Global health systems

People health systems is the focus of this years Global Health Systems symposium as the world gathers in Cape Town to share ideas to address global health challenges.



September in Pictures at Chiawelo Community Practice

A Colouful Practice – Celebrating Heritage Day!

The team at Chiawelo Community Practice (CCP) celebrated South Africa’s cultural diversity during the week surrounding Heritage Day by dressing in various traditional attire. Patients and visitors to the practice were treated to cultural dress representing Sotho, Pedi, Zulu, Tsonga, Xhosa, and even Mozambican culture, showcasing the diversity of traditions that health workers at CCP come from.

Heritage Day 2014Heritage Day 2014_2

Mapping Chiawelo

The team of Community Health Workers (CHWs) at CCP revised the way they are working in the community by mapping their streets and organising their workload more effectively. Using a large map, CHWs have a better sense of how to navigate the dense population in Chiawelo’s Ward 11, and are in a better position to organise themselves in terms of health promotion activities in the community

Mapping Chiawelo

Research Day at Wits

A few members of the CHW team, lead by David Kampi, manned a stand at the Wits Research Day to showcase the work being done at CCP. There was tremendous interest by members of faculty and students attending the Research Day, and discussions are in place to set up a student volunteer programme at CCP.

Wits Research Day

Student Visits 

A group of Masters Medical Sociology students doing a course on HIV/AIDS visited CCP to see how the practice works in relation to the existing service. The students were able to engage with clinicians at the practice, and were fortunate enough to be taken on a guided tour of the Hanyani HIV/AIDS clinic at Chiawelo Community Health Centre by Sister Ester Mazibuko.

Wits MA Soc Students

Gordhan’s ‘back to basics’ campaign a wake-up call for municipalities

THE national government has told municipalities what they need to do — now it needs to help citizens to force them to do it. Largely ignored by media determined not to cover anything that might make a difference to people’s lives, the national government last week hosted a local government summit. Often, official summits are an excuse for politicians to state the obvious. But this summit was important: it showed that Pravin Gordhan’s national ministry responsible for local government is serious about trying to fix municipalities and that the national government is backing it….more

Wits ICT interest in CCP

A team from Wits visited CCP and Klipspruit West Clinic to explore it as a base for an NRF collaboration with Egypt on ICT . The plan is to support re engineering of PHC services in a site in SA based on 10 years of experience of this in Egypt. The ICT team are having a workshop on the project in Wits on Thursday.



Nyaope tearing Tshwane families apart while rehab centres are scarce

Rural FamilyCommunity leaders say nyaope is tearing Tshwane communities apart while there are too few rehabilitation centres to help people who use the drug. Recently, NGOs from Eersterust, Hammaanskraal and Montana gathered for a march and prayer vigil in response to the area’s nyaope problem, which local community leaders say is fuelling crime and causing learners to leave school. Dimakatso Mahapa says she wishes she could turn back time to when she was 15 years old – before nyaope destroyed her relationship with her family…. more


Huraprim is hard work

IMG_1843.JPGShehnaz Munshi is hard at work on her research project in Ekurhuleni District. She is interviewing community health workers and their supervisors who are part of the Ward Based Outreach Teams. A startling comment from a community health worker:

They (government) dont care!

HURAPRIM presence

IMG_1836 The Wits Research Day was an excellent opportunity to network. The poster by Shehnaz Munshi was an opportunity to engage with many interested academics. The presentations by Stephen Pentz and Shabir Moosa were well received. We have to plan for CHWs to do posters and presentations next year!

CHWs from Chiawelo at Wits Research Day

IMG_1834CHWs from Chiawelo Community Practice (CCP) were represented well with three very enthusiastic CHWs – David, Nkosinathi and Gundo – manning a stand in the Wits Research Day at Medical School. There were actively ‘selling’ CCP to students and professors whilst the video on CCP ran. Many academics noticed them and have shown indicated interest in visiting CCP. They collected names and contact details and went away satisfied with their experience.

Jozi Family Medicine Team to present at Wits Research Day


Jozi Family Medicine Team to present at Wits Research Day

The team from Jozi Family Medicine will be giving three different presentations at the Wits Research Day on the 17th of September.

Shabir Moosa will be talking about the views of key leaders in South Africa on implementation of family medicine, and the critical role in the district health system.

Stephen Pentz will be presenting on ethical challenges in Primary Healthcare Re-engineering

And Shehnaz Munshi has a poster looking at the inclusion of allied health professionals in integrated primary care teams

Go here to find out more about Wits Research Day

See abstracts for the presentations below:

Ethical challenges in Primary Healthcare Re-Engineering

Primary health care (PHC) re-engineering in South Africa is seen as crucial to reforming and strengthening the current health system and represents a change is thinking from poorly co-ordinated, verticalised programmes characteristic of current PHC services to a more integrated, team-based approach within PHC. This research focused on the ethical challenges with regards to the implementation of Municipal Ward-based PHC Outreach Teams; one of the three streams in the model for PHC re-engineering (aside from district-based clinical specialist teams and school health services). The study conducted 28 focus group interviews with purposively selected stakeholders in 5 of the 7 sub-districts of the City of Johannesburg, including stakeholders from government, private and academic institutions, NGOs, and people in the community identified as influential to the implementation of PHC re-engineering. The data was analysed qualitatively following the framework method. The results revealed ethical concerns with the current health service including poor services; poor standards of care; concerns with medication; problematic attitudes; and fear of attending clinics. The ethical challenges particularly associated with PHC re-engineering included issues with confidentiality; the reception of Community Health Workers (CHWs) in the community; challenges encountered by CHWs; political dynamics; and transparency, corruption and nepotism. Beyond an ethical crisis in health care in South Africa, the research concludes that challenges with professionalism with regards to CHWs remains problematic. CHWs have an incredible potential to increase access to services and effect meaningful health prevention and promotion at community level, however, the researchers caution that it is unethical to send poorly trained, incapacitated non-professionals into dangerous, structurally violent areas to deal with serious social and health conditions without adequate support.


“The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system”

Background: Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being a new discipline in South Africa. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues.

Methods: This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposefully selected leaders using an interview guide. Thematic content analysis was based on the framework method.

Results: Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and ‘specialist’ status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance / quality improvement; and providing support to community-oriented care. Respondents’ spoke of consolidating the development and training of family physicians, and shaping human resource policy to include family medicine.

Conclusions: Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care – a tall order, requiring strong teamwork. It requires family physicians to proactively develop team-based models of care, reform education and advocate for clearer policy.

CHW Training on Stroke and Rehabilitation


A team of Occupational Therapist and Physiotherapists, along side students from Wits University, trained the Community Health Workers (CHW) at Chiawelo Community Practice on stroke and rehabilitation. The training focused on the role of physiotherapy, dealing with pressure sores, positioning stroke patients, and upper and lower limb exercises; all accompanied by practical sessions.

Here are a few responses from the CHWs who reported back on what they learnt from the training:

“Going for Physiotherapy training has taught me not only what a stroke means, but how to help the stroke patient to be more independent and get a feel of having their lives back to normal”

“We were taught hot to assist the patients with dressing up, hot the family/friends can move them from one chair to another, and how to position the patients to check for bed sores and pressure sores”.

“The training was good. We learnt how to transfer patients from the bed to a wheelchair, or chair”.

“We learnt how to help a stroke patient to be independent, to be able to do things for him/herself”.

“I learnt how to position patients who are bed-ridden and teach the whole family to do exercises to help them with their habits”

“Empowering me more and making me see that stroke patients can still get help and live a normal life”

A special thanks to Sanchia Adam, Talor Golach, Zainab Ismail, and Reggie Sefeffe, as well as all the Wits students who were involved in training.