School of Public Health Report of Activities 2019–2020 by University of the Western Cape

School of Public Health FACULTY OF COMMUNITY & HEALTH SCIENCES

Report of Activities 2019–2020

The Vision & Purpose The School of Public Health (SOPH) was founded in 1993 to support the establishment of a district health system in a new democratic South Africa. Its vision is the optimal and comprehensive health and well-being of populations in developing countries, particularly Africa, living in healthy and sustainable environments with access to and participation in appropriate, high quality, comprehensive and equitable basic services, including health services and systems, rooted in human rights and social justice. The purpose of the School is to support and train policy makers and implementers who are knowledgeable and skilled in the principles and practice of public health, whose practice is based on research, influenced by informed and active communities, and implemented with a commitment to equity, social justice and human dignity.

Since its inception, the SOPH has established itself as a significant and pioneering initiative in public health with a national and, increasingly, continental influence. Some of its key achievements have been • establishing a multi-level postgraduate programme in the field of public health, culminating in a Master of Public Health and doctoral studies in Public Health; • providing continuing education opportunities for health and welfare practitioners through our annual Summer and Winter Schools; • establishing a substantial integrated research and service programme to which many of our students have contributed; • being the holders of two NRF SARChI chairs and hosting the Extra-Mural SAMRC Research Unit; and • being designated a World Health Organisation Collaborating Centre for Research and Training in Human Resources for Health Development. In line with the overall orientation of the School, most of our research focuses on health policy and systems, social determinants of health and building a districtbased public health system. It addresses four inter-related programme areas, namely HIV/AIDS and TB, maternal and child health, public health nutrition, and non-communicable diseases. The School is part of the Faculty of Community and Health Sciences – which also includes the departments of Occupational Therapy, Physiotherapy, Social Work, Natural Medicine, Nursing, Psychology, Human Ecology and Dietetics, and Sport, Recreation and Exercise Science.

CONTENTS DIRECTOR’S FOREWORD ................................................................................................. 2 THE ACADEMIC PROGRAMME ........................................................................................4 The postgraduate programme ....................................................................................4 Doctoral programme: Enriching African practice and scholarship ................ 7 Our global reach: Geographical origins of students 2019 – 2020 .................. 9 Student academic achievements ............................................................................. 10 Graduated with a PhD in Public Health ...................................................................15 Short courses and continuing education ................................................................19 RESEARCH AND PROJECT WORK ...............................................................................21 Collaborations through SARChI ................................................................................22 Countdown to 2030 ......................................................................................................25 Whole of Society Approach: Addressing early childhood development and the First Thousand Days Initiative ..............................................................26 Cape Town Together and the Community Action Networks (CANs) ..........28 Sixth Health Systems Research Global Symposium ......................................... 30 Promoting African adolescents’ full potential through ‘accelerator interventions’ ..............................................................................................................33 Improving access to vaccines and medical products: Building capacity in supply chain management in East Africa .....................................................35 Promoting food and nutrition literacy using multi-media education-entertainment ........................................................................................36 Projects ..............................................................................................................................38 Collaborative projects with UWC’s Department of Dietetics and Nutrition .............................................................................................................. 50 LINKS, PARTNERS AND FUNDERS ..............................................................................53 SPECIAL EVENTS ...............................................................................................................55 Jakes Gerwel Awards: Outstanding Contributions in Public Health ............55 Annual David Sanders Lecture in Public Health and Social Justice .............56 STAFFING Farewell to Comrade Professor David Sanders: SOPH founding director..58 Staff farewells ................................................................................................................. 60 Staff of the School of Public Health ........................................................................62 PUBLICATIONS ....................................................................................................................74

Director’s Foreword The Director’s foreword is always the last piece of our biennial reports to be written, after reading the full draft of the contents, and reflecting on the past two years. This is particularly so for this report which covers the 2019/20 period, as in my, and probably many colleagues’ memories, 2019 has all but disappeared behind the life- and world-changing year that 2020 turned out to be. We have published reports of our activities every two years for about the past twenty years. This year we are publishing it electronically for the first time, perhaps reflecting the rapidly accelerated replacement of print with on-line resources (although I don’t think I will change my preference for reading in print). But while the electronic format will make the report easily available around the world, easily readable on mobile phones and tablets, I am also aware that the ubiquitous presence of on-line meetings, digital resources and a world of information that can be tapped any time does not mean equitable access. When we surveyed our students and short course participants last year, we learned that while access has increased substantially, bandwidth, data access and data cost, remain substantial barriers. In this report we reflect on the changes we have introduced and will be introducing to our postgraduate programmes – and the big shifts in our continuing professional development activities, having had to cancel the SOPH Winter School for the first time in 28 years. Reconciling the constraints imposed by COVID-19 with the needs of our audiences, and making use of emerging opportunities, has been a prevailing theme of (virtual) conversations in the SOPH. Our well-tested, blended teaching modalities which have been in place and evolving since 2000, provided us with a really valuable infrastructure when, in early 2020, along with the rest of the world, we moved our offerings completely on-line due to the COVID-19 pandemic. Developing the internal capacity and exploring the technological possibilities to offer the best possible educational experience virtually to our student audience, while also taking account of continuing barriers and inequities in access to the digital world, will be an ongoing and exciting endeavour as well as a steep learning curve for all of us over the next few years.

We also reflect on our students’ resilience. When the COVID-19 pandemic hit health services in Southern Africa and beyond, we expected that many of our enrolled students may struggle to progress with their studies as most are health professionals and managers within their public health sectors and have been on the frontline of the pandemic. To our great surprise this was not the case, however. There were very few dropouts, pass rates have been remarkably high, and even requests for extensions on assignment submissions remained the exception. We have been enormously impressed by, and grateful for, our students’ commitment to their studies and their resilience to continue under very difficult circumstances. They all deserve a big shout-out and our full commitment to do everything to support them in the completion of their degrees. In 2020, 28 students received their Postgraduate Diploma, 23 received their Master degree, and three students received their doctorates in Public Health. The SOPH’s research continues to be anchored by its two NRF SARChI research chairs and the Extra-Mural SAMRC Research Unit. They not only shape our strong focus on health policy and systems research, but also substantially support capacity building through a carefully structured and innovative doctoral support programme, doctoral bursaries and post-doctoral fellowships. Thematically, much of our research resists easy categorisation: many of our projects – whether in HIV, maternal, child and adolescent health, food security or non-communicable diseases – incorporate questions of systems functioning, governance arrangements, gender perspectives, political economy and social justice. These pages cannot do justice to the entirety of our research portfolio, but we have highlighted a few projects as an indication of the scope of our work. The onset of the COVID-19 pandemic impacted our research in a number of ways, as it did around the world. Face-to-face field work activities came to a halt and, where possible, were substituted with virtual engagements (such as telephonic interviews). Other project activities had to be suspended or postponed, and projects have had to adapt to looming funding cuts. But we also responded to the multiple, sudden research needs generated by the pandemic; for example, we supported the Western Cape Department of Health’s reflections on governance and health worker wellness during COVID-19; participated in

a multi-country survey exploring mask use among runners; examined the impact of COVID-19 on mental and sexual health of the population; and surveyed how COVID-related initiatives, such as lockdowns, impacted cooking practices. Some of our research also informed our contributions to public policy debates, contributing articles in the media on the National Health Insurance and the health human resource strategy; the alternatives to a failing public health system in the Eastern Cape; and the importance of community mobilisation during the COVID-19 pandemic. As I said in my last foreword, the SOPH is its people. Our great shock and sorrow in 2019 was the sudden and untimely death of the School’s founding director, Emeritus Professor David Sanders, who passed away unexpectedly in August at the age of 74. In this report we reflect on his life and legacy and share some of the tributes and photos from his memorial. We also lost one of the security officers in our building, Ms Sheryl Cordon, who succumbed to complications from COVID-19, after battling the disease and its aftermath for nine months.

Three staff members, Prof Di Cooper and Drs Suraya Mohamed and Hazel Bradley retired, and Assoc Prof Lucia Knight took up a position at UCT. We wish them well for their next life phase. We are fortunate to have been joined by two new permanent academic staff members, Dr Bey-Marrié Schmidt and Assoc Prof Olagoke Akintola, and by Dr Martina Lembani in a new role as senior lecturer. And Ms Nolitha Komeni re-joined the School as senior office co-ordinator. They are all introduced in more detail later in this report. I want to end by thanking all those who continue to make the SOPH a vibrant and exciting endeavour: first and foremost, my colleagues who make and shape the SOPH; our Dean and colleagues from the Faculty who supported us and steered a steady ship through a very turbulent time last year; our students, who probably teach us as much as we teach them; our funders, partners and collaborators who support our work and work with us for better health and social justice. I hope you will enjoy reading this report and will feel encouraged to engage with us, whether through our educational programmes, our research or our future on-line events. - Prof Uta Lehmann

THE ACADEMIC PROGRAMME For the past 29 years, the School of Public Health (initially the Public Health Programme) has trained public health practitioners in South and sub-Saharan Africa for district health system development and implementation through • short courses offered by staff and visiting experts at annual Winter and Summer Schools; and • a multi-level postgraduate programme delivered through a flexible learning approach.

The Postgraduate Programme The postgraduate programme consists of three courses and qualifications: • Postgraduate Diploma (PGD) in Public Health (NQF Level 8) • Master of Public Health (MPH) (NQF Level 9) • PhD in Public Health (NQF Level 10) The table below reflects our enrolment figures over the past four years, showing a substantial increase in 2020 of enrolments in the PGD, with only moderate variations in the MPH and PhD registrations.

Students registered for the postgraduate programmes: 2017 – 2020 Qualification Postgraduate Diploma in Public Health Master of Public Health PhD in Public Health Total postgraduate students

2017 47 134 52 233

2018 34 139 52 225

2019 44 131 50 225

2020 64 136 47 247

Students who graduated in 2019 and 2020 are listed on pages 10 to 14. As in previous years, they live and work in Southern, East and West Africa (see map on page 9), with 54% coming from South Africa, 44% from other African countries and 2% from outside of the African continent.

Dr Bey-Marrié Schmidt joined the SOPH as a senior lecturer in November 2020 from the Cochrane Centre of the South African Medical Research Council (SAMRC). She has a background in anthropology and public health – and received her PhD in Public Health from the University of Cape Town in 2019, with a thesis focusing on ‘The factors affecting a data harmonisation innovation in the Western Cape, South Africa’. Bey has a particular interest, and extensive expertise, in evidence reviews synthesis and knowledge translation, and specifically in systematic and ethical stakeholder engagement in research in South Africa. Her expertise will provide important expansions of the School’s focus and niche areas, both in our academic and research activities.

Postgraduate Diploma in Public Health The Honours-level Diploma facilitates access to postgraduate qualifications for those who have a three-year tertiary qualification (e.g. some nurses and environmental health officers). The qualification also serves as a useful complementary qualification for professionals who already have Master or Doctoral degrees, but who are seeking a public health foundation for career purposes. Offered at Level 8 on the National Qualifications Framework (NQF), the Diploma inducts students into the field of public health. It introduces concepts of population health and the burden of disease within the preventive and promotive paradigm; orientates students to public health in an era of globalisation; offers training in a range of key skills for academic study in the field; and, importantly, guides students in conducting a monitoring and evaluation project which responds to the management role that many of our students occupy. As with the Master and doctoral programmes, the Diploma is offered through various blended learning modalities, including carefully developed self-study learning materials and virtual on-line sessions, making it broadly accessible to practitioners within and beyond our borders.

of our programmes through distance and blended learning. This mode of delivery is particularly valuable as almost all of the School’s students are health professionals studying part-time while they work. They are often employed in demanding management positions, and most are professionals with families. These commitments combine to present them with the typical challenges facing mature, part-time students.

Developing delivery at a distance While many of our Diploma and Master students have supplemented their distance learning by attending Summer and Winter Schools held on campus in Cape Town – or have attended contact sessions such as the mini-thesis weeks – some never come to the School at all. This means that instead of classroom teaching, much of our students’ learning experiences are mediated through well-developed learning materials and student support, now largely offered on-line. Student support is mostly given via e-mail and phone, through extensive feedback on written assignments and mini-theses and, increasingly (since 2020), also through on-line teaching sessions (see below).

The SOPH considers its Master degree to be its flagship programme. It comprises eight modules – some of which are compulsory and some elective – plus a small research study (‘mini-thesis’). The topics of those written by our 2019 and 2020 graduates are listed on page 11 of this report.

In the early years of our distance programme, all our modules were printed and sent to students at the beginning of each year such that each student received a big box of learning materials and readings to see them through the academic year. During the past few years, however, we have begun to distribute study materials electronically and to record and post lectures on UWC’s on-line learning platform, iKamva. In addition we have increasingly engaged with the opportunities afforded by new technologies – experimenting with Google discussion groups, podcasts, use of blogs, and on-line teaching using media such as Skype, Zoom or Webex.

Since its inception in 1994 the MPH has attracted large numbers of students from all over Africa – and more so since 2000 when we started offering all

Our blended teaching modalities provided a really valuable infrastructure when, in 2020, along with the rest of the world, we moved our offerings completely

The Master of Public Health (MPH)

Assoc Prof Olagoke Akintola joined the SOPH in January 2021, bringing with him exciting inter-disciplinary perspectives and approaches, following his qualifications and expertise in zoology, business administration, public health and gender studies, health promotion and HIV, and school health. He has conducted research and published extensively on social determinants of health, the intersections of HIV/AIDS, the gendered nature of care work and poverty, and access to health services for vulnerable and marginalised populations. In the SOPH he will lead, expand work and teach in his areas of interest as well as public health research in our Master programme.

on-line due to the COVID-19 pandemic. When faceto-face learning activities became impossible, these modalities allowed us to continue our programmes without much disruption – in sharp contrast to most other programmes at UWC and universities around the world who had to move their teaching and learning on-line, with the steep learning curves and resourcing this has entailed.

Making advantage We have used the opportunity and impetus provided by the conditions that the COVID-19 lockdowns imposed, to start taking our thinking about virtual learning to a new level. Since its inception, our Winter and Summer Schools have been offered through face-to-face learning, and have provided students with the opportunity to engage with one another and with staff, while receiving an introduction to their modules. As we had to cancel our Winter School in 2020 due to COVID-19, for the first time in its history, we introduced realtime virtual teaching sessions for all our modules; these were well attended and much appreciated by students. Going forward we will also prepare for a virtual Summer School to be held in March 2021, transforming the five-day face-to-face teaching events into a virtual format.

In 2020 our e-learning specialist, Ziyanda Mwanda, qualified with a Masters in Education, specialising in Educational Technology. In her mini-thesis, Ziyanda researched how SOPH students use WhatsApp to support their peer learning. Titled ‘Social media enhanced boundary crossing: exploring distance students’ ecosystems of learning support’, her study explored different student support systems and how students use WhatsApp to navigate these when they study from a distance. The research was predominately qualitative with a small quantitative element to investigate postgraduate distance students’ ecosystem of learning support holistically. The findings revealed that students used a combination of formal and informal tools to support their learning, including social media, particularly WhatsApp, which enables the crossing of transitional, formal and informal learning contexts, hierarchical

Developing the internal capacity and exploring the technological possibilities to offer the best possible educational experience virtually to our students will be an ongoing and exciting endeavour for all of us over the next few years. The results will be shared on our new website.

The effects of COVID-19 on student progress When the COVID-19 pandemic hit health services in Southern Africa and beyond, we expected that many of our enrolled students may struggle to progress with their studies as most are health professionals and managers within their public health sectors and were on the frontline of the pandemic. To our great surprise this was not the case, however. There were very few dropouts, pass rates have been remarkably high, and even requests for extensions on assignment submissions remained the exception. We have been enormously impressed by, and grateful for, our students’ commitment to their studies and their resilience to continue under very difficult circumstances. They all deserve a big shout-out and our full commitment to do everything to support them in the completion of their degrees.

and time and space boundaries. Recognising social media as an important part of students’ learning support ecosystem allowed an expanded view on learning support. Ziyanda’s timely study recommends that institutions recognise and nurture the use of social media as a costeffective student support strategy which is guided by institutional guidelines and policies.

This is Ziyanda and her daughter, Ndalo, celebrating her graduation.

Doctoral programme: Enriching African practice and scholarship Since its launch in 2000, the SOPH doctoral programme in Public Health has made significant progress. We are experiencing an increasing and differentiated demand for doctoral education and the number of PhD students has grown over the last 20 years from an annual average of 4 to around 50 per year. The programme’s flourishing reputation is seen in the 272 applications we received in 2019 and 2020. In addition to the School’s good reputation, the flexibility of the programme and its niche orientations are big attractions – in addition to its relatively affordable fees. We have a growing pool of available supervisors covering a range of topics, reflecting the expertise of SOPH colleagues and a network of collaborators from other institutions.

Student profile The table below reflects the profile of PhD graduates, current students and recent applicants in the School. In 2020, 46 students enrolled in the programme, three-fifths of whom were female (60%). Just over half (56%) were living in South Africa while one third were from other African countries. These profiles are consistent with those of the PhDs who have graduated to date. The only difference is a slight increase in the ratio of foreign to South African students – which reflects the high demand for doctoral training from other parts of the continent and realises the SOPH’s vision and purpose of promoting equity and dedicating our limited resources to making an impact on the continent.

Total number Gender Female Male Country of residence South Africa Other African countries Countries outside Africa

Graduates to date

Current students

Recent applicants (2019-2020) 272

60% 40%

65% 35%

35% 65%

60% 27% 13%

56% 33% 11%

25% 69% 6%

The majority of students are embedded in research or programmes, either at the SOPH or in their respective institutions. Some are attached to research projects that carry PhD scholarships, and the rest are self-funded or receive funding from various sources. The majority of candidates work full time and are self-sponsored.

Recent graduates In 2019 and 2020, SOPH graduated nine PhD candidates (see page 14). The topics of their dissertations are given on page 15, reflecting the wide range of fields in which they are engaged. Their careers also vary, from being scholars in academia, leaders or managers in the health or development sector, to practitioners and knowledge workers in various health-related settings.

A streamlined and integrated doctoral programme The expansion of the doctoral programme has necessitated more structured approaches, from selection to supporting students through the doctoral journey, integrating them into the life of the SOPH and maintaining throughput rates.

A PhD co-ordinating team of four SOPH staff screen the candidates’ submissions using a newly developed process which streamlines and systematically manages diverse categories of applicants. They identify those candidates who are most likely to succeed in completing the ‘academic marathon’ that a PhD journey represents, and whose interest and focus matches the supervision expertise and availability in the School.

Facilitating support for candidates Writing a doctoral dissertation can be lonely at the best of times – exacerbated in 2020 by the restrictions imposed by COVID-19. To sustain momentum amongst students and supervisors, we developed a multi-facetted programme of support and learning activities, encouraging communication and engagement, not only with the SOPH, but also among peers. We did the following: • •

Developed and implemented a virtual induction series for incoming doctoral students. Ensured almost daily communications through our Sakai-based on-line doctoral portal (called

• •

iKamva) – including celebrating achievements like publications, proposals accepted, etc. We regularly posted information regarding internal and external opportunities for virtual learning and support to our students. Hosted a bi-weekly on-line journal club on Monday mornings. Intensified peer support and networking opportunities through bi-monthly webinars. Ten webinars were held in 2019 and 2020 – addressing field work challenges; wellbeing and resilience during the pandemic; engaged scholarship; celebrating learning; practical issues in theory application and development; knowledge translation; mixed methods research; and PhD by publication or monograph.

been integral to the research and academic life of SOPH, including supporting the Diploma and Master teaching programmes. These engagements are in line with the commitment of the School and University to build senior academic capacity in the country and on the continent – and indeed, a significant proportion of graduates have become lecturers and supervisors at SOPH and other universities.

Coping with COVID-19 Since the onset of COVID-19 and subsequent lockdown measures, students and supervisors have faced new sets of challenges. We have created space for, and engaged in, collective sense-making and have reinforced wellbeing and resilience. As the responses to COVID-19 began to take hold, we conducted short surveys with supervisors and students about the implications for individual projects. The survey revealed that a significant number of students who were in their data collection phases had to make changes or adaptations. We compiled an inventory of COVID-19 impacts on all students, supporting adjustments to research proposals, especially those in field work phases (e.g. shifting to secondary data analysis, conducting systematic reviews).

•

Held an on-line writing camp every Friday morning during 2020. This provided an opportunity for protected writing time, to enhance discipline, motivation and self-accountability, to feel part of a community, and get guidance and tips from others.

In addition, the School facilitated access to financial support for more than half the students through generous support from partners – notably the Belgian Directorate-General for Development Co-operation (through its Framework Agreement with the Institute for Tropical Medicine at the University of Antwerp), and the South African National Research Fund (through two SARChI chairs in Health Systems Governance and in Health Systems, Complexity and Social Change – see page 22). Furthermore, once enrolled, candidates are encouraged to participate in postgraduate teaching, which is considered a valuable part of the doctoral journey, supporting a range of graduate attributes such as deepening knowledge, developing critical and analytic abilities and communication skills. Over the last few years, at least a dozen of the enrolled candidates have

The success of our programme during this period, especially our ability to sustain momentum and progress among students and supervisors, rested on our readiness to make use of remote working, on-line and distance-based learning modalities, capitalising on our many years of experience with these modalities. This allowed us to move into new modes of delivery fairly quickly, facilitating expanded participation of staff and students no matter their location. In addition we hosted meetings of supervisors every four months, to share approaches to supporting students through the COVID-19 crisis and to further develop supervisory capacity among staff the SOPH.

Our Global Reach: Geographical origins of our students 2019-2020 USA 3

Canada

Germany

India

Nicaragua 1

Sudan 1 Nigeria Ghana

Sierra Leone 1

17 Cameroon 1

Uganda 3

Congo

Kenya 3

Rwanda 1

Tanzania 2

Zambia

Malawi

3 Zimbabwe

Namibia

14 Botswana 1

Eswatini South Africa 171

Lesotho

Student Academic Achievements In • • •

2019 and 2020, 55 students graduated with the Postgraduate Diploma in Public Health 45 students graduated with the Master of Public Health (MPH) 9 students graduated with a PhD in Public Health

Postgraduate Diploma in Public Health 2019 Abdullah, Amina Amakali, Hertha Mumbala Cawe, Nangamso Cokoyi, Ayanda Alfred Denhere, Knowledge Hanong, Mamosotho Itumeleng Jajbhay, Mateenah Imran Jegede, Olubukola Esther Konko Masombo,Nisha Manivasen, Parmanathan Mdlekeza, Nozuko Arizona Mjwara, Phindile Perseverance Mlotshwa, Gail Moyo, Sidubangani Mphafi, Mphainyane Mucharunga, Tatenda Mutandwa, Michelle Farai Ndlovu, Sizwe Junior Nel, Nadine Nghayo, Hlulani Alloy Ngwenya, Andile Emmanuel Orakwue, Ikenna Runeyi, Sinazo Salie, Shaun Ashley Topalo, Celine Kamunima Vermeulen, Marcia Christine Zokufa, Nompumelelo

2020 Abdullah, Mubeena Brima, Osman Chris Cottee,Yolanda Daka, Joseph Dube, Kiriana Hartley, Tasneem Kayamba, Francis Mabweazara, Smart Zivanai Maganga, Joseph Munashe Maguranyanga, Tarisai Rose Mbadaliga, Lusani Odelia Mdaka-Thoka, Thoko Prudence Mhlongo, Siphiwe (cum laude) Mkhonta, Zamokuhle Temvelo Muparuri, Lawrence Mutenda, Lydia Nengu Ngomane, Helen Noluthando Oehmen-Janse van Vuuren, Tanya Okaiyeto, Florence Olafusi, Oluwaseun Olayemi Palele, Xoliswa Pierre, Melanie Joan Roux, Joanne Margaret Simelane, Spanela Kenneth Singh, Larissa Svogi, Chiedza Tiva, Nhlamulo Regnatia Williams, Abigail

‘As a distance learner, besides the knowledge gained from the course material, I have also appreciated the opportunity for networking during contact time. I found the course material engaging and the learning platform (iKamva) was easy to navigate. I appreciated the great calibre of educators, the collaborative style and the open approach to public health and social justice. As a mature learner, I felt supported throughout the course and valued the additional sessions on academic reading and writing, how to use Mendeley and how to perform searches in the library. ‘I can already see how my MPH experience has changed the way I think and how I approach issues in my sphere of work - hopefully towards a more holistic, inclusive child health service, not only at my hospital, but on a broader level.’ 2020 MPH graduate, Anita Parbhoo, South Africa

Master of Public Health (MPH) Following their course work, MPH students are required to conduct a small research project. Written up as minitheses, these cover a range of public health topics that are of interest and concern to the students. A number of themes can be seen across the 45 mini-theses of the students graduating in 2019 and 2020. HIV/AIDS and TB remained the main focus of study, addressed by just over a third of the studies (17 of 45). Perhaps mirroring the progress of the pandemic and development of HIV and TB-related services, six examined issues relating to adherence while only one addressed prevention, one was on testing and two on access to services. Two studied co-morbidities while four focussed on HIV-related issues affecting mothers and infants. Maternal and child health was addressed in a total of nine mini-theses. Of the other five, one focussed on immunisation and two each on access to care and to feeding. Three other studies focussed on other aspects of food and nutrition – while one study addressed another social determinant of health, namely water and sanitation. Eight mini-theses focussed on adolescents, three of which were to do with sexual and reproductive health and five with HIV/AIDS. A wide range of topics was addressed in the seven studies on non-communicable diseases – particularly diabetes and cancer, but including issues relating to risk, palliative care, access to medicines and use of services – as well as absenteeism from, and care in, the workplace. Access to medicines and pharmaceutical supply issues were addressed in five mini-theses: three were to do with supply cost and management, one with community dispensing and one with assisted access. While systems issues were inherent in a range of these studies, the human factor was addressed in three ways. The experiences of staff and the human resource systems used for delivering health services were the focus of seven studies; users’ /patients’ behaviours and perceptions of the system and services were addressed in five studies; and two studies enquired into the needs and experiences of the family and caregivers.

2019 CHAZOVACHII, Julian

The health workers’ uptake of continuing professional education in selected provincial hospitals in Zimbabwe

DAVIDS, Lameez

Knowledge, attitudes and practices of contraception amongst adolescent girls from selected high schools in a low socio-economic community in Cape Town

DELE-IJAGBULU, Kemi Dorcas

The aetiologies, clinical presentation, diagnostic difficulties and outcomes of meningitis among HIV-positive adults admitted to Livingstone Hospital, Port Elizabeth

GEZA, Gcobisa

Evaluation of the effect of adolescent and youth friendly services implementation on HIV testing uptake among youth (aged 15 – 24 years) in health facilities of Amathole District

‘Working in the field of media and communications in a sexual and reproductive health agency, this qualification has made me more confident about the way I communicate issues in terms of advocating for women’s and girl’s health. I am also using my knowledge to provide technical support to influence media content to represent sexual and reproductive health and rights issues from a social determinants of health perspective so as to be able to influence public opinion and health policy at national and global levels. ‘I am looking at strengthening my career in public health communication to advance the health and wellbeing of people and populations.’ 2020 MPH graduate, Evelyn Kiapi, Uganda

HANYINDA, Kelvin

The availability and adequacy of Water, Sanitation and Hygiene (WASH) infrastructure in 13 mission hospitals in rural Zambia

IREGBU, Francis

Routine immunisation status and its socio-economic determinants among children attending the Federal Medical Centre, Owerri, Nigeria

JALLOW, Carmen (cum laude)

Assessment of changes in pharmaceutical performance among primary health care health facilities that received technical assistance in a rural district of the Eastern Cape, South Africa

KUWENGA, Rudo

An assessment of the characteristics of adolescents at enrolment into antiretroviral therapy, and factors influencing their retention rates in Zimbabwe

MALABA, Rickie

Exploration of adherence to treatment challenges experienced by HIV-positive adolescents on antiretroviral treatment in Insiza district, Zimbabwe

MASEKO, Mbali

Chronic non-communicable diseases, absenteeism and workplace wellness initiatives at a consumer goods company in South Africa

MENSAH, Daniel Kweku Adabo

Adolescents’ perceptions on the use of adolescent friendly sexual and reproductive health services in Omaruru District, Namibia

MLUNGWANA, Juliet Juju

Factors influencing the teaching of comprehensive sexuality education in high schools in KwaZulu-Natal

NDATEBA, Innocent

Factors associated with type 2 diabetes mellitus (T2DM) in people living with HIV/ AIDS attending primary health care centres in Rwamagana District, Rwanda

NDLOVU, Patson

The factors contributing to low uptake of vasectomy in Bulawayo, Zimbabwe

ODUMOSU, Olusegun Murtala Adherence to anti-retroviral treatment among gay men and other men who have sex with men living with HIV, attending a LGBT clinic in Tshwane, Gauteng OLADELE, Tajudeen

Determining the risk of non-communicable diseases amongst the mentally ill patients attending psychiatric out-patient clinic at the Federal Neuropsychiatric Hospital Kware Sokoto in Nigeria

OLUTUASE,Victory

Assessment of antibiotic dispensing practices of community pharmacists in Jos, Plateau State, Nigeria

RASSA, Adam

A cost analysis of medicine donation programmes to Tanzania’s neglected tropical diseases control programme

SOMWE, Jean-Jacque Kalonji

HIV-positive street children’s access to treatment for HIV/AIDS in the district of Katuba, in the south-west of the city of Lubumbashi, Democratic Republic of Congo

STEFANUS, Frieda Ndapvudja

Understanding the perceptions of women who experienced any delay in accessing appropriate health care services during childbirth in Otjiwarongo District Hospital, Namibia

TEMMERS, Lynette

Factors influencing the collaboration between community health workers and the public primary health care facilities in delivering primary health care services

WILLOUGHBY, Jo-Ann (cum laude)

Acceptability of collectors of medicine parcels for non-communicable disease patients from a primary health care facility in the Western Cape

‘The concepts I learnt during the MPH have helped me to see a bigger picture on health systems beyond just health supply chains. Prior to this, I focused my entire attention on ensuring no stockouts, overstock, wastage and expiry of health commodities’ without necessarily paying attention to health system issues that are precursors to the problems I encountered daily. It was a major shift in my career as I started to practically realise how different building blocks are interacting to ensuring health systems perform well. ‘Although I am from Tanzania, I am working in Sierra Leone as supply chain technical advisor with Crown Agents (UK), Saving Lives Programme. Working in a different country and context, the principles I learnt in the MPH are l relevant and very helpful in my daily work.’ 2019 MPH graduate, Adam Rassa, Tanzania (Sierra Leone)

2020 BWALYA, Clement Mudala

Retention in HIV care among female sex workers on antiretroviral treatment in Lusaka, Zambia: A retrospective cohort study

KETELO, Asiphe

Determining food and nutrition literacy of community health workers in the Western Cape, South Africa

KIAPI, Evelyn Matsamura

Media representations of female genital mutilation/cutting in two daily Ugandan newspapers: A critical discourse analysis

KOROKA, Priscilla

Factors affecting adherence to antiretroviral therapy among adolescents living with HIV/AIDS in Masvingo District, Zimbabwe

LANGEVELD, Liane Celeste

Exploring the perceptions of staff regarding the services offered at a substance abuse rehabilitation centre for women in Cape Town

MAMBA, Nompumelelo

The perceived needs and challenges of family caregivers in providing palliative care for relatives living with cancer in the Hhohho Region, Kingdom of Eswatini

MANDIMA, Patricia Fadzayi

Determining the level of non-booking for antenatal care and associated barriers and risk for mother-to-child transmission of HIV among pregnant women in Chitungwiza city, Zimbabwe

MATEMA, Shingirai Trymore

Assessment of medicine supply management at primary health care facilities in a rural district of KwaZulu-Natal, South Africa

MAUGHAN, Samantha Jane (cum laude)

Outcomes of paediatric ART patients down-referred from a tertiary and a regional hospital to primary care facilities in Buffalo City Municipality, Eastern Cape

MBEWE, Madalitso

Understanding young people’s experiences and perspectives on HIV prevention in four communities in Zambia

MBUNYUZA, Lungelwa

Treatment adherence in TB/HIV co-infected patients in Mount Frere, Eastern Cape

MOOS, Anbrenthia Yvette

A qualitative feasibility study to evaluate the use of a screening tool to detect neurocognitive deficits among perinatally HIV-infected children by primary health care workers

MUSVAIRE, Rufaro

Spatial analysis of the distribution of stunting and its associations with key child health and nutrition determinants at provincial level in Zimbabwe

NDLOVU, Sibusiso

Comparison of patient experiences in three differentiated antiretroviral delivery models in a public health care facility

NG’AMBI, Baleke

An exploration of mothers’ experiences, perceptions and attitudes towards existing behavioural change communication interventions on exclusive breastfeeding in Mpika District, Zambia

PARBHOO, Anita Naginlal (cum laude)

An exploration of clinicians’ experiences of the opportunities and challenges of being a hybrid manager at a hospital in the Western Cape

ROBERTS, Erin Melody (cum laude)

Exploring the experiences and perceptions of health care workers (HCWs) regarding infant feeding options provided to HIV-positive mothers of infants 0 – 12 months of age

SHANGE, Nkosinathi

Investigating the determinants of use of health care services by South African adults with non-communicable diseases: An analysis of the Prospective Urban Rural Epidemiological (PURE) study cohort

‘I learnt quite a lot about myself, how to interact with other people – and started being more perceptive about what is happening around the global village, particularly the social determinants of health. It was not an easy ride but very worth it. ‘Since the completion of my MPH I got promoted to assistant director in pharmaceutical services at a government hospital in the public sector and my studies have allowed me to be more inquisitive towards health care systems. I am now at a position where I can evaluate the impact of policy and legislation on service users and I have the opportunity to contribute to how we can meaningfully engage policy makers in making them aware about the disparities that exist in the health sector.’ 2020 MPH graduate, Shingirai Matema, Zimbabwe

SIMELANE, Lungile Cynthia

Pregnant women’s perceptions on the factors that contribute to late antenatal care booking in the Shiselweni Region in Swaziland

VAN DER WALT, Nicolette

Health managers’ experiences and perceptions of intersectoral collaboration at the primary health care level in two urban sub-districts of the Western Cape Province

WENTZEL, Annalie

Determinants of compliance behaviour among patients living with diabetes referred for diabetic retinopathy treatment at a government health care facility in Cape Town, South Africa

YAMOAH, Daniel Awusi

A study of the content, type, style and extent of food and beverage advertising in South Africa: Investigating four free-to-view television channels (SABC 1-3 and eTV)

ZEEMAN, Celestè Marion

Exploring the barriers and facilitators of access to care as experienced by caregivers of children who were admitted to a specialised tuberculosis hospital

PhD in Public Health 2019 ADEBIYI, Babatope Oluwadamilare

Foetal alcohol spectrum disorders: The development of guidelines to inform policy

ADOM, Theodosia

Individual and environmental factors associated with obesity among young children in primary schools in Ghana

AMDE, Woldekidan Kifle

Unpacking capacity development: A systemic exploration of a partnership of African universities to develop capacity on health workforce development

CLAYFORD, Mario Andre

Investigating predictors of health related quality of life and functional status in middleaged to older adults with hypertension living in a selected urban community in South Africa

NANDI, Sulakshana

Equity, access and utilisation in the state-funded universal insurance scheme (RSBY/ MSBY) in Chhattisgarh State, India: What are the implications for universal health coverage?

NEETHLING, Ian Garth

Enhancing burden of disease information for health sector decision making

2020 MOTHUPI, Mamothena Carol

Development of an approach for measurement and monitoring of the continuum of care for maternal health in the South African health system

MULONDO, Michael Albertus

Participatory action research approach to address the poor water, sanitation and hygiene conditions in an informal urban settlement in Windhoek, Namibia

NCUBE, Nondumiso Beauty Queeneth

A systematic approach to improve rational medicine use in Swaziland

‘I have already started using my newly acquired knowledge and skills in my work through supporting district health teams in community and health system strengthening and in the provision of equitable access to cost effective and quality health services as close to the family as possible. I have also been able to use my knowledge to support the design of quality health and nutrition programmes that addresses the unique needs of communities. I am now a better manager as I now look at the whole population rather than just the patient.‘ 2020 MPH graduate, Baleke Ng’ambi, Zambia

Graduated with a PhD in Public Health About 50 students are currently enrolled for doctoral studies; some are our own staff, some are attached to research projects which carry PhD scholarships, and some are self-funded. While the number of graduates from the PhD programme was initially small, this is increasing as the programme matures, such that in 2019 and 2020, nine students graduated with PhDs, one of whom is a member of SOPH staff. The topics of their studies are given on the next few pages. Working towards a doctorate requires the ability to overcome doubt, exhaustion, and loneliness – and the tenacity to persist despite competing demands for time and attention. It really helps when students investigate a topic that fascinates them and/or is part of their daily work. The reasons why three graduands chose their particular topics and what their research had focussed on are also given – as well as how their research, and having a PhD, will impact their careers.

BABATOPE ADEBIYI

Foetal alcohol spectrum disorders: The development of guidelines to inform policy Supervisor: Dr A-M Beytell Co-supervisor: Dr C Mukumbang Citation: While South Africa has the highest prevalence of FASD [foetal alcohol spectrum disorders] globally due to the excessive rate of alcohol consumption during pregnancy, there is no specific policy addressing FASD in the country. This study used a multi-method research with a modified Delphi technique to develop a guideline to inform policy on the prevention and management of FASD in South Africa. The guideline developed from this thesis has the potential to assist policy makers to formulate a multi-sectoral policy for the prevention and management of FASD in SA. Five of seven articles from the thesis have been published in high impact peer-reviewed international journals and two are under review.

THEODOSIA ADOM

Individual and environmental factors associated with obesity among young children in primary schools in Ghana Supervisor: Prof T Puoane Co-supervisor: Prof AP Kenge Citation: Overweight and obesity are risk factors for non-communicable diseases such as cardio-vascular diseases and some cancers. Understanding factors associated with overweight/ obesity among children presents an opportunity for timely and appropriate interventions. Utilising the socio-ecological framework, the study assessed the prevalence and determinants of childhood overweight/obesity and explored population level policies that encourage supportive environments for healthy living. The prevalence of overweight/obesity was 16.4%, indicating that overweight/obesity is a public health issue in primary school learners. There were gaps in the literature in terms of populationbased interventions. A number of modiﬁable risk factors were identiﬁed and recommendations made for relevant stakeholders.

THEODOSIA ADOM ‘My research focused on how children’s health behaviours interacted with the food and physical activity environments in the home, school, community and at policy level to contribute to overweight/ obesity.’ Why did you undertake this study? ‘In my experience as a researcher in human nutrition, I have witnessed firsthand the phenomenon of the double burden of malnutrition resulting from human and socio-economic development. Middle class families in urban Ghana are relying more and more on rapidly growing fast food chains, with high intakes of energy-dense foods and sugary drinks, as these are seen as a status symbol. This is coupled with sedentary lifestyles, obesity and increasing prevalence of non-communicable diseases. The pre-adolescent children in these families, who are at a critical stage of developing independent physical activity and dietary behaviours, are most vulnerable to the changes that are occurring in their environments.’ ‘I undertook this research to explore the magnitude and correlates of unhealthy weight of pre-adolescent school children who are, most often, under-represented in national surveys in Ghana. The findings could be helpful in guiding the design of timely public health interventions.’ What will you be doing now that you have a PhD? ‘I will continue my work as a researcher. A career in academia is a path I will like to pursue in the near future ... It will be great to mentor students and early career academics by imparting needed knowledge and skills.’

WOLDEKIDAN KIFLE AMDE

MAMOTHENA MOTHUPI ‘I specialised in qualitative and quantitative methods for the measurement and assessment of determinants of maternal health outcomes, particularly those related to health system interventions and social determinants of health. I relied on theory that accommodates complexity in emergence of health outcomes, and laid the ground work for a more comprehensive way to assess public health performance in maternal health. I say ‘public health performance’ because I also argued for expansion of the boundaries of the ‘health system’ when we consider the indicators/factors that make a difference. This also justifies the current focus on multi-sectoral collaboration and multi-sectoral accountability for maternal health outcomes. What will you be doing now that you have a PhD? ‘I am keen on a research-oriented career, where I design and conduct research and evaluation of public health/ population health interventions. I will be looking for different avenues to which I can contribute my evolving theoretical understandings and research findings – including communities of health systems and policy, implementation science, and health outcomes research practitioners. I also want to get more involved in the advocacy for just and equitable systems that ultimately impact people’s health and wellbeing. ‘There are a lot of practitioners and institutions who are working in the advocacy space across different disease areas and issues, from the grassroots to global health levels, trying to influence the political economy of health. I admire their work and I want to learn more from them and hopefully contribute a significant chunk of my time to supporting causes.’

Unpacking capacity development: A systemic exploration of a partnership of African universities to develop capacity on health workforce development Supervisor: Prof U Lehmann Co-supervisor: Prof D Sanders

Citation:

This study explored the partnership between the University of the Western Cape (UWC) and three African universities and health ministries (in Rwanda, Mozambique and Ethiopia) to develop capacity in health workforce development, geared to strengthening national leadership and training capacity in health workforce development. All three international examiners praised the thesis as an important, politically and culturally sensitive contribution to our understanding of the importance and complexity of collaboration between academic institutions, and between academic institutions and ministries of health – and to strengthening collaborative practice in future.

MARIO CLAYFORD

Investigating predictors of health-related quality of life and functional status in middle-aged to older adults with hypertension living in a selected urban community in South Africa Supervisor: Prof T Puoane Co-supervisor: Prof P Naidoo

Citation:

Hypertension is one of the leading risk factors for heart disease, strokes, and preventable causes of premature deaths in South Africa. Quality of life (QoL) is inherent to everyone, and a decrease in QoL increases susceptibility to other ailments. This study investigated which socio-demographic, psycho-social and disease characteristics are the best predictors of QoL and functionality in individuals with hypertension. The outcome of the study revealed higher QoL and functionality in people who were married, less stressed using proactive coping, more highly educated, and who were disability free. It highlighted the adverse impact of disability and presence of co-morbid diseases on QoL and functional status. The value of the study lies in the fact that assessing how an individual perceives his or her health is necessary to developing appropriate treatment strategies which should lead to positive health outcomes.

MAMOTHENA MOTHUPI

Development of an approach for measurement and monitoring of the continuum of care for maternal health in the South African health system Supervisor: Assoc Prof L Knight Co-supervisor: Dr H Tabana

Citation:

The continuum of care is a public health framework for providing comprehensive maternal health care at the community and health system level, and according to needs throughout the lifecycle.

This study developed and tested a novel model for measuring and monitoring the continuum for maternal health in South Africa, called the adequacy model. The model guided the assessment of service provision, selection and evaluation of indicators, and development of a performance tracking index that can be used at district and provincial levels. The research used a mixed method design to strengthen understanding of continuum and make recommendations for maternal health research and practice. The analytical framework developed in this study can also be adapted within other LMIC contexts to improve performance measurement and monitoring.

MICHAEL MULONDO

Participatory action research approach to address the poor water, sanitation and hygiene conditions in an informal urban settlement in Windhoek, Namibia Supervisor: Prof B van Wyk

Citation:

Water, sanitation and hygiene (WASH) are fundamental to health and are regarded as a fundamental human right for survival, dignity, productivity, reproductive health and happiness. In informal urban settlements appropriate WASH interventions are not in place, and the risks of mortality and morbidity are high. This study conducted a participatory action research study to address the poor WASH conditions in Havana informal urban settlement in Windhoek, Namibia. It was informed by a scoping review of WASH interventions globally. Starting with a situation analysis of WASH conditions in Havana, the study developed, implemented and evaluated a community WASH action plan, combining health education and social entrepreneurship to address the poor WASH conditions in the community by the community.

SULAKSHANA NANDI

Equity, access and utilisation in the state-funded universal insurance scheme (RSBY/MSBY) in Chhattisgarh State, India: What are the implications for universal health coverage? Supervisor: Prof H Schneider

Citation:

This study examined the equity and access impacts of a major insurance scheme introduced in India in 2009, which enabled public funds to be used extensively for private hospital care for the first time. Through a series of empirical studies in Chhattisgarh State, where the researcher has lived and worked as a health advocate for many years, the study demonstrated the failure of the publicly funded health insurance scheme to achieve its goals of improved affordability, access and equity of health care. This study raises important questions on the value of such financing models for advancing universal health coverage, particularly in the context of a highly commercialised private health sector – providing important lessons for other countries (such as South Africa) which are embarking on similar reforms.

NONDUMISO NCUBE ‘I specialised in pharmaceutical public health, where I researched the rational/appropriate use of medicines, including antibiotics, in public sector facilities in Eswatini (formerly Swaziland).’ How will it impact your career and your world? ‘Findings from my research were used in the revision of Eswatini’s current standard treatment guidelines and essential medicines list (STG/EML). Findings also raised awareness of the high and inappropriate use of antibiotics in the country. ‘The work I did for my PhD has equipped me with skills that I have used as a contributor to the STG/EML revision, the development of the National Supply Chain Strategy for health commodities in Eswatini – and the development of a roadmap for the introduction and phase-out of antiretroviral medicines in Eswatini. It also contributes to my current work, a project that is facilitating the establishment of an antimicrobial use/ consumption/resistance (AMU/C/R) surveillance system in Eswatini using a One Health Approach.’ What will you be doing now that you have a PhD? ‘I am using the skills acquired in my current position where I am working on an AMU/C/R surveillance project supported by the Fleming Fund and implemented by ICAP at Columbia University, Eswatini Country Office. The project aims to establish AMU/C/R surveillance in human health, animal health, and the environment using a One Health Approach. I am also supporting upcoming public health professionals, particularly those enrolled at UWC, in their quest to become public health professionals.’

NONDUMISO NCUBE

A systematic approach to improve rational medicine use in Swaziland Supervisor: Dr H Bradley Co-supervisors: Prof R Laing, Prof H Schneider

Citation:

Irrational use of medicines is a global problem that results in mismanagement of patients, wastage of resources and public health problems. This study assessed patterns of medicine use, identified the reasons for this and tested a short intervention (audit and education) in public health facilities in eSwatini. The research documented widespread irrational use of medicines, such as polypharmacy and high antibiotic use, including amongst patients with non-communicable diseases. Factors contributing to irrational use of medicines were found at multiple levels - system, provider and patient - and the limited intervention was not able to sustainably shift practices. Achieving rational medicines use will require a combination of interventions involving a range of system players and levels.

IAN NEETHLING

Enhancing Burden of Disease information for health sector decision making Supervisor: Prof H Schneider Co-supervisor: Dr D Bradshaw

Citation:

This study proposes a framework to guide decision makers on the use of burden of disease information for health planning. Showing limits to the established disability-adjusted life year methodology in the South African context, it developed and presented an alternative approach namely, amenable and preventable mortality. Using this approach, the research was able to show the extent of under-performance of the health system, and the still huge racial and geographical inequities in health status in South Africa. It offered recommendations for using amenable and preventable mortality to assess health system performance and public health intervention effectiveness, benchmarking and resource allocation – which have major relevance to future health reforms in South Africa.

Short Courses and Continuing Education The annual Winter School short course programme is the oldest and one of the most regular features in the School of Public Health’s calendar; we celebrated its 25th anniversary in 2017. Each year we have welcomed between 150 and 700 colleagues and students from South Africa and other countries to participate in a wide range of short courses, engage with peers and experts, and enjoy the emblematic peanut butter and jam sandwiches. We have postponed the event only once – in 2010 when we moved it from June/July to September to avoid clashing with the Soccer World Cup. But in 2020, COVID-19 and the associated lockdowns saw us cancelling Winter School for the first time. Not only did travel restrictions and the need for social distancing make a face-to-face event impossible, but most of the usual course participants are health workers and managers who were at the centre of having to manage responses to the pandemic.

2019 In 2019, 164 participants attended nine courses from 1 – 19 July: • Health Management • Epidemiology and Control of HIV/AIDS • Tuberculosis and Malaria in the era of Antiretrovirals • Globalisation and Health: Key Aspects for Policy Markers, Managers and Practitioners • Pharmaceutical Policy and Management • Understanding & Analysing Health Policy • Monitoring & Evaluation of Health & Development Programmes • Current Thinking and Practice in Health Promotion • Introduction to Complex Health Systems

2020 – and going forward The cancellation in 2020, the uncertainty of when we will be able to have big face-to-face events again, and the sudden ubiquity of on-line meetings and events, has caused us to reflect on how can we refresh our continuing professional development (CPD) role and offerings. Various opportunities have been created by a much wider use of on-line engagements – for example connecting people over big geographies; creating peer learning platforms; giving access to colleagues who, for one reason or other, cannot travel to Cape Town for a course. After several surveys of our students and Winter School alumni, and after extensive internal conversations, we are in the process of reconceptualising and expanding our CPD programme: restructuring existing short courses to be offered on-line, creating webinars, and planning special events for our large pool of alumni. There is a lot to learn and consider: expanding our own capacity to provide excellent on-line facilitation; creating an integrated and seamless web platform for on-line events, keeping in mind data and bandwidth constraints of our constituency; exploring and advocating for the willingness of our own institutions, employers and professional bodies to recognise on-line events for CPD purposes; establishing the logistics and costing of on-line programmes. We hope to begin to make an initial menu of short courses and webinars available from the middle of 2021, and to then rapidly expand our programme in 2022. Please see our plans as they develop on our social media and new website: soph.uwc.ac.za.

‘I managed to create networks through attending Winter and Summer Schools … getting to know colleagues from different countries, cultures and background and their different experiences in the context of public health. This also meant I was able to see a bigger picture and not feel alone in my study journey. ‘UWC School of Public Health is an international institution which provides cutting edge, world class public health capacitation to students – which I found beneficial as I got to learn on real life problems, and we managed to provide real life and sustainable solutions. ‘As I am currently working as a programme manager in an international organisation, the courses on social determinants of health, health management and globalisation and health have been vital to my executing my role and responsibilities.’ 2020 MPH graduate, Sibusiso Ndlovu, Zimbabwe

RESEARCH AND PROJECT WORK On the following pages we report on the research and project activities conducted in the SOPH in 2019 and 2020. We introduce several focus areas in some detail, before providing a complete list of all our projects. The School’s research is characterised by its collaborative nature. The list of partners in this report reflects the extensive network of links we have with local and international academic institutions, health sector partners, local community organisations and international development organisations. This work is supported by a wide range of funders, both large and small, which include, among others, the EU, NIH, IDRC, NRF, SAMRC and the Belgian government.

The HPSR work intersects with the School’s other research foci in a number of ways. We report on two exciting international projects – the first of which focuses on monitoring the health of women, children and adolescents (Countdown 2030). The other, a UKRI-funded multi-year hub for Accelerating Achievement for Africa’s Adolescents, aims to determine which combination of ‘accelerator’ services or interventions (from across the health, education, social and economic sectors) can most efficiently help adolescents achieve their potential across multiple life domains and SDG targets.

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Health Policy and Systems Research (HPSR) remains a cornerstone of our work, clustered around, and supported by, two SARChI Chairs in Health Systems and an Extra-Mural SAMRC , Advocacy, Policy arch wo e s e Other projects in the School also Research Unit (Health Services rk ,R -t g explore public health challenges to Systems). The resources in ha h c faced by adolescents, from the generated by the chairs and HOW WE WORK: impact of violence to access the extra-mural research In partnership and community-based to health services. unit provide us with Locally and internationally invaluable opportunities HIV/AIDS remains an to shape and advance ial determinants * Equit ES: Soc y important programmatic M research agendas of E TH area of work, with importance to the Global Non-communicable diseases * Food security projects exploring South and to invest Pharm public health * Mental public health the acceptability in nurturing the next HIV * Maternal and child health * and feasibility of a generation of academics Men’s health * Sexual & reproductive health family intervention to in HPSR through doctoral Gen licy d er improve ART adherence bursaries and postd po * Gov ernance * Health systems an (Sinako); and interventions doctoral fellowships. to improve adherence Inter-disciplinary, inter-sectorally and retention in care for Over the past two years Supporting open access & adolescents on anti-retroviral we worked closely with the open source therapy in the Western Cape. Western Cape Government as they explored inter-sectoral Food security, food choices and collaboration in the Whole of Society their interaction with non-communicable Approach to governing. Collaborative diseases, as well as pharmaceutical public health, governance has also been the focus of the have continued to feature strongly in our research Mphatlalatsane Project, a multi-partner and portfolio. We report on a collaboration with the comprehensive maternal and newborn care University of Rwanda, lending our expertise in strengthening initiative in three provinces. curriculum and materials development to support their development of a Regional Centre of Excellence The interface between formal health systems and for Vaccines, Immunization and Health Supply Chain community systems runs as a thread through much Management, a project funded by Health Research for of our HPSR, sometimes more, sometimes less Action (HERA), Belgium. explicitly. In this report we highlight the development of an Action Learning Fellowship programme for the Besides the articles highlighting specific projects, our Community Action Networks (CANs) during the summary of projects (from page 38) gives an overview COVID-19 pandemic, which allowed eight community of the full breadth and depth of the SOPH’s research organisers/activists from a number of different CANs endeavours. to work together throughout the course of 2020 to facilitate a range of cross-CAN activities.

Collaborations through SARChI The School of Public Health (SOPH) continues to receive significant national research funding from the Department of Science and Innovation/National Research Foundation (NRF) and the South African Medical Research Council (SAMRC). This funding has been principally in the form of funded research chairs (SARChI) and an Extra-Mural SAMRC Research Unit. The first SARChI Chair in Health Systems Complexity and Social Change was established in 2013 and is occupied by Prof Asha George. This was followed by the Extra-Mural SAMRC Research Unit (Health Services to Systems) in 2014 and a second SARChI Chair in Health Systems Governance held by Prof Helen Schneider. These sources of core funding have allowed us to develop lines of enquiry attuned to our perspectives as embedded researchers situated in the Global South; to invest heavily in capacity building (particularly through our doctoral programme); to advance our collaborative activities through established initiatives such as CHESAI (the Collaboration for Health Systems Analysis and Innovation); and to mobilise additional funding and partnerships.

Mutual strengthening The two SARChI chairs and the Extra-Mural Research Unit are fully integrated into the functioning of the SOPH in a mutually beneficial manner: the programmes leverage the considerable administrative and pedagogical infrastructure of the SOPH while the SARChI chairs help to support key strategic functions in the School. Asha leads the School’s research domain, providing cross-cutting support that enables the SOPH to maintain its high level of research productivity; and,

The South African Research Chair Initiative (SARChI) was established by the Department of Science and Technology (DST) and the National Research Foundation (NRF) as a strategic intervention to increase scientific research capacity through the development of human resources and the generation of new knowledge, empowering top talent to develop particular fields. since 2017, Helen has convened, with Wolde Amde, a structured and increasingly successful doctoral programme (described elsewhere in this report). Given their core roles in the SOPH, we were delighted when both SARChIs and the Extra-Mural Research Unit were successfully reviewed and awarded new five-year cycles of funding during the reporting period. In addition, Helen’s SARChI was upgraded from a Tier 2 to a Tier 1 status. Both Asha and Helen have received NRF B-ratings, and in 2020 Asha featured in the list of ten researchers at UWC within the top 100,000 researchers globally, in terms of 2019 research citations. The themes of research and engagement Asha and Helen are pursuing in the next cycle advance a number of key areas that were consolidated or initiated during the 2019/20 biennium.

Collaborative governance One strand of our work addresses the inter-related ideas of governance, bottom-up health system strengthening and universal health coverage. Building on a previous evaluation (‘3-feet’) – which brought together ideas of local health system strengthening (centred on the district and the sub-district) with programmatic and health outcomes – we are

evaluating the Mphatlalatsane Project, a multi-partner and comprehensive maternal and newborn care strengthening initiative in three provinces. In this evaluation, we are specifically seeking to develop insights into the mechanisms of ‘mesolevel stewardship of quality improvement’, the local processes of leadership and governance that sustain gains in quality and outcomes in health systems such as South Africa’s. Working jointly with the SAMRC’s Health Systems Research Unit, we have finalised the design and begun the field work. This evaluation is complemented by the work of doctoral candidate Fidele Mukinda, which explored local accountability for maternal, neonatal and child health in a rural district. He documented a local health service context saturated with mechanisms and discourses of performance accountability, challenging the common mantra of low accountability amongst frontline providers. Mary Kinney is also undertaking doctoral research on how maternal and perinatal audits are undertaken and sustained over time in the Western Cape’s rural hospitals. Ida Okeyo’s doctoral studies took forward the specific focus on collaborative governance, through her case study of the Western Cape’s area-based Whole of Society Approach (WoSA) to the ‘First Thousand Days’ of an infant’s life (see article on page 26). Our presentation of the findings to provincial and local government stakeholders in October 2020 has set the stage for a new phase of prospective research and engagement from 2021 on the governance of placebased, local intersectoral collaboration.

Research priorities These initiatives build knowledge on, and foreground, the vital importance of bottom-up health system strengthening as a necessary balance to the topdown and macro-level policy making – such as in the emerging national health insurance (NHI) reforms. In this regard we facilitated, together with the SAMRC, a process of research priority setting for universal health coverage that provided an holistic appraisal of multi-faceted and multi-disciplinary health policy and systems research needs in South Africa. A national poll, which was part of this process, rated research on leadership and governance as the top health system priority, followed by research on human resources for health. Following these discussions, Manya van Ryneveld completed and published a desk review of human resources for health governance in South Africa.

Beyond the SOPH – and South Africa Helen and Asha’s organisational roles have extended considerably beyond the SOPH, however – and their engagements beyond the borders of South Africa. In November 2019 Helen chaired the Scientific Committee of the national Dialogue on Universal Health Coverage in South Africa, hosted by the

The importance of community engagement and multi-sectoral action was also one of the multiple messages produced by the Lancet Commission on Child Health and the SDGs to which Asha George contributed. Along with embedded researchers in India and Pakistan, funders and UN agencies, Asha published a commentary on governance as being key for multi-sectoral action required to address the social determinants underpinning adolescent health. As with WoSA, this analysis forms the start of likely future agendas of work on the structural determinants of child and adolescent health.

SAMRC; and in 2020 she chaired the Task Team on Research for the development of UWC’s new Institutional Operating Plan (2021-5).

country settings. The collaboration has also supported co-authorship with WHO authors of analysis articles in the British Medical Journal.

Going beyond South Africa, Helen has been active in a regional collaboration focusing on Community Health Systems (CHS). The bilateral NRF-Swedish Research Council networking grant allowed us to host two multicountry workshops, bringing together researchers from the universities of Zambia, Makerere, Western Cape, Cape Town, Muhimbili and Umeå (Sweden). The workshops were held at the Chaminuka Lodge in Lusaka and culminated in the formulation of research priorities and a Chaminuka Declaration of Values and Principles for Research on CHS. A special issue of the International Journal of Health Policy and Management is currently being co-edited by this collective and will appear in early 2022. This network has also been awarded follow-up funding from 2021.

We have also been leading a stream of work on health systems drivers of coverage and equity for maternal and child health as part of Countdown 2030, a collaboration between academics and UN agencies. Analysis was undertaken on how the Global Financing Facility/ World Bank addresses adolescent health from a systems lens, based on planning documents for the first 11 recipient countries. This has spurred additional funding and interest in broadening content analysis of further cross-cutting topics on Global Financing Facility country planning documents. Asha is also on the Results Advisory Group for the Global Financing Facility.

In 2020, Asha led a Memorandum of Understanding between the SOPH and the United Nations University’s International Institute of Global Health to jointly work on a Gender and Health Hub. Together we have led an open and participatory research agenda-setting process on gender and COVID-19, enlisting over 400 participants from primarily low- and middle-income

Both Helen and Asha serve on Scientific and Technical Advisory Committees/Groups of the WHO. Helen is on the STAC for the Alliance for Health Policy and Systems/ WHO, while Asha serves on the STAG for the Human Reproduction Program/ WHO. From 2018 to 2020 Asha has also served as the Chair of the Health Systems Global society.

SARChI funding also supports three post-doctoral fellows in the SOPH who are contributing to various research projects, developing capacity in teaching and supervision by contributing to our academic programme, and writing publications based on their PhD research. Dr Michelle de Jong (January 2019 - March 2021) Michelle’s background is in psychology and she obtained her PhD through the Journalism and Media Studies Department at Rhodes University. Her thesis explored discursive constructions of health and identity among young South African adults, paying particular attention to the influences of neoliberalism and consumer culture. At SOPH she is working on developing publications based on her PhD research, assisting with the Globalisation and Health course, and supporting research linked to the SARCHI on Health Systems, Complexity and Social Change. Dr Solange Mianda (July 2019 - current) Solange Miada is working on the evaluation of the Mphatlalatsane project, a QI/ system strengthening initiative for improved maternal, neonatal and reproductive health care in three catchment areas of the country. She completed her PhD at the University of KwaZulu-Natal in 2019, through a thesis which proposed a composite model of intervention for ensuring clinical leadership in the labour ward of district hospitals, towards the reduction of maternal and perinatal mortality in the era of SDGs. Dr Henry Zakumumpa (November 2019 - December 2020) Henry Zakumumpa completed his PhD in Health Systems from Makerere University (Uganda) in 2018. His research focused on the sustainability of ART scale-up implementation in Uganda’s health system. During his time with the SOPH. Henry focussed on case studies and manuscript publications on the comparative experiences between high and low absorption of PEPFAR-supported workers in Ugandan health districts.

Countdown to 2030 The main aim of the Countdown to 2030 programme is to strengthen collaboration between academics and various UN agencies to improve the monitoring and measurement of women’s, children’s and adolescents’ health. The School of Public Health (SOPH) holds a series of sub-grants from UNICEF USA to support the health policy and systems-related work of the Countdown to 2030 programme, for the period 2017 to 2022. These include • Phase 1 activities – the Drivers Technical Working Group (Drivers TWG) and the British Medical Journal (BMJ) series; and • Phase 2 activities – the Maternal and Newborn Health Exemplar project and the Data and Analysis Centers for the Countdown country collaborations. Co-chaired by the SOPH’s Prof Asha George, the Drivers TWG initially focused on four main work streams: digital health tools; quality improvement; adolescent health; and gender mainstreaming.

Outputs related to this work have included • engagement on four journal supplements; • 20 journal articles; • six conference presentations; • representation on multiple UN technical working groups; • the establishment of one national community of practice in India; and • engagement in the WHO–UNICEF–Lancet Commission on ‘A future for the world’s children?’. The Drivers TWG has also supported the revision of the health systems indicators in the Countdown 2030 profiles. For Phase 2 activities, the School is leading the Data and Analysis Center for Health Policy and Systems. This aims to provide technical guidance and tools that support the reviews of national plans and programmes / investment cases that address Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH-N) within the remit of the World Bank’s Global Financing Facility.

SOPH researchers rated by the National Research Foundation (NRF) During this reporting period, SOPH had nine NRF-rated researchers. One staff member was rated for the first time and three others improved or maintained their ratings. •

B-rated researchers: Emeritus Prof David Sanders, Prof Helen Schneider and Prof Asha George.

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C-rated researchers: Emeritus Prof Thandi Puoane, Prof Diane Cooper and Assoc Prof Zandile Mchiza.

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Y-rated researchers: Dr Hanani Tabana, Assoc Prof Lucia Knight and Dr Marisa Casale.

Our incoming Prof Olagoke Akintola is also a C-rated researcher. SOPH is also pleased to have a number of NRF-rated researchers amongst its extraordinary staff: •

Prof Lucy Gilson is B-rated.

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Prof Tanya Doherty and Prof Debra Jackson are C-rated researchers.

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Assoc Prof Ehi Igumbhor is Y-rated.

Whole of Society Approach: Addressing early childhood development and the First Thousand Days Initiative Intersectoral collaboration for health – where the health sector works with other sectors to address social determinants of health – has been advocated since the 1978 Alma Ata Declaration of Primary Health Care and, more recently, by the Sustainable Development Goals. Addressing social determinants of health is particularly crucial between conception and when a child is two years old, during which time development occurs in all domains – sensory, motor and cognitive. Conceived of as the First Thousand Days (FTD) and referred to as ‘nurturing care’, this period therefore presents a window of opportunity for early childhood interventions that ensure a conducive environment for adequate child development. An intersectoral approach to FTD is crucial as evidence shows that integrated health, nutrition and stimulation interventions promote positive outcomes that impact the whole life course. Launched in 2016 by the Province in the Western Cape, the FTD Initiative has been a focus of research at the School of Public Health (SOPH). This has included examining policy processes from 2016 to 2019 to better understand the real-life possibilities for, and constraints to, intersectoral action for health. As part of the broader FTD study, doctoral candidate Ida Okeyo and professors Helen Schneider and Uta Lehmann have analysed how the FTD Initiative emerged and was formulated within the Saldanha Bay Municipality - an area that was experimenting with approaches to joined-up government referred to as the ‘Whole of Society Approach’ or WoSA.

The Whole of Society Approach The WoSA was approved by the provincial Cabinet in April 2017 and was framed as a co-created and collaborative endeavour between provincial government sectors and local municipalities. The goals were linked to broader policies and frameworks at all levels - from the global Sustainable Development Goals, the country’s National Development Plan, the Provincial Strategic Plan and the Integrated Development Plans of local government. The WoSA was to be piloted in two rural sub-districts (Saldanha Bay and Drakenstein) and two urban subdistricts (Khayelitsha and Hanover Park/Manenburg). General WoSA plans for each region included the assignment of heads of provincial departments to lead each area and an entry process into each community that would be guided by the local municipalities.

The Saldanha Bay WoSA process began at the end of the 2017 and was led by the head of the provincial Health Department along with local municipal players. One of the earliest activities was the establishment of strategic focus areas and accompanying local area teams. The FTD Initiative itself was launched in Saldanha Bay in early 2019.

Figure 1: Life course approach that shaped the WoSA network [DSD: Department of Social Development; DCAS: Department of Community and Safety; DOH: Department of Health; WCED:Western Cape Education Department]

Saldanha Bay Municipality During 2019 we conducted qualitative interviews with key informants involved in the Saldanha Bay WoSA team. We also observed five WoSA team meetings for different governance structures and analysed key WoSA documents. Although still in its infancy, early findings of the FTD Initiative have shown how the WoSA team adopted the life-course approach as a central framing idea, with FTD and early childhood development as key focus areas for co-ordinated action. The ‘Carol and Lindi’ story – of a mother and child living in an ideal state with the necessary tools, opportunities and appropriate services to cater for their needs over the life-course – provided a powerful common joint framework which was readily adopted by various stakeholders. They frequently repeated the story, symbolising a new collective mindset focused on communities and citizens rather than an inward looking, sectoral approach.

Figure 2:The Carol and Lindi story Following the launch of the FTD in Saldanha Bay, a referral pathway was co-created by the departments of Health (across levels of care), Social Development and Home Affairs for pregnancy and early child care, reflecting an early commitment to intersectoral processes in the Social Cluster of the WoSA Saldanha team. In May 2019, the Saldanha Bay Municipality hosted an early childhood development (ECD) conference, bringing together numerous actors and stakeholders interested in addressing challenges related to ECD. This was widely seen as an agenda-setting moment for intersectoral relationships, both within and between local and provincial government spheres. The WoSA pilot in Saldanha Bay demonstrated that creating the necessary institutional capability for intersectoral action can be enabled by an area-based approach. Crucially this has to be underpinned by strong founding principles, facilitative and distributed leadership, multi-level governance systems and

processes of implementation that focus on building cross-sector relationships. The WoSA in Saldanha Bay has so far proven to be a successful model of collaborative governance, but has required substantial investments of time by skilled and highly committed senior managers. The next cycle of the Provincial Strategic Plan (20192024) and the recent COVID-19 Recovery Plan show the provincial government’s adoption of the WoSA approach as a way of addressing a number of complex socio-economic problems – including safety, unemployment and poverty. See the case study report: Okeyo, I, Lehmann, U & Schneider H. (2020) Case study report. The First Thousand Days within the Western Cape Whole of Society Approach: Lessons for the collaborative governance of intersectoral action for health.

Cape Town Together and the Community Action Networks (CANs) In March 2020, as COVID-19 was rapidly taking hold in South Africa, a network of neighbourhood-level community support and mutual aid groups began to emerge across the city of Cape Town. This movement of Community Action Networks (CANs), known as Cape Town Together, was initiated by a small team of social justice activists, community workers, and public health specialists, who knew that a co-ordinated and robust community response would be fundamental to confronting the challenges of COVID-19, many of which would not be clinical or health-related at all, but rather socio-economic. The idea behind the initiative was that any group of ordinary residents, no matter their background, training or means, could come together and start a CAN in their own neighbourhood. Within a few weeks, hundreds of CANs had appeared across the city, spanning the usual divides that have come to characterise Cape Town – racial, spatial and class-based.

One of the primary tasks taken on by CANs across the city was to respond to the ‘second pandemic’ of hunger, where the already high levels of food insecurity in the city were severely exacerbated by stringent lockdown regulations. Community kitchens sprang up around the city and became central to the network’s activity. They also became important places where COVID-19 safety practices - such as masks, social distancing and sanitising - could be demonstrated and shared with people in a relatable and approachable way. With the support of the School of Public Health (SOPH) an Action Learning CAN Fellowship Programme was developed for eight community organisers/activists from a number of different CANs. This group was able to work together throughout the course of 2020 to facilitate a range of cross-CAN activities, including regular reflection and learning opportunities, five cross-CAN workshops, two city-wide bike rides, and story collecting sessions and interviews. Regular engagements with the Department of Health were also held as part of supporting a societal COVID-19 response. The Action Learning Programme also contributed to supporting the establishment and moderation of on-line platforms to enable city-wide organising, including the Facebook page and WhatsApp groups. It also enabled discussion and co-learning sessions between Cape Town Together, Eastern Cape Together and Gauteng Together on our ‘Imagined Futures’ and how to build alternatives in a post-COVID world. Lastly, a local model for COVID-19 care was developed, including an on-line training module for communitybased support for COVID-positive people.

The CANs are self-organised, voluntary and completely autonomous, with residents deciding how best to respond to the COVID-19-related challenges in their particular contexts. There is no hierarchy and decisions are made entirely independently. CANs, or CAN members, came together to form specific organising nodes to take on cross-CAN tasks, including the hosting of weekly ‘co-learning’ sessions that were open to the whole network and covered a wide range of topics from applying for the COVID-19 relief grant to dealing with increased levels of domestic violence due to lockdown. Many forms of spontaneous collaboration and co-ordination were experimented with.

The support extended by SOPH also made it possible to fund a number of projects documenting these efforts. Some of the valuable lessons and experiences from this time of intense community mobilisation were captured in a self-published book of community kitchen recipes, stories and accounts of the work of Cape Town Together and the CANs titled Dala Kitchen – More than a Cookbook. A short documentary film on Cape Town Together provided another opportunity to tell the story of the CANs and the work of thousands of ordinary people working to support their communities during the pandemic.

Sixth Health Systems Research Global Symposium Characteristic of most meetings held in 2020 given COVID-19 restrictions, the Health Systems Research Global Symposium scheduled to be held in Dubai in November 2020, took place on-line. Held in three phases over a few months, it was widely attended by people from across the world, with the virtual platform providing challenges as well as opportunities for engagement. This included opening up the space to many who may not have been able to access the conference in-person, thus increasing access to new and exciting knowledge and research in the field of health systems research. The theme ‘Re-imagining health systems for better health and social justice’ was addressed through three sub-themes: engaging political forces; engaging social, economic and environmental forces; and engaging technological and data driven innovations.

SOPH at the Symposium The School of Public Health (SOPH) was actively engaged in both planning, and presenting at the symposium – with Prof Asha George, as chair of Health Systems Global (HSG), playing an important co-ordinating and oversight role. As chair, Asha opened the conference, alongside Emerging Voices for Global Health, Dr Tedros Adhanom Ghebreyesus (WHO Director General) and Director General of the Dubai Health Authority, His Excellency Humaid Al Qutami. Oral presentations and panel discussions were prerecorded and streamed in the various phases and subthemes. SOPH researchers participated as follows: •

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Ida Okeyo presented on the policy adoption and implementation challenges of the South African intersectoral policy on the First Thousand Days of Childhood. Ida Okeyo and Tanya Jacobs presented on what can be learnt about power and politics in policy processes by using discourse analysis. Asha George facilitated a panel discussion on gender gaps in digital health, and presented on overcoming blind spots and biases to seize opportunities and responsibilities for transforming health systems. Sulakshana Nandi presented on addressing the failures of publicly-funded health insurance schemes in India – particularly the role of power, social institutions and the political economy of health care.

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Manya van Ryneveld presented a 25-year review of human resources for health in South Africa, alongside a panel discussing power and contestation in the governance of the health workforce.

SOPH doctoral and post-doctoral students and researchers were involved in a number of organised and skills-building sessions, often working collaboratively with other institutions. These focused on a range of health policy and systems research areas. One of the organised sessions was the memorable debate that focused on resolving the long-standing argument regarding which factors really influence health policy processes in low- and middle-income countries (LMICs). Hosted by the Alliance’s Health Policy Analysis Fellows, it included Ida Okeyo from the SOPH. Along with colleagues from India and the USA, the SOPH hosted a skills-building session, drawing on case studies from PhD students from the School, the University of Cape Town and the Tata Institute of Social Sciences. This offered an introduction to the innovative discourse and historical analysis approaches for analysing power and politics. The SOPH’s Dr Hazel Bradley moderated a skillsbuilding session that showcased four experts’ presentations of different methodologies used to measure medicines quality and use. This focused on applying newly acquired knowledge about study design, data analysis and interpretation for decisionmaking to promote medicines quality and efficient medicines use. Hazel also helped to co-ordinate a skills-building session on core challenges of medicines in universal health care, addressed from a health system and policy perceptive. This explored examples from four countries/regions – Mexico, Kenya, Moldova and the Asian region – each being at a different stage of scaling up health and medicine coverage.

SOPH researchers also presented posters covering a range of topics such as maternal health policy implementation experiences (Enyi Etiaba), continuum of care for maternal health (Mamothena Mothupi), social determinants of alcohol consumption during pregnancy (Michelle de Jong), addressing foetal alcohol spectrum disorder (Babatope Adebiyi), clinical leadership in health systems (Solange MIanda), and human resource management (Verona Mathews). Innovative presentations included live sessions in which researchers presented their topics to virtual audiences. The participation of SOPH staff and students in the Symposium was made possible through a number of HSG scholarships, as well as scholarships from the Countdown 2030 sub-grant held by the SOPH.

Community The sense of community that HSG provides to health systems researchers all over the world was felt strongly throughout the conference, despite having to

host an event of this size virtually. The exchange of knowledge, experience and insights was inspiring and substantial and the Symposium delivered an excellent platform that will continue to build and catalyse this global community. Two SOPH doctoral students participated in the 4th Symposium on Global Health Policy Research, held alongside the Health Systems Research Global Symposium: • Waasila Jassat presented on the implementation of policy on the decentralised drug-resistant TB programme in South Africa in a panel: ‘A policy lens on complex health and social welfare problems’; and • Tanya Jacobs presented a gender analysis of adolescent health policy in South Africa in a panel: ‘Who is heard and silenced in health policy making’.

Medicines in Health Systems Thematic Working Group (MiHS TWG) Health Systems Global (HSG) has a number of thematic working groups which facilitate ongoing research and conversations on a range of themes and issues. The Medicines in Health Systems Thematic Working Group (MiHS TWG) is one of these. From October 2019, SOPH’s Dr Hazel Bradley has been a co-ordinator in the MiHS TWG and, together with three other members of the leadership team, organised the following activities. Webinars: Three webinars were held during 2020, each followed by a blog that was uploaded on the website and disseminated to the members. The topics were: • Patent pool, falsifications and shortages: What COVID‐19 teaches us about medicines access during a pandemic. • Access to medicines in a global pandemic: Spotlight on South Africa, Bolivia and Nigeria. • Repeated household and facility phone interviews to measure medicines’ availability and price: Methodology and feasibility. Newsletters: Three newsletters were disseminated. As members were invited to contribute, they featured short discussions of topical themes from Bolivia and Nigeria. Website: A new website was developed: https://healthsystemsglobal.org/thematic‐groups/medicines/ Sessions at the 2020 Symposium: Two sessions were organised and presented: • Skills‐building session: Health systems research methods to study medicines quality and use. • Organised session: Quo vadis? Medicines in universal health coverage.

THE UKRI GCRF ACCELERATING ACHIEVEMENT FOR AFRICA’S ADOLESCENTS HUB

YEAR 2 HIGHLIGHTS

RESPONDING TO NEW CHALLENGES ACHIEVING IMPACT AT SCALE

Promoting African adolescents’ full potential through ‘accelerator interventions’ By 2050 Africa will be home to half a billion adolescents. Despite the incredible opportunity this young population presents, they also face multiple risks and challenges. Many will find themselves trapped in a cycle of poverty, unemployment, violence, low education and poor health. In order for our continent to achieve the SDGs and the African Union’s Agenda 2063, we need new approaches that support youth development and help young people realise their aspirations.

The UKRI GCRF Accelerating Achievement for Africa’s Adolescents Hub The UKRI GCRF Accelerating Achievement for Africa’s Adolescents Hub was launched in 2019 to contribute to the goal of transforming the potential of Africa’s adolescents into a thriving future for the continent. This five-year project is one of 12 being financially supported by UK Research and Innovation Council (UKRI) Global Research Hubs through the Global Challenges Research Fund (GCRF). The project’s aim is to determine which combination of ‘accelerator’ services or interventions – from across the health, education, social and economic sectors – can most efficiently help adolescents achieve their potential across multiple life domains and SDG targets. This would provide policy makers with valuable evidence to choose programmes that work and are cost-effective and scaleable. The project is led by an interdisciplinary team at Oxford University and the University of Cape Town, with research and government partners across Africa, as well as global partners – including UNDP, UNICEF and the WHO – NGOs and young people themselves. The University of the Western Cape (UWC), through the SOPH, is one of the Hub’s African research partners. Since January 2020, Prof Marisa Casale has been leading a work package within the Hub that focuses on scale-up, acceptability and cost-effectiveness of adolescent interventions in Africa. In June 2020, Dr Oluwaseyi (Seyi) Somefun joined the SOPH and Hub team as a post-doctoral researcher, and has been collaborating on the adolescent acceptability component of this work.

Progress and achievements to date In its first two years, the Hub has already exceeded its key 2024 objectives. In response to the urgent challenge of COVID-19, it is already reaching at least 38 million children and adolescents across the region (and a total of 164 million worldwide) with parenting support and cash transfers, these being the primary accelerators identified in research studies from seven African countries. The Hub has also built capacity among 30 African early-career researchers, and has produced over 40 publications, including in The Lancet and Nature journals. The work package led by Marisa, with its associated studies, has made significant headway towards its 2020/21 and longer-term goals, while adapting to the realities of COVID-19. Besides contributing to the broader Hub research and activities, she and Seyi have been directly involved in a number of specific activities and outputs. They contributed to a major UNICEF – Accelerate Hub COVID-19 report: ‘Beyond Masks: Societal impacts of COVID-19 and accelerated solutions for children and adolescents’. This was released on World Children’s Day in November 2020, at a UNICEF webinar attended by 600 participants. They have also published six commentary pieces on COVID-19 and youth in Africa, in outlets such as The Conversation Africa and Africa in Fact, to reach broader audiences beyond academia.

Marisa has collaborated on various analyses focused on mitigating the impact of COVID-19, preventing childhood violence, and addressing mental health and treatment adherence among adolescents living with HIV. She has also co-authored six related 2020 Hub journal publications.

Findings to date A key overarching finding is that better caregiveradolescent interaction and social support (including support groups) are important protective factors for adolescent mental health and HIV treatment adherence. Marisa is currently working with a team in

the Hub and the UNICEF Southern and Eastern Africa Office to develop evidence and programming briefs, based on these findings. • A Hub-wide broad strategy for acceptability research was developed in early 2020. It includes synthesising existing empirical evidence on adolescent acceptability in Africa, refining a theoretical framework for adolescent acceptability, and collaborating with Hub projects on acceptability research. A systematic review of acceptability studies with adolescents and youth in Africa over the past decade has been completed, and is currently being written up. • Since August 2020 Marisa and Seyi have been collaborating on user testing of a mobile phone violence-prevention parenting app in 12 countries, including South Africa, Nigeria and Kenya. This Hub project is part of the open-access and rigorously evaluated Parenting for Lifelong Health (PLH) Digital research. After usability and acceptability testing, the app will be piloted in South Africa in collaboration with UNICEF and the Department of Social Development. • Strong progress has been made in developing and testing an approach to conducting economic analyses with observational data, and exploring approaches for ‘accelerator’ cost-benefit analyses with multiple outcomes. We look forward to future application, documentation and refinement of these approaches. The outputs from this work published in 2019 and 2020 are included in the publications list on page 74.

Dr Oluwaseyi Somefun Dr Oluwaseyi (Seyi) Somefun joined SOPH as a post-doctoral fellow in July 2019, linked to the UKRI GCRF Accelerating Achievement for Africa’s Adolescents Hub. As such she is involved in research investigating the cost-effectiveness and acceptability of interventions designed to improve the wellbeing of adolescents in Africa. Seyi’s scholarly interests range widely from adolescent sexual and reproductive health, social networks to mixed research methodology. She is strongly interested in improving health behaviours of adolescents through health communication and policy dissemination. She has experience in both domestic and international settings. She plays an ongoing active role in several interdisciplinary research projects. The majority of these have been published in high ranking international and national accredited journals. Seyi’s doctoral thesis applied a mixed method approach and engaged diverse young adults across different regions in Nigeria. Her central aim was to explore how young people overcome risks in the face of adversity and focus on issues like resilience and vulnerability.

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Improving access to vaccines and medical products: Building capacity in supply chain management in East Africa Vaccination, along with clean drinking water and sanitation, are public health interventions that have made the greatest contribution to improving health outcomes globally. Ensuring access to vaccines for all populations is an ongoing challenge, however, with the current SARS-CoV-2 pandemic highlighting global inequities in financing, distribution and administration of COVID-19 vaccines. Although immunisation coverage across Africa has greatly increased over the past few decades, with corresponding reductions in disease mortality and morbidity, coverage rates in many countries are far from reaching their national targets. In addition, although national estimates of routine coverage are assessed annually, they conceal heterogeneities in coverage and preclude an assessment of local barriers to vaccination and areas of weakness within vaccine delivery systems. Over the past few years, vaccine access in these countries has been expanded through the efforts of global agencies – including the World Health Organization, United Nations Children’s Fund, the Bill and Melinda Gates Foundation and GAVI, The Vaccine Alliance – though gaps in supply chain systems remain a stumbling block. In March 2016 the East African Community (EAC) Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management (RCE-VIHSCM) was launched. Based at the School of Public Health at the University of Rwanda in Kigali, it is a partnership with the EAC partner states, the global community, UN agencies and collaborative universities from the region and beyond. The vision of the RCE is to become an autonomous, well-recognised, top-class, regional ‘knowledge hub’, providing high quality pre- and in-service training to pharmacists and others involved in supply chain management at various levels of the health system. Its main purpose it to disseminate best practices in vaccines, immunisation and health supply chain management.

of the RCE. From 2016 to 2019 we assisted with the development and co-ordination of short course training and the continuous development of training support for staff developing their Master programme. The team was led by Dr Hazel Bradley and included Prof Richard Laing, Jennifer Birkett and Ziyanda Mwanda. To this end, four members of the University of Rwanda team visited the SOPH in 2017 where they participated in the Medicines Supply Chain Management short course at Winter School. They were also introduced to UWC’s learning management system and several of the e-learning tools that the SOPH has developed and used in its distance learning programmes. The SOPH team’s subsequent visits to Rwanda consolidated this learning through workshops to build capacity and transfer skills to our colleagues regarding the development of on-line learning materials and individual mentoring. We also provided support to on-line teaching and support staff working on the Master in Health Supply Chain Management. The first cohort of Master students, comprising largely of pharmacists already working in supply chain management positions in EAC countries, graduated in 2019. The intention is that they will provide much needed expertise in the various facets of supply chain management in their countries – Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda; and that this, in turn, will lead to improved immunisation coverage and, ultimately, improved health outcomes for their populations. The RCE at the University of Rwanda is supported by the German Development Bank (KfW) who have agreed to additional funding of Euro14 mill for a further four years (2021 – 2024) to establish the RCE as a centre for digital teaching and learning for the EAC and beyond - in health supply chain management.

SOPH’s involvement Building on an existing relationship with the University of Rwanda and having experiences of developing a blended Master of Public Health (MPH) programme, the School of Public Health (SOPH) was contracted by Health Research for Action (hera), Belgium, to provide expertise to support the University’s establishment

Promoting food and nutrition literacy using multi-media education-entertainment More than 70% of South African women and 39% of men are either overweight or obese, according to the latest national survey conducted by Statistics South Africa. Most live in disadvantaged communities, especially in periurban townships characterised by economic constraints, where a lack of information about food and nutrition lives alongside an obesogenic food environment that makes it difficult to make healthier food decisions. The South African government has outlined strategies for the control and the prevention of obesity and its consequences, considered non-communicable diseases (NCD). The strategies focus largely on health promotion, encouraging the curbing of behavioural lifestyles such as smoking and binge drinking plus promoting interventions to reduce body size like making better food choices and engaging in physical activity. Health workers who operate in low- to middle-income communities are not immune to obesity and the associated NCDs, and tend to lack information about food and nutrition. It is particularly important that community health workers (CHWs) are well-informed, as they serve as liaisons between health services and the community and, as such, can engage in health promotion activities, providing community nutrition education, social support and healthy food advocacy.

Multi-media entertainment-education tools Substantiated international evidence suggests that various forms of media are important modalities for promoting health, especially messages to prevent and manage obesity. These range from formal media (like television and magazines) to social media (such as WhatsApp and FaceBook). Using media creatively can reinforce new and old health messages, support health changes, encourage maintenance of change, and keep health issues on the public agenda. Growing evidence also suggests that to reach very large audiences effectively, health messages need to be entertaining. This project therefore sought to develop entertaining healthy food and nutrition messages through using short stories in the form of comic booklets and videos. These would be disseminated through different media, especially SMS messages and WhatsApp both of which are accessible to the majority of CHWs who operate in disadvantaged communities.

Main aims of the project The overall aim of this two-year project, then, was to develop and validate a multi-media education-entertainment (MM-EE) programme designed for CHWs who operate in Gugulethu, Nyanga and Kensington in Cape Town. The intention was to improve their food and nutrition literacy and their body image, both in their own interests and so that they can demonstrate and promote these ideas to the communities in which they work. This was part of a larger project whose main aim was to improve food and nutrition literacy with a view to curbing obesity in disadvantaged communities of South Africa. CHWs who were working for the St John non-profit organisation and who were offering health promotion services in these communities were approached to participate in the study. They had to be 19 years or older. Of the 96 CHWs chosen, the majority was then assessed as obese and had risky eating behaviours. They welcomed information on meal planning, food choices (including reading food labels), as well as food preparation – and were keen on getting health messages in entertaining forms and directly from health specialists.

What the project did Baseline data on nutrition literacy collected from the CHWs informed the development of seven two-page comic booklets and seven animated video clips. The idea was that the CHWs would access these comics and videos through text messages and WhatsApp, first to inform themselves and then to inform the communities with whom they worked. The project ran for 24 months and its effectiveness is now being assessed. This entails analysing the final data collected from the CHWs to ascertain what changes in knowledge there may have been, which will be a measure of the effectiveness of this health promotion intervention.

Academic dissemination Some of this work formed the basis of an MPH student’s mini-thesis. Titled ‘Determining body image, food and nutrition literacy of community health workers operating in three Cape Metropole townships in the Western Cape, South Africa’, Asiphe Ketelo graduated in December 2020. A poster presentation on the outcomes of the baseline data was delivered at the Public Health Association of South Africa (PHASA) conference in 2019. The outcomes of the analysis of the post-intervention data will be published in an ISI-accredited journal during 2021. This project was undertaken in partnership with the University of Antwerp, and Katholieke Universiteit (KU) Leuven, with financial support from VLIR-UOS (Belgium, Flanders).

Yes, having a healthy diet is so good, but exercising is also important for your body.

Projects This is a listing of projects undertaken in 2019 and 2020 – many of which have resulted in substantial publications listed at the end of this report. They were implemented by the staff of the School of Public Health (SOPH), often in collaboration with partners whose organisations are named wherever this is the case. Only the names of the SOPH staff, students (both current and alumni), NRF interns, post-doctoral fellows and the School’s extraordinary professors are named here, however.

COVID-19 PROJECTS A number of projects were undertaken in 2020, following the advent of the COVID-19 pandemic. These were all parts of larger international studies and included topics such as food and cooking, mental health of students and of the general population, the experiences of community health workers and the use of cloth masks. •

ordering in prepared foods while others embarked on learning how to cook for the first time. Anecdotal evidence that many people have engaged in cooking less healthy meals has resulted in a major concern that overconsumption of these foods may affect the health of people globally. The project produced a report - Impact of the COVID-19 pandemic on Food Literacy: A multicountry observational study in 38 countries (De Backer et al., 2021) – and four webinar presentations: COVID 19 lockdown mental health consequences and changes with respect to shopping, food preparation and consumption among South Africans: Facebook survey. These were organised by the SASUF (South Africa Sweden University Forum) consortium, the University of Johannesburg’s Food Evolution Research Lab, UWC’s Health Sciences and the South African Association of Family Ecology and Consumer Science (SAAFECS).

Cloth face mask use during COVID-19 crisis: A multi-country on-line cross-sectional study among adult runners Anam Nyembezi, Zandile Mchiza, Sunday Onagbiye, Timothy Makubuya This multi-country study was conducted between July and September 2020 in the United States and South Africa. These countries were selected as COVID-19 community transmission was still occurring and there were still active cases at the time. Undertaken in collaboration with the University of Missouri-St. Louis (USA) and the UWC Department of Sport, Recreation and Exercise Science, the aim was to assess adult runners’ knowledge, attitudes, and practices regarding the use of cloth face masks/ coverings to prevent the spread of COVID-19. A total of 372 participants were conveniently invited using Facebook and WhatsApp, 294 being from South Africa and 78 from the USA. The majority (78%) belonged to a running club and 91% cited fitness as the reason for running/jogging. More than half (53%) were screened, 24% were tested and 15% tested positive for COVID-19. The study showed 94% of the participants had accurate knowledge and 86% positive attitudes regarding COVID-19. 61% reported always wearing a mask when running, with 60% often using buffs. The percentage of those who incorrectly used the mask was low; never covered mouth (12%) and nose (16%), lowered mask (13%), never washed mask (3%) and hands after removing mask (4%). The majority (67%) reported that sometimes they saw other runners not wearing a mask, not covering mouth (66%) and nose (64%). The perceived risk of contracting COVID-19 among the general population was higher (47%) compared with doing so from other runners (31%).

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Corona cooking Zandile Mchiza A partnership between UWC, the University of Antwerp and Katholieke Universiteit (KU) Leuven, this project explored the changes in shopping, cooking and food consumption that have occurred globally during the COVID-19 lockdown crisis. Forced to stay home, with restaurants in many countries closed, some people have resorted to

The project was undertaken with financial support from the Research Foundation Flanders, Flanders Innovation & Entrepreneurship. •

The impact of the COVID-19 pandemic on the mental health and wellbeing of the South African population Hanani Tabana In May 2020 an on-line survey was administered to adults 18 years and older living in South Africa. The study measured the prevalence and severity of psychological distress among the general population during COVID-19 containment measures, and aimed to establish longitudinal estimates of the impact on mental health and psychological distress of COVID-19 and the different containment measures applied during various phases of the pandemic. The study was undertaken in partnership with the UWC Division for Postgraduate Studies, the University of Cape Town and the University of Antwerp (Belgium).

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The experiences of community health workers affected by COVID-19 during the outbreak in South Africa: A qualitative study Lungiswa Tsolekile, Uta Lehmann In 2020 SOPH began a review of the role of community-based services during the COVID-19 pandemic in the Western Cape Province, as part of a wider review of public health responses led by the provincial health department. Linked to the SAMRC HSSU Research Unit, this work will be part of a larger study to be conducted in 2021 with community

health workers (CHWs) who are employed by nongovernmental organisations in Cape Town, as well as the nurse co-ordinators and managers who work with them. Based on the lived experiences of CHWs working as frontline healthcare workers during the COVID-19 outbreak in Cape Town, the larger study will explore the meaning and impact of COVID-19 and its care and outbreak control measures. The CHW study is part of a larger project – led by the University of Cape Town in collaboration with Stellenbosch University and the Western Cape Department of Health – that seeks to obtain data on the plurality of experiences, practices, and ideas. These will be captured through an in-depth inquiry with four key stakeholder groups, each comprising a broad spectrum of participants, namely public health responders, frontline healthcare workers, community action networks and people with COVID-19. •

An examination of the impact of the COVID-19 outbreak on wellbeing in higher education students Lucia Knight, Anton Delport A survey was conducted in mid-2020 with a view to understanding the wellbeing of higher education students in various countries. It focused on changes resulting from the COVID-19 outbreak and the measures that were implemented by governments and higher education institutions in response to the epidemic; the effects of different institutional and national policy contexts were also investigated. The study included an assessment of how students’ living conditions and workloads had changed and how these related to stress levels and impacts on mental health, and health behaviour during the COVID-19 outbreak; it also looked at the various mediating roles of other stressors, social support, and COVID-19 knowledge. This research was undertaken in collaboration with the University of Antwerp (Belgium) and was part of a global study. The final report will be available in late 2021.

Demographic profiling of postgraduate students in the SOPH Verona Mathews, Corinne Carolissen To date, no investigation has been conducted to determine the profile of students enrolling in the postgraduate programmes of the SOPH. The aim of this study was, therefore, to determine the demographic profile of the postgraduate public health students and their motivations for pursuing a distance learning postgraduate qualification in public health. It sought to contribute to the body of knowledge of lifelong learning and adult education.

Strengthening capacity for research, education, policy support, advocacy and networking of the partners in the field of human and animal health Helen Schneider, Woldekidan Amde, Asha George, Uta Lehmann, Hazel Bradley, Ziyanda Mwanda, Carnita Ernest, Teresa de Lima In 2017 the SOPH renewed its partnership with the Institute of Tropical Medicine (ITM), Antwerp in collaboration with the universities of Pretoria and Cape Town. The partnership secured a new five-year grant from the Belgian Development Co-operation to strengthen the partners’ capacity for research, education, policy support, advocacy and networking. SOPH’s key focus with ITM has been on strengthening South-based knowledge generation based on ‘embedded country’ health policy and systems research (HPSR) and education. The project involves a focus on three synergistic strategies, namely • doctoral and post-doctoral level training and curriculum development; • South-South networking; and • collaborative HPSR and supervision. In 2019 and 2020 the School consolidated our predoctoral, doctoral and post-doctoral programmes, providing for a range of flexible modalities of support to enhance student and supervisor capacity and experience through the various phases of the PhD. We also intensified peer support and networking opportunities through bi-monthly webinars, established an on-line writing camp and ran an induction programme for 13 new enrolees during the course of 2020. (See page 7 on the School’s PhD Programme.) We have also been able to deepen the collaboration (teaching, research, supervision) between ITM and UWC in a few critical areas: health system governance, pharmaceutical public health and short course development. We launched a jointly run ITM-UWC on-line module in Pharmaceutical Public Health and Management, which constitutes a third MPH module in the Pharmaceutical Public Health area of specialisation at SOPH. Academic literacies embedded within the Public Health curricula at the School of Public Health, University of the Western Cape Nikki Schaay, Hazel Bradley, Arona Dison, Jenny Birkett Initiated in 2018, this project is being undertaken in collaboration with the UWC Writing Centre (Directorate of Teaching and Learning) with the aim of identifying academic literacies required by public health professionals, both as public health postgraduate students and in relation to their professional practice. It has included analysing how academic literacies are embedded in, and aligned within, the curriculum of the SOPH’s Postgraduate Diploma (PGD) and Master of

Public Health (MPH) qualifications, as well as exploring the roles played by the various supports offered by the School in developing the academic literacies of these students. Rich data from participatory workshops and qualitative interviews with SOPH students and academics will inform the School’s future e-learning and teaching practices. Human Resources for Health Leadership and Management course Uta Lehmann, Woldekidan Amde SOPH is one of four academic institutions in an academic consortium contracted by the WHO Workforce Department to develop prototype curricula for training in Human Resources for Health (HRH) leadership which will contribute to the implementation of the Global Health Workforce Strategy. This comprises developing a Master programme, a one-month Diploma course and a two-week executive course, plus associated training materials, to be used internationally. The design will allow for the inclusion of individual modules into postgraduate training programmes and continuing education courses. Co-ordinated by Universidade Nova de Lisboa (Portugal), the consortium comprises the • Instituto de Higiene e Medicina Tropical(Portugal), WHO Collaborating Centre on Health Workforce Policy and Planning; • Semmelweis University (Hungary) - Health Services Management Training Centre, WHO Collaborating Centre on Human Resources for Health Development; • Universidade do Estado do Rio de Janeiro (Brazil) - Instituto de Medicina Social, WHO Collaborating Centre for Health Workforce Planning and Information; and • SOPH which is the WHO Collaborating Centre for Research and Training in Human Resources. Supporting community health workers through interprofessional learning Thandi Puoane, Lungiswa Tsolekile, Peter Delobelle This project aims to develops a strategy of interprofessional learning which will support and strengthen community health workers (CHWs) in preventing non-communicable diseases (NCDs) in South Africa. While most CHWs are volunteers with limited training, they are becoming an important part of interdisciplinary healthcare teams in the community. Universities have a prominent and important task in supporting CHWs by sharing knowledge and expertise and contributing to their training and empowerment. This project therefore focuses on developing an overall model to provide standardised training for CHWs, resulting in betterprepared health workers.

This is being undertaken through a mutual approach in which universities and CHWs may learn with, from and about each other – focussing on the design of an interprofessional model for co-operation between CHWs and students, researchers, lecturers and other stakeholders. The project is funded by VLIR-UOS (Belgium) and is being undertaken in collaboration with the VIVES University of Applied Sciences, Department of Health Care (Belgium), and four South African universities: UWC Interprofessional Education Unit; University of Venda School of Health Sciences, Department of Public Health; University of Free State, Faculty of Health Sciences, School of Nursing; and University of Cape Town, Chronic Diseases Initiative for Africa. Monitoring and evaluating the Human Resources for Health – challenges and requirements for an information system Verona Mathews, Calsey Carolissen There is a dearth of reliable and up-to-date information on monitoring and evaluating human resources for health (HRH) in low- and middle-income countries, especially in South Africa. This study is identifying the challenges in monitoring and evaluating HRH, and is assessing the types of evidence produced, with a view to providing a baseline for the development of a monitoring and evaluation framework for the country’s national health system. This project has been supported by UWC Senate Research Funding. Scholarly health informatics learning Verona Mathews, Corinne Carolissen The Millennium Development Goals, and now the Sustainable Development Goals – as well as the WHO’s efforts to promote measurement of country-level health indicators – has underscored the need for students of public health, information systems and information technology to be able to manage and interpret large data sets. The main goal of this project was to increase the quality and relevance of education in health information systems at the universities of Oslo and the Western Cape, and at Nelson Mandela University. This was done through developing joint educational material on global health information systems, supporting student mobility and fostering collaboration between academic institutions. The project was supported through a four-year grant from the Norwegian Centre for International Co-operation in Education (SIU), and was undertaken in collaboration with the Norwegian Institute of Public Health and the Health Information Systems Program, South Africa (HISP-SA).

A people-centred approach through self-management and reciprocal learning for the prevention and management of type 2 diabetes (SMART2D) Thandi Puoane, David Sanders, Peter Delobelle, Lungiswa Tsolekile, Mark Spires, Mariam Hassen, Kululwa Ndayi, Tshilidzi Manuga, Boniswa Mphiti, Khumbula Ndibaza, Kholiswa Mphiti, Sandile Luke, Sunday Onagbiye Launched in 2015, SMART2D explored new interventions for addressing the growing burden of type 2 diabetes in high-, middle- and low income countries. Based on reports from the formative research (led by SOPH), an intervention design was implemented. During 2017 and 2018, 584 study participants were enrolled, of whom half were recruited for the intervention arm and half for the control arm. Study participants in the intervention arm were assigned to community health workers for individual follow-up and attended structured peer-led support groups as part of the intervention. Participants in the control group received usual care. In 2019, process and end-line evaluations were conducted. To date, key outputs have included two site-specific (South African) articles based on formative research; and six consortium-based articles published in peerreviewed journals; several oral / poster presentations at local and international conferences; and one PhD graduation (Mark Spires – who now works at the City University of London). SMART2D is an EU H2020-funded multi-centre study. The South African research has been supported through close collaboration with The Caring Network in Khayelitsha and the Chronic Diseases Initiative for Africa (CDIA) at the University of Cape Town.

Sivile Senza: Adapting the Diabetes Prevention Programme for a developing world context Thandi Puoane, Lungiswa Tsolekile, Mariam Hassen, Asiphe Ketelo, Kenneth Mulalo, Cynthia Paka, Rivalani Derrick Chauke, Smart Mabweazara, Hanani Tabana The overall purpose of the Sivile Senza Lifestyle Africa project is to adapt the Diabetes Prevention Programme (DPP) – a lifestyle modification intervention used in many countries – for delivery in a developing world setting and to evaluate its feasibility and effectiveness in an urban community in South Africa.

The project’s official launch in 2018 followed an initial phase in 2017 during which materials were adapted for local use through collaborative work with the Children’s Mercy Hospital (USA), the University of Cape Town and the South African Christian Leadership Association Health Project (SACLA). A significant adaptation was to shift the mode of delivery to support groups, known as health clubs, run by community health workers. In what is effectively the third year of Sivile Senza – meaning ‘We have heard, now we can do’ – the project undertook a randomised trial with about 60 existing health clubs, taking baseline measurements and starting the intervention. In early 2019 data from the first group of clubs, along with baseline data for the control group of clubs, were collected to assess the effect of the intervention. The National Institutes of Health (NIH) funds the project through the Children’s Mercy Hospital.

SINAKO: Households in HIV care. Developing and testing an intervention to capitalise on the intermediate role of the household in community support for chronic HIV care Lucia Knight, Kenneth Mulalo, Anton Delport, Neo Sematlane, Tanyaradzwa Dube, Anathi Qina with fieldstaff: Nceba Phike, Esihle Nyalambisa, Boniswa Jwili, Eleanore Francis, Sandile Luke, Kholiswa Mphiti Michelle Odendaal Current research on support for people living with HIV has focused on community-level (community health workers - CHWs) and the individual (the patient), leaving out the family/household level to which the individual is closely connected, especially in the South African context. Working closely with colleagues at the University of Antwerp, this four-year project, begun in 2018, is investigating the potential mediating role of the household in chronic HIV care in South Africa. The study is framed within the Individual-HouseholdCommunity model for comprehensive HIV research in high prevalence, resource-limited settings. It includes developing and testing – in a cluster randomised controlled trial (RCT) – a household intervention to stimulate HIV competence levels and create HIV competent households. The intention is that this optimises the impact of CHWs’ support on individual antiretroviral treatment (ART) outcomes. In addition, a qualitative study to assess the acceptability of the intervention is being undertaken. As the RCT was halted in 2020 due to COVID-19, telephonic follow-up was conducted to collect both quantitative and qualitative data to explore the impacts of COVID-19, lockdown and the situation in 2020 on the HIV-positive respondents enrolled in the original study.

Data are being analysed and will be published in late 2021, when we also hope to start the RCT component of the project again. The project is being undertaken in collaboration with TB/HIV Care and the University of Antwerp (with joint supervision of participating PhD students). It is supported by a number of donors including the Flemish Interuniversity Council (VLIR-UOS), Research Foundation-Flanders (Belgium) and the South African National Research Foundation. Improving adherence, retention in care and treatment outcomes for adolescents in the Western Cape Metropole Brian van Wyk, Ebrahim Kriel, Zaida Orth, Ferdinand Mukumbang, Shelley Vickerman, Shabaana Osman With respect to adherence and retention in care, adolescents (10-19 years) on antiretroviral therapy (ART) are doing comparably worse than adults and children. Within this study, it is hypothesised that, in addition to the well-known challenges with long-term adherence related to chronic conditions, the particular reasons for poor treatment outcomes for adolescents may be related to a lack of psycho-social support and transition guidance from paediatric to adult HIV programmes. The primary aim of the study is to develop guidelines to support adolescents living with HIV (ALHIV) to achieve and sustain improved treatment outcomes (viral load suppression). Our quantitative analysis found low rates of viral load suppression and diminishing retention in care during the first two years after being initiated on ART. Qualitative findings from three research sites indicate that adherence and retention in care remain challenges for ALHIV as well as health care providers. Current interventions to promote adherence – youth clubs and family clinic – hold promise, but at present fall short of meeting the psychosocial needs of ALHIV. Begun in 2018, this three-year project is undertaken in partnership with the Western Cape Provincial Government Department of Health and the University of Missouri-Columbia. It is supported through grants from UWC Senate Research Funding, a self-initiated research grant from the South African Medical Research Council and Cape Higher Education Consortium/Western Cape Government Innovation fund, as well as the University of Missouri-South Africa Education Program and a University of Missouri Catalyst research grant. The effects of violence and crime on youth access to HIV and sexual and reproductive health care delivery in violence- and crime-vulnerable suburbs in Cape Town Di Cooper, Nomazizi Cishe, Nomfundo Cishe, Ntobeko Ngwagi, Michelle Odendaal Completed in 2020, this project sought to understand the mechanisms employed by youth and public sector primary healthcare providers to cope with the impact of endemic violence on youth access to HIV services in violence-andcrime vulnerable suburbs in Cape Town. It also explored

which initiatives may be helpful in addressing these challenges, relevant for both South Africa as well as other contexts with endemic urban violence. The in-depth interviews with healthcare providers revealed that the effects of crime and violence impacted on providers at the level of their workplace and within the surrounding communities; and identified levels of resilience. Findings from interviews with youth attending health services revealed fear of encountering crime and violence on their way to visit health services as hindering their access. Despite this, most youth reported devising strategies to access health service when they needed to. The project resulted in a number of publications – like an article in the Journal for Advanced Nursing – and engagements with stakeholders to share findings. The project was funded by the South African Medical Research Council and a small seed grant from the University of Essex. Collaborative partnerships addressing the effects of urban violence on youth access to health services in South Africa and Brazil Di Cooper, Asha George The aim of the project was to improve understandings of the effects that urban violence may have on hindering or delaying youth access to sexual and reproductive healthcare and trauma services. Possible context-specific health system interventions to address barriers were identified through stakeholder engagement. This project built on previous exploratory research conducted in two suburbs of Cape Town with high levels of violence that had focused on the impact of violence on youth access to HIV care (see above). Continuing this work with the University of Essex, this project expands its focus geographically by collaborating with colleagues at Universidade Estadual de Campinas (UNICAMP) São Paulo at the Universidade Federal do Rio Grande do Sul (UFRGS) in Brazil. It has broadened the healthcare focus to explore the impact of violence on youth access to sexual and reproductive healthcare and trauma services. It is supported through an NIHR (UK) Global HPSR Development Award. Improving adolescent sexual and reproductive health (SRH): The influence of early adolescent gender socialisation on later SRH. A South AfricanFlemish study Di Cooper, Lucia Knight, Suraya Mohamed, Hanani Tabana, Ntobeko Ngwagi, Michelle Odendaal, Mamothena Mothupi This cross-sectional research study sought to understand how gender norms – including those related to sexual and gender diversity – evolve and develop during the first years of adolescence (12-14 years); and to assess the influence of gender norms on adolescents’ sexual and reproductive health (SRH) and access to health services. By early March 2020, a survey had been completed by 569 of an intended sample of 900 learners (aged 12-14 years) in 12 sampled public sector schools in the greater Cape Town – after which data collection had to be stopped due to the COVID-19 pandemic. Initial findings indicate that

they will contribute to improved understanding of the links between adolescent gender norms and SRH. Our ability to directly disseminate information on the findings has been severely constrained by the closure of schools. Nonetheless in early 2020 we disseminated briefing documents of the study’s interim results to stakeholders – including policy makers and managers in the departments of Education and Health; to teachers and learners in schools and to parents /caregivers. Findings are being published in the Journal of Adolescent Health in 2021 and further articles are being prepared for submission to peer-reviewed journals. This has been a collaborative study with the International Centre for Reproductive Health at Ghent University, Belgium. In addition, the project links to the 15-country Global Early Adolescent Study led by Johns Hopkins University, and has research arms in Cape Town and urban areas of Flanders, Belgium. The team has also participated actively in the Academic Network for Sexual and Reproductive Health and Rights Policy (ANSER). The SOPH component of this study was supported by a grant from the South African National Research Foundation awarded as part of a Flemish (FWO)/South African Research Collaboration Programme. Understanding the intersections between mental health wellbeing, HIV and adolescent pregnancy: A knowledge production and systems study Hanani Tabana, Martina Lembani, Suraya Mohamed, Di Cooper The overall aim of this research was to explore the understandings and experiences of pregnant and postpartum adolescents aged 15-19 in selected facilities in Mpumalanga and the Western Cape with regards to mental health wellbeing and HIV. It also sought to understand the perspectives of those in the adolescents’ social environments. Ultimately it aimed to develop relevant intervention(s) to address any identified needs and supportive mechanisms related to the intersections between adolescent pregnancy/postpartum, mental health wellbeing and HIV. A mixed methods approach was used and the study was exploratory in nature. Comprising two phases, the first phase used qualitative interviews and narratives of life histories to explore the understandings and experiences of various groups of individuals – namely pregnant and post-partum adolescents and their peers, partners and parents/caregivers, as well as frontline health providers and teachers – with regards to adolescent pregnancy, HIV and mental health. The second phase is quantitative, comprising a crosssectional survey that will lead to the development of a quantitative instrument for assessing the intersections between adolescent pregnancy, HIV and mental health. The questionnaire will be developed based on phase 1 outcomes. The project is funded by the National Research Foundation.

Understanding the mental health disorders among males who have been traditionally circumcised in the Eastern Cape province Anam Nyembezi Initiation and traditional male circumcision have become a matter of significant public health concern in recent years, following an increase in the morbidity and mortality rates resulting from botched circumcisions. As little is known about the mental health problems of traditionally initiated and circumcised men who are hospitalised, the aim of this study is to understand these problems among those admitted to a public hospital in the Eastern Cape province. The study comprised a two-phased mixed method design. Phase 1 was a formative qualitative study intended to gain deeper knowledge of health worker insights into the mental health of traditionally initiated and circumcised men – to better understand the surveillance systems and strategies for monitoring mental health disorders like depression, anxiety, post-traumatic stress. In mid2019 in-depth interviews were conducted with five participants (two doctors, a nurse, a counsellor and an administrator) during which three broad reasons for hospital admissions by these young men were identified: debridement, assault and dehydration. Reported mental health symptoms were anxiety, post-traumatic stress, psychosis and depression. Challenges faced during the admission were the lack of mental health services, staff, assessment tools and privacy. Phase 2 will seek to ascertain the utilisation of mental health care services by traditionally initiated and circumcised men, to identify contextual factors that enable or prevent their use and implementation of the systems and strategies that are needed. The project is a partnership with Walter Sisulu University and the Nelson Mandela Academic Hospital and is supported by funds from the South African Medical Research Council. African Men for Culture & Education (AM4CE): An explorative cultural comparison of male success with traditional initiation Anam Nyembezi An additional scoping project to explore comparative experiences of traditional initiation and male circumcision in South Africa and in the African diaspora in the United States is being supported through the University of Missouri-South Africa Education Program (UMSAEP). This qualitative study will be conducted in four countries: South Africa, Uganda, Kenya and United States. Using in-depth interviews, participants will be asked to share their knowledge, attitudes, beliefs and mental health issues related to traditional initiation and circumcision. In 2020 this project was stalled due to COVID-19; the intention is to resume in the second half of 2021.

Barriers to exclusive breastfeeding in women

Street food vending model

Di Cooper, Hanani Tabana, Erin Roberts

Zandile Mchiza

This research project has described and explored a range of factors – individual, interpersonal, community, social and health care and health systems – that have shaped South African women’s lived experience and their capacity to exclusively breastfeed. The aim was to identify potential solutions and improved implementation of infant feeding policies and programmes. Qualitative interviews were conducted with women at two Cape Town public sector primary healthcare sites to identify barriers to effective exclusive breastfeeding. Healthcare providers at three public sector primary healthcare sites in Khayelitsha, Cape Town were also interviewed, to explore their attitudes towards different infant feeding options, especially for HIV positive mothers. This was against the background of their understanding of the changes in revised 2013 Infant and Young Child Feeding policy guidelines. The project was undertaken in collaboration with the University of Massachusetts (USA). It was funded through an award from the DST/NRF Centre of Excellence in Food Security at UWC.

The main aim of this ongoing multi-year project was to implement the newly developed, sustainable street food vending business model (SFVBM) for selling healthy and safe foods in the streets of Cape Town and surrounding areas – while enabling street food vendors to make a decent living and consumers to make healthy food choices. The secondary aim was to investigate the metabolic profile, blood pressure, body size and behaviours of taxi drivers who operate at selected locations around Cape Town and who consume street foods daily. Other aims were to explore various issues like the types and nutritional value of street foods, the regulatory environment governing street food vending, and the knowledge and intentions of consumers to purchase healthy street food. Initial findings have been integrated within a socioecological framework to develop the four components of the SFVBM: a business component, food and nutrition component, hygiene component, and a mobile street food vending cart. This model has been piloted, evaluated, adapted and is now ready for implementation in all South African provinces to test its effectiveness. This project was undertaken in partnership with the South African Medical Research Council, the Cape Peninsula University of Technology and the University of Cape Town, and has been supported financially by the National Research Foundation.

Food insecurity and ART adherence among older people living with HIV in the Western Cape Lucia Knight South Africa has one of the highest HIV prevalence rates in the world and, given the widespread rollout of antiretroviral treatment (ART), is seeing increasing numbers of older persons (aged 50 and over) living with HIV (OPLWH). Older Africans are an understudied and underserviced population with regards to HIV, health and social support. A formative qualitative study conducted with OPLWH and with health care providers in and near Khayelitsha, Cape Town, found that older people tested late for HIV; that women in particular were shocked to hear they were HIV-positive (they had not seen themselves as ‘at risk’); and that testing and treatment for HIV and noncommunicable diseases were siloed, causing OPLWHs to experience barriers to integrated holistic care. A secondary study looked at food insecurity and ART adherence among OPLWH in the Western Cape. The initial findings highlighted the need to explore the messaging older people are receiving about food and the interaction/need for food; and whether messaging is adequately tailored to their ability to access sufficient food. It also demonstrated the vital roles played by the state-funded old age pension and, in some cases, the disability grant, both in ensuring food security as well as supporting their families more broadly. Completed in 2019, this study was was conducted in collaboration with University of Missouri-Columbia and funded by the DST/NRF Centre of Excellence in Food Security.

Body size, mental health, and inequality: A life course approach Zandile Mchiza This research project, conducted between 2018 and early 2021, investigated the social and developmental origins and consequences of overweight and obesity, negative body image, disordered eating, and impaired psychological wellbeing. It did so across the life course, and across generations, of parents and children in South Africa and Sweden. In focussing on improving understandings of the role psychological wellbeing plays in the development of overweight and obesity, special attention was paid to identifying modifiable risk factors and social determinants of health, such as socio-demographic characteristics, family and social environment and social mobility – identified as possible factors in mediating and/ or moderating the relationship between body mass index and psychological wellbeing across life courses. Substudies included: • investigating the socio-demographic and early life determinants of overweight and obesity among men and women across a range of different policy and social contexts; • quantifying the social and health consequences of overweight and obesity among men and women from different socio-economic groups;

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investigating the role of body image and poor psychological health for body size trajectories across different stages of the life course; • exploring the long-term health and reproductive outcomes of disordered eating; and • testing whether effects on body size and mental health of social or health disadvantage and social mobility are transmitted differentially through maternal and paternal lines. The project used existing complementary information from surveys, cohort studies and register data linkages in South Africa, Sweden and Australia, and applied methods from life course and social epidemiology. Preliminary findings were presented at the 2018 National Nutrition Congress. The project was undertaken in partnership with the South African Human Sciences Research Council and two Swedish educational institutes: Stockholm University and the Karolinska Institutet. It was jointly financed by the South African Medical Research Council and the Swedish Research Council for Health, Working Life and Welfare (FORTE). Researching the obesogenic food environment, its drivers and potential policy levers in South Africa and Ghana David Sanders, Rina Swart, Florian Kroll, Mariam Hassen Funded by the Canadian International Development Research Centre (IDRC), this four-year study sought to better understand the changing nature of food acquired and consumed in poor communities in South Africa and Ghana; it also enquired into the drivers of these changes, and the potential policy levers available to improve the healthfulness of the local food environment. Data collection entailed research on individual and household consumption, mapping and surveying the local food geography in two South African and two Ghanaian research sites, tracing key foods up value chains, and exploring policy options and the political economy of food governance. The study also explored, and made recommendations on, the policy and regulatory environments in South Africa and Ghana. A special supplement of Public Health Nutrition is being prepared to share the various findings. At least three other articles have been published – two by Ghanain colleagues and another on Achieving the right to food for South Africa: Justice, security, sovereignty and the politics of malnutrition published in World Nutrition.

In collaboration with UWC’s NRF/DST Centre of Excellence (COE) in Food Security, the project also nurtured short stories by participants from Khayelitsha. These have been featured in several places including at the Southern Africa Food Lab workshop in Pretoria in 2019. The project was undertaken in partnership with UWC’s NRF/DST COE in Food Security and the Institute for Poverty, Land and Agrarian Studies (PLAAS) as well as with Kwame Nkrumah University of Science and Technology in Ghana and in collaboration with the University of Sydney, Australia and the Southern Africa Food Lab at the University of Stellenbosch. Using a multi-media entertainment-education programme as a tool to prevent obesity in black South African women Zandile Mchiza, Asiphe Ketelo, Hlolisiso Nonkeneza Completed in 2019 this project developed a multimedia education-entertainment (MM-EE) programme to improve the food and nutrition literacy, as well as body image, of South African women who lived in the poorly-resourced communities of Gugulethu, Nyanga and Kensington in Cape Town. Focusing on the development and validation of the approach/methodology, the project worked with 96 conveniently sampled female community health workers (CHWs) who operated community health clubs in these townships. The MM-EE programme instruments included 30 video clips, and accompanying written materials in the form of two-page comics, which were co-scripted with the CHWs, as well as researchers, health professionals and local media producers. The intervention used media platforms including text messages and WhatsApp to share the educational materials. The post-intervention data are being analysed. This project was undertaken in partnership with the University of Antwerp and the Katholieke Universiteit (KU) Leuven, with financial support from VLIR-UOS (Belgium).

Prospective Urban and Rural Epidemiology (PURE) study: A prospective cohort study to track changing lifestyles, risk factors and chronic disease Rina Swart, Lungiswa Tsolekile, Thandi Puoane, Derrick Chauke, David Sanders SOPH continues to be a research partner in this international project which aims to track the changing lifestyles, risk factors and chronic disease among 225,000 people over 15 years (from 2009-2024) across 27 high- to low-income countries from every major region of the world. In so doing, the Prospective Urban and Rural Epidemiological (PURE) study intends to identify the factors that drive the development of risk for chronic noncommunicable diseases (NCDs), with a view to reducing their prevalence in the entire population. Households are visited every year to determine any life changes that may have occurred over the past year; medical measurements collected at baseline are repeated every three to five years. As the PURE populations are ageing, the future focus will be on healthy ageing, fragility and dementia. A nested study – on the costs of chronic diseases – is described below. The Cape Town and Eastern Cape research sites are managed by SOPH, collaborating with researchers from the South African Medical Research Council, Human Sciences Research Council and the University of Cape Town. This research is funded by Hamilton Health Sciences, Canada. •

PURE: Cost of chronic diseases: Measuring the impact of CVD costs on equity and impoverishment This project aims to adapt, develop and implement a standardised methodology to capture health care costs for households of patient with cardiovascular disease (CVD) – and to assess the impact these costs have on health care utilisation and risk of impoverishment. It builds specifically on the initial findings from PURE which showed the large gap in treatment for common CVDs in low- and middleincome countries (LMICs). The study seeks to answer two questions: • how costs associated with health care for CVD affect the care-seeking decisions of households in LMICs; and • among those who do seek care, whether health care costs increase short- and long-term risk of impoverishment.

Using a mixed-methods approach, the study concentrated on five conditions that comprise a large share of the total burden of disability related to CVD, namely hypertension, hypercholesterolaemia, angina, heart failure and secondary prevention following myocardial infarction (heart attack). Detection, treatment and long-term management of these conditions is essential to avoiding more costly and often life-threatening, acute CVD events, including heart attack and stroke. Initiated in 2017, the project is being undertaken in collaboration with the London School of Hygiene and Tropical Medicine with funding support from Wellcome Trust. Support to the implementation of the East African Community Regional Centre of Excellence for Vaccines, Immunisation and Health Supply Management Hazel Bradley, Jenny Birkett, Ziyanda Mwanda Between 2016 and 2019 the SOPH provided expertise to assist the University of Rwanda establish the EAC (East African Community) Regional Centre of Excellence for Vaccines, Immunisation and Health Supply Chain Management (RCE-VIHSCM). The vision of the Centre is to become an autonomous, well-recognised, top-class, regional ‘knowledge hub’, providing high-quality preand in-service training, disseminating best practices regarding vaccines, immunisation and health supply chain management. Key areas of support provided by SOPH were • the development and co-ordination of short-course training; and • continuous development of training support for the Master programme, focussing especially on learning management systems and open source e-learning platforms. Four members of the University of Rwanda team attended an SOPH Winter School short course on Medicines Supply Chain Management (MSCM), also learning about UWC’s learning management system and being introduced to several e-learning tools at the School. The SOPH team’s visits to Rwanda focussed on building capacity and transferring skills regarding the development of on-line learning materials, and mentoring on-line teaching and support staff. The first cohort for the Master degree in MSCM graduated in 2019 and included participants from all six EAC member states (Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda). The Regional Centre is funded by the German Development Bank (KfW) through Health Research for Action (hera). KfW has agreed to support a second cycle during which the RCE will be established as a centre for digital teaching and learning for the EAC and beyond in health supply chain management.

Availability of essential medicines and human resources for contraception and medical abortion in different health districts of Cape Town

An assessment of a toy-based intervention aimed at promoting cognitive development for children aged 2-5 years old in Cape Town, South Africa

Lucia Knight, Jessica Dutton

Emma Chademana, Brian van Wyk

This project is an initial phase in producing new insights about the real-world restrictions to contraception and medical abortion in an urban, liberal legal setting (South Africa). The first aim is to investigate the availability and affordability of essential medicines and trained healthcare providers for contraception and medical abortion in public health facilities in various geographical locations of Cape Town. The second aim is to understand the barriers women experience in accessing contraception and medical abortions. The study is a collaboration with Ghent University.

The Bright Start programme aims to support caregivers of young children (2-5 years) to begin to develop cognitive skills from early childhood. Implemented in Crossroads, Cape Town, in 2019, it is based on the cognitive development module/intervention developed by colleagues at University College London. 115 caregivers were divided into six groups for 2-3 year olds and six groups for 4-5 year olds. Sessions were held at two-week intervals to allow carers to repeatedly implement each toy activity with their children. At each session, carers were taught a toy-based activity and were each given a toy to take home and play with their children. Quantitative data were collected at the start of each subsequent session to assess how caregivers and their children experienced play with the last toy introduced. In addition, post-intervention qualitative assessments were conducted comprising 20 individual interviews, three focus group discussions with carers and a focus group discussion with facilitators. The pilot study found that the toy activities increased the children’s knowledge of colours, shapes, animals and counting. Caregivers also reported that playing with their children helped them to better understand them and bond with them. The sessions also offered some respite for many caregivers who indicated that when they were at the sessions they could forget about problems at home. Caregivers also established social networks. The study was undertaken in collaboration with Oneto-One Africa Children’s Fund and the University College London.

Respectful maternal care and the barriers to quality of care among providers across the continuum of maternal care in South Africa Lucia Knight, Jessica Dutton, Stephanie Gormley In the MDG era, South Africa partially improved maternal health by increasing antenatal care coverage and the proportion of births attended by skilled health personnel. The goal to reduce the maternal mortality ratio (MMR) to 37.5 per 100,000 live births (or less) was not met, however. The current MMR is approximately 147 per 100,000 live births, which is still far from the current SDG target which is to reduce MMR to 70 per 100,000 live births or less. Research shows that 60% of maternal deaths in South Africa are preventable through improved care. If preventable maternal deaths were realised, the country could reach the SDG target. The aim of this research was to better understand the context of respectful maternal care and the barriers to quality of care throughout the continuum of maternal health care in South Africa. It aimed to synthesise existing evidence about respectful maternal care; to explore the drivers of disrespect and abuse from the perspective of providers in urban Western Cape (especially nurses and midwives); and to understand the health system and structural factors that contribute to norms of midwifery practice and barriers to quality of care in urban Western Cape. The ultimate purpose of the research was to develop a conceptual framework for the analysis of barriers to quality of care and drivers of disrespect and abuse, in order to inform the implementation of new maternal health guidelines. Data collection for the project is completed and analysis is underway. The project was funded by the South African Medical Research Council.

An evaluation of process and contextual factors in the implementation of the National Department of Health-led Mphatlalatsane quality improvement initiative in three provinces of South Africa Helen Schneider, Solange Mianda The Mphatlalatsane Initiative is a multi-partner collaboration spearheaded by the National Department of Health (NDoH) which aims to improve maternal and newborn health in three provinces - Limpopo, Mpumalanga and the Eastern Cape. The SoPH is working with the South African Medical Research Council (SAMRC) in an evaluation of Mphtlalatsane. The SOPH team is specifically identifying the key elements of an enabling sub-district, district, regional and national environment for improved quality and outcomes of maternal and newborn healthcare. In particular this entails exploring what macro- (regional/national), meso- (sub-district/district), and micro- (facility) level processes and contextual factors explain variations in the uptake and outcomes of the Mphatlalatsane quality improvement interventions, and the implications for scale-up and spread.

In 2020 a scoping review of approaches to service delivery strengthening interventions for maternal and newborn health was undertaken - the protocol for which has been published. Health policy and systems research: Strengthening community-based health systems Helen Schneider, Nelisiwe Maleka Completed in 2020, this three-year project sought to enhance research capacity and competence for designing and conducting health policy and systems research with a focus on community-based health systems (CHS). It also sought to understand how, for whom and under what circumstances, innovations in community-based delivery achieve gains in access to healthcare and strengthens health systems. Undertaken with Umeå University (Sweden) the Umeå-UWC collaboration (known as the ‘U2U collaboration’) enabled the School to leverage a wider (South-South-North) network and set of collaborative arrangements on CHS. This network includes the universities of Cape Town and of Zambia, Muhimbili University (Tanzania), Makerere University (Uganda), and the Centre for Health Equity and Governance in Health Systems (Guatemala). The project culminated in a two-workshop series in Lusaka, Zambia, the first of which (in June 2019) was attended by 33 participants from seven institutions in the U2U wider network as well as frontline workers, managers and senior policy makers from the Zambian Ministry of Health. The workshop explored the multiple lenses on CHS, and developed research priorities which were captured in Chaminuka workshop report. In a follow-up writing workshop held in March 2020, a smaller group of participants planned a special issue of the International Journal on Health Policy and Management on CHS – to be co-edited by UWC, Umeå and University of Zambia. This project was funded by the Swedish Foundation for International Co-operation in Research and Higher Education (STINT) and the South African National Research Foundation. In late 2020, the Swedish Research Council awarded the network (now referred to as CHS Connect) a further three years funding (2020-2022) to consolidate and advance its activities. Countdown to 2030 Asha George, Tanya Jacobs, Mary Kinney, Ulla Walmisley, Amnesty LeFevre (consultant) The main aims of the ‘Countdown to 2030’ programme are to improve the monitoring and measurement of women’s, children’s and adolescents’ health. SOPH holds sub-grants from UNICEF USA to support the health policy and systems-related work of the Countdown to

2030 programme, including Phase 1 activities (the Drivers Technical Working Group [Drivers TWG]) and Phase 2 activities (the Maternal and Newborn Health Exemplar project and the Data & Analysis Centers (DAC) for the Countdown country collaborations). For Phase 1 activities, the Drivers TWG, co-chaired by SOPH’s Asha George, has focused on four main work streams: digital health tools; quality improvement; adolescent health; and gender mainstreaming. Outputs related to this work have included engagement on four supplements, 20 publications, four conference presentations, representation on multiple technical working groups, establishment of one national community of practice, and engagement in the WHO– UNICEF–Lancet Commission ‘A future for the world’s children?’. The Drivers TWG has also supported the revision of Countdown 2030 indicators. For Phase 2 activities, SOPH has led the Data & Analysis Center for Health Policy and Systems, which aims to provide technical guidance and tools that support the reviews of the RMNCAH-N national plans and programmes / investment cases. Future research will focus on understanding the content of health system and policy levers in the Global Financing Facility’s country investment cases. Gender and Health Hub Asha George, Mamothena Mothupi, Ulla Walmisely In 2019 UWC entered into a memorandum of understanding (MoU) with United Nations University International Institute for Global Health (UNU-IIGH) to work together on advancing research and policy on gender and health from a global South perspective. SOPH’s Asha George is a member of the Core Working Group for the Gender and Health Hub funded by the Bill and Melinda Gates Foundation. Under this MoU, SOPH will support gender and health activities in sub-Saharan Africa and undertake gender analysis in health systems (primary health care, human resources for health). As a part of this collaboration, Asha George led the analysis on violence against women health workers as a part of the BMJ Series on Women’s Health and Gender Inequalities co-edited by WHO and UNU-IIGH. UWC has been co-convening an open and consultative process to set research priorities on Gender and COVID19. Since September 2020, over 400 participants, mostly from low- and middle-income country settings have been engaged, a research protocol finalised and five thematic reports drafted.

Children in All Policies 2030 Asha George, Ida Okeyo, Ulla Walmisely, Tanya Doherty While children should be at the centre of the concept of sustainability that underlies the Sustainable Development Goals (SDGs), agreed upon by all countries as the framework to guide development efforts, no country is adequately protecting children’s health, their environment and their future. A global collaboration between the WHO, UNICEF, The Lancet, and University College London (UCL) has brought together researchers, policy makers, advocates, political leaders and, most importantly, children to drive policy change. They have been using the evidence, assembling coalitions, and producing powerful advocacy for children’s current and future health and wellbeing, building on the recommendations of the WHO-UNICEFLancet Commission report published in February 2020. The UCL Secretariat of the ‘Children + SDGs 2030 Initiative’ supports and co-ordinates this global collaboration. Crosssectoral activities have emphasised the building of lasting partnerships for children at global, regional, and country level – beginning in three to five countries. The SOPH, in partnership with the Health Systems Unit at the South African Medical Research Council and Mark Tomlinson from the Department of Global Health at Stellenbosch University, will play a central role in promoting this agenda, notably leading work on community and multi-sectoral approaches to addressing alcohol as a determinant of children’s and adolescent’s health and wellbeing in South Africa. Strengthening health system responsiveness to citizen feedback about health services in South Africa and Kenya Nikki Schaay, Helen Schneider While responsiveness to citizen rights, needs, expectations and values is understood to be an essential quality of health systems, there is a limited understanding of the architecture, implementation and effectiveness of feedback and response mechanisms in health system settings in low- and middle-income countries. This embedded health policy and systems research study undertaken in South Africa and Kenya seeks to answer two questions: • What policies and mechanisms (formal and informal) work for receiving and responding to citizen feedback on health systems? • How can health systems responsiveness be strengthened towards the development of learning, equitable health systems?

Begun in 2018, this three-year project has involved policy mapping and in-depth, multiple case studies of feedback mechanisms in each country, with an explicit strategy for cross-country analysis and embedding the research in policy processes to inform future improvements. The project is a partnership between the SOPH, Kenya Medical Research Institute (KEMRI) and the universities of Oxford and Cape Town (which also plays the co-ordinator role); an advisory role is undertaken by the Public Health Foundation of India. It is supported by the UK Medical Research Council’s Joint Health Systems Research Initiative. Punching above their weight: Building capacity for research on why some countries have better life expectancies than predicted by national income David Sanders, Fran Baum, Nikki Schaay The Punching Above their Weight (PAW) Network brings together academics, public servants, policy makers and civil society activists from 14 countries in order to design and undertake research to better understand why some countries are able to ‘punch above their weight’ in terms of producing good health outcomes relative to other countries with similar levels of economic development. To this end the Network has developed a series of research questions related to the complex interplay of political factors, governance regimes, civil society action, and specific policies that are thought to potentially contribute to the ability of a country to ‘punch above its weight’. Using the framework developed by the Network, case studies of three countries were conducted: Ethiopia, Brazil, and the United States. In February 2019, 16 participants from 8 countries met in Cape Town. Established in 2017 in Bellagio, Italy, The PAW Network was chaired by Prof David Sanders of SOPH, Prof Fran Baum of Flinders University, Australia and Prof Jennie Popay of Lancaster University, UK. Activities have been supported through a Global Challenges Research Fund Networking Grant, part of the UK’s Official Development Assistance (ODA).

Collaborative Projects with UWC’s Department of Dietetics and Nutrition SOPH collaborates with the UWC Department of Dietetics and Nutrition and the DSI/NRF Centre of Excellence in Food Security on a range projects led by Prof Rina Swart. They have been grouped as follows • Food and nutrition security • Food consumption patterns • The food environment, focusing on obesity prevention strategies Those participating in the research are drawn from a range of organisations, and are listed here. The SOPH also provides administrative support for these projects.

FOOD AND NUTRITION SECURITY Student food security UWC Dietetics & Nutrition: Rina Swart, Ernie Kunneke UWC Social Work: Rinie Schenck UWC students: Nolukholo Mabharwana, Morongoa Tlhako In our 2017 exploration of food and nutrition security among UWC students, food insecurity was reported by 28% of respondents, with 22% regularly going to bed hungry and 11% reporting severe food insecurity (regularly going without food for more than 24 hours). Two students continue to explore this topic under the supervision of Rina Swart. A review was done of all programmes on campus that support students who are food insecure – from individual departmental initiatives during examination periods to the programme that provides food parcels to students in need run by the institution. Another on-line survey of food insecurity of students at the four public universities in the Western Cape will be conducted in 2021. Young adults not employed and not in education and training (NEET) UWC Dietetics & Nutrition: Rina Swart, Ernie Kunneke UWC Social Work: Rinie Schenck UWC, Institute for Social Development: students North West University In 2018 a study was begun to explore the food and nutrition security of young adults (aged 18-25 years) who were not employed and were not engaged in education and training (NEETs) and who lived in Langa or Fisantekraal (Western Cape province) or Ikageng (North West province).

A standardised survey instrument and anthropometric measurements were used with 300 participants in Langa and Ijkaneneg – while in Fisantekraal, the dietary intake, anthropometric status and food acquisition patterns of young adults 18-24 years was taken. In all three sites the qualitative component, intended to explore the young adults’ perceptions of food environments in more depth, were prevented by COVID-19 restrictions. The project is being undertaken in collaboration with North West University, and includes support for postgraduate students from the Institute for Social Development at UWC.

FOOD CONSUMPTION PATTERNS Maternal health and nutritional status of mothers UWC Dietetics & Nutrition: Rina Swart UWC SOPH: Nazeeia Sayed (post-doctoral fellow) Stellenbosch University: Ronelle Burger Wits: Abigail Harper This project has supported a post-doctoral fellow to complete descriptive and inferential analyses regarding the maternal health and nutritional status of mothers, using the General Household Surveys, the Income and Expenditure Surveys, the National Income Dynamic Survey and the South African National Health and Nutrition Examination Survey (SAN HANES); and, in particular, the 2016 Demographic and Health Survey data. During the COVID-19 lockdowns in 2020, data collected through momconnect were analysed to explore associations between breastfeeding and hunger as well as mental health and hunger during the hard lockdown period in 2020. The project is funded through the DSI/NRF Centre of Excellence in Food Security.

Dr Nazeeia Sayed Dr Nazeeia Sayed is a registered dietician – and post-doctoral fellow at the SOPH. Her PhD assessed complementary feeding practices using nutrition modelling software and found iron, zinc and calcium as nutrients of concern in 6-11 month-old breastfed infants in KwaMashu, KwaZulu-Natal. Findings of focus group discussions supported the inclusion of grandmothers in efforts to improve infant feeding. Since October 2020 Nazeeia has been working with Prof. Rina Swart and supporting the National Dietary Intake Survey. Her current research focus is on food environments and drivers of food choice.

Nazeeia’s experience includes working in the areas of food composition, teaching community nutrition, project technical nutrition support, project management, partnerships, and communication development. From 2017-2019 she was an executive and management member of the Association for Dietetics in South Africa.

National dietary intake study UWC Dietetics & Nutrition: Rina Swart, Ernie Kunneke UWC SOPH: Zandile Mchiza, Nazeeia Sayed (post-doc) UWC COE Food Security: Julian May No national data on dietary intake of adults are currently available and the National Food Consumption Survey which documents the dietary intake of children 1-9 years is 20 years old. While the Third National Risk survey documented adolescent risk behaviour including food consumption, adequacy of nutrient intake was not included. Commissioned by the National Department of Health, this research seeks to document the food consumption patterns and nutrient intake of South Africans in order to provide nationally and provincially representative data on the diets of South Africans and factors affecting their food choices. A desk top review has been conducted on foods procured, nutritional status and dietary intake of people living in South Africa. It includes a summary of available literature (1997-2019) as well as foods produced and food retail in South Africa (2005-2019). A survey will be implemented in 2021. UWC leads a consortium of 11 South African higher education institutions who will assist with management of data collection, quality assurance and final reporting on the findings. They are Departments of Dietetics or Nutrition at the universities of Stellenbosch, Free State, Pretoria, Zululand, Limpopo, Venda, South Africa, the Western Cape and the Sefako Makgato University, Nelson Mandela University and North West University. Gendered aspects of food consumption UWC Dietetics & Nutrition: Rina Swart UWC SOPH: Michelle de Jong KNUST: Reggie Anan, Charles Apprey The nutrition needs and consumption patterns of men and women are not only different, but they also have different views, different roles as well as strategies towards food and nutrition security. This study focuses on exploring the gender roles and views towards food and nutrition security - the gendered roles and views of what people eat, what influences their choices of what they eat, how they access what they eat, how often they have access to what they eat, as well as their perceptions and coping strategies with regards to these aspects. The study will supplement metadata analyses with key informant and focus group interviews in six communities in South Africa – Mt Frere, Khayelitsha, Langa, Fisantekraal, Ikageng and the Witzenberg municipality – and Ahodwa and Erutiye in Ghana. While the data analyses have been completed, focus group discussions have been delayed given COVID-19. This study is also linked to the national dietary intake survey (see above). The project is funded through the DSI/NRF Centre of Excellence in Food Security.

Food consumption, gut microbiome and chronic disease in disadvantaged urban and rural communities UWC Dietetics & Nutrition: Rina Swart UWC SOPH: Sikhumbule Joni UWC student: Denise Stokell Stellenbosch University, African Microbiome Institute: Stephen OKeefe, Matsepa Ramaboli & Lucky Nesengani This study is exploring the relation between composition of the diet, gut microbiome and lifetime risk profile for cardio-vascular disease among a sub-sample of participants in the PURE study (see pg 46 above). The dietary intake component of the project is funded through the DSI/NRF Centre of Excellence in Food Security whilst AMI funders are responsible for support of the gut-microbiome component of the study.

THE FOOD ENVIRONMENT, FOCUSING ON OBESITY PREVENTION STRATEGIES This work is supported by the Gillings School of Public Health at the University of North Carolina (UNC) and the Bloomberg Foundation. Evaluation of the implementation of the health promotion levy UWC Dietetics & Nutrition: Rina Swart UWC SOPH: David Sanders, Tamryn Jenkings UNC: Shu Wen Ng, Barry Popkin, Mike Essman The purpose of this project was to provide evidence to guide policy actions aimed at promoting healthy diets. The research begun in 2018 with baseline data on food and beverage consumption collected from 2,500 households and individuals in Langa, Cape Town, prior to the implementation of the legislated tax (‘sugar tax’) on sugary beverages (SSBs). A repeat survey was undertaken six months later, while a one-year follow-up was undertaken in early 2019. Data analyses will begin to assess any changes in consumption of taxed beverages over time, as well as the contribution of these beverages to total nutrient intake (especially energy). Knowledge, attitudes and perceptions of SSBs and links to obesity and non-communicable diseases will also be collected during each round of the survey. In addition, prices of all beverages (taxed and nontaxed), as well as any reformulation of the size of units of beverages, is being collected from six supermarket groups and from all spaza shops in Langa on a threemonthly basis to monitor price changes.

Large reductions in taxed SSB intake was found, separating the effects of behavioural change from reformulation. This reduction was partially compensated by an increase in sugar and energy from

untaxed beverages. Because policies such as taxes can incentivise reformulation, our use of an up-to-date Food

Composition Table that reflects a rapidly changing food supply is novel and important for evaluating policy effects on intake. Most behavioural drivers were not strongly linked to taxed beverage intake. However, participants expressing an intention to reduce SSB intake had a greater reduction in volume consumption than those who did not intend to do so. Fieldworkers who contributed to data collection were: Dietary intake and anthropometry collection: Chuma Maqina, Kelly Leman Scott, Sarona Munyai, Sikhumbule Joni, Lamla Sajini, Sisa Honesi Martins, Olwethu Mateta, Siyabulela Mditshwa, Andiswa Magwaza, Abongwe Benge, Ayakha Sigwabe, Masingita Nyalungu, Namhla Baskiti, Andisiwe Siramza, Siphesihle Thotsho, Nomhle Poni, Ntombizodwa Nako Household questionnaires: Mawande Nelani, Pamela Magubane, Emmanuel Obasa, Zukiswa Mfinyongo, Ziyanda Lufele, Zikhona Lobola, Asisipho Majongile, Nqabakazi Majeke, Yanga Gadu, Busiswa Mqhayi, Priscilla Nkhensani, Thandokazi Magqaza, Onele Maqambayi, Nonelwa Ngcingane, Tembakazi Msutwana, Sisipho Mabaso, Chumani Matiwane, Akhona Rasmeni, Sisipho Mngqnge Nutrition facts panel data UWC Dietetics & Nutrition: Rina Swart UWC SOPH: David Sanders, Tamryn Jenkings Univ Limpopo, Human Nutrition and Dietetics: Makoma Bopape UNC: Jessica Ostrowski, Bridget Hollingsworth The South African law (Act 54 of 1972) requires that the labels of packaged food should display basic information regarding the producer/manufacturer of the product, the ingredients used and, if a health or nutrition claim is made, detailed information on the nutrient composition of the food product. Many products now provide the latter. In support of, and to monitor, potential reformulation of food products following policy action, this project collects photographic information of all packaged food products from food retailers (supermarkets) in the Western Cape, particularly in Langa (in support of the project on the health promotion levy) and Khayelitsha (in support of the project on researching obesogenic food environments). All supermarkets in Durbanville have been included as an additional site. Information from the photographic evidence is captured digitally.

This data will support the health promotion levy project by monitoring any reformulation of products pre- and post-tax. It will also provide information for the implementation planning of the proposed nutrition information label for South Africa and will subsequently translate into food labelling and marketing regulations. Findings related to child-directed marketing of breakfast cereals and nutritional composition of snack foods are expected to be published in 2021. Research Assistants and fieldworkers who contributed to data collection were: Luchrechia Afrika, Vashika Chibba, Lisa Deyce, Alice Khan, Thandokazi Mahuzi, Kholiswa Manisi, Tyler Coats, Valentine Khumalo, Aneeqah Latief, Zintle Phekana, Stephanie Röhrs, Sharna Solomons and Morongoa Tlhako. Evaluation of a simplified nutrition information label for packaged food in South Africa UWC Dietetics & Nutrition: Rina Swart UWC SOPH: David Sanders, Tamryn Jenkings Univ Limpopo, Human Nutrition & Dietetics: Makoma Bopape Wits: Safura Abdool Karim Vital Strategies: Nandita Marukutla, Luyanda Majija UNC: Lindsey Smith Tallie, Emily Busey This project aims to develop a suitable nutrient profiling model for packaged food in South Africa to identify foods high in critical nutrients. A stepwise process has been used to develop a model, following Rayner’s internationally used approach. Together with another three models purposefully selected from other countries, this model is being applied to the food supply information collected in the nutrition facts panel project in order to validate the model. The number and proportion of foods falling into either the compliant or non-compliant categories are being used to identify the ability of the nutrient profiling model to identify products that contain high levels of critical nutrients. The mean content of critical nutrients will be calculated. Differences between models regarding the proportion of foods identified as compliant will be explored by using tests of proportions. Following the development of the nutrient profiling model, a warning label to inform consumers of foods high in the nutrients of concern was developed through four stages. Recommendations on the most effective front of pack label to inform consumers on high levels of critical nutrients as well as the unhealthiness of packaged foods have been

made to the National Department of Health.

LINKS, PARTNERS AND FUNDERS Links and partners NATIONAL

INTERNATIONAL

Academic

Cape Peninsula University of Technology Durban University of Technology Nelson Mandela University National Research Foundation (NRF) North West University Sefako Makgatho Health Sciences University South African Medical Research Council Stellenbosch University University of Cape Town Health Policy and Systems Division, School of Public Health and Family Medicine Women’s Health Research Unit Chronic Diseases Initiative for Africa (CDIA) Department of Paediatrics and Child Health African Centre for Cities - African Food Security Urban Network (AFSUM) University of Free State University of KwaZulu-Natal University of Limpopo University of Pretoria University of South Africa University of the Western Cape Department of Dietetics and Nutrition Department of Psychology Department of Sport, Recreation and Exercise Science DST/NRF Centre of Excellence in Food Security Institute for Poverty, Land and Agrarian Studies (PLAAS) Interprofessional Education Unit School of Pharmacy Writing Centre, Directorate of Teaching and Learning University of the Witwatersrand University of Venda University of Zululand Walter Sisulu University

Government

City of Cape Town: Health Department Provincial departments of health: Eastern Cape, Limpopo, Mpumalanga, Western Cape National Department of Health

Civil society and research organisations

Health Information System Project (HISP) Health Systems Trust Human Sciences Research Council (HSRC) Ikamva Labantu One to One Africa Children’s Fund Peoples’ Health Movement South Africa (PHM) South African Christian Leadership Association Health Project (SACLA) Southern Africa Food Lab St John TB/HIV Care Association The Caring Network

Addis Ababa University, Ethiopia School of Public Health African Population and Health Research Center, Kenya African School of Economics, Benin Boston University, USA School of Public Health Centre for Health Equity and Governance in Health Systems, Guatemala Dodowa Health Research Centre, Ghana Eduardo Mondlane University, Mozambique Flinders University of South Australia Southgate Institute for Health, Society and Equity Ghana Institute for Management and Public Administration (GIMPA), Ghana Ghent University, Belgium International Centre for Reproductive Health Great Lakes University of Kisumu, Kenya Institute of Public Health, Bengaluru, India Institute of Tropical Medicine, Antwerp, Belgium Johns Hopkins University, USA Karolinska Institutet, Sweden Katholieke Universiteit Leuven, Belgium Kenyan Medical Research Institute (KEMRI), Kenya Kwame Nkrumah University of Science and Technology, Ghana Lancaster University, UK London School of Hygiene & Tropical Medicine, UK Makerere University, Uganda School of Public Health McMaster University, Canada Population Health Research Institute Muhimbili University of Health and Allied Sciences, Tanzania Ningbo University, China Semmelweis University, Hungary Umeå University, Sweden United Nations University, Malaysia International Institute for Global Health University College, London, UK University of Antwerp, Belgium University of Dodoma, Tanzania University of Edinburgh, Scotland University of Essex, UK University of Ibadan, Nigeria College of Medicine University of Kent, UK University of Massachusetts, USA University of Missouri, USA University of Missouri-Columbia University of Missouri-St Louis University of North Carolina at Chapel Hill, USA Gillings School of Global Public Health Global Food Research Program University of Oslo, Norway Department of Informatics University of Oxford, UK

University of Rwanda Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management University of Southampton, UK Universidade Estadual de Campinas, Brazil Universidade do Estado do Rio de Janeiro, Brazil Universidade Federal do Rio Grande do Sul, Brazil Universidade Nova de Lisboa, Portugal University of Sydney, Australia School of Public Health University of Uppsala, Sweden University of Zambia VIVES University of Applied Science, Belgium

Government

African Union Development Agency – NEPAD National Health Systems Resource Center, India

Professional and civil society organisations

Agency for Research and Development Initiative, Uganda Academic Network for Sexual and Reproductive Health and Rights Policy (ANSER), Belgium Busara Center for Behavioral Economics, Kenya Children’s Mercy Hospital, USA The Children’s Research Institute Collaborative Care Systems, Finland Global Alliance for Chronic Diseases (GACD) Health Research for Action, Belgium Health Systems Global International Network for Food and Obesity/Noncommunicable Diseases Research, Monitoring and Action Support (INFORMAS), Australia Norwegian Institute of Public Health, Norway Peoples’ Health Movement (PHM) Raising Voices, Uganda

Global institutions

Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland UNICEF, New York, USA Health, Nutrition and HIV Sections World Health Organization, Afro region Health Systems and Services Directorate World Health Organization, Geneva, Switzerland

Funders Funders are considered to be the organisations with whom the SOPH has the funding contract/ relationship. This can include a sub-contract of a larger grant managed by the funding organisation.

NATIONAL Cape Higher Education Consortium (CHEC) DST/NRF Centre of Excellence in Food Security, UWC Mauerberger Family Foundation Fund National Research Foundation (NRF) South African Medical Research Council (SAMRC) UWC Senate Research Funding

International Belgian Government (via the Framework 4 Agreement with the Institute of Tropical Medicine, Belgium) Bill and Melinda Gates Foundation, USA, through US Fund for UNICEF and UNU Bloomberg Foundation, USA, through University of North Carolina Children’s Mercy Hospital, USA Clinton Health Access Initiative, USA ELMA Philanthropies Services, USA, through SAMRC European Commission Flemish Interuniversity Council (VLIR-UOS), Belgium Swedish Research Council for Health, Working Life and Welfare (FORTE), Sweden, through SAMRC German Development Bank (KfW), Germany, through hera Hamilton Health Sciences Corporation and McMaster University, Canada Population Health Research Institute, Health Research for Action (hera), Belgium International Development Research Centre (IDRC), Canada Joint Health Systems Research Initiative, UK Karolinska Institutet, Sweden London School of Hygiene and Tropical Medicine, UK Medical Research Council (MRC), UK, through UCT National Institutes of Health (NIH), USA National Institute for Health Research, UK Norwegian Centre for International Cooperation in Education (SIU), Norway Official Development Assistance (ODA), UK Global Challenges Research Fund Research Foundation – Flanders (FWO), Belgium Swedish Foundation for International Co-operation in Research and Higher Education (STINT), Sweden United Nations University - International Institute for Global Health, Malaysia University of Antwerp, Belgium University of Missouri South African Education Program (UMSAEP), USA/SA University of North Carolina at Chapel Hill, USA US Fund for UNICEF, USA World Health Organization (WHO), Switzerland, through Universidade Nova de Lisboa, Portugal

SPECIAL EVENTS Every year we hold two special events. The first celebrates one of the School’s graduates selected to receive the Jakes Gerwel Award for an Outstanding Contribution in the field of Public Health – a celebration which has been taking place since 2013. The second annual event is the David Sanders lecture in Public Health and Social Justice which, as the title suggests, addresses a current issue which reflects the School’s commitment to equity, social justice and international solidarity, values which guided founder director David’s work and which are central to the SOPH’s identity and endeavours. While these events were held in 2019 as usual, the restrictions imposed by the COVID pandemic meant that neither was held in 2020 – although a recipient for the Jakes Gerwel Award was identified. * Our thanks to Nicklaus Kruger (UWC’s Media, Marketing and Communications Unit) for material for these articles.

Jakes Gerwel Awards: Outstanding Contributions in Public Health The Jakes Gerwel Award recognises a student who has demonstrated through their work the ability to have an impact on an aspect of population health. It is open to all graduates of the School who have, through their work, made an impact on public health through professional or academic leadership and innovation. This award honours the late Prof Jakes Gerwel, former Vice Chancellor of the University of the Western Cape (UWC) who, among other things, advocated passionately for, and supported the development of, South Africa’s first School of Public Health to be established outside of a medical school. He clearly saw the need for UWC to focus on public health practice based on solid science that led to measurable improvements in peoples’ health. Over the past few years, the School has achieved these aspirations – and the award, endowed by the Mauerberger Foundation Fund, recognises Prof Gerwel’s central role in promoting public health practice. “Jakes Gerwel was the Rector of UWC for seven years – it wasn’t all that long,” Prof Uta Lehmann, SOPH Director noted. “And yet we still rest on the foundations that he built during those years. He was a very remarkable man for a very special time, and his vision is still very present in the University, and the wider community.” • •

The 2019 award went to Siraaj Adams, CEO of Digital Health Cape Town and co-founder of Iyeza Health. Juanita Arendse, Sub-structure Manager: Northern /Tygerberg, Western Cape Department of Health, was recognised for the award in 2020. The event has been postponed to 2021 due to COVID-19.

2019: Siraaj Adams The 2019 recipient of the Jakes Gerwel Award was Siraaj Adams, CEO of Digital Health and co-founder of Iyeza Health. Siraaj obtained his Pharmacy degree in 2000 and Master of Public Health (MPH) in 2016, both from UWC; he also has an MBA from the University of Cape Town. Following ten years in HIV disease management, Siraaj used his pharmacy, public health, business and entrepreneurial skills to move into the development of digital platforms for health. He believes that “the digital health landscape is ripe with opportunity – for entrepreneurs, but also for the public who need convenient health solutions, and for the overstretched public health care system” – and that “the best medical solutions can be rolled out to the masses, and that is something that’s very exciting.” Siraaj’s presentation at the award ceremony on 18th July 2019 was on ‘Mobile health, community engagement

and the coming revolution’. His organisation Digital Health aims to use technology to address diseases like HIV and TB, lifestyle issues and pregnancy, wellness and exercise, and more. “We seek to ensure seamless integration across the health services system in terms of drug prescription, review, dispensing, provision and delivery, including a fully-tracked health logistics service that allows people to monitor the door-to-door delivery of medicine.” Digital Health supports start-ups to mature, to enable them to access commercial contracts and obtain long-term sustainability and stability. It helps local entrepreneurs to engage with mentors, leading health care organisations and business leaders to refine their innovations. Siraaj is also the strategic partner to Iyeza Health, which started out as a ‘last mile logistics’ service in Cape Town – i.e. the fast and efficient movement of goods from one place to another, from a central location to the final delivery destination. As a subcontractor to the Western Cape Government Chronic Dispensing Unit, Iyeza Health has been responsible

for the delivery of chronic medication to 30 public sector clinics in low-income areas in Cape Town – and sometimes to patients’ homes. “In addition, one of the critical things for us as pharmacists and pharmacy researchers, Iyeza Health has achieved the required cold chain compliance, and built the required digital infrastructure in order to scale the business nationally.” Siraaj credits his MPH as being a turning point in his career to focus his skills on health innovations at a population level, and at the same time partner with local entrepreneurs to apply digital solutions to community level initiatives. “I was lucky in that I also got involved very early on in getting involved – and this unique network was something that I’ve been able to work with over time as well - and that can help empower others.” “Digital health is an evolving space. Everybody’s trying it, nobody’s really got it right yet - but we’re going to keep trying. And ultimately, people in need of better care are going to see the difference. That’s what we need to see.”

Annual David Sanders Lecture in Public Health and Social Justice To celebrate Emeritus Professor David Sanders’ contribution as founding director of the School of Public Health at UWC, and his influence in the field of public health generally, an annual lecture was instituted in 2012 in his name. Each year an eminent speaker is invited to engage scholars, practitioners, policy makers and activists in contemporary challenges and opportunities for public health research, teaching and practice. In bringing scientific excellence and implications for political and social action to bear on their chosen issue, they continue the vigorous, socially engaged, scholarly debate and practice that characterised much of David’s engagement. Previous speakers have included Prof Hoosen Coovadia, Prof Richard Laing and Dr Mary Bassett, among others, and have focused on issues including access to medicines, the link between race and health, and the challenges of devising public health systems in developing nations. • •

The 2019 lecture was given by Advocate Adila Hassim, lead counsel for the Life Esidimeni case, who presented on ‘Decanting Life Esidimeni: Valuing life and human dignity in South Africa’. No lecture was given in 2020, given the constraints imposed by COVID.

2019: Adila Hassim Advocate Adila Hassim was lead counsel in the Life Esidimeni arbitration – a legal investigation into one of the biggest human rights failures in democratic South Africa, and the deaths of at least 144 mental health care service users from causes including starvation and neglect. Her lecture, entitled ‘Decanting Life Esidimeni: Valuing life and human dignity in South Africa’ delved into the truth behind the Life Healthcare Esidimeni scandal, and the inability of those involved to take responsibility for their actions. “Of all that we learned during the hearings, all of the terrible things, there was one vein that ran coldly through the evidence,” Hassim said, “and that was the repeated claim by government officials that they were obeying orders, and that they could not take individual responsibility.” They did it to save money, they said; and because nobody could have foreseen how bad things would get. And because, as would be repeated so many times, they had “instructions from above”. In 2015, Gauteng health MEC Qedani Mahlangu announced the province would terminate a decades-old contract with the private hospital group Life Esidimeni to provide state-subsidised care for about 1,700 mental

health patients. The contract, Mahlangu argued, had become too expensive. The cost per patient per day at Life Esidimeni was R320. The budget allocated to the NGOs who took the patients was R112 per patient per day. “Just imagine: R112 per day, to provide all of the care – the medical care, the residential care, the food and water and basic necessities and more – that a patient might need,” Hassim noted. “The idea that in the name of costs you would spend so little on the lives of citizens, that human beings would matter less than money, is reprehensible. And in fact it cost the government much more than that in the end.” Hassim asserted that the conditions that led to the disaster really had “nothing to do with resources” but had “everything to do with civil servants who did not perform their jobs in a manner consistent with the law, or with the rights of the patients or the families.”

lightly, especially in law. And they are not words that one would expect to be used to describe treatment of human beings in South Africa at the hands of the government in 2016. They are words that should have died with apartheid – but didn’t.”

“The department and the MEC were warned four times in writing before November 2015,” Hassim explained. “They were warned by people who worked in the field; people who understood what the implications of the transfer would be, and what would be needed to make them work. There was media, advocacy, protests, litigation.”

The power of the law

“Not a single individual in the department took responsibility,” Hassim noted. “Not one. The officials involved in decision-making were eager to eschew individual accountability, to explain why they could not be held accountable for their own actions. The responsibility, they noted, was collective – belonging to the system as a whole, and in no part to them.” That held even for those at the very top. Dr Barney Selebano, former Gauteng Health Department Head, testified that, despite his senior position, and his acknowledgement that he was the person signing documents and approving the project, he was powerless to stop the project.

Decanting While ‘decanting’ is an international description of the careful process of moving to community-based care, this is not what happened in the Esidimeni case, where over a thousand mental health care patients were forcibly transferred from Life Esidimeni – the private healthcare provider where they were, by all accounts, well cared for – to unlicensed and unqualified NGOs in Gauteng province. The transfers happened in a short period of time, due process was not followed, and patients were not cared for anywhere near adequately. Family members of deceased patients reported seeing patients walking around naked, that one NGO gave the same standard set of medication to every patient, and that bodies were badly decomposed. Justice Moseneke described the account of the Esidimeni removals as one of death, torture and disappearance. “These are not words that are used

In March 2018, after 44 days of testimony and contemplation, arbitrator Justice Dikgang Moseneke ruled that families of the affected patients must each be paid R1.2 million, made up of R20,000 for funeral expenses‚ R180,000 for shock and psychological trauma, and R1 million in constitutional damages. “Most lawyers would consider the story to be a victory from a legal perspective,” Hassim commented. “After all, the families were vindicated in the end, and awarded damages for the loss of their loved ones – an absolute first in South African law. But I would like to suggest that this is not a story of victory but one of law’s failures. Why? Because despite the fact that we have one of the world’s most progressive constitutions, if not the most, it was not enough to prevent the loss of life that occurred.” If the system is as poorly functional as it was in that situation, at that time, in that place, why should we not expect to be repeated? “I think that what helps is simply to listen,” Hassim said. “You don’t have to agree with what you hear, but you need to take stock of it. As a manager, if you create a culture where you think people can speak in your presence and express their real opinions, and know that they will be heard, then that will go a long way towards coming to the right decision eventually.” And that goes not just for public health, or even for the public sector – that matters wherever people make decisions that affect the lives of others. “We have to start in another part of the constitution – Section 195,” she said. “We have to demand the appointment of public servants who are capable, honest and serious about their constitutional obligations: public servants who put people first. Maybe then we’ll obviate the need for lawyers to protect us from our government – and our society will be the better for it.”

FAREWELL TO COMRADE PROFESSOR DAVID SANDERS: SOPH FOUNDING DIRECTOR1

On 30 August 2019, the SOPH’s founding Director, Emeritus Professor David Sanders passed away unexpectedly while on holiday in the UK with his wife, Sue Fawcus. His passing came as an enormous shock to his colleagues in the School and across the world. Despite having formally retired in 2010, he had continued to be deeply involved in a wide range of research and advocacy activities, both at the SOPH and the People’s Health Movement. David grew up and trained as a medical doctor in Zimbabwe (then known as Rhodesia), but left for the UK where he obtained specialisations in paediatrics, tropical and community health and became a member of the Royal College of Physicians. From early on in his career he combined his professional work with political activism, working with Southern African liberation movements, the medical campaign against private practice in the UK and for the preservation of the National Health Service (NHS); and he was a persistent advocate for primary health care.

In 1980 David and Sue returned to Zimbabwe where he assisted in building up district health services on the primary health care model with a strong emphasis on community organisational structures that had been developed during the Zimbabwe liberation struggle. He also ran a rural child feeding programme based on local foods. He then transitioned to the University of Zimbabwe’s Department of Paediatrics and then to Community Health where he organised a rural-based teaching programme for undergraduates. These rural primary health care initiatives inspired many health care workers (HCWs) to continue this kind of work in many countries around the world. His own children, Ben, Lisa and Oscar, were born during this time and were a treasured addition to his life. He also further developed his love of fly fishing which was a big feature of holidays with his extended family who were such an important part of his life in Zimbabwe. In 1993 David was recruited by the late Prof Jakes Gerwel, then Rector of the University of the Western Cape, to spearhead the establishment of a Public Health Programme at the University, to assist in building a new health system in South Africa – a task he pursued with characteristic energy and determination. David attracted a formidable team of like-minded academics to this initially tiny undertaking from which he established the largest continuing education public health programme in Africa. This included starting the first Master of Public Health (MPH) programme open to health practitioners who were not medical doctors – many of whom were from beyond the country’s borders. Having developed the Programme into a School in 1993, David initiated a wide range of research, advocacy and policy support initiatives.

Throughout his academic career David married academic work with health activism, campaigning for a sugar tax; for a stronger focus on comprehensive primary health care; and against the international monopoly of food companies which promote the obesity epidemic etc. His insistence on the link between political change and health as embodied in the Alma Ata Declaration, and of the fundamental importance of addressing the social determinants of health, came together in the Peoples’ Health Movement of which he was a founder and to which he remained fervently committed. These are also embodied in his seminal publications The Struggle for Health and Questioning the Solution. The process of revising The Struggle for Health for a second edition, in which he was engaged when he passed away, is being completed by his wife and several colleagues; we hope to launch this in 2022. The tributes, messages and condolences that flooded in from hundreds of people after David’s death all expressed a profound sense of loss, as well of deep gratitude for his work and contribution: for the tenaciously urgent voice of the health activist and commentator fighting for health as a human right, fighting against persistent inequity and injustices; for the leader who helped build the post-independence health system in Zimbabwe and later in South Africa; for establishing and building the School of Public Health at UWC, and the People’s Health Movement both globally and in South Africa. And for being one of the public health community’s voices of conscience – who could be relied upon to ask inconvenient questions at a world health assembly, a TV debate or a local workshop, expressing in an enviably articulate and sharp manner what many of us could not find the words to say. These tributes can be found on the websites of the School of Public Health and the People’s Health Movement. On 19 September 2019 we remembered David and celebrated his life at a memorial in the SOPH attended by more than 400 people. The SOPH building, funded by the Atlantic Philanthropies, is a visible manifestation of the respect and acknowledgment of David’s work – and the School will be associated with David Sanders’ name for a very long time to come. While it is not his only legacy, it is an important one, and his unwavering focus on health equity and of social justice continues to shape and direct our work. 1.

A big thank you to David’s son Oscar. Much of the account of David’s life before he joined UWC comes from Oscar’s eulogy to his father at his memorial.

Staff Farewells Dr Hazel Bradley Hazel Bradley joined SOPH in 2003, having obtained her MPH through the School in 1999. In her PhD thesis completed in 2013 she considered the evolving roles and competencies of district pharmacists in Cape Town’s primary health care facilities. Ensuring accessible, good quality pharmaceutical services at a primary level has long been Hazel’s vision, having worked as a pharmacist in a poorly-resourced setting prior to joining the SOPH. This led her to establishing Pharmaceutical Public Health as an important area of specialisation within SOPH – and she presented several short courses with UWC School of Pharmacy colleagues. She also worked closely with Prof Richard Laing of Boston University and Dr Raffaella Ravinetto from the Institute of Tropical Medicine, Antwerp – and has been involved in various initiatives in Southern and Eastern Africa, focusing on strengthening health supply chain management and pharmacovigilance and regulatory capacity. Always deeply committed to her role as educator, as senior co-ordinator of the School’s academic programme, Hazel valued team work and remaining accountable to her colleagues, while never being afraid to try out innovative ways of teaching and learning as an essential part of professional practice. The many academic and research partnerships that have profiled SOPH within the field of pharmaceutical public health in sub-Saharan Africa is, as Assoc Prof Renier Coetzee of UWC School of Pharmacy suggested, a “legacy of Hazel Bradley”! Hazel will continue to retain research links with the SOPH during her retirement.

Prof Diane Cooper Di joined the SOPH in 2015, having worked in our sister Department at the University of Cape Town for 25 years where she taught and researched in the Women’s Health Research Unit. Di’s focus on women’s health has included focusing on the social determinants, gender issues and sexual and reproductive health – engaging with issues like contraception, pregnancy and female cancers. More recently, her focus has been on the intersection between sexual and reproductive health (SRH) and HIV, particularly the SRH needs of youth living with HIV and teenage pregnancy. This has involved her internationally – for instance as a member of a Task Team based at Harvard University looking at maternal health and HIV. She has also worked with a number of local and international NGOs. For many years, Di participated in committees of the National Department of Health – and in the province, she was involved in the original rollout of the Termination of Pregnancy and in task teams addressing the integration of sexual and reproductive health and HIV. Di will retain research links with the SOPH during her retirement.

On 26 January 2021 we lost our colleague Sheryl Cordon who, together with Nadia Follentine, looked after the security in the School of Public Health building for many years. Having lost her husband to COVID early on during the pandemic, Sheryl also contracted COVID, developing complications which eventually overwhelmed her. Sheryl had worked at UWC as a campus security officer since 2012 and had been responsible for the SOPH building for much of this time. We all knew Sheryl as a quiet, always helpful, gentle presence in the School, and we miss her enormously.

Assoc Prof Lucia Knight Lucia joined the SoPH as a senior lecturer in 2015 and was promoted to Associate Professor in 2019. She has been very involved in the research aspect of the Master programme, realigning the teaching of research and convening the Qualitative Research Methods module. During her six years at the School she supervised over 20 MPH and two PhD students, and was the Faculty Higher Degrees representative for a number of years. Alongside the opportunities the School provided to grow as an independent researcher, Lucia obtained funding for research, including for some large-scale internationally funded projects. Now at the University of Cape Town where she heads the Division of Social and Behavioural Sciences at their SOPH, Lucia is also an Extraordinary Professor at our School. She maintains three ongoing projects and four PhD students who will continue to completion under her supervision.

Dr Suraya Mohamed Suraya moved from radiography into public health when she first enrolled in the School’s Postgraduate Certificate in Public Health. After graduating with her MPH in 2005, she joined the SOPH as a lecturer in health promotion, obtaining her PhD in 2015. Suraya’s work has focussed on health promotion. She was involved in convening several health promotion short courses at Winter School and MPH elective modules – and worked on the project on ‘The development of health promoting schools in addressing TB and HIV’. Her PhD thesis was on ‘Factors influencing the implementation of health promoting schools: A multiple case study of three secondary schools in a resource limited community in Cape Town’. This intersectoral project involved a multidisciplinary team from UWC, participants from the Western Cape departments of Health and Education, and the school management, staff, learners and parents from three Western Cape schools. More recently Suraya’s research interests have focussed on adolescent health and wellbeing, including sexual and reproductive health; and she was involved in several international projects including the Global Early Adolescent Study. For several years Suraya was the postgraduate-level co-ordinator in the School, overseeing the Postgraduate Diploma programme in particular. Her commitment to her colleagues, especially in mentoring new staff members, her teamwork and her roles as an educator and MPH student supervisor will be missed by everyone at SOPH.

STAFF OF THE SCHOOL OF PUBLIC HEALTH

Professor and Director Prof Uta Lehmann, MA, PhD (Hannover) Uta Lehmann is a social scientist by training and has worked in public health and health personnel education for 30 years. She joined the SOPH in 1999, and has been its director from 2009 to 2012, and again since 2017. Her interests and expertise lie in health policy and systems research, human resource development, and qualitative research. Her research projects have included a focus on understanding how relationships, power and politics impact on the functioning of health systems, and exploring ways to support the voice and capacity of frontline providers and community health workers. She has led capacity strengthening initiatives for human resources development with sister institutions in other African countries and with international partners. Uta works extensively with the WHO and is the co-ordinator of the WHO Collaborating Centre for research and training in human resources for health.

Emeritus professors Emeritus Prof David Sanders, MBChB (Birmingham), DCH (RCS Eng), MRCP (UK), DTPH (London), DSc (Hon Causa) (UCT) David Sanders headed the SOPH from its inception in 1993 till 2009. David passed away unexpectedly on 30 August 2019. He was not only a well-renowned academic who shaped research and teaching in public health for almost five decades, but was also a consummate activist and commentator who spoke truth to power – a great public intellectual. He was a founding member of the People’s Health Movement (PHM) and Tekano Fellowship Programme. At the time of his passing, David held the position of co-chair of PHM and Chairperson of the Governing Board of the Chronic Diseases Initiative for Africa; and was working on an updated second edition of his seminal book The Struggle for Health. (See our tribute to David on page 58).

Emeritus Prof Thandi Puoane, B(Cur), BA Soc Sci (UNISA), MPH, DrPH (Berkeley) Thandi Puoane has a background in nursing, has taught at universities in South Africa and the USA and has been a principal investigator for a range of research projects. She has extensive experience in nursing, teaching and public health research. Her research areas include child nutrition including the hospital management of severe malnutrition; identification of CVD risk factors, particularly obesity; participatory action research and monitoring and evaluation of programmes. Recently she has been working with community health workers in developing and implementing community-based programmes for prevention and control of NCDs. Thandi is a member of Chronic Disease Initiative for Africa and is the Cape Town PI of the global Prospective Urban Rural Epidemiological study. She is rated as a C2 scientist by the National Research Foundation. Thandi has written several chapters in books and has published widely in local and international peer reviewed journals.

NRF SARChI Chairs Prof Asha George, MSc (Harvard), DPhil (Sussex) Asha George joined the SOPH in 2016 as the South African Research Chair (SARChI) in Health Systems, Complexity and Social Change. Asha is a qualitative researcher focuses on the frontline interface and governance of services, taking into consideration community and health worker perspectives. Her longer-term national level work includes partnering with allies across community, district, state and national health systems in India to advance maternal health from a gender and rights perspective. She has worked in Mexico with government ministries and the UN system to advance the Beijing and Cairo agendas for women’s health and rights. Since 2016, Asha has been on the board of Health Systems Global, serving as its vice-chair from 2016 to 2018 and chair from 2018 to 2020. She currently leads the Drivers Working Group for Countdown to 2030, is a commissioner for the Lancet Commission on

Re-Aligning Child Health for the SDG Era, and serves on the Scientific and Technical Advisory Group for the Human Reproduction Program/ Department of Reproductive Health Research at WHO, Geneva. Asha is rated as a B3 scientist by the National Research Foundation. She is an Adjunct Professor at the Johns Hopkins School of Public Health and a Principal Visiting Fellow at the United Nations University’s International Institute of Global Health. Since 2002, she has co-edited two volumes, four journal supplements, and has published over 120 journal publications and multiple technical reports and guidance documents. Prof Helen Schneider, PhD (Public Health), MBChB (Cape Town), MMed (Witwatersrand), DCH (SA College of Medicine), DTMH (Witwatersrand) Helen Schneider is a public health specialist and health systems and policy researcher who has worked for more than 25 years on the problematics of South Africa’s health system. She joined the SOPH in 2011 and was director from 2013 to 2016. Since 2015, she has been the director of the UWC/SAMRC Health Services to Systems Research Unit, and has occupied the South African Research Chair (SARChI) in Health Systems Governance since 2016. Helen’s research and policy interests have included an understanding of the political dynamics of AIDS policy under the Mbeki government and the health systemwide implications of programmatic interventions such as ARV scale-up; the implementation of South Africa’s ward-based outreach team strategy; governance and leadership of national community health worker programmes; and most recently, contemporary approaches to district health system strengthening and governance. She holds a number of positions on international committees, including two with the World Health Organization – namely Scientific and Technical Advisory Committee: Alliance for Health Policy and Systems Research (2018-2020); and the Advisory Committee on Health Systems Governance for Universal Health Coverage (from 2016). Helen is rated as a B2 scientist by the National Research Foundation.

Professors Prof Diane Cooper, B Soc Sci, BA Hons, PhD (Cape Town) (Retired from permanent staff in December 2020) Diane Cooper joined the SOPH as a professor in 2015 from the SOPH and Family Medicine at UCT. She has a Social Science background and a PhD in Public Health. Her main research interests are sexual and reproductive health (SRH), particularly among youth; gender and health; maternal health and women’s health. Her recent research projects have included local and international research collaborations focusing on the impact of gender norms on early adolescent SRH; the impact of violence on youth in accessing SRH services; SRH and HIV service integration; contraception; and teenage pregnancy. Diane has worked with the national and Western Cape provincial departments of health on the development of a number of SRH policies and programmes, including in adolescent and youth health. She has links with several non-governmental organisations. She is rated as a C2 scientist by the National Research Foundation – and will continue to retain research links with the SOPH during her retirement. Prof Brian van Wyk, BSc (Hons), MSc Psychology, DPhil (Stellenbosch) Brian van Wyk is a research psychologist with a passion for postgraduate supervision and teaching and innovation in health research methods. Brian trained in the Health Systems Research Unit of the South African Medical Research Council from 2000-2003, where he conducted his doctoral research on the effects of health reforms on the organisation of care and team functioning in a primary health care setting. Prior to joining SOPH as a lecturer in January 2006, he was a chief researcher in the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council. In 2006-7, he was a Fogarty training fellow in the epidemiology of HIV/ AIDS and TB at the Mailman School of Public Health at Columbia University, New York.

Brian merges his training in health systems research and experience in researching social and behavioural aspects of HIV/AIDS in his current research which aims to improve adherence and treatment outcomes for adolescents on HIV treatment. Brian was deputy dean of Research and Postgraduate Studies in the Faculty of Community and Health Sciences from 2013 to 2016 and is currently vicechairperson on UWC’s Biomedical Research Ethics Committee. He represents UWC Senate on UWC Institutional Forum.

Associate professors Assoc Prof Lucia Knight, BSc (Cape Town), MPopStuds (UKZN), PhD (London) (Left SOPH in September 2020) Lucia Knight is a family demographer with particular experience in the study of HIV, families, poverty and social protection in Southern Africa. She has been working on the Sinako project which focuses on the intermediate role of the household in community support for chronic HIV care. Lucia has worked with colleagues at the University of Antwerp, designing and testing a model for a familybased intervention to improve ART adherence; she has also explored access to care and ART adherence among older people living with HIV in the Western Cape. These projects have built on her earlier research which dealt with family-based, self- and home-based testing for HIV, assessing the impacts of maternal mortality for families; and a large-scale cohort study exploring the well-being of children growing up with the dual burdens of HIV and poverty. Lucia has become the Head of the Division of Social and Behavioural Sciences at the School of Public Health and Family Medicine at the University of Cape Town and was appointed as an Extraordinary Professor with UWC SOPH in December 2020. She continues to lead on the Sinako project. Assoc Prof Zandile June-Rose Mchiza, BSc (Nutrition & Dietetics) (Western Cape), MSc, PhD (Cape Town) Zandile Mchiza specialises in research on obesity, nutrition and non-communicable disease. Prior to joining the SoPH in January 2018, she was a senior research specialist and a senior specialist scientist at the Human Sciences Research Council and the South African Medical Research Council (SAMRC), respectively. In these posts she led and collaborated in projects directed at improving and preventing nutritional disorders, body size and image distortion as well as metabolic diseases in South Africa and other African countries. More recently, she has been reviewing food-, nutrition- and health-related laws and policies to identify key legislation and policy adoption and delivery challenges with a view to finding workable solutions to inform legislation and policy amendments. Her other interest is capacity development, especially developing research skills of previously disadvantaged young scientists.

Zandile convenes the Descriptive Epidemiology course and organises the Non-Communicable Disease Research Cluster for the School. She has been an associate editor for the Public Health Nutrition Journal; and has participated in panel committees for Research Career Development organised by the National Research Foundation, the SAMRC and the NIH (Fogarty Initiative).

Senior lecturers Dr Hazel Bradley, B Pharm (Hons) (Bath), MPH, PhD (Western Cape) (Retired from permanent staff in December 2020; continues in a part-time contract position) Hazel Bradley has lead the area of specialisation in Pharmaceutical Public Health within the Master of Public Health (MPH). This has included the first fully on-line modules offered by SOPH: Rational Medicines Use, Medicines Supply Management and Pharmacy Policy and Management. Hazel’s most recent research areas have included systems approaches to investigating and improving medicines management, safety and access; pharmaceutical human resources and district level services; and pharmaceutical and public health education and training. She has worked closely with international collaborators from Boston University School of Public Health and the Institute of Tropical Medicines, Antwerp. Hazel trained as a pharmacist in the UK and, prior to joining the SOPH in 2003, worked with a Cape Town NGO delivering community-based primary health care services. She will continue to retain research links with the SOPH during her retirement. Dr Martina Lembani, BSc (Univ of Malawi), MADS (Western Cape), MADM, PhD (Ruhr-Bochum) (Joined SOPH in January 2021) Martina Lembani is a demographer who specialised in international development studies and development management. She joined the SOPH in 2014 as a postdoctoral researcher on health policy and systems research projects, after which she has worked in various capacities at the School. In late 2020 she was appointed as a senior lecturer from January 2021. Martina specialises in health policy and systems research, including the use of systems dynamics modelling methodology focusing on maternal health, sexual reproductive health, mental health and food environments. Her focus is on health systems resilience and responsiveness and her current area of interest is migration and health. She convenes the Master programme module on Population Health and Development: A Primary Health Care Approach. Previously Martina worked in the field of HIV and AIDS, community development and monitoring and evaluation, particularly with NGOs. From 1999 to 2004 she was a monitoring and evaluation co-ordinator on a community empowerment project in Malawi. More

recently, from 2018 to 2019, she worked as the African regional monitoring and evaluation manager for a Cape Town-based NGO focusing on eye health. Dr Verona Mathews, BA (Hons) Social Work, MPH, PhD (Western Cape) Verona Mathews specialises in health information systems. Her research focus is on human resources for health, specifically in the areas of monitoring and evaluation, human resource management and information systems. She works on both national and district levels to design and implement a human resource information system to inform evidence-based planning and decision-making. Verona participated in a national rollout of the District Health Information System in South Africa, facilitating and co-ordinating the development, training and implementation of the system. More recently she has expanded to focusing on the decentralisation of human resource management in the public health sector. Dr Anam Nyembezi, BA (Hons), MPP (KZN), PhD (Maastricht, Netherlands) Anam Nyembezi’s training is in work and social psychology; his passion is men’s health research. Prior to joining the SOPH in January 2018, he was a research specialist in Population Health, Health Systems and Innovation at the Human Sciences Research Council where he conducted research focused on maternal and child health, sexual and reproductive health, mental health, and noncommunicable diseases. He also spent several years at the South African Medical Research Council researching youth risk behaviours, including understanding the determinants of HIV behaviours among traditionally circumcised men. His current research interests on men’s health focuses on sociobehavioural aspects of sexual reproductive health, HIV/AIDS, mental health and non-communicable diseases. Anam teaches and convenes the Health Promotion and Alcohol Problems modules of the PGD and Master programme. Dr Bey-Marrié Schmidt, MPH Epid, PhD (Cape Town) (Joined SOPH in November 2020) Bey-Marrié Schmidt is a public health researcher with training in anthropology and epidemiology. Her expertise is in qualitative and quantitative systematic reviews of public health and health system interventions, and knowledge translation methods that bridge the gap between research evidence and health policy and practice.

Having joined the SOPH in November 2020, BeyMarrié will convene the Qualitative Research Methods module of the Master programme as well as lead two research projects: ‘Strengthening community engagement in TB and HIV vaccine trials in South Africa (CETH)’ funded by the European and Developing Countries Clinical Trials Partnership; and ‘Knowledge Translation Platforms for bridging public health and health systems research into Universal Health Coverage related policy and practice (KTP-UHC)’. Bey-Marrié is also an associate staff member of Cochrane South Africa, a unit of the South African Medical Research Council. Dr Hanani Tabana, BSc (Hons), MPH (Cape Town), PhD (Karolinska) Hanani Tabana’s training is in epidemiology. Prior to joining the SOPH, she was a lecturer in the Community Health Division at Stellenbosch University. Hanani spent several years at the South African Medical Research Council conducting HIV prevention research, and her research continues to be in HIV/ AIDS, with a focus on maternal and child health (including sexual and reproductive health), and mental health. In addition, she conducts economic evaluations alongside research studies. Dr Lungiswa Tsolekile, BSc (Hons) (Dietetics), MPH, PhD (Western Cape) Lungiswa Tsolekile is a dietician who has been involved in research on chronic poverty. Her main interests are in the primary prevention and control of chronic non-communicable diseases (NCDs) and obesity in adults and children. She has worked with community health workers (CHWs) in promoting healthy lifestyles for prevention of chronic NCDs, as well exploring the use of motivational interviewing by CHWs to change the eating behaviours of community members. She has also been involved in the global Prospective Urban and Rural Epidemiological study. Lungi was promoted to senior lecturer in 2020.

Lecturers Dr Suraya Mohamed, Nat Dip (Rad) (Cape Technikon), MPH, PhD (Western Cape) (Retired from SOPH in December 2019) Suraya Mohamed initially worked as a radiographer in various state and private hospitals. Suraya’s abiding research interests have been adolescent health and wellbeing, including sexual and reproductive health. Her work has focused on health promotion and health promoting schools – and she was involved in the Health Promoting Schools Network.

Senior researchers Dr Peter Delobelle, Doctor in Medicine, Surgery and Obstetrics, PhD (Belgium) Peter Delobelle is a medical doctor with a background in the public and private sectors. Having worked as general practitioner, specialist in training, and medical journalist he eventually became a public health practitioner through his field work for Médecins Sans Frontières. On arriving in South Africa in 2004, Peter worked on HIV/AIDS/TB referral systems in Limpopo province which resulted in the development of a health promoting hospital. He became interested in global health and health systems research through his affiliation with the Institute for Tropical Medicine in Belgium, and with SOPH. His research focuses on health systems and promotion in the fields of HIV/AIDS, noncommunicable disease (especially diabetes), maternal and child health, and health information systems. He has a keen interest in system dynamics modelling and complexity science and is involved in projects with national and international partners. Peter was actively involved in the International Union for Health Promotion & Education and acted as the European co-ordinator for its student and early career network. Ms Nikki Schaay, BA (Hons) Psychology (Natal), MPH (Western Cape) Nikki has worked at the SOPH since 2004. She recently became overall co-ordinator of the academic programme, and continues to convene a core module of the Master programme (Population Health and Development: A Comprehensive Primary Health Care Approach) and facilitates a short course on community participation in health. Nikki is particularly interested in researching how practitioners, and the health services more generally, can develop more responsive and participatory ways of working with clients and community members of the health system. Prior to joining the School, Nikki worked in the field of HIV. She managed a local NGO which was one of the first community-based organisations in South Africa to support a cadre of grassroots HIV educators; then co-ordinated a provincial HIV advocacy network; and later directed a national project which provided technical assistance to the National Department of Health, specifically in relation to HIV multi-sectoral capacity building and policy development. Over the past ten years Nikki has also been involved in short-term, international consultancy work. She has evaluated community-based HIV prevention and care projects and has contributed to the development of an index to measure HIV/AIDS-related stigma and discrimination, undertaken in collaboration with UNAIDS and the Global Network of People living with HIV/AIDS (GNP+).

Mr Gary Spolander, MPH (Birmingham), MHRD, MBA (Wolverhampton), BSocSci (Cape Town) (Left SOPH September 2019) Gary Spolander supported the teaching of health management in the SOPH from 2017 to 2019. Trained as a social worker, he worked in human resource development and in the social services in the UK for several years, and then taught leadership and management at Coventry University. He is presently completing his PhD with Keele University in the UK.

Researchers Dr Woldekidan Kifle Amde, BA (Addis Ababa), MA (Ruhr-Bochum), MA, PhD (Western Cape) Wolde’s research interests are in health policy and systems research, human resources for health, and capacity development. His recent doctoral work was informed by his involvement in inter-university collaborative initiatives to develop capacity in health policy and systems research, and in human resource leadership and management. In 2019 he graduated with a PhD in Public Health – a programme he also co-ordinates for the School with Helen Schneider. In addition he co-convenes the introductory module for the Postgraduate Diploma programme. Prior to joining the SOPH in 2009, Wolde worked as a development professional in Ethiopia, focusing on vulnerability and risk associated with disadvantaged groups, and access and usage to information communication technologies. He currently co-ordinates and manages content on the SOPH’s website and social media platforms. Ms Tamryn Frank, BSc Dietetics, M Nutrition (Stellenbosch) Tamryn Frank joined the SOPH in 2018 as a researcher, working in the field of obesity and non-communicable disease prevention. This informs her current doctoral research on obesity prevention policies in low-income settings. She is currently serving on the research working group advising the South African National Department of Health on Front-of-Package labelling. Prior to joining the SOPH, Tamryn worked for eight years as a primary health care dietitian for the provincial departments of Health, both in the Eastern and Western Cape. Her Master research – undertaken through Stellenbosch University (South Africa), Makerere University (Uganda) and Oslo University (Norway) - focused on human rights and food security.

Ms Tanya Jacobs, BSocSc (Cape Town), Hons (Psych) (Rhodes), MPH (Western Cape) Tanya Jacobs joined the SOPH in May 2017 as a consultant to the Partnership for Health Leadership and Management (PAHLM) project, a collaboration between the universities of the Western Cape and Cape Town and the city and provincial Health departments. As such, she facilitates Action Learning Sets with participants from the Klipfontein, Mitchell’s Plain and Northern/ Tygerberg sub-structures. She taught on the Management Strategies Course. Between 2018 and 2019 Tanya was also a researcher in the Countdown 2030 team, a global initiative focusing on reproductive, maternal, newborn, adolescent and child health. Her focus is on adolescent health, including multi-sectoral adolescent collaboration; provision of sexual and reproductive health interventions in humanitarian settings; as well as an analysis of the global financing facility investment cases and project appraisal documentation. Tanya is currently a PhD candidate with the SOPH – focusing on a gender analysis of adolescent health policy in South Africa. Ms Mary Kinney, BA (Ohio Wesleyan), MSc (Cape Town) Mary Kinney joined the SOPH in November 2017 as a researcher for the Countdown to 2030 Drivers Group, assessing implementation factors of quality improvement initiatives for maternal and newborn health. She is currently managing the project’s Health Policy and Systems Data & Analysis Center (DAC), which provides guidance on measuring the health systems drivers that underpin coverage and equity of women’s, children’s, and adolescents’ health. Mary’s research interests include health system and policy research, maternal and child health and implementation science. She is currently a PhD candidate at SOPH focusing on implementation research for maternal and perinatal death surveillance and response. Mary is an assistant editor at the BMC Reproductive Health and serves on multiple global maternal and newborn health technical working and oversight groups. Mr Florian Kroll, MA (Albert-Ludwigs Univ, Freiburg) (Left SOPH August 2020) Florian Kroll has a keen interest in the links between food systems transitions, poverty, governance and public health, especially in African cities. Having conducted research and training on urban food insecurity in Johannesburg since 2008, Florian has collaborated with the DST-NRF Centre of Excellence in Food Security. This led to his involvement with the SOPH, where he has managed the IDRC-funded project, ‘Researching obesogenic food environments in South Africa and Ghana’ between April 2017 and August 2020. Following his Master degree in historical anthropology, Florian consulted to the NGO sector on agro-ecology, ethnobotany and health.

Mr Ntobeko Nywagi, BSocSc (Hons)(Cape Town) (Left SOPH June 2020) Between October 2017 and June 2020 Ntobeko was a researcher for the three-year bilateral collaborative research study with Ghent University on improving adolescent sexual and reproductive health (SRH) – and which looked particularly at the influence of early adolescent gender socialisation on later sexual and reproductive health. Funded by the South African National Research Foundation and Belgian Research Foundation Flanders, the study is part of a 15-country Global Early Adolescent Study (GEAS) led by Johns Hopkins University. Prior to this, Ntobeko worked in research projects focusing on HIV/AIDS, women’s health and gender, SRH, youth and health studies. He has had extensive experience in research supervision and liaison with all levels of stakeholders in projects undertaken in communities. Ntobeko is a social scientist and is currently doing his Master degree at the SOPH. Dr Sunday Onagbiye, BEd (Hons), MA (OAU, Ife), PhD (NWU, Potchefstroom), Cert. Prevention Strategies for NCDs (Oxford) (Left SOPH December 2019) Sunday Onagbiye was at the SOPH from 2018 to 2019, working as a researcher in a four-year collaborative research project on the self-management approach and reciprocal transfer for type 2 diabetes (SMART2D). Sunday is a human movement scientist/physical activity and health specialist. His research interests are in public health promotion in the areas of physical activity intervention and non-communicable diseases (NCDs) risk factors, health-related quality of life, cardio-metabolic disease, energy expenditure, obesity, health risks behaviour, mental and musculoskeletal health, and PA and climate change. His doctoral work was in human movement science and he has a studied prevention strategies for NCDs at Oxford. Ms Manya van Ryneveld, BSocSc Hons (Cape Town), MSc (Oxford) (Joined SOPH in April 2019) Manya van Ryneveld joined the SOPH in April 2019 and works with the Extra-Mural SAMRC (Health Services to Systems) Research Unit, in keeping with her interests in health systems and policy research, policy reforms for national health insurance, and the application of critical social theory in public health. Her research interests include community health systems, understanding everyday care, informality and grassroots self-organising during health emergencies. Currently a PhD candidate with the School, Manya has a background in social anthropology and an MSc in International Health and Tropical Medicine from Oxford.

Research project managers and co-ordinators Ms Mariam Hassen, BHMS (Rhodes), BSc Med (Hons) (Cape Town) Following 12 years in biokinetics in the private sector, Mariam Hassen entered the field of public health when she joined the SOPH in 2016. She works with two projects, both of which focus on strengthening systems regarding diabetes intervention and prevention in local communities. Mariam is interested in contributing to understandings of diabetes epidemiology, management and social innovation in introducing opportunities in diabetes prevention and management. Mr Mulalo Kenneth Muhali, BEnvSc (Venda) Kenneth Muhali joined SOPH in 2013 as a National Research Foundation intern, working as a research assistant for the PURE project that focuses on environmental, biological and societal influences on obesity and non-communicable diseases (NCDs). In 2016 he joined the SOPH as a research officer with the diabetes prevention programme, Sivile SenzaLifestyle Africa, a study that aims to reduce community members’ risk for NCDs by motivating them to eat healthily and engage in physical activity. Since 2019 he has been the intervention manager for the Sinako Project which focuses on the intermediate role of the household in community support for chronic HIV care. Ms Cynthia Paka, Dip Gen Nursing & Midwifery (College of Nursing), Dip PaedNursSc (Cecilia Makiwane Nursing College) Cynthia Paka is community liaison for the diabetes prevention programme, Sivile Senza-Lifestyle Africa programme. Cynthia studied nursing at Livingstone Hospital, followed by a Diploma in Paediatric Nursing Science at Cecilia Makiwane Hospital in the Eastern Cape. She continued to work mostly in paediatrics as a professional nurse, until she retired in 2000. Since then she has been working in communities with the SACLA Health Project.

Education specialists Ms Ziyanda Mwanda, BSc Biotech (Western Cape), PGD in Ed Tech, MEd Ed Tech (Cape Town) Ziyanda Mwanda is an e-learning specialist, who obtained her Master degree in Education Technology in 2020. Her research interests are around the use of social media to support distance and postgraduate students. Ziyanda leads the School’s innovation efforts in educational technology and virtual learning. She prepares academic multi-media materials for the course work programmes, providing e-learning support to both students and teaching staff. She also co-ordinates the School’s presence on the University Learning Management System, iKamva.

Part-time and associate staff Ms Jenny Birkett, BA, HDip Ed (Natal), MEd Applied Lang Studies (Cape Town) Education specialist Jenny Birkett’s background is mainly in adult education. She worked for many years teaching and developing training materials for adult literacy and adult education NGOs, and she has lectured at Cape Peninsula University of Technology (CPUT) and on UCT’s Adult Education Certificate programme. Jenny has experience, and an interest, in language education and academic development, having trained language educators at UWC, and worked on academic support programmes in UWC’s Education Faculty and at the CPUT. Since 2014, Jenny has been providing education and language input to assist with SOPH’s materials development and other initiatives. Ms Sarah Davids, Diploma (Coach Companion SA,) BSc Occupational Therapy (Cape Town), MPH (Wales) Sarah Davids is a facilitator and coach with an interest in capacity enhancement, systems strengthening, quality of care and wellness and continuing education of health care workers. She is exploring the integration of organisational and relationship systems coaching principles within management training. Sarah is the convenor of the Management Strategies for Health module of the Master programme. Ms Barbara Hutton, BSocSc (Hons), BEd (Hons) (Witwatersrand) Education specialist Barbara Hutton is a senior educationist. She has strong foundations in adult education, distance learning and in writing and editing learning material for different audiences, with a specific focus on public health. Her interest is in making learning accessible to students and in helping to enhance their on-line learning experiences by providing feedback and coaching, and by building their confidence towards facilitating their overall success. Barbara has convened the Postgraduate Diploma module on Population Health and Development: A Primary Health Care Approach I. Dr Thubelihle Mathole, BSc (Hons), MPA (Zimbabwe), PhD (Uppsala) Senior researcher Thubelihle Mathole joined SOPH in February 2008. She has wide experience in research, training and programme planning and management. Her areas of interest are international/global health, monitoring and evaluation, human resource management, HIV/ AIDS and maternal and child health. She is involved in postgraduate supervision.

Prof Rina Swart, BSc Hons (Stellenbosch), MPhil, PhD (Western Cape) Rina Swart is a dietitian / nutritionist and member of staff in UWC’s Department of Dietetics and Nutrition. Her postgraduate qualifications and area of specialisation are in public health nutrition, with a focus on the prevention of all forms of malnutrition through nutrition policies and programmes, as well as the evaluation of such policies and programmes. Since 2014, she has served as the Nutrition Programme Leader within the DSI/NRF Centre of Excellence in Food Security. Registered with the HPCSA, Rina is also a member of the Assoc of Dietetics in South Africa (ADSA) and the Nutrition Society of South Africa (NSSA); she has served as president (2006-2010) and then chairperson of the NSSA Council (2010-2012). She is an active member of the World Public Health Nutrition Association (WPHNA), and is currently on the working group on competency development of accredited public health nutritionists. In 2016 she arranged the Congress of the WPHNA in Cape Town. Most recent and ongoing projects include evaluation of the impact of the Health Promotion levy; development and evaluation of a Front of Pack label to inform South Africans of packaged food products high in critical nutrients (sugar, salt, saturated fat); and a national dietary intake survey. Ms Ulla Walmisley, BSc Physiotherapy (Witwatersrand), MPH (Western Cape) Ulla Walmisley is a public health researcher with an interest in health systems strengthening and adolescent health. She trained as a physiotherapist at Wits, and continues to do some clinical work in this field. Motivated by a desire to make a difference on a larger scale, she completed her MPH at SOPH in 2018 and moved into the academic sphere. She is co-marker on the Management Strategies for Health module of the MPH – and has completed work on a scoping review related to adolescent health for Prof Brian van Wyk.

Research assistants Ms Asiphe Ketelo, B Env Stud (Walter Sisulu), MPH (Western Cape) (Left SOPH January 2020) As a National Research Foundation intern at the SOPH, Asiphe worked on the global PURE project as a research assistant for two and a half years, collecting data in the field and undertaking administrative duties. From 2016 to January 2020 she was part of the Sivile Senza-Lifestyle Africa project, a diabetes prevention programme that focused on behaviour change in eating and exercise in two of the biggest townships in Cape Town. This informed her mini-thesis for her MPH in which she examined the food and nutrition literacy of community health workers in the Western Cape. She graduated in 2020.

Dr Smart Mabweazara, Dip Ed, Sports & Phys Ed (Zimbabwe), BSc Hons (Nat Univ of Sc & Tech), MA, PhD (Western Cape) (Left SOPH October 2019) Smart worked in the diabetes prevention project, Sivile Senza-Lifestyle Africa, as a research assistant from 2017 until 2019. He assisted with the development of physical activity tools, co-ordination of field work and preparation of manuscripts for publication. His research interests include the prevention and management of non-communicable diseases using physical activity, as well as the development of contextualised physical activity interventions for lowincome populations. Smart’s Master and PhD degrees are in sport, recreation and exercise science – and his doctoral research addressed the promotion of physical activity among HIV-positive adults of low socioeconomic status. Ms Tshilidzi Manuga, BSc (Nutrition) (Venda) (Left SOPH October 2019) Tshilidzi Manuga was a research assistant for the SMART2D project, and a research assistant for the PURE project. She has a BSc degree in nutrition and is currently a Master student in the SOPH. Ms Hlolisiso Nonkeneza, BSc (Med Bioscience) (Western Cape) Having joined SOPH in 2017 as a student assistant, helping with general administrative functions, Hlolisiso now does project administrative duties. In 2019 and 2020 she has worked with the Edutainment Project. Ms Michelle Odendaal, Electronics Technician (Wingfield College) (Left SOPH June 2020) Michelle has varied experience in field work, data capturing and transcribing. She initially joined the SOPH in 2007 as a fieldworker and data capturer for a study on waiting and service times and on the Global Health Initiatives. From March 2018 to June 2020, she was a research assistant on the Global Early Adolescent Study. Ms Nomfundo Cishe Nomfundo has worked as a transcriber, data capturer and fieldworker in various research projects, including at the Desmond Tutu Health Foundation and at the University of Cape Town. She is currently working on two studies at UWC: one at the Centre of Excellence in Food Security and the other at SOPH, examining the impact of violence and crime on youth health service access.

Field staff Mr Rivalani Derrick Chauke, BSc Nutrition (Venda) (Left SOPH September 2019) Until 2019 Rivalani was a fieldworker on the Sivile Senza-Lifestyle Africa, a diabetes prevention programme that focuses on eating and exercise behaviour change in two townships in Cape Town. Ms Boniswa Jwili, Dip Enrolled Nurse Assistant (Elliot Hospital) Since 2009 Boniswa Jwili has been a fieldworker and data capturer for the PURE project, having worked as a fieldworker and a moderator for ten years. From 2016 until 2019 she worked on the SMART2D project, and the Sinako Project from June 2019 until June 2020. Prior to joining SOPH, Boniswa worked for several companies doing market research. Sandile Luke, BComm (Acc) (Walter Sisulu) Sandile worked for the global PURE project as a research assistant from 2013 to 2017, collecting data in the field and undertaking administrative duties as a fieldworker co-ordinator at the Eastern Cape site in Mount Frere. In May 2017 he joined the selfmanagement diabetes programme (SMART2D) as a fieldworker; and from October 2019 until June 2020 has worked on the Sinako Project . Ms Kholiswa Mphithi Kholiswa Mphithi brought her experience from various research projects, especially market research, to the PURE project when she joined in 2009 as a fieldworker. From 2017 to October 2019 she worked as a fieldworker with the self-management diabetes programme (SMART2D) after which she joined the Sinako Project. Mr Khumbula Ndibaza, Dip Nursing (Groote Schuur Nursing College) From 2009 Khumbula was a fieldworker and a data capturer for the PURE project – after which he was a fieldworker with the self-management diabetes programme (SMART2D) until September 2019. He is now working on the Sinako project. Khumbula has a Diploma in Nursing and is currently studying for a BA in Community Health Psychology at UNISA. Sivile Senzo-Lifestyle progamme, Sinako fieldworkers: Fieldworkers on Sivile Senza and fieldwork team leaders on Sinako from June 2019: • Nceba Phike • Esihle Nyalambisa Fieldworkers on Sivile Senza and fieldworkers on Sinako from June 2019: • Bongiwe Paka • Eleanore Francis • Thozama Honono–Kasozi • Sindiswa Mmango

Nutrition fieldworkers (Food Environment Team) Fieldworkers and control officers: from February 2018: • Mr Tyler Coates • Mr Sikhumbule Joni • Ms Alice Khan from February 2019: • Ms Aneeqah Latief • Ms Sharna Solomon • Ms Morongoa Tlhako from May 2019: • Ms Zintle Phekana

Administrative and support staff Ms Nolitha Komeni, BCom Management (Western Cape), PGCE (UNISA) Senior Office Co-ordinator (Joined the SoPH in June 2019) Nolitha Komeni re-joined the SOPH in June 2019 as the senior office co-ordinator, having previously held the position of administrative assistant / receptionist at SOPH in 2013. In the interim she worked for two years as Administrative Officer in UWC’s Education Faculty and for four years as faculty assistant at the Faculty of Health and Wellness on the Bellville Campus of the Cape Peninsula University of Technology. In her new position at the SOPH she heads the Administration of the School and her responsibilities include office and personnel management, oversight of Summer and Winter Schools and oversight of the financial administration of projects. Ms Carnita Ernest, BA, BSocSc (Hons) (Cape Town) Project manager Carnita Ernest re-joined SOPH to manage the Project Unit in August 2016, having occupied this post when it was first established in 2008. She oversees all funded projects, providing assistance to academics, monitoring the progress of projects and reporting. Carnita is a development practitioner with more than 15 years of experience in civil society organisations in South Africa and more broadly on the African continent, focusing on issues of governance, peacebuilding, health and development. She has worked for the Centre for the Study of Violence and Reconciliation, and the Centre for Citizens’ Participation in the African Union – as well as as an independent consultant. Carnita has conceptualised and led complex multicountry projects, undertaken fundraising for project and institutional needs, and overseen end-of-cycle evaluations of programmes, working with a diverse range of individuals and stakeholders. Her work is underpinned by her personal commitment to human rights, gender equity and social justice.

Ms Sidiqa Abbas Finance administrative officer Sidiqa Abbas is responsible for the financial administration of various projects in the School which includes the management of various project funds. She came to the University in May 2010, having worked in the private sector. Ms Cara Fisher, BCom Finance (Hons) (Western Cape) Finance administrative officer (Joined SOPH June 2019) Cara Fisher joined the SOPH in June 2019 after a longterm contract with UWC’s Economics Management Sciences Faculty as a facilitator. She is responsible for smaller National Research Foundation entities and all payment requests. Ms Tasneem Abrahams-Abbas Administrative officer Tasneem Abrahams-Abbas joined the SOPH in 2017, after a short-term contract at UWC’s Business Innovation Centre. She is responsible for building management, venue allocation and provides support to a range of staff. She also procures the equipment and assists with Winter and Summer School administration. Ms Bridget Basson, BAdmin (Hons) (Western Cape) Administrator Bridget Basson joined the SOPH in 2000, after working at the Education Policy Unit at UWC as a student assistant. She provides administrative/logistical support to a range of staff, arranges conferences, travel, and is involved in the co-ordination of the Summer and Winter Schools. Ms Ntombomzi Buzani Receptionist Ntombomzi Buzani joined SOPH while working for Securitas as a security officer at UWC. She was posted in the SOPH building from 2013. In March 2017 SOPH appointed her as office assistant and six months later as receptionist. She is responsible for the switchboard, general administration and venue bookings and assists with the Summer and Winter Schools. Ms Corinne Carolissen, ND Exec Sec & NHDPSE (PenTech) Senior programme officer Before joining SOPH in 2001, Corinne Carolissen worked in the retail industry for a buying support group, first as a buyer’s assistant and then as secretary to the regional manager. After studying Education, she moved to the non-governmental sector where she worked for Grassroots Educare Trust for 8 years in finance and administration, taught adult learners, and organised national workshops. At SOPH, Corinne co-ordinates the administrative functions of the academic programmes, including co-ordinating thesis administration for the Master and doctoral programmes; she assists with the Winter and Summer Schools administration and provides support to a range of staff and students.

Ms Teresa de Lima Financial administrator Before joining the SOPH in May 2004, Teresa worked at the SA Reserve Bank for 16 years, as well as at the Independent Development Trust and the European Parliamentarians for Africa. She is responsible for the financial administration of various projects in the School which includes the management of many project funds. Ms Janine Kader, HCED, Adv Dip Pub Admin (Western Cape) Administrative officer: Postgraduate Programme Janine Kader joined the SOPH in February 2002. She co-ordinates the administration for the Postgraduate Diploma and Master of Public Health, which includes co-ordinating the intake of new students and their registration, and provides administrative support to a range of academic staff and students. In 2020 Janine graduated with the Advanced Diploma in Public Administration. Ms Tamlin Petersen, Adv Dip Management (Western Cape) Administrative officer Tamlin Petersen joined the SOPH in 2002, initially working part-time on the Summer and Winter Schools. She joined the staff full time in 2009, when she became the administrative co-ordinator for the newly-formed UWC Centre for Research in HIV and AIDS, a position she held for five years. This comprised the overall administration of the Centre and event management, particularly the annual international HIV-in-Context Research Symposiums. Following this, she has become the Events and Grants Administrator for the School. In 2020 Tamlin graduated with the Advanced Diploma in Management. Ms Verna Williams Administrative officer Verna Williams has been assisting with Winter and Summer Schools for many years; and has also been assisting with reception and general administrative duties.

Honorary professors Prof Fran Baum, Bachelor of Arts (Hons) (Wales), PhD (Nottingham) Prof Fran Baum is the Matthew Flinders Distinguished Professor of Public Health, and foundation Director of the Southgate Institute of Health, Society and Equity at Flinders University, Adelaide, Australia. SOPH has had a long-standing, collegial relationship with both Fran and the Southgate Institute. In 1997 she and members of her academic team provided invaluable technical assistance to the School in establishing its pioneering distance education programme and were co-authors of many of the original core module of our MPH programme. Since then, Fran and the SOPH, under the leadership of the late Emeritus Prof David Sanders, have continued to

work together on a number of international public health research initiatives such as ‘Revitalizing Health for All: Learning from Comprehensive Primary Health Care (CPHC) Experiences’ (2007-2011), and, more recently, on ‘Punching above their weight: Building capacity for research on why some countries have better life expectancies than predicted by national income’ (2018-9). Fran is internationally recognised as a leader in applying social science skills to the study of the social and economic determinants of health and health equity. She has been advisor and consultant to the WHO on Healthy Cities, Health in All Policies and the social and economic determinants of health, and has a strong record of research translation to policy and practice. Most notably she served as a Commissioner on the WHO Commission on Social Determinants of Health from 2005 – 2008. Fran is a dynamic and esteemed public health educator and facilitator and we use her books, The New Public Health and the more recent Governing for Health, as key resources in our Postgraduate Diploma and MPH learning and teaching programmes. Prof Lucy Gilson, BA (Hons) (Oxford), MA (East Anglia), PhD (London) Prof Lucy Gilson holds the appointment of professor both at the University of Cape Town (UCT) and the London School of Hygiene and Tropical Medicine, UK – and is an honorary professor at the University of the Witwatersrand. Throughout her career, her research has been driven by a concern for equity in health and health care. This has involved conceptual and empirical work on issues of health care financing, organisation, management, and policy change. Lucy has also played a leading role in developing the field of health policy analysis, and currently manages a continental initiative to strengthen training in this field. She has also conducted collaborative research with colleagues in other countries in Eastern and Southern Africa, and in Asia. Lucy has had a long-standing relationship with the UWC SOPH, initially introducing her groundbreaking work in health policy analysis to the SOPH in a Winter School short course in 2008. Since then she has led numerous collaborations in health policy and systems research and teaching between UCT and UWC, including the CHESAI, CHEPSAA and DIALHS projects.

Extraordinary professors Dr Marisa Casale, Banking & Econ Sc (Siena), Masters Dev Studs (Padua), PhD Health Psych (Cape Town) Dr Marisa Casale joined the SOPH in 2017, originally as Extraordinary Senior Researcher. She has a multidisciplinary background, comprising banking and economic science, development studies and health psychology (the field of her PhD). For the past 16 years

she has been conducting multi-disciplinary health research in southern and South Africa, focusing mainly on caregiver and child health in the context of HIV. This has comprised work on HIV prevention and treatment adherence among youth, social networks and health, health financing and the economic aspects of HIV. Marisa has been a senior researcher and programme head of Health Governance and Finance at the University of KwaZulu-Natal’s Health Economics and HIV/AIDS Research Division (HEARD) and a senior teaching and research fellow at Oxford University’s Department of Social Health and Intervention, where she is now an Associate Member. She is currently work package lead and member of the executive group of the UKRI-GCRF Accelerating Achievement for Africa’s Adolescents Hub, led by Oxford University. Marisa has worked extensively within multi-country partner networks, including with UNAIDS, UNICEF, IFPRI, Metropolitan Life, IDRC, ODI, SIDA, South African government departments and international university partners. Prof Tanya Doherty, BNursing, MSc Nursing (Cape Town), MPH (Harvard), PhD (Uppsala) With qualifications in nursing and public health, Prof Tanya Doherty’s main research focus areas are community interventions to improve child health and nutrition. She has led cluster-randomised trials, cohort studies and multi-country evaluations of programmes across Africa. She has published over 100 peer reviewed articles. Tanya holds a joint position with the SOPH and the South African Medical Research Council. Prof Debra Jackson, BSN (Florida State), MPH (San Diego State), DSc (Boston) In August 2020 Prof Debra Jackson joined the London School of Hygiene and Tropical Medicine as the inaugural Takeda Chair in Global Child Health and Deputy Director of the MARCH Centre. Prior to this she had worked in the Health Section of UNICEF as Senior Health Advisor and Chief of the Implementation Research and Delivery Science Unit, which focused on maternal, newborn, child and adolescent health programme research, data and digital health. Debra lived in South Africa from 2000 to 2013 and has experience working across Africa, Asia, Pacific Islands and the USA. At the SOPH she served as principal investigator for research projects such as the multi-country PROMISE-EBF trial on promoting exclusive breastfeeding as well as the evaluation of the National South African Prevention of Mother-toChild Transmission of HIV. She has qualifications in nursing, public health, epidemiology and biostatistics. Her research interests are maternal and child health, nutrition, CRVS (civil registration and vital statistics), health systems, imbedded implementation research, maternal and child health data and digital health. She has over 140 peer-reviewed publications and serves on several global and WHO advisory committees.

Prof Richard O Laing, MD (Zimbabwe), MSc (London), DA (South Africa), MBChB (Zimbabwe) Prof Richard Laing is a physician who worked for 18 years at all levels in the Ministry of Health in Zimbabwe. After receiving postgraduate degrees in public health and health policy, he spent 13 years in Boston, USA, where he initially worked for an international consulting company, Management Sciences for Health, establishing the International Network for the Rational Use of Drugs. He was also an editor for Managing Drug Supply (2nd edition). Richard taught international public health at Boston University School of Public Health before joining the WHO in mid-2003 as a medical officer. During his ten years at WHO, he served on a number of expert committees and has been engaged in working on measurement of medicines pricing and availability as part of the joint WHO/HAI project on medicine prices. In 2014 Richard returned to the Boston University School of Public Health as Professor of International Health, teaching primarily in the pharmaceuticals track. Richard’s research has focused on access to medicines such as insulin, and on evaluating pharmaceutical company access initiatives such as Novartis NCD Access and the IFPMA multi-country Accelerating Access for NCDs. He has an extensive list of academic publications: he edited the Essential Drugs Monitor; he was one of the authors of the Priority Medicines for Europe and The World reports; and was also the editor of the WHO World Medicine Situation (3rd edition). Richard has received two Carnegie African Diaspora Fellowships which enable him to spend time at UWC. Prof Christina Zarowsky, MD (McMaster), MPH (Harvard), PhD (McGill) Prof Christina Zarowsky was a professor in the SOPH where she also headed the university-wide Centre for Research in HIV and AIDS from 2009 to 2013. At the end of that year she left to become the Professor and Director of the Department of Social and Preventive Medicine in the School of Public Health of the University of Montreal – and is also a researcher at the University of Montreal Hospital Research Centre. A medical doctor and anthropologist, Christina has specialised in public health. From 2000, she worked for the Canadian International Development Research Centre (IDRC) where she led the Research for Health

Equity suite of programmes and developed several donor partnerships. Her work at SOPH took forward the focus of her work at IDRC which examined public health and health systems issues from a governance perspective, emphasising civic engagement, attention to power and process, and strengthening linkages between research, policy, practice, and social change. Her areas of interest include social determinants of health, community and systems perspectives on HIV and AIDS, refugee and migrant health, and research capacity strengthening.

Extraordinary associate professors Assoc Prof Ehimario Igumbor, BSc (Hons) (Zimbabwe), MPH (Venda), PhD (Western Cape) With an initial degree in physiotherapy, Ehi Igumbor joined the SOPH as a senior lecturer in epidemiology and health information systems in 2007. He left in October 2012 to join the Centers for Disease Control and Prevention (CDC) in Pretoria. Ehi’s research interests include chronic disease epidemiology, burden of disease analyses, public health education and routine health information systems. He holds an MPH, majoring in Health Measurements (epidemiology, biostatistics and population studies) and a PhD in Public Health. Dr Vera Scott, MBChB, DCH (Cape Town), MPH, PhD (Western Cape) A medical doctor, Vera Scott worked as a clinician and programme co-ordinator within a fledgling district health system in Mitchells Plain in Cape Town in the late 1990s. While at the SOPH, she worked extensively on projects aimed at developing and strengthening district health information systems and contributed to developing a South African HIV Gauge, a Cape Town Equity Gauge and provincial HIV and TB monitoring and evaluation systems. Vera completed an MPH at the SOPH in 2001, and her PhD in 2015 through which she explored the factors that influence how facility managers use health information. She left in February 2016 to help establish the Tekano Fellowship Programme.

PUBLICATIONS These published works have been authored by SOPH staff and associated researchers including post-doctoral fellows. The work of SOPH Honorary and Extraordinary Professors is included only where the publication is undertaken in relation to the School.

From theses to articles: Publishing from the Master and doctoral programmes Eight MPH graduates have converted their mini-theses into articles which have been published in accredited research journals. This attests to the quality of research conducted by these Master-level students, and is a significant marker of effective research capacity development in SOPH. The burgeoning doctoral programme gives opportunities for early engagement in research through completing the PhD by publications or publishing research articles following completion of the PhD by monograph. In 2019 and 2020, 28 PhD students/graduates in Public Health produced 44 peer-reviewed publications in accredited health research journals. These are included in the publications list on these page – all student publications being marked with an *.

Books Shung-King M, Lake L, Sanders D & Hendricks M (eds). (2019). South African Child Gauge 2019. Cape Town: Children’s Institute, University of Cape Town.

Chapters in books Sanders D, Hendricks M, Kroll F, Puoane T, Ramokolo V, Swart R & Tsolekile L (eds). (2019). The triple burden of malnutrition in childhood: Causes, policy implementation and recommendations. In ShungKing M, Lake L, Sanders D & Hendricks, M (eds). South African Child Gauge 2019. Cape Town: Children’s Institute, University of Cape Town, pp 145-160. Schneider H, Daviaud E, Besada D, Rhode S & Sanders D. (2020). Ward-based primary health care outreach teams in South Africa. In Perry HB(ed). Health for the people: National Community Health Worker Programs from Afghanistan to Zimbabwe. Washington DC: USAID, pp.363-380.

Articles in peer-reviewed journals *Adebiyi BO, Mukumbang FC, Cloete LG & Beytell AM. (2019). Policy makers’ perspectives towards developing a guideline to inform policy on foetal alcohol spectrum disorder: A qualitative study. International Journal of Environmental Research and Public Health, 16(6), p.945. doi.org/10.3390/ijerph16060945 *Adebiyi BO, Mukumbang FC & Erasmus C. (2019). The distribution of available prevention and management interventions for Foetal Alcohol Spectrum Disorder (2007 to 2017): Implications for collaborative actions. International Journal of Environmental Research and Public Health, 16(12), p.2244. doi.org/10.3390/ ijerph16122244

*Adebiyi BO, Mukumbang FC & Beytell AM.(2019). To what extent is Foetal Alcohol Spectrum Disorder considered in policy-related documents in South Africa? A document review. Health Research Policy and Systems, 17. doi.org/10.1186/s12961-019-0447-9 Absetz P, Van Olmen J, Guwatudde D, Puoane T, Alvesson HM, Delobelle P, Mayega R, Kasujja F, Naggayi G, Timm L & Hassen M. (2020). SMART2D— development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden. Translational Behavioral Medicine, 10(1), pp.25-34. doi.org/10.1093/tbm/ibz188 *Adom T, Kengne AP, De Villiers A & Puoane T. (2019). Association between school-level attributes and weight status of Ghanaian primary school children. BMC Public Health, 19. doi.org/10.1186/s12889-0196937-4 *Adom T, De Villiers A, Puoane T & Kengne AP. (2019). Prevalence and correlates of overweight and obesity among school children in an urban district in Ghana. BMC Obesity, 6(1), p.14. doi.org/10.1186/ s40608-019-0234-8 *Adom T, Kengne AP, De Villiers A, Boatin R & Puoane T. (2020). Diagnostic accuracy of body mass index in defining childhood obesity: Analysis of crosssectional data from Ghanaian children. International Journal of Environmental Research and Public Health, 17(1), p.36. doi.org/10.3390/ijerph17010036 Agyapong NAF, Annan RA, Apprey C, Aduku LN & Swart EC. (2020). The association between dietary consumption, anthropometric measures and body composition of rural and urban Ghanaian adults: A comparative cross-sectional study. BMC Nutrition, 6, pp.1-12. doi.org/10.1186/s40795-020-00339-6 Al-Murani F, Aweko J, Nordin I, Delobelle P, Kasujja FX, Östenson CG, Peterson SS, Daivadanam M & Alvesson HM. (2019). Community and stakeholders’

engagement in the prevention and management of Type 2 diabetes: A qualitative study in socioeconomically disadvantaged suburbs in region Stockholm. Global Health Action, 12(1), p.1609313. *Amde WK, Marchal B, Sanders D & Lehmann U. (2019). Determinants of effective organisational capacity training: lessons from a training programme on health workforce development with participants from three African countries. BMC Public Health, 19(1), p.1557. doi.org/10.1186/s12889-019-7883-x *Amde WK, Sanders D, Sidat M, Nzayirambaho M, Haile-Mariam D & Lehmann U. (2020). The politics and practice of initiating a public health postgraduate programme in three universities in sub-Saharan Africa: The challenges of alignment and coherence. International Journal for Equity in Health, 19(52), pp.114. doi.org/10.1186/s12939-020-01163-x Arku RE, Brauer M, Ahmed SH, AlHabib KF, Avezum Á, Bo J, Choudhury T, Dans AM, Gupta R, Iqbal R, Ismail N & Puoane T. (2020). Long-term exposure to outdoor and household air pollution and blood pressure in the Prospective Urban and Rural Epidemiological (PURE) study. Environmental Pollution, 262, p.114197. doi. org/10.1016/j.envpol.2020.114197 Ashigbie PG, Laing RO, Wirtz VJ, Nkrumah N, Kemboi A & Nwokike J. (2020). Registration timelines of antiretroviral medicines in Ghana and Kenya. Aids, 34(7), pp.1093-1095. doi: 10.1097/ QAD.0000000000002514 Ashish KC, Gurung R,*Kinney MV, Sunny AK, Moinuddin M, Basnet O, Paudel P, Bhattarai P, Subedi K, Shrestha MP & Lawn JE. (2020). Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: A prospective observational study. The Lancet Global Health, 8(10), pp.e1273-e1281. *Assegaai T & Schneider H. (2019). National guidance and district-level practices in the supervision of community health workers in South Africa: A qualitative study. Human Resources for Health, 17. doi. org/10.1080/16549716.2019.1609313 *Assegaai T & Schneider H. (2019). The supervisory relationships of community health workers in primary health care: Social network analysis of ward-based outreach teams in Ngaka Modiri Molema District, South Africa. BMJ Global Health, 4(6). doi.org/10.1136/ bmjgh-2019-001839 Beran D, Laing RO, Kaplan W, Knox R, Sharma A, Wirtz V.J, Frye J, Ewen M. (2019). A perspective on global access to insulin: A descriptive study of the market, trade flows and prices. Diabetic Medicine, 36(6), pp.726-733. doi.org/10.1111/dme.13947 Bhavadharini B, Dehghan M, Mente A, Rangarajan S, Sheridan P, Mohan V, Iqbal R, Gupta R, Lear S, Wentzel-Viljoen E, Avezum A & Tsolekile L. (2020). Association of dairy consumption with metabolic syndrome, hypertension and diabetes in 147 812 individuals from 21 countries. BMJ Open Diabetes Research and Care, 8(1), p.e000826. doi.org/10.1136/ bmjdrc-2019-000826j

Bigdeli M, Rouffy B, Lane BD, Schmets G, Soucat A, The Bellagio Group. (2020). Health systems governance: The missing links. BMJ Global Health, 5, e002533. doi:10.1136/bmjgh-2020-002533 *Birungi FM, Graham SM, Uwimana J, Musabimana A & Van Wyk B. (2019). Adherence to isoniazid preventive therapy among child contactsin Rwanda: A mixed-methods study. PLOS ONE, 14(2): e0211934. doi.org/10.1371/journal.pone.0211934 Bodini C, Baum F, Labonté R, Legge D, Sanders D, Sengupta A. (2019). Methodological challenges in researching activism in action: civil society engagement towards health for all. Critical Public Health, 19:1. doi. org/10.1080/09581596.2019.1650892 Boulle A, Davies M.A, Hussey H, Ismail M, Morden E, Vundle Z, Zweigenthal V, Mahomed H, Paleker M, Pienaar D, Tembo Y, … Schneider H, et al. (2020). Risk factors for COVID-19 death in a population cohort study from the Western Cape Province, South Africa. Clinical infectious diseases, ciaa1198. https:// academic.oup.com/cid/advance-article/doi/10.1093/ cid/ciaa1198/5899044 Boydell V, Schaaf M, George A, Brinkerhoff DW, Van Belle S & Khosla R. (2019). Building a transformative agenda for accountability in SRHR: Lessons learned from SRHR and accountability literatures. Sexual and Reproductive Health Matters, 27(2), pp.64-75. https:// www.tandfonline.com/loi/zrhm21 Boyes ME, Cluver LD, Meinck F, Casale M & Newnham E. (2019). Mental health in South African adolescents living with HIV: Correlates of internalising and externalising symptoms. AIDS Care, 31(1), pp.95104. doi.org/10.1080/09540121.2018.1524121 Boyes ME, Pantelic M, Casale M, Toska E, Newnham E & Cluver LD. (2020). Prospective associations between bullying victimisation, internalised stigma, and mental health in South African adolescents living with HIV. Journal of Affective Disorders, 276(1), pp.418423. doi.org/10.1016/j.jad.2020.07.101 Brady L, De Vries S, Gallow R, George A, Gilson L, Louw M, Martin AW, Shamis, Stuart T. (2019). Paramedics, poetry, and film: health policy and systems research at the intersection of theory, art, and practice. Human Resources for Health, 17(1), p.64. Brown A, Harries J, Cooper D & Morroni C. (2019). Perspectives on contraceptive implant use in women living with HIV in Cape Town, South Africa: A qualitative study among primary healthcare providers and stakeholders. BMC Public Health, 19(1), p.1003. doi.org/10.1186/s12889-019-7312-1 *Cailhol J, Gilson L & Lehmann U. (2019). A decade of aid co-ordination in post-conflict Burundi’s health sector. Globalization and Health, 15(1), p.25. doi. org/10.1186/s12992-019-0464-z Campbell L, Masquillier C, Thunnissen E, Ariyo E, Tabana H, *Sematlane N, *Delport A, *Dube LT, Knight L, Flechner TK & Wouters E. (2020). Social and structural determinants of household support for ART adherence in low- and middle-income countries: A systematic review. International Journal of Environmental Research and Public Health, 17(11), p.3808.

Carbone N.B, Njala J, Jackson DJ, Eliya M.T, Chilangwa C, Tseka J, Zulu T, Chinkonde J.R, Sherman J, Zimba C and Mofolo IA. (2019). “I would love if there was a young woman to encourage us, to ease our anxiety which we would have if we were alone”: Adapting the Mothers2Mothers Mentor Mother Model for adolescent mothers living with HIV in Malawi. PLOS ONE, 14(6). doi.org/10.1371/journal Casale M, Boyes M, Pantelic M, Toska E & Cluver L. (2019). Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma? Journal of Affective Disorders, 245, pp.82-90. doi.org/10.1016/j. jad.2018.10.102 Casale M, Carlqvist A & Cluver L. (2019). Recent Interventions to improve retention in HIV care and adherence to antiretroviral treatment among adolescents and youth: A systematic review. AIDS Patient Care and STDs, 33(6), pp.237-252. doi: 10.1089/ apc.2018.0320 Casale M. (2020). COVID-19: Can this crisis be transformative for global health? Global Public Health, 15(11), pp.1740-1752. DOI: 10.1080/17441692.2020.1811366 Catley D, Puoane T, Goggin K, Tsolekile LP, Resnicow K, Fleming K, Smyth J.M, Hurley E.A, Schlachter S, Vitolins M.Z, Lambert E.V, Hassen M, Muhali K & Schoor R. (2020). Adapting the Diabetes Prevention Program for low-and middle-income countries: preliminary implementation findings from lifestyle Africa. Translational Behavioral Medicine, 10(1), pp.46– 54. doi.org/10.1093/tbm/ibz187 Catley D, Puoane T, Tsolekile L, Resnicow K, Fleming K, Hurley EA, Smyth JM, Vitolins MZ, Lambert EV, Levitt N & Goggin K. (2019). Adapting the Diabetes Prevention Program for low- and middle-income countries: Protocol for a cluster randomised trial to evaluate ‘Lifestyle Africa’. BMJ Open, 9(11). doi. org/10.1136/bmjopen-2019-031400 Cleary S, Orangi S, Garman E, Tabani H, Schneider M & Lund C. (2020). Economic burden of maternal depression among women with a low income in Cape Town, South Africa. BJPsych Open, 6(3). doi. org/10.1192/bjo.2020.15 Cooper D, Green G, Tembo D, *Christie S. (2019). Levels of resilience and delivery of HIV care in response to urban violence and crime. Journal of Advanced Nursing, 75(8), pp.1723-1731. doi.org/10.1111/jan.14022 Corbin JH, Mweemba O, Ottemöller FG, Pederson A, Leitch S, Boston-Fisher N, Matenga TFL, Delobelle P, Ayele C & Wicker J. (2020). Deconstructing hegemonic epistemologies: An urgent call for antiracist scholarship for health promotion and Black lives. Editorial. Health Promotion International, 35, pp 889-891. doi: 10.1093/heapro/daaa108 Coutsoudis A, Sanders D, Dhansay M.A, Van Stuijvenberg ME & Benn CS. (2019). Is it time for South Africa to end the routine high-dose vitamin A supplementation programme? SAMJ: South African Medical Journal, 109(12), pp.907-910. doi.org/10.7196/ samj.2019.v109i12.14203

*De Jong M, Collins A & Plüg S. (2019). “To be healthy to me is to be free”: How discourses of freedom are used to construct healthiness among young South African adults. International Journal of Qualitative Studies on Health and Well-being, 14(1), p.1603518. doi. org/10.1080/17482631.2019.1603518 De Man J, Aweko J, Daivadanam M, Alvesson HM, Delobelle P, Mayega RW, Östenson CG, Kirunda B, Kasujja FX, Guwattude D, Puoane T, Sanders D, Peterson S, Tomson G, Sundberg CJ, Absetz P, Van Olmen J. (2019). Diabetes self-management in three different income settings: Cross-learning of barriers and opportunities. PLOS ONE, 14(3), p.e0213530. doi. org/10.1371/journal.pone.0213530 De Man J, Wouters E, Delobelle P, Puoane T, Daivadanam M, Absetz P, Remmen R & Van Olmen J. (2020). Testing a self-determination theory model of healthy eating in a South African township. Frontiers in Psychology, 11, p.2181. Delobelle P. (2019). Big tobacco, alcohol, and food and NCDs in LMICs: An inconvenient truth and call to action; Comment on “Addressing NCDs: Challenges from industry market promotion and interferences”. International Journal of Health Policy and Management, 8(12), pp.727–731. Doherty T, Horwood C, Haskins L, Magasana V, Goga A, Feucht U, Sanders D, Tylleskar T, Kauchali S, Dhansay MA & Rollins N. (2020). Breastfeeding advice for reality: Women’s perspectives on primary care support in South Africa. Maternal & Child Nutrition, 16(1), p.e12877. Doherty T & *Kinney M. (2019). Low birthweight: Will new estimates accelerate progress?. The Lancet Global Health, 7(7), pp.e809-e810. https://www.thelancet. com/journals/langlo/article/PIIS2214-109X(19)30041-5/ fulltext#back-bib1 Duong M, Islam S, Rangarajan S, Leong D, Kurmi O, Teo K, Killian K, Dagenais G, Lear S, Wielgosz A, Nair, S & Igumbor EU. (2019). Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV1 (PURE): An international, communitybased cohort study. The Lancet Global Health, 7(5), pp.e613-e623. doi.org/10.1016/S2214-109X(19)30070-1 *Dutton J & Knight L. (2020). Reproducing neglect in the place of care: Normalised violence within Cape Town midwifery obstetric units. Agenda, 34:1, pp.1422. doi.org/10.1080/10130950.2019.1704481 *Dzomeku V, Van Wyk B & Lori J. (2019). An integrative literature review of interventions addressing knowledge, attitudes, and skills of health team to achieve best maternal outcomes. Journal of Midwifery and Reproductive Health, 7(4), pp.1971-1980. http://jmrh.mums.ac.ir/article_13477.html Egbe CO, London L, Kalideen S, Delobelle P & Datay I.(2020). The need to regulate electronic cigarettes amidst health concerns: Let’s follow the evidence. South African Medical Journal, 110(3), pp.178-179. doi. org/10.7196/SAMJ.2020.v110i3.14568

*Erasmus MO, Knight L & Dutton J. (2020). Barriers to accessing maternal health care amongst pregnant adolescents in South Africa: A qualitative study. International Journal of Public Health, 65, pp. 469–476. doi.org/10.1007/s00038-020-01374-7 Essack Z, Ngcobo N, Van der Pol N, Knight L, Rochat T, Mkhize M & Van Rooyen H. (2019). Refining interventions through formative research: A focus on ethical considerations in a family-based homebased counselling and testing (FBCT) intervention in KwaZulu-Natal. Journal of Empirical Research on Human Research Ethics, 15(3), p. 153-162. doi. org/10.1177%2F1556264619885214 Falconer NS, Casale M, Kuo C, Nyberg BJ, Hillis SD & Cluver LD.(2020). Factors that protect children from community violence: Applying the INSPIRE model to a sample of South African children. Journal of Interpersonal Violence. doi.org/10.1177%2F0886260519898425 Fuhr DC, Weobong B, Lazarus A, Vanobberghen F, Weiss HA, Singla DR, Tabana H, Afonso E, De Sa A, D’Souza E, Joshi A, Korgaonkar P, Krishna R, Price LN, Rahman A & Patel V. (2019). Delivering the Thinking Healthy Programme for perinatal depression through peers: An individually randomised controlled trial in India. Lancet Psychiatry, 6(2), pp.115-127. doi. org/10.1016/S2215-0366(18)30466-8 George AS, Amin A, GarcÍa-Moreno C & Sen G. ( 2019). Gender equality and health: Laying the foundations for change. The Lancet, 393(10189), pp.2369-2371. doi. org/10.1016/S0140-6736(19)30987-0 George A, LeFevre AE, *Jacobs T, *Kinney M, Buse K, Chopra M, Daelmans B, Haakenstad A, Huicho L, Khosla R, Rasanathan K, Sanders D, Singh NS, Tiffin N, Ved R, Zaidi SA & Schneider H. (2019). Lenses and levels: The why, what and how of measuring health system drivers of women’s, children’s and adolescents’ health with a governance focus. BMJ Global Health, 4(Suppl 4), p.e001316. doi.org/10.1136/ bmjgh-2018-001316 George A, McConville F, De Vries S, Nigenda G, Sarfraz S & McIsaac M. (2020) Violence against women health workers: The tip of the iceberg of gender power relations in global health. BMJ, 371:m354. doi. org/10.1136/bmj.m3546 George A, Olivier J, Glandon D, Kapilashrami A & Gilson L. (2019). Health systems for all in the SDG era: Key reflections based on the Liverpool statement for the fifth global symposium on health systems research. Health Policy and Planning, 34(Supplement_2), pp.ii135-ii138. doi.org/10.1093/heapol/czz115 George AS, Amin A, De Abreu Lopes CM & Ravindran TS. (2020). Structural determinants of gender inequality: Why they matter for adolescent girls’ sexual and reproductive health. BMJ, 368. doi. org/10.1136/bmj.l6985 Gilson L, Ellokor S, Lehmann U & Brady L. (2020). Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa. Social Science & Medicine, 266, p.113407. doi. org/10.1016/j.socscimed.2020.113407

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Zulu, JM, Kinsman J, Hurtig A, Michelo C, George A & Schneider H. (2019). Integrating community health assistant-driven sexual and reproductive health services in the community health system in Nyimba district in Zambia: mapping key actors, points of integration, and conditions shaping the process. Reproductive Health, 16(122). 10.1186/s12978-0190788-4.

Newspaper articles/blogs/podcasts – and policy briefs Brady L, Notywala A, Ryklief A, Swartbooi N, Van Ryneveld M & Whyle E. (2020). The power of people caring for those affected by Covid-19. Daily Maverick, 13 April 2020. https://www.dailymaverick.co.za/ article/2020-04-13-the-power-of-people-caring-forthose-affected-by-covid-19/ CAN Activists (2020). Cape Town Together: Organising in a city of islands. Daily Maverick, 30 June 2020. https://www.dailymaverick.co.za/article/202006-30-cape-town-together-organising-in-a-city-ofislands/ Casale, M. (2020). A stronger and more united Africa? Africa in Fact, Issue 55, October 2020. https://gga.org/ author/marisa-casale/ Doherty T, George A & Tomlinson M. (2020). We need to act now for the sake of our children. The Journalist, 25 August 2020. http://www.thejournalist.org.za/ spotlight/we-need-to-act-now-for-the-sake-of-ourchildren/ Doherty T, Lake L, Kroon M, Witten C, Rhoda N & Sanders D. (2019). Conflict of interest and the infant formula industry - a call to action. thebmjopinio,3 October 2019. https://blogs.bmj.com/bmj/2019/10/03/ conflict-of-interest-and-the-infant-formula-industrya-call-to-action/ George A, LeFevre A & Ved R. (2019). Taming the Wild West of digital health innovation. Project Syndicate, 11 June 2019. https://www.project-syndicate.org/ commentary/global-health-digital-innovationaccountability-by-asha-george-et-al-2019-06 George A, Ved R & Lefevre A. (2019). Digital tech can boost health. Mail & Guardian, 28 June 2019. https:// mg.co.za/article/2019-06-28-00-digital-tech-canboost-health?fbclid=IwAR2pD6RlKIiTfSUZuw2yC_ Q6LuWeLJw8_nLHDtgaU2j3ThoJEw3H9n1Z9KA#. XWYeUjT8uUB.facebook George A. (2019). When gender bias creates unequal health systems. Player FM. Opinion has it, 12 August 2019. https://player.fm/series/opinion-has-it/whengender-bias-creates-unequal-health-systems-ashageorge

Gilson L. & Lehmann U. (2020). Reflections on COVID-19 from health systems perspectives: Digest 1&2&3. Collaboration for Health Systems Analysis and Innovation (CHESAI), 21 April 2020. http://chesai.org/ index.php/about-us/blog/116-reflections-on-covid-19from-a-health-systems-perspective-digest-1-2-3 Kalideen S, London L, Egbe C, Delobelle P & Datay I. 2019. A fit of the vapers. The case against e-cigarretes.Daily Maverick, 28 May 2019. https://www. dailymaverick.co.za/article/2019-05-28-a-fit-of-thevapers-the-case-against-e-cigarettes *Kinney M. (2020). Collaboration for health systems analysis and innovation (CHESAI). Evaluating women’s voice in the politics of new born health, Tweet, 3 March 2020, viewed 05 March 2020, http://www. chesai.org/index.php/about-us/blog/114-elevatingwomen-s-voice-in-the-politics-of-newborn-health London L, Delobelle P, Egbe C & Kalideen S. (2019). Claims and evidence: How safe is vaping? University of the Western Cape School of Public Health – Latest News, 11 November 2019. http://www.uwcsoph.co.za/ index.php/about/news-and-announcements/latestnews/282-claims-and-evidence-how-safe-is-vaping Olamijuwon, E, Dake, FAA, Somefun, OD. (2020). Flaws in the collection of African population statistics block COVID-19 insights. August 3, 2020, The Conversation. Reynolds, L & Sanders D. (2019). To have or not to have an NHI. Daily Maverick, 22 August 2019. https:// www.dailymaverick.co.za/article/2019-08-22-to-haveor-not-to-have-an-nhi Schneider H. (2019). Assessing community health worker programme governanace: A guiding Framework. CHW Central, August 2019.https://www. chwcentral.org/blog/assessing-community-healthworker-programme-governance-guiding-framework Somefun OD. and Adebay K. (2020). Africa’s research ecosystem needs a culture of mentoring. The Conversation, 4 August 2020. https://theconversation. com/africas-research-ecosystem-needs-a-culture-ofmentoring-143030 Somefun, AD & Casale, M. (2020). How to keep adolescents’ social networks strong in a disrupted world. The Conversation, 15 October 2020. https:// theconversation.com/how-to-keep-adolescents-socialnetworks-strong-in-a-disrupted-world-147688 Somefun, O. (2020). Weathering the Storm: COVID-19 and the case for Universal Basic Income in Nigeria. June 12, 2020, The Republic. June/July 2020, Special Focus: Covid-19.

S omefun , OD. (2021). Sexual and reproductive health interventions to build resilience in youth. February 9, 2021, The African Academy of Sciences Tomlinson M, George AS & Doherty T. (2020). Drastic action is needed to ensure a better future for South Africa’s children. The Conversation, 3 March 2020. https://theconversation.com/drastic-action-isneeded-to-ensure-a-better-future-for-south-africaschildren-132291 Van Ryneveld M, Lehmann U & Schneider H. (2020). Stronger governance is at the heart of addressing the health workforce crisis. Spotlight, 7 September 2020. https://www.spotlightnsp.co.za/2020/09/07/strongergovernance-is-at-the-heart-of-addressing-the-healthworkforce-crisis/ Van Ryneveld, M. (2019). PHASA 2019 Reflections: The right to health after 25 years of democracy. Health-E News, 01 October 2019. https://health-e.org. za/2019/10/01/phasa-2019-reflections-the-right-tohealth-25-years-into-our-constitutional-democracy/ Whyle E, Van Ryneveld M, Brady L & Radebe B. (2020). Sparks, flames and blazes: Epidemiological and social firefighting for Covid-19. Daily Maverick, 24 April 2020. https://www.dailymaverick.co.za/article/2020-04-24sparks-flames-and-blazes-epidemiological-and-socialfirefighting-for-covid-19/ Whyle E, Van Ryneveld, M & Brady L. (2019). Ten Questions about Sizani Universal Healthcare -the DA’s answer to NHI. Health-E News, 16 September 2019. https://health-e.org.za/2019/09/16/10-questions-aboutsizani-universal-healthcare-the-das-answer-to-nhi/

Technical reports Barasa E, *Mothupi MC, Guleid F, Nwosu C, Kabia E, Araba D, Orangi S, Muraya K, Gitaka J & Marsh K. (2020). Health and socio-economic impacts of physical distancing for COVID-19 in Africa. Nairobi: Kenya Medical Research Institute (KEMRI). Barasa E, *Mothupi MC, Guleid F, Nwosu C, Kabia E, Araba D, Orangi S, Muraya K, Gitaka J and Marsh K. (2020). What are the health and socio-economic impacts of physical distancing in African countries and how can they be mitigated? Policy Brief. Health and socio-economic impacts of physical distancing for COVID-19 in Africa. Nairobi: Kenya Medical Research Institute (KEMRI). *Okeyo I, Lehmann U & Schneider H. (2020). The First Thousand Days within the Western Cape Whole of Society Approach: Lessons for the collaborative governance of intersectoral action for health. Technical Report. Cape Town: School of Public Health, University of the Western Cape. Schneider H with the Chaminuka Collective. (2019). Lenses, metaphors and research priorities on community health systems. Workshop Report. Chaminuka Lodge, Lusaka, Zambia, 10-14 June 2019. UNICEF (Casale M). (2020). Beyond Masks: Societal impacts of COVID-19 and accelerated solutions for children and adolescents.

Acknowledgements Written by staff of the School of Public Health Conceptualised by Uta Lehmann and Penny Morrell Compiled and co-ordinated by Uta Lehmann, Penny Morrell, Carnita Ernest and Tamlin Petersen Edited by Penny Morrell Design by www.themediachilli.co.za

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