Research Articles (School of Public Health)

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Peer-learning and support among health policy and systems research actors in West Africa: a social network analysis
(BioMed Central Ltd, 2025) Defor, Selina; Mukinda, Fidele Kanyimbu; Lehmann, Uta
Background: Health policy and systems research (HPSR) is vital for strengthening health systems, yet its development in West Africa remains constrained by limited capacity. To strengthen capacity, the West African Network of Emerging Leaders in Health Policy and Systems (WANEL) was created to foster peer learning and cross-country collaboration among early- and mid-career HPSR actors. This study used Social Network Analysis (SNA) to examine WANEL’s structure and functioning, with the aim of understanding how well the network supports its capacity and HPSR field-building goals. Methods: A cross-sectional whole-network survey was conducted with all 103 WANEL members, supported by document reviews and qualitative interviews. Relationship types assessed included acquaintance, communication, advice, mentorship and research collaboration. Data were analysed using Gephi to visualize relational patterns and compute metrics such as density and centralization, while qualitative findings provided context for interpreting network dynamics. Results: While WANEL has enhanced cross-country awareness and disciplinary diversity, the network exhibits low cohesion and high centralization. Key support relationships, particularly mentorship, advice and collaboration are sparse and unevenly distributed. A few actors dominate the flow of information and access to opportunities, while many, especially early-career and francophone actors, remain peripheral or isolated. Network interactions are driven by prior relationships and linguistic or professional affinity, limiting broader engagement. Conclusion: Findings reveal structural barriers that constrain WANEL’s potential to act as an inclusive platform for HPSR capacity-strengthening. To fulfil its vision, the network must address its current fragmentation by building stronger cross-cutting ties, broadening participation and decentralizing influence. This study contributes empirical insights into the design and governance of regional HPSR networks in low- and middle-income contexts and underscores the importance of relational infrastructure in advancing collective capacity.
Contextual constraints and dilemmas influencing health providers’ prescription practices in a conflict-affected area: qualitative insights from Mopti, Mali
(Public Library of Science, 2025) Ravinetto, Raffaella M.; Coulibaly, Issa; Diarra, Yacouba
Armed conflicts present complex, multidimensional challenges that severely compromise both access to and the quality of healthcare, including the adequate prescription of essential medicines. This study aimed to identify and understand the factors underlying the irrational prescribing of medicine in areas affected by armed conflict in the Mopti region in Mali. An exploratory qualitative study was conducted using a semi-structured interview guide to collect data from 30 participants, including health professionals from three health districts, representatives of the regional health directorate, members of community health associations, and staff from non-governmental organisations (NGOs) working in health sector. Interviews were recorded, transcribed, and subjected to thematic content analysis, using NVIVO 14 (2023 version) to support coding and data retrieval. Study participants reported a range of health system- and patient-related factors contributing to irrational prescribing practices in these conflict-affected areas. Health systems factors included: an imbalance between workload and the availability of qualified staff; limited access to professional training and training resources; poor adherence to prescription guidelines and procedures -often a consequence of contextual constraints; and coercion from armed terrorist groups. Administrative and political challenges were also highlighted, including weak monitoring and supervision mechanisms within the local health system; a lack of oversight by health and regulatory authorities in blockaded areas; the development of an informal pharmaceutical sector to compensate for deficiencies in the formal system; and over prescription of medicines linked to insurance schemes.
Ritshidze's community-led monitoring system as a source of information on health system responsiveness in South Africa
(South African Medical Association, 2025) Govendor, Karessa; Schneider, Helen; Barron, Peter
Ritshidze is a large-scale community-led monitoring (CLM) system in South Africa, which has been conducting quarterly surveys of patient experiences at >400 primary healthcare facilities and community sites since 2019. This in-practice piece examines the data collected and publicly reported by Ritshidze, to highlight its role as an independent, complementary source of information on primary healthcare performance. It argues that CLM has significant potential to enhance health system responsiveness. We provide an overview of the data collection system, involving close to 500 data points organised into seven domains, and then focus on two sets of indicators that illustrate the utility of the monitoring and reporting system. The indicators selected are a set that assesses patient time spent at a facility (as a proxy for waiting times), illustrating both the depth and the breadth of the Ritshidze database; and the length of HIV prescriptions ('length of medicine refill'), as an indicator of the improvements in responsiveness of the health system to the needs of patients. Integrating CLM data into formal health system monitoring and evaluation frameworks could enhance the responsiveness of the health system to patients and communities, one of the key overall objectives of the district health system.
“I’ll continue if I have a positive mind”: identifying the ways in which depression and PTSD impact prep adherence among prep-experienced pregnant and postpartum women in Cape Town, South Africa
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Knight, Lucia; Stanton, Amelia; Fertig, Madison
Pregnant and postpartum people (PPPs) face heightened risk for HIV acquisition, yet depression and trauma-related symptoms can undermine adherence to pre-exposure prophylaxis (PrEP). To inform the development of a brief mental health-focused adherence intervention, we explored the impacts of depression and posttraumatic stress disorder (PTSD) symptoms on PrEP use among PPPs in Cape Town, South Africa. Twenty-eight PPPs with elevated symptoms of depression and/or PTSD and recent PrEP adherence challenges completed qualitative interviews. Six antenatal providers were also interviewed. Thematic analysis revealed three key findings with subthemes that deepen exploration of each theme: (1) depression and PTSD symptoms contributed to missed PrEP doses or late pickups by increasing doubt about PrEP efficacy, amplifying pill burden, intensifying avoidance and withdrawal (e.g., hypersomnia and disengagement from providers), and disrupting memory through rumination and emotional overload; (2) most PPPs preferred support from professional counselors, while a minority preferred informal support; and (3) intervention design considerations included aligning patient and provider goals, selecting between individual or group formats, and addressing integration barriers such as staffing and space constraints. Providers affirmed the need for embedded mental health support. Intervention strategies that increase PrEP knowledge and motivation while targeting emotional withdrawal, fatigue, and cognitive overload may improve adherence and reduce HIV risk in this population.
Maternal age and parity influences on health outcomes: a multivariable regression analysis of mothers and infants
(BioMed Central Ltd, 2025) Nyati, Lukhanyo H.; Alcock, Stephanie; Leal, Michelle
Background: Adverse pregnancy and birth outcomes remain significant public health challenges, particularly in low- and middle-income countries (LMICs). Maternal age and parity are recognised as key factors, yet their combined influence on maternal and infant outcomes is less understood, especially in LMICs. Objectives: We investigated the combined effects of maternal age and parity on maternal health risks, including body mass index (BMI), gestational diabetes mellitus (GDM), and hypertension, as well as infant birth outcomes, namely birth weight, length, and gestational age, in an urban South African cohort. Methods: This study used data from 830 pregnant women (aged 18–44) enrolled in the Soweto First 1000 Days (S1000) longitudinal cohort. Group comparisons were conducted using ANOVA, chi-square, or Kruskal-Wallis tests. Multivariable Linear and logistic regression models assessed associations between age-parity and outcomes, adjusting for sociodemographic factors. Analyses were conducted in StataSE 18; p <.05 was considered significant. Results: Mothers > 23 years, ≥ 1 child had higher BMI (28.6 kg/m², p <.001) and increased likelihood of hypertension (44.1%, p <.001), and GDM (7.4%, p =.012). Nulliparous women showed greater gestational weight gain (0.39 kg/week, p <.001) and an increased likelihood of having low birth weight (2960 g vs. 3185 g, p =.002), small for gestational age (SGA) (22.9%, p =.009), and shorter birth length infants (z = − 0.29, 95% CI: [− 0.57 to − 0.01], p =.04). Infants of mothers ≤ 23 years, ≥ 1 child had higher birth weight (β = 0.60, 95% CI: [0.32–0.88]; p <.001) and length z-scores (95% CI: [0.01–0.97], p =.046). Hypertension (β = −0.99, 95% CI: [− 1.52 to − 0.45], p <.001) and GDM (β = −0.57, 95% CI: [− 1.10 to − 0.04], p =.036) were associated with shorter gestational age. Conclusion: Maternal age and parity were associated with distinct risks to maternal and infant health. These findings support the need for more targeted, risk-based antenatal strategies in LMICs.
Assessing the performance of local pharmaceutical systems: an analytical approach to improve access to medicine
(SAGE Publications Ltd, 2025) Ravinetto, Raffaella; Kok, Maarten Olivie; Fanda, Relmbuss Biljers
Well-functioning pharmaceutical systems are crucial for ensuring universal access to medicines and their appropriate use. While existing frameworks for analysing pharmaceutical systems generally focus on the national level, in many countries, the core functions are often managed locally within a broader national framework. Despite this local focus, there has been no effort to conceptualize a ‘local pharmaceutical system’ as a distinct entity with its own goals, functions and operational components. A method for analysing and comparing the performance of local pharmaceutical systems (LOPHAS) within a country is still lacking. We aim to develop an analytical approach and framework to assess the performance of LOPHAS and guide improvements in access to essential medicines. We conducted an integrative literature review and consulted with purposively selected experts. We systematically searched for existing approaches for conceptualizing or assessing pharmaceutical systems and empirical studies in which these were applied and combined this with insights from 23 reviews and guidebooks suggested by experts to develop the LOPHAS approach and framework. We identified 13 existing frameworks and 16 studies that had applied these frameworks to analyse pharmaceutical systems. Building on these findings, we propose that a LOPHAS has six core functions: (1) local governance, (2) managing product supply, (3) financing, (4) developing human and physical resources, (5) appropriate dispensing and use of medicines and (6) monitoring performance. For each function, we defined operational components and indicators. The primary outcomes of a LOPHAS are access to medicine and appropriate use of medicine. The LOPHAS framework provides a practical tool for assessing and comparing the performance of LOPHAS. By identifying areas for improvement, it can guide policymakers, healthcare providers and local administrators in strengthening systems to ensure that essential medicines are accessible and used appropriately, supporting broader health goals.
Improving health professionals’ capacity to respond to the climate crisis in Africa: outcomes of the Africa climate and health responder course
(Frontiers Media SA, 2025) Amde, Woldekidan; Magalhães, Danielly De Paiva; Sorensen, Cecilia
Introduction: The fragile health systems in Africa worsen climate-related health impacts, making capacity building essential to strengthen adaptation and resilience. The Africa Climate and Health Responders Course was developed to address the urgent need for climate and health education among African health professionals. Organized by the Global Consortium on Climate and Health Education (GCCHE) in collaboration with ASPHA, Africa CDC, WHO AFRO, Project ECHO, and other regional partners, the course aimed to enhance awareness, communication skills, and preparedness in responding to climate-related health challenges. Methods: Delivered online via Zoom with over 11 sessions (September 17–October 22, 2024), the course featured expert lectures, case studies, and live discussions. Simultaneous interpretation in English, French, and Portuguese ensured broad accessibility. Participants who attended at least 70% of live sessions and passed the final exam received a certificate. A longitudinal survey was applied to understand the course impact. Results: The course attracted 7,572 registrants, with 89% from Africa. While 3,500 participants attended at least one session, only 1,657 participated (1,607 from Africa) attended 70% or more of the sessions and completed the final survey. Participants held positions in government (31%), Non-Governmental Organizations (NGOs) (27%), academia (24%), private sector (11%), and others (7%). Their main professional backgrounds were public health (33.2%), medicine (16.3%), and environmental health (13.2%). The majority of participants (66%, n = 1,100) had never received prior training in climate and health; among them, 36% (n = 392) were students and 64% (n = 708) were not students. Discussion: The course significantly improved participants’ self-reported confidence and perceived preparedness, with increases in: climate-health awareness (+22%); confidence in risk communication (+40%); preparedness for adaptation and resilience (+36-37%), and professional responsibility in climate-health action (+21%). These findings highlight not only the feasibility and effectiveness of virtual training in this context, but also the opportunity for scaling such initiatives to build a climate-resilient health workforce across Africa. Skilled professionals are key to fostering multi-stakeholder collaboration, integrating climate-health education, and engaging communities—efforts that require sustained investment in capacity building to institutionalize competencies and strengthen public health systems and policies over the long term.
Healing bodies, healing communities: a community-based qualitative study of adult survivors of childhood sexual trauma in South Africa
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Morgan, Leona; Nadar, Sarojini; Keygnaert, Ines
Highlights: Body-based care models respond better to long-term, intergenerational and somatic aspects of sexual trauma in survivors being historically excluded from mental health care. Co-creation of care pathways ensures culturally sensitive approaches that are responsive to lived experiences of marginalized survivors of childhood sexual trauma. What are the main findings? Relational safety and somatic engagement were foundational to trauma recovery, enabling survivors to process trauma at their own pace and integrate dissociative experiences through embodied therapeutic praxis. Recovery was relational and continuous, with participants reporting increased peace, authenticity and social connection despite structural barriers, highlighting the effectiveness of culturally grounded, non-pathologizing care. What is the implication of the main finding? Integrative Trauma-Informed Care (ITIC) offers a culturally sensitive, adaptable framework that can be tailored to diverse communities and age groups, emphasizing embodied, intergenerational and relational healing. Decolonial and feminist approaches to mental health care can bridge epistemic gaps in ITIC praxes by centering survivors’ lived, embodied experiences, promoting sustainable and inclusive therapeutic models globally. Background: While sexual trauma is inherently an embodied experience, research on psychological interventions that is cognisant of geographic and socio-political community contexts within which embodied, therapeutic interventions occur remains limited. Decolonial, African and feminist community psychologies have noted this epistemic–ethical gap. Objectives: This paper explores the co-development of trauma-informed care pathways for adult survivors of childhood sexual trauma (CST) in under-resourced communities in Cape Town, South Africa. The study aimed to integrate intergenerational community knowledge, embodied therapeutic practices and collaborative approaches into locally relevant models of care. Methods: Drawing on feminist mental health frameworks, this qualitative study engaged 13 adult female survivors who identify as “coloured”. Embodiment was central in guiding the deconstructive therapeutic praxis, informing both the co-development of care pathways and the conceptualization of integrative trauma-informed care (ITIC) beyond pathologizing, deficit-based narratives. The cultivation of trust and the situated lived realities of survivors were foregrounded to illustrate the relational dimensions of trauma recovery. Results: Establishing relational safety emerged as the foundation for therapeutic engagement, supported by non-directive therapeutic probing. Grounding practices, affective regulation and embodied awareness enabled participants to process trauma at their own pace. Somatic engagement allowed the integration of dissociative experiences while strengthening relational resilience. Recovery was a continuous process, with participants reporting increased peace, authenticity and capacity for social connection despite structural barriers to community support. Conclusions: The development of care pathways was embedded within the research process itself, offering an approach that is culturally sensitive and responsive to survivors’ lived experiences. ITIC accounted for temporal, intergenerational and embodied trauma and should be adaptable across age and community-specific needs. The ITIC approach offers a transferable framework for co-developing de-pathologizing, culturally responsive interventions that can be adapted across diverse global contexts to support sustainable trauma integration.
Women’s experiences of communication and supportive care during labour: a qualitative study in rural KwaZulu-Natal, South Africa
(BioMed Central Ltd, 2025) Doherty, Tanya; Luthuli, Silondile; Horwood, Christiane
Background: Quality maternal care is crucial to improve outcomes for both mothers and newborns. Many initiatives to improve maternal care concentrate on improving clinical practice. However, women’s experiences of care are also important determinants of health outcomes. Establishing strong interpersonal relationships between health workers and women is essential for delivering high-quality person-centered care, with health workers who empathize with women, respect their needs and concerns, and communicate effectively. Aligned with the World Health Organization standards of care framework, this study aimed to explore women’s experiences of care during labour and childbirth, focusing on communication, respectful, and supportive care. Methods: A qualitative exploratory study was conducted with postpartum women in rural district hospitals in KwaZulu-Natal. Purposive sampling was used to recruit women from communities within the hospitals’ catchment areas. Data were collected through focus group discussions (FGDs) conducted in the local language of participants. Five FGDs were conducted between January and April 2023. Inductive thematic analysis using NVivo v12 was employed to analyze the data. Findings: A few women described positive experiences of care, but most women reported suboptimal care characterized by poor communication, lack of privacy, and disrespectful treatment. Participants described experiences of verbal and physical abuse, being called demeaning names, facing invasive procedures without providing consent, and inadequate emotional support, such as their concerns being systematically ignored and birth companions being denied entry to labour wards. Some women responded to these challenges through various coping mechanisms including staying quiet to avoid confrontation, following instructions rigidly, seeking advice from other women in the labour ward, and in some cases standing up for themselves. Some women described persistent anger and distress as a result of their experiences. Conclusion: The findings of the study highlight persistent gaps in effective communication and supportive care for women during labour and childbirth. Possible interventions could be aimed at improving communication skills of health workers as well as fostering a culture of empathy and respect for women in their care. In addition, empowering women through antenatal education and implementing birth companion policies could further improve women’s experiences during labour and childbirth.
Public health diplomacy: summary of the methods and outcome of the 1st University of Memphis School of Public Health Diplomacy Summit
(Frontiers Media SA, 2025) Amde, Woldekidan; Joshi, Ashish; Magana, Laura
Public health diplomacy addresses global challenges impacting societies, economies, the environment, and health by integrating foreign policy and development. The University of Memphis School of Public Health hosted a multistakeholder summit to identify strategies and competencies essential for effective public health diplomacy. A 3-day summit included 29 participants from 15 countries, representing the WHO, the World Federation of United Nations, and seven regional public health associations. An iterative human-centered design (HCD) approach and concept mapping were employed to facilitate discussions and generate actionable recommendations. Developed a working definition of Public Health Diplomacy emphasizing cross-disciplinary collaborations, communication, negotiation, and consensus building. Produced a 9-point action plan to establish a global framework, launch capacity-building initiatives, and institutionalize public health diplomacy as a public health discipline.
Tracking viral control in adolescents on antiretroviral therapy in Lusaka, Zambia: a retrospective cohort analysis
(AOSIS (pty) Ltd, 2025) Moomba, Kaala; van Wyk, Brian; Crowley, Talitha
Background: In 2023, an estimated 39.9 million people globally were living with HIV, of which 1.55 million were adolescents aged 10–19 years. The 2021 Zambia HIV Impact Assessment revealed lower viral suppression rates in adolescents (15–24 years old) compared to adults on antiretroviral therapy (ART). Lusaka District, Zambia, has the highest number of adolescents on ART, with a 15.1% HIV prevalence in 2018. Objectives: To determine the prevalence and factors associated with viral suppression among adolescents living with HIV (10–19 years) on ART in Lusaka District, Zambia. Method: A retrospective cohort analysis was done of 3409 adolescents on ART at public health facilities in Lusaka from January 2023 to December 2023, and who had viral loads recorded. Socio-demographic, clinical, treatment and behavioural data were extracted from electronic health records and analysed using SPSS version 29. Results: The adolescent cohort in Lusaka achieved 91.8% viral suppression rate (< 1000 copies/ mL), with 79% fully suppressed (< 50 copies/mL). In multivariate analysis, older adolescents (15–19 years) had lower odds of suppression compared to younger adolescents (10–14 years) (adjusted odds ratio [AOR] = 1.79; confidence interval [CI]: 1.32–2.43). Higher odds of viral suppression were linked to first-line dolutegravir regimen (AOR = 5.12; CI: 3.23–8.11) and optimal adherence (AOR = 1.89; CI: 1.03–3.47), while regimen switches reduced the odds of viral suppression (AOR = 0.60; CI: 0.45–0.80). Conclusion: Zambia reached the previous UNAIDS 90-90-90 targets with a viral suppression rate of 91.8%. However, to reach the revised 95% target by 2030, tailored interventions should be implemented to improve adherence and retention in care, particularly for older adolescents
Policy implementation and recommendations to address the double burden of malnutrition in South Africa: expert assessment using the expanded Healthy Food Environment Policy Index (Food-EPI)
(BioMed Central Ltd, 2025) Mchiza, Zandile June-Rose; Holliday, Nicole; Delobelle, Peter
Background: South Africa faces a double burden of malnutrition (DBM), the coexistence and interaction of multiple forms of malnutrition (undernutrition, micronutrient deficiencies, and overweight/obesity) within individuals and households and across the life course. A healthy food environment is necessary to reduce this DBM. The Healthy Food Environment Policy Index (Food-EPI) can be used to evaluate the implementation of public nutrition and food environment policies in comparison with international best practices. The aim of this study was to assess the extent of implementation of healthy food environment policies in South Africa using an expanded DBM Food-EPI framework, benchmark policies against international best practices, develop priority policy recommendations, and compare implementation progress since the 2016 South African Food-EPI assessment. Methods: From October 2023 to March 2024, a panel of 23 national experts from different tiers of government (Department of Health), academia, and civil society was invited to participate in the Food-EPI assessment. Through two workshops and online feedback, experts evaluated the implementation of food environment policies across 60 indicators, compared these policies to international best practices, and proposed and prioritized a list of policy actions based on perceived implementation gaps. Results: Of the 23 invited experts, 13 participated in the benchmarking workshop in which about 70% of indicators were rated at very low to low levels of implementation. Overall, of the 48 original indicators, the mean level of implementation improved from 2016 to 2024. Of the 12 indicators that addressed the DBM, eight were rated at very low to low levels of implementation. The experts (original panel plus four additional participants) then proposed ten priority actions, mainly across the domains of Food Promotion, Food Prices, Funding, and Platforms for Interaction. Conclusions: Application of the expanded Food-EPI in South Africa showed improvements for the original indicators compared with 2016 and highlights the need for additional policy efforts to improve public nutrition policy and address the DBM.
Global maternal child health initiatives and programs 1974 to 2023
(Springer, 2025) Jackson, Debra
Aim: This review paper aims to review Global MCH initiatives and note trends across the last five decades (1974–2023). Methods: As an organizing framework, MCH initiatives and programs have been classified into five categories: Global Health Conferences, Declarations or Strategies; Global Health Surveys; Global MCH Programs; Global MCH related Data Initiatives or Working/Advisory Groups; and Global MCH Partnerships or Networks. Results: Over 50 Global MCH initiatives and programs have been implemented during this period. The first International Conference on Primary Health Care and the Alma Ata Declaration in 1978 initiated a new era of global public health. International conferences building on Alma Ata with a focus on population health and MCH, along with global surveys to measure the health status of populations across countries and global working groups to analyze these data, emerged over the next decades. Global MCH partnerships also emerged for advocacy and coordination of an increasing number of efforts to improve maternal, newborn, child and adolescent health and well-being—towards achieving the Millennium (2000–2015) and Sustainable (2016–2030) Development Goals. Conclusion: Four trends were noted across these five decades: (1) MCH Mortality decreased but unacceptable inequities persist with COVID-19, ongoing conflicts and climate change threatening these gains. (2) Implementation of primary health care (PHC) as envisioned by Alma Ata in 1974 continues to see a debate about selective versus comprehensive programs. (3) As mortality declined (Survive), the field expanded focus to child well-being (Thrive) and across preconception through adolescents (Transform). (4) Global MCH issues are relevant across high-income (HIC) and low-middle income (LMIC) settings to achieve health and well-being of all women and children everywhere.
Perceived accuracy and utilisation of DHIS2 data for health decision making and advocacy in Kenya: a qualitative study
(Public Library of Science, 2025) Oware, Phoene Mesa; Omondi, Gregory; Adipo, Celestine
Reliable health information systems (HIS) are critical for effective decision-making in the delivery of Primary Health Care and Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (PHC/RMNCAH+N) services. In Kenya, the District Health Information Software 2 (DHIS2) platform serves as the primary HIS for tracking health indicators. This qualitative study explored perceptions of DHIS2 data accuracy and use for decision-making among PHC/RMNCAH+N stakeholders across 15 counties in Kenya. 89 Key Informant Interviews were conducted with PHC/ RMNCAH+N stakeholders, to explore experiences, barriers, and facilitators of DHIS2 data use. Thematic network analysis was employed to identify recurrent themes and generate insights into the utility of DHIS2-generated information. Sociotechnical challenges included limited technical capacity among health staff, inadequate analytical skills, and reliance on a small pool of Health Records Information Officers (HRIOs). However, positive practices emerged, such as the use of DHIS2 dashboards and user-friendly outputs, which were valued for supporting evidence-based decision-making and advocacy, particularly at higher levels of health management. In some counties, visual displays of data, including scorecards and performance trends, facilitated budget advocacy and community engagement. Contextual challenges and constraints, such as use of inconsistent data collection tools across counties post-devolution, human resource shortages, and limited integration of private sector data, contributed to incomplete reporting. These challenges underpinned perceived inaccuracy of DHIS2 data, arguably, hindering the complete reliance on DHIS2 data for planning and decision making. The study highlights the need for targeted investments to improve DHIS2 data accuracy and use through stronger stakeholder coordination, enhanced data synthesis skills, and fostering a culture of data ownership among a wide range of stakeholders in health, including political actors.. Addressing these gaps will contribute to improvement in DHIS2 data quality, enhanced ownership and reliance on DHIS2 data by PHC/RMNCAH+N stakeholders for decision making in Kenya.
Strategies and responses to the effects of climate change on health systems in Sub-Saharan Africa: a scoping review protocol
(Public Library of Science, 2025) Chimatiro, Chancy Skenard; Mianda, Solange; Lembani, Martina
Background Climate change is recognized as the greatest global health threat of the 21st century. Projections suggest that the Sub-Saharan African region will face more consequences of climate change than any other region globally. The health systems within the region have been affected by the negative effects of climate change. Mapping strategies and responses used in the region to address the effects of climate change on health systems in Sub-Saharan Africa could be a starting point for understanding evidence-based decision-making to inform best practices. Methods This scoping review will follow the methodological framework by Arksey & O’Malley. A wide range of databases will be searched to identify articles published on the strategies and responses to the effects of climate change on the health systems in Sub-Saharan Africa. Only peer-reviewed articles (original quantitative and qualitative studies, mixed methods, systematic reviews, editorials, and commentaries) published in English Language between 2010 and 2024 will be reviewed. All Book chapters and the grey literature (dissertations, conference proceedings, abstracts, reports) and publications primarily focusing on climate change strategies and responses without effects on health systems will be excluded. Covidence software will be used during study selection, data extraction, and summary. Deductive thematic analysis will be performed using predetermined themes from the objectives. Dissemination The results of this scoping review will be disseminated at local and international research conferences. Furthermore, the findings will be published in open-access journals targeting different audiences. The findings will also be shared with the Ministry of Health in Malawi for possible policy considerations.
Perceptions of South Africa’s master of public health graduates on the degree’s contribution to their leadership at work and in society
(Frontiers Media SA, 2025) Schaay, Nikki; Tshitangano, Takalani; Zweigenthal, Virginia
Introduction: Integrating public health functions into national health systems is essential to enhance population health. The Master of Public Health (MPH) degree is an important foundation for public health practice in low-and middle-income countries such as South Africa. However, insufficient evidence on individual motivations for undertaking the MPH and the perceptions of graduates on the utility of the degree at work and in society and its contribution to their leadership skills informed this study. Methods: A consortium of academics from eight South African universities developed a self-administered questionnaire to measure inter alia the socio-demographic characteristics, motivations, career paths, perceptions of the utility of the degree, and its contribution to their professional and personal development. The study population comprised the 2012–2016 cohort of MPH graduates from eight universities. Following informed consent, eligible graduates completed an online survey via REDCap. The data were analyzed using Stata. Results: A total of 221 graduates completed the survey. The mean age of respondents was 35 years, and the majority were from South Africa (53.2%) or other African countries (43.2%). The majority (91.1%) completed the MPH to improve their skills or to promote their personal development for senior management and leadership roles. Approximately 75% used identified leadership skills at work, but only half these skills were obtained from the MPH. Over 80% of respondents positively impacted on their workplace and in society, using skills mostly derived from the MPH in all domains. Discussion: This cohort of MPH graduates exercised leadership in different settings, but many stated that these skills were not obtained from the MPH programs. The COVID-19 pandemic underscored the need for public health leaders skilled in communication, collaboration, and crisis management, amidst considerations of social justice and equity. Hence, leadership skills need to be intentionally included in MPH programs in South Africa.
Global prioritised indicators for measuring WHO’s quality-of-care standards for small and/or sick newborns in health facilities: development, global consultation and expert consensus
(BMJ Group, 2025) Jackson, Debra; Day, Louise Tina; Vaz, Lara M E
Objectives The aim of this study was to prioritise a set of indicators to measure World Health Organization (WHO) quality-of-care standards for small and/or sick newborns (SSNB) in health facilities. The hypothesis is that monitoring prioritised indicators can support accountability mechanisms, assess and drive progress, and compare performance in quality-of-care (QoC) at subnational levels. Design Prospective, iterative, deductive, stepwise process to prioritise a list of QoC indicators organised around the WHO Standards for improving the QoC for small and sick newborns in health facilities. A technical working group (TWG) used an iterative four-step deductive process: (1) articulation of conceptual framework and method for indicator development; (2) comprehensive review of existing global SSNB-relevant indicators; (3) development of indicator selection criteria; and (4) selection of indicators through consultations with a wide range of stakeholders at country, regional and global levels. Setting The indicators are prioritised for inpatient newborn care (typically called level 2 and 3 care) in high mortality/morbidity settings, where most preventable poor neonatal outcomes occur. Participants The TWG included 24 technical experts and leaders in SSNB QoC programming selected by WHO. Global perspectives were synthesised from an online survey of 172 respondents who represented different countries and levels of the health system, and a wide range of perspectives, including ministries of health, research institutions, technical and implementing partners, health workers and independent experts. Results The 30 prioritised SSNB QoC indicators include 27 with metadata and 3 requiring further development; together, they cover all eight standard domains of the WHO quality framework. Among the established indicators, 10 were adopted from existing indicators and 17 adapted. The list contains a balance of indicators measuring inputs (n=6), processes (n=12) and outcome/impact (n=9). Conclusions The prioritised SSNB QoC indicators can be used at health facility, subnational and national levels, depending on the maturity of a country’s health information system. Their use in implementation, research and evaluation across diverse contexts has the potential to help drive action to improve quality of SSNB care. WHO and others could use this list for further prioritisation of a core set.
A systematic review assessing the association between extreme temperature exposure and cardiovascular health outcomes in Africa
(Academic Press Inc., 2025) Sello, Mamakase G.; Kyeyune, Jemimah; Kgatla, Hellen; Mchiza, Zandile J
The African continent is grappling with a rising prevalence of cardiovascular diseases (CVDs) in conjunction with the growing threat of climate change and its associated extreme temperatures. This systematic review aims to assess the relationship between extreme temperature exposures (heat and cold exposure) and cardiovascular health outcomes in African populations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in compiling this evidence. A comprehensive literature search was performed on PubMed-Medline, Scopus, Web of Science, and Google Scholar as the primary databases to identify relevant studies published from January 1990 to October 2024. Both hot and cold temperature extremes were linked to detrimental cardiovascular outcomes related to stroke. Exposure to sudden drops in minimum temperature exceeding 2.4 °C was linked with a 43 % higher risk of stroke. Elderly women (≥65-years) exposed to cold had the highest mortality rates and were more vulnerable to air pollution interactions during moderate temperatures (20–23 °C). Exposure to high temperatures (>37 °C) was associated with increased rates of heart failure and stroke. Hypertension was identified as a significant risk factor, with 37.6 % of stroke patients having pre-existing hypertension; notably, 86.2 % of these cases were linked to heat exposure. The highest CVD vulnerability was observed among females, older adults, and rural dwellers. The evidence presented in this systematic review suggests that exposure to both extreme cold and heat significantly contributes to the development of cardiovascular diseases. However, further studies are needed to validate and strengthen these findings.
Knowledge translation platforms: Broker, intermediary or more? A scoping review of definitions, functions and characteristics
(BioMed Central Ltd, 2025) Shmidt, Bey-Marrié; Mulopo, Chanelle; Späth, Carmen
Background: Knowledge translation platforms (KTPs), also referred to as intermediaries, play a key role in supporting evidence-informed decision-making. Numerous KTPs exist globally, striving to translate evidence into policy. However, these platforms are described in varying ways, and some KTPs do not explicitly identify themselves as such. This makes identification, recognition and leveraging of KTPs suboptimal. It also hinders opportunities for learning, adapting and scaling of such platforms. Objective: This scoping review aimed to synthesize the literature on the variety of definitions, functions and characteristics of a KTP with a view to harmonize these aspects of KTPs and offer a revised framework of functions. Methods: This review was conducted using recommended methods and reporting guidelines. Searches were performed in PubMed, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) using a predetermined search strategy, without date or geographical restrictions. Included studies were analysed and synthesized in ATLAS.ti, following Braun and Clarke’s six steps of thematic analysis. Findings: With one exception, all KTPs did not identify themselves as such in their names. Five common elements emerged across the KTP definitions: (i) a physical or virtual platform (ii) that engages with and convenes different stakeholders (iii) through a set of knowledge translation activities and outputs (iv) to contribute to health decision-making. We identified KTP activities that aligned with the core functions described in the Valmeekanathan et al. (Valmeekanathan et al. in Tert Educ Manag 27:227–256, 2021) framework – namely knowledge exchange, dialogue and capacity – but also additional activities, including engaging funders, planning for sustainability and scalability, providing training grants and initiating innovative knowledge translation processes that integrate knowledge across projects and sectors to maximize impact. Conclusion: This review provides a synthesized definition of KTPs while expanding on the three core functions described in the Valmeekanathan et al. (Valmeekanathan et al. in Tert Educ Manag 27:227–256, 2021) framework. To maximize their impact, sustained investment, stronger institutional support and integration into national policy ecosystems are essential.
Monitoring District Health System performance in South Africa: a proposed dashboard based on key pragmatic indicators
(South African Medical Association, 2025) Schneider, Helen; Barron, Peter; Mahomed, Hassan
Effective monitoring and evaluation (m&e) systems are central to ensuring the performance and accountability of the district health system (dhs). Current systems in south africa are suboptimal and poorly oriented to the decision-making needs of district managers. Drawing on a who measurement framework for the performance of primary healthcare, and as a follow-up to a first article describing the challenges of m&e systems in the dhs, this article proposes a dhs performance monitoring dashboard that is both practical and pragmatic. The dashboard was constructed in an iterative and consultative process, and consists of 20 indicators for quarterly monitoring a set of general criteria underpinning the choice of indicators is spelled out (e.g. The data are readily available and reliable). Indicators that do not have much variability, or are better suited to annual evaluation (e.g. Number of community health workers per 1 000 population) are not included. The dashboard includes the name or description of the indicator, the definition of the indicator, why it is useful, challenges and pitfalls to be considered when analysing the indicator and how it can be used for decision-making. We propose that these indicators be assessed, tracked and monitored on a quarterly basis by relevant managers at the facility sub district and district levels. We emphasise that the purpose of this dashboard is not external compliance, but rather to support district managerial decision-making and accountability.

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