Health & Social Systems
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Ntirhisano (traditional healers)
Strengthening the primary health care system through partnerships with traditional healers.
Ntirhisano is a transformative initiative dedicated to reshaping healthcare paradigms in rural South and Southern Africa by bridging the gap between traditional healing practices and the biomedical health system. There are about 200,000 traditional healers in South Africa, surpassing registered biomedical professionals. Ntirhisano thus recognises their significant role within communities and seeks to explore, through interdisciplinary research, their role in the delivery of primary health care.?
Many patients use both biomedical and traditional healing, creating challenges in treatment. This work aims to empower traditional healers through education, ensuring safe and effective care. It also promotes better collaboration between traditional and biomedical practitioners, improving patient referrals and overall healthcare quality.
The central aim of Ntirhisano is to enhance health outcomes, both for acute and chronic conditions, by partnering with traditional healers from local communities. The ultimate goal is to create a transportable model of cooperation between these two systems at the primary healthcare level, establishing a sustainable and scalable approach for similar settings. By fostering mutual respect and shared understanding, Ntirhisano envisions a future where traditional healers contribute effectively to the healthcare landscape, uplifting the well-being of rural communities within South and Southern Africa.
- PI(s): Carolyn Audet, Ryan Wagner
- Project Manager: Wonderful Mabuza
- Funder: NIH (USA)
- Collaborating Institutions: Vanderbilt University (USA)
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PHIRST-C Study
Prospective Household Study of SARS-CoV-2, Influenza, and Respiratory Syncytial Virus Community Burden, Transmission Dynamics and Viral Interaction in South Africa (PHIRST-C Study)
PHIRST-C was designed to provide critical insights into the natural history of SARS-CoV-2, helping shape strategies for pandemic containment and mitigation at local, regional, and global levels. The study focused on estimating the community burden of the virus and understanding its transmission dynamics, with a special emphasis on differences between age groups and individuals living with or without HIV.
Conducted as a prospective cohort study, PHIRST-C followed households in rural Agincourt and urban Klerksdorp from July 2020 to August 2021. Researchers collected mid-turbinate nasal swabs twice a week from all household members, regardless of symptoms, and tested them for SARS-CoV-2 using real-time RT-PCR. Participants were also surveyed about their symptoms and health-seeking behaviour. Every two months, serum samples were collected and tested for anti-SARS-CoV-2 antibodies through 2022.
The study revealed high levels of asymptomatic infections (85.3%) and found that HIV-infected individuals who were not virally suppressed were more likely to experience symptomatic illness and shed the virus for a longer period than those without HIV. Importantly, the research showed that control measures targeting symptomatic individuals might have limited effectiveness, as symptom status of the index case did not influence the likelihood of household members becoming infected.
- PI: Cheryl Cohen
- Co-investigators: Kathleen Kahn, Stephen Tollman, Xavier Gómez-Olivé, Neil Martinson
- Project Manager: Floidy Wafawanaka
- Funders: US Center for Disease Control (USA), National Institute for Communicable Diseases (SA), Wellcome Trust (UK)
- Collaborating Institutions: NICD, and Perinatal HIV Research Unit (PHRU) (SA)
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Verbal Autopsy with Participation Action Research (VAPAR)
VAPAR tackles the issue of exclusion from healthcare by connecting service users with providers to generate actionable, locally relevant research. The program addresses two critical challenges:
- The lack of research on the health needs of those excluded from healthcare and information systems.
- The underutilisation of evidence by key authorities, such as health service planners, managers, policymakers, and providers at various levels.
VAPAR: Fostering Collaboration for Health Equity
VAPAR creates a dynamic space where research connects people and services through a mutually supportive learning and action process. By combining longitudinal data with personal narratives and visual images, we generate insights and interpretations that are directly relevant to both communities and health systems. The goal is to drive meaningful impact on health services by fostering inclusive, adaptive knowledge partnerships that strengthen health systems and contribute to achieving health equity.
Our Objectives:
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Strengthen Health Systems through Knowledge Partnerships
We bring together diverse groups to reflect and act on insights about disease burdens, social and health system factors, and the needs of disadvantaged communities. By engaging health systems at all levels, we work to develop actionable recommendations, implement plans, and continuously reassess progress.2. Evaluate Health, Equity, and Empowerment
Through three cycles of reflection and action, we analyse health outcomes, behaviours, and service provision. Our focus is on understanding why and how changes occur and assessing their impact on health equity, empowerment, and the use of evidence in different social and political contexts.3. Build Sustainability and Transferability
We aim to integrate VAPAR into everyday health systems to turn co-produced evidence into lasting action. By supporting communities of practice with teaching, training, and widespread dissemination, we ensure that health systems actors, public stakeholders, and research groups can continue driving change through co-produced evidence.
PI: Lucia D’Ambruoso
Co-Investigators: Stephen Tollman, Kathleen Kahn, Maria van der Merwe, Gerhard Goosen, Jerry Sigudla
Funder: South Africa Health Systems Research Initiative from DFID, MRC, Wellcome Trust, ESRC (SA); Scottish Funding Council, Newton Fund, GCRF (UK)
Collaborating Institutions: University of Aberdeen, and Queen Margaret University (Scotland); Mpumalanga Department of Health (SA); Umea University (Sweden)
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Know your numbers
People over 60 years old in South Africa have a high prevalence of hypertension. In this age group, over four million receive an Older Person Grant (OPG), and many recipients queue to collect these grants. These queues – at post offices, retail stores and mobile South African Social Security Agency (SASSA) cash payment points – present a unique opportunity to deliver an intervention for blood pressure (BP) reduction to people who are generally not able to access public health services at clinics.
Know Your Numbers (KYN) was a 12-month study aimed at assessing whether regular blood pressure (BP) measurements and feedback in grant queues, combined with promoting hypertension awareness and referrals to care, could help reduce BP in participants. The study took place in six queues in the Bushbuckridge sub-district in Mpumalanga, where BP was measured monthly. Alongside these measurements, we promoted hypertension knowledge, introduced a BP Report Card, and referred individuals with high blood pressure for care.
Throughout the intervention, we performed over 7,000 BP measurements, with 73% of them taken from women. The results showed that regular BP measurement in grant queues, combined with increased hypertension awareness, was effective in reducing BP among older, rural populations.
- PI(s): Xavier Gómez-Olivé, Charles Parry
- Project Manager:?Jane Simmonds
- Funder: South African Medical Research Council
- Collaborating Institutions: SAMRC