infected while undergoing it. I am not saying traditional male circumcision is wrong. But why do initiates continue to die or have botched operations if things are done the right way,” he asked.

While the department does not actively promote medical circumcision, and while Mecetywa is clearly very aware of being in a minority, there are in fact significant numbers of medical circumcisions being conducted in the Eastern Cape. According to Dekeda, 14 637 were performed in the province in 2022, while 14 300 have been performed so far this year.

Medical male circumcision is an elective procedure that is widely available in the public sector, often provided via NGOs. The process typically involves counselling, a pre-assessment to check for anything that may hamper a client’s ability to be circumcised, post-operative care, and follow-up visits. Clients will typically also be offered an HIV test.

VMMC in the Western Cape

Meanwhile, in the Western Cape, the Department of Health and Wellness in collaboration with the City of Cape Town and the Department of Cultural Affairs and Sport has implemented an initiation consent form as a mechanism to uphold ethics. It includes medical screening that helps minimise and mitigate potential risks.

Western Cape Department of Health spokesman Mark Van der Heever told Spotlight, “The initiation consent form is further reviewed to enable alignment to developments as these emerge. Training and capacitation of traditional surgeons is a key element to strengthening partnership following a whole of government and whole of society approach.”

Van der Heever says since 2020, 274 circumcisions were performed by a Medical Officer invited by the traditional healers to perform the circumcisions.  A total of 131 977 medical male circumcisions, according to Van der Heever, were performed at the Western Cape health facilities since 2013, with 13 105 performed just last year.

The rest of the stats are as follows:

2013 – 12 581

2014 – 15 990

2015 – 14 131

2016 – 11 982

2017 – 15 127

2018 – 14 557

2019 – 18 000

2020 – 5 750 (COVID)

2021 – 10 754 (COVID)

2022 – 13 105

Van der Heever adds that between April and March 2023, Medical Male Circumcision was reported at 130 public health sites and a total of 12 259 circumcisions were performed across the province.

“The province also has two Men’s Health Clinics (in Karl Bremer and Elsies River). With the intention of increasing access to services, we are in discussions to upskill clinicians to enable service provision at health facilities. Current service provision is based on roving teams in both the metro and rural districts, which limit access to availability of the team.”

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight

Categories : HIVTags :

Opinion: HIV Investments Remain No-brainers, but Some Things Need to Change

On By ModernMedia
Photo by Miguel Á. Padriñán

By Marcus Louw for Spotlight

Making the case for governments and donors to pump money into the HIV response has become more difficult over the last decade. This is partly a result of the notable successes we’ve had – for example, in 2022, HIV-related deaths in South Africa were down to less than a fifth of what it was in 2005. There is clearly some justification for the point of view that HIV simply isn’t the crisis it used to be.

That said, it is also true that about 8 million people in South Africa are living with HIV. This number will continue to rise in the coming years as the rate of new HIV infections is much higher than the rate of HIV-related deaths. Barring a major scientific breakthrough, all these millions of people will require antiretroviral medicines for the rest of their lives, both for their own health and to reduce onward transmission of the virus. In this context, a failure to maintain and improve HIV treatment and prevention programmes will have catastrophic consequences.

There is also increasing competition with other areas of urgent need. In recent years, climate change and COVID-19 have understandably made the headlines much more frequently than HIV. There is also a slow shift underway in South Africa’s disease burden, away from HIV and tuberculosis toward non-communicable diseases (NCDs) such as diabetes and hypertension.

Still a no-brainer

Despite these shifts, there is good reason to think that spending money on HIV continues to offer excellent value for money. For example, according to a recent report by Economist Impact (part of the Economist group that also publishes the Economist magazine), for every dollar spent on HIV in South Africa from 2022 to 2030, it is estimated the country will see GDP gains of over $7.

We also have a good idea of the impact and cost-effectiveness of specific HIV-related interventions. According to the most recent version of the South Africa HIV investment case, published in December 2021, condom provision continues to be the most cost-effective intervention in South Africa, followed by antiretroviral treatment, infant testing, pre-exposure prophylaxis for men who have sex with men, and general population testing. Voluntary medical male circumcision has become less cost-effective as coverage levels have risen in recent years, but remains worth it. In fact, the investment case leaves no doubt that most of the key interventions needed to combat HIV in South Africa are both worth it and affordable.

Despite all this, according to a recent UNAIDS report, global investment in HIV has taken a knock in recent years, and in 2022 we were essentially back down to the same level as in 2013. Such reductions constitute a crisis in HIV funding, especially in poor countries that are heavily reliant on donor funds. In South Africa, key interventions like antiretroviral treatment and condoms generally remain funded, but public sector health budgets have been shrinking in real terms, something that is no doubt impacting the HIV programme.

Time to leverage HIV investments

This brings us back to the knotty problem with which we started – while HIV remains a large and serious problem and most investments in combatting HIV remain excellent value for money, making the case for these investments has become more difficult due to competing priorities and the fact that, in South Africa at least, people are not dying of AIDS at nearly the rate they did 20 years ago. How to best make the case in a way that convinces governments and donors to put up the money in this context is a devilishly hard problem.

There are certainly no simple solutions.

What there is, though, is some indications that a too narrow focus on HIV is becoming a harder sell. There is also a risk that as funds for HIV get harder to come by, and the clamour for funding NCDs becomes more pronounced, we may end up pitting diseases against each other in a way that benefits no one.

Given the incredible acuteness of our HIV crisis ten and 20 years ago, a laser focus on HIV was right and necessary. Today, however, the reality is that many people living with HIV are also living with NCDs like diabetes or hypertension, something that will become only more so as the population of people living with HIV grow older. It is clear that we need to start doing a better job of integrating care and treatment for all the different diseases one person might have – the key is to do so in a way that doesn’t drop the ball when it comes to HIV.

In some areas progress is already clear – medicines distribution via pickup points closer to people’s homes were fuelled by the need to get ARVs to people, but is now also being used to distribute medicines for some NCDs. In other areas, such as data systems, integration however remains limited and the systems available for HIV and TB remain superior to those for NCDs.

There appears to be a broader policy shift along these lines. As recently reported on Devex, the Global Fund to Fight HIV, TB, and Malaria’s current five-year strategy explicitly endorses and promises funding for integrating non-communicable disease services with TB and HIV programmes. UNAIDS’s new ‘The path to end AIDS’ report also makes the right noises on the “deeper integration of HIV and other health services”, as does South Africa’s National Strategic Plan for HIV, TB, and STIs 2023 – 2028.

Of course, the road from policy-level ambitions such as these and change on the ground can be a long one – to some extent such integration has been on the cards for over a decade. But, rising NCD rates, an ageing population of people living with HIV and comorbidities, and funding pressures mean that getting integration right is now more urgent than ever.

One of the arguments for HIV-specific funding has always been that HIV investments have benefited healthcare systems more generally, even if that was not the primary intention. Maybe in this next act of the HIV response then, the key will be to stop thinking of health system improvement as a side effect of HIV investments and instead lean into the idea of explicitly leveraging what we’ve done and will continue to do in HIV to improve health systems more generally.

Republished from Spotlight under a Creative Commons Licence.

Source: Spotlight

Categories : General InterestTags :

Going Viral: Dr Chivaugn Gordon on Medical School with a Difference

On By ModernMedia
Dr Chivaugn Gordon, head of undergraduate education at UCT’s Department of Obstetrics and Gynaecology, reflects on her love of teaching future doctors about women’s health issues. PHOTO: Nasief Manie/Spotlight

By Biénne Huisman for Spotlight

With humour and wearing an occasional wig, Dr Chivaugn Gordon teaches medical students about serious women’s health issues. During hard lockdown she delighted students at the University of Cape Town (UCT) with educational videos using household items as props. For example, she created an endometrium (the inner lining of the uterus) from hair gel and red glitter, performed a biopsy on a potato, and showed a chicken hand puppet go into labour.

One video features a patient named Zoya Lockdownikoff – who is a spy – consulting with her doctor about abnormal menstrual bleeding. Gordon, in a blonde wig with round sunglasses, plays Lockdownikoff; and Gordon’s husband, Dr Adalbert Ernst, plays her doctor.

Lockdownikoff explains that the bleeding started when she “did a very complicated backflip to escape a very compromising situation” and that it’s ruining her expensive super-spy coats.

Gordon is head of undergraduate education at UCT’s Department of Obstetrics and Gynaecology, while Ernst is with the university’s Department of Anaesthesia and Perioperative Medicine.

Speaking from her yellow-walled lounge in Cape Town’s Bergvliet, Gordon says: “I became a doctor because I love working with patients. And then I realised, oh cool, I love teaching too. And now I can do these two things together.”

Interest in IPV

For Gordon a driving interest has been intimate partner violence (IPV) which she introduced into her undergraduate curriculum in 2015.

“The aim is to have graduating doctors who are able to recognise intimate partner violence. Everybody thinks that you can’t possibly be abused unless you have a black eye or a fractured arm. But actually, IPV is often more psychological. It’s often psychological abuse. So the challenge is to teach young doctors what are the red flags in someone’s behaviour, or in their clinical presentation, that might indicate IPV.”

Published online in April, Gordon delivered a talk for TEDxUCT called “Tackling IPV, one awkward dad conversation at a time”, in which she notes IPV is “a global pandemic that has been ongoing since time began”. The title refers to Gordon’s father who raised her.

According to a paper published in the journal Lancet Psychiatry last year, IPV is the most common form of violence worldwide; it is most prevalent in unequal societies, and its victims are mostly women and girls. The paper states that worldwide 27% of women and girls aged 15 and older have experienced physical or sexual IPV, but in South Africa the figure is estimated to be much higher, between 33 and 50%.

Gordon contributed to South Africa’s revised Domestic Violence Amendment Act of 2021, through UCT’s Gender Health and Justice Research Unit.

The new legislation broadens the definition of domestic violence to include (above and beyond physical and sexual abuse) emotional, verbal or psychological abuse, which is described as “a pattern of degrading, manipulating, threatening, offensive, intimidating or humiliating conduct towards a complainant that causes mental or psychological harm…including (repeated) insults, ridicule or name calling; (repeated) threats to cause emotional pain; the (repeated) exhibition of obsessive possessiveness or jealousy…”

Gordon highlights the term coercive control. “Because that underpins most serious intimate partner violence. So, somebody who is extremely controlling; they want their partner to do what they want, when they want, and how they want immediately. They normally start isolating you from friends and family so they can spin a narrative of your reality that can’t be contested by anyone else. And it also makes it more difficult to leave.”

Red flags

Gordon highlights some of the IPV red flags that doctors should look for in their patients.

“Depression, anxiety, PTSD, insomnia, [and] things like self-medicating with substances,” she says. “Because when you are living in absolute, abject terror every day of your life, it’s going to manifest in some kind of psychological manner. So, when people have been broken down and worn down and their self-esteem has been eroded it also affects the way they might interact with the healthcare professional.

“Big red flags come out in body language. Usually when someone goes to a doctor, they tell you everything about all their symptoms, because they want you to make them better. So, if you’ve got a patient who is closed off, they’re not making eye contact, they’re avoiding answering your questions, they’re just very reticent and you can’t get anything out of them…then you’ve got to think.”

Gordon stresses that IPV happens across economic strata and in all walks of life. “Every time I run this workshop, a medical student who comes from a very privileged background, from a very financially stable, loving home, comes to me, saying this is happening to her. It happens everywhere. I’ve got medical colleagues, several, who have experienced intimate partner violence. It doesn’t discriminate.”

Republished from Spotlight under a Creative Commons Licence.

Source: Spotlight