On 5 October 2024, the South African Medical Research Council (SAMRC), in collaboration with the Clinton Health Access Initiative (CHAI), convened a dialogue with key stakeholders to discuss a proposed new model of maternity care for theprivate sector. A diverse group of stakeholders, including representatives from the public and private health sectors, midwives, obstetricians, civil society, academic institutions, and non-governmental organisations were present. The platform allowed for the exchange of insights, perspectives, and expertise on the challenges and opportunities in developing sustainable and accessible models of care. Here we share the documents from the dialogue.

Contact: (tanya.doherty@mrc.ac.za)

Journal articles

1. Solanki GC, Doherty T, Brijlal V, Daviaud E, Fawcus S. Towards developing new private sector obstetric care and contracting models in South Africa: Insights from public hospitals using private general practitioners to provide caesarean deliveries. S Afr Med J [Internet]. 2024 Apr. 18; 114(4):e1531. https://samajournals.co.za/index.php/samj/article/view/1531
2. Doherty T, Clow S, Wibbelink M, Yazbek M, Downe S. Midwifery models of care in the context of increasing caesarean delivery rates. Bulletin of the World Health Organization 2025; 103(6):410-2. DOI: 10.2471/BLT.24.293035

Reports and presentations

• Stakeholder Dialogue on Developing New South African Private Sector Maternity Care and Contracting Models
• Feedback on main inputs at maternity care dialogue held on 5 September
• Technical considerations for furthering heart-centred maternal care in South Africa
• A proposal for developing new South African private sector maternity care and contracting models
• Obstetric care model - Some legal considerations

Media article

Mail and Guardian - https://mg.co.za/partner-content/2024-08-30-the-case-for-developing-alternative-maternity-care-models-in-sa/

Conference presentations

Board of Healthcare Funders Conference May 2025

• Tanya Doherty - Developing New South African Private Sector Maternity Care and Contracting Models: Findings from a Deliberative Dialogue and towards mapping a way forward?

Video

For further information please contact Prof Tanya Doherty (tanya.doherty@mrc.ac.za)

Respectful maternal and newborn care is a priority, yet little evidence exists on what works to improve it. Strategies typically involve once-off didactic teaching which fails to encourage self-reflection or sustainable learning cultures. Our project has tackled this challenge through participatory learning processes, embedded in routine service delivery. A multi-disciplinary team developed the Strengthening Teamwork and Respect (STAR) intervention approach and toolkit which was implemented in nine rural hospitals in South Africa. A before-after mixed method evaluation was conducted to assess feasibility and impact of the intervention on person-centred maternity care and hospital organisational culture.

The midwife-led STAR intervention aimed to give control to health professionals to identify their own priorities for improving their working environment and ways of relating to women in their care. The findings will advance the evidence base for interventions to improve respectful care and cultures of teamwork and learning.

With approval of the KwaZulu-Natal Department of Health, the STAR project is a partnership of the South African Medical Research Council (SAMRC), the Centre for Rural Health at the University of KwaZulu-Natal, and the London School of Hygiene and Tropical Medicine.

Contact: tanya.doherty@mrc.ac.za

Journal articles

1. Doherty T, Petrus R, Land S, Horwood C, Filippi V, Haskins L, et al. Strengthening teamwork and respect (STAR) in maternity units: developing a health system intervention in South Africa. Global Health Action 2025; 18(1). DOI: 10.1080/16549716.2024.2440982
2. Doherty T, Horwood C, Mapumulo S, Haskins L, Manda S, Penn-Kekana L, et al. Case for improving respectful care: results from a cross-sectional survey of person-centred maternity care in rural South Africa. BMJ Public Health 2024; 2(2). https://bmjpublichealth.bmj.com/content/bmjph/2/2/e001086.full.pdf
3. Horwood C, Haskins L, Filippi V, Penn-Kekana L, Manda S, Mapumulo S, et al. Organisational learning culture in maternity units: A mixed-method study in rural district hospitals in KwaZulu-Natal, South Africa. SSM - Health Systems. 2025. https://doi.org/10.1016/j.ssmhs.2025.100081
4. Moxon SG, Graham W, Filippi V, Blencowe H, Doherty T, Kabakian-Khasholian T, Kumar MG, Oluoch D, Hinton L. Nothing About Us Without Us: Consolidating Experiences of Maternity Care to Advance Equity. BJOG, 24 July 2025. https://doi.org/10.1111/1471-0528.18300

Conference presentations

SOMSA conference August 2025

• Makhosazana Buthelezi - Reducing absenteeism to enhance respectful maternity care.

43rd Conference on Priorities in Perinatal Care in Southern Africa – March 2025

• Makhosazana Zulu – Reducing absenteeism to enhance respectful maternity care
• Monica Mejeni – Improving respectful care for women who have suffered bereavement
• Petronella Lunda – A conceptual framework to promote respectful perinatal care
• Mfundo Magoso – Introducing birth companions: A strategy to enhance respectful maternity care
• Zama Khosa – Experiences of implementing birth companions in a rural district hospital
• John Vaughn, Tanya Doherty, Lyn Haskins, Neil Moran – Workshop – Strengthening Teamwork and Respect (STAR) in maternity units: Experiences from implementing a quality improvement intervention in rural KwaZulu-Natal

FIGO World Congress of Gynecology and Obstetrics Conference October 2025

• Tanya Doherty - A participatory learning and action intervention to improve respectful maternal and newborn care

PI: Dr Wanga Zembe, Dr Vundli Ramokolo, Prof Tanya Doherty, Prof David Sanders, Prof Rina Swart
A longitudinal birth cohort study identifying women during pregnancy and following them up with their children from birth until 2 years to assess the nutritional status and dietary patterns of recipients and non-recipients of the CSG in Langa Township, Western Cape. This study builds upon the qualitative study outlined under Study 3. It is partially funded by the Centre of Excellence for Food Security and will run from 2016-2019.

The birth cohort commenced in March 2016. Fieldwork is in progress with the aim to recruit and follow up 500 mothers and their children.

Collaboration: The Centre of Excellence for Food Security, and UWC School of Public Health,

Contact person
Dr. Wanga Zembe (wanga.zembe@mrc.ac.za)
Dr Vundli Ramokolo (Vundli.ramokolo@mrc.ac.za)

PI: Dr Wanga Zembe-Mkabile, Dr Vundli Ramokolo, Prof Tanya Doherty

Overview
The advent of the Covid-19 pandemic in South Africa and across the globe, with associated national lockdowns, poses special challenges and implications for household food security, and child health and wellbeing among poor households. It is important to assess how Child Support Grant-eligible but non-recipient, and recipient households are experiencing and coping with the threat of Covid-19 and the accompanying restrictions on movement, as well as potential loss and or reduction of income.

Study Aim

To explore the experiences of Covid-19 among recipients and non-recipients of the CSG in Langa Township, Western Cape

For this qualitative study we are conducting twenty  telephonic qualitative interviews over two time points with participants (mother-child pairs) that we have been following up for two years in a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security. For this additional piece of research we are exploring  participants’ experiences of accessing social grants in the time of Covid-19; their experiences of securing food for their children and households, experiences of restrictions to movement, loss of earnings due to not working and social distancing while living in informal settlements and or small housing structures with small or no yard space; experiences with safety; perspectives and concerns they might have for themselves and their children and families at this time; and what they see as the role of social grants and the CSG in particular in providing support to impoverished and vulnerable households and communities in the time of Covid-19.

The study will provide learnings and lessons on how poor households reliant on small social grants cope during pandemics such as Covid-19 and the ways in which the social security system in South Africa can better respond to and support children and families from poor households.

Collaboration
SAMRC

Project status
Qualitative interviews are in progress. As part of this study we have published an Op-Ed in the Daily Maverick which communicates emerging results and the implications thereof for policy and practice. Link to the article: https://www.dailymaverick.co.za/article/2020-05-26-covid-19-and-social-grants-relief-measures-welcome-but-not-enough/#gsc.tab=0

Contact person
Dr. Wanga Zembe-Mkabile: wanga.zembe@mrc.ac.za

PI: Prof Yanga Zembe,

Co-PI: Dr Wanga Zembe

Aim: To explore the engagement of poor people with public health policies, interventions and food knowledge systems, including social media, and how these shape their food experiences and eating practices in Langa Township, Cape Town

Objectives

• To explore the food experiences and eating practices of CSG recipients and non-recipients
• To examine the kind of nutrition education that CSG recipients and non-recipients, and their sources of health information and knowledge regarding nutrition
• To explore how the CSG recipients and non-recipients regard these sources of information, including their considerations regarding their accessibility, credibility, usefulness and impact
• To determine the perceptions CSG recipients and non-recipients have regarding the influence of the food and nutrition messaging and education that they are exposed to, on what and how they eat
• To explore CSG recipients and non-recipients’ knowledge of and familiarity with policies on nutrition and healthy food practices, and how they interpret and apply these
• To determine the role of socio-cultural knowledge systems about food on gender-based food practices, as well as the influence of such gender norms on how public health nutrition education and interventions are interpreted and applied by CSG recipients and non-recipients
• To understand the ways in which Covid-19 has affected the resourcefulness and capabilities of CSG recipients and non-recipients in their quest to ensure adequacy of food in their households

Methods:

For this qualitative study 20 telephonic qualitative interviews will be conducted with participants (primary caregivers) and five with spaza shop owners from a cohort of mother-child pairs that we have been following up for two years in a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security

Collaborators: CoE for Food Security

Project status: Awaiting ethical approval; data collection soon to commence.

PIs: Lieve Vanleeuw, Wanga Zembe

Overview

Amid the COVID-19 crisis TB patients face increased vulnerability due to the consequences of the COVID-19 response such as loss of income, challenges to access healthcare services and anti-TB medication, increased stigma, and a loss of social support structures. Many of them are already poor, and many depend on informal work or have lost their jobs. The COVID-19 social and economic response in South Africa, however, might also offer some alleviation to TB patients’ burden by accessing the Covid-19 Social Relief of Distress Grant (SRDG) designed for unemployed working age adults who are destitute because of the virus. Our study will explore how the COVID-19 epidemic and response have affected the social, economic, and health situation of TB patients, as well as how COVID-19 measures to alleviate the social and economic effects of the COVID-19 epidemic and response such as the Social Relief of Distress Grant have affected TB patients’ vulnerability.

Aims

1. Explore how the COVID-19 epidemic and response, such as the lockdown measures, have affected the health, social and economic burden of TB patients in Cape Town, South Africa.
2. Explore how COVID-19 measures to alleviate the social and economic effects of the COVID-19 epidemic and response such as the Social Relief of Distress Grant have affected TB patients’ vulnerability.
3. Explore perceptions of healthcare workers working with TB patients of two primary healthcare clinics in Cape Town on how the COVID-19 crisis has affected TB patients in Cape Town, South Africa.
4. Explore perceptions of SASSA officials on the Social Relief of Distress grant and other forms of assistance for TB patients in Cape Town, South Africa.

Collaboration

Tampere University Finland

Tampere TB Foundation Finland

Project status

Protocol approved by the SAMRC Ethics Committee. Interviews to start in October 2020.

Contact person

PIs: Lieve Vanleeuw, Wanga Zembe

Overview

TB remains a major health problem and the number one cause of death in South Africa. While TB is closely associated with poverty, it can also push households into worsening impoverishment through costs associated with the disease such as the cost of food and travel and the loss of income. In addition, household contacts of TB patients have an increased risk of developing TB. Transmission of TB can infect multiple members of the household which in turn can aggravate the social and economic burden of TB and diminish household resilience over time. TB patients frequently also suffer from chronic conditions like HIV and diabetes. The coordination of health and social services for each of these conditions can put an extra burden on the patient. The co-occurrence of TB and chronic conditions, in the context of a broader set of socio-economic factors such as household vulnerability to multiple and recurring transmission of TB, fragmented social and healthcare services, and poverty can have a syndemic effect on the burden of TB for patients.

Aim

The study aims to explore patient experiences of the multiplicative burden of TB caused by the co-occurrence of TB and chronic conditions such as HIV and diabetes, in the context of a broad set of socio-economic factors such as household vulnerability to multiple and recurring transmission of TB, poverty, overcrowding, stigma, and fragmented social and healthcare services. It furthermore aims to explore patient experiences of existing interventions like contact screening, integration of services and the disability grant that can potentially alleviate the syndemic burden of TB in the Western Cape, South Africa.

Project status

Semi-structured interviews have been conducted with TB patients and healthcare workers at 2 clinics and officials from the South African Social Security Agency (SASSA) in Cape Town. Collected data is currently being analysed and written up for publication.

Collaboration

Tampere University Finland

Tampere TB Foundation Finland

Contact person

Lieve Vanleeuw: Lieve.vanLeeuw@mrc.ac.za

PI: Dr Wanga Zembe

Co-Investigators: Lieve Vanleeuw; Yanga Zembe

A two-year mixed-methods research project that aims to assess (i) the levels of social support, economic empowerment and social protection available to adolescent girls and young women (AGYW), and (ii) the impact thereof on health and wellbeing of AGYW.

The main outcomes of the project are:

1. Synthesized evidence on best practice models regarding social protection, economic empowerment and social support interventions that can protect and improve the health and wellbeing of AGYW in LMIC settings.
2. Empirical evidence on the correlation between social protection, economic empowerment, and social support resources, interventions and programmes to proximal indicators associated with vulnerability, poor health and wellbeing among AGYW in South Africa.
3. Knowledge on gaps, opportunities and acceptability of expanded state-provided social protection and economic empowerment interventions to protect and promote health and wellbeing in AGYW in South Africa.
4. Recommendations for an integrated package of financial, economic and social support interventions to protect and promote the health and wellbeing of AGYW based on outcomes 1, 2 and 3.

Project status: The rapid review has been completed and a progress report for year 1 has been submitted to funders. The qualitative component of the project was carried out in 2019, as well as secondary analysis of data and engagement with stakeholders. Further analysis of data and writing up of reports and publications from the work have commenced.

Contact person

Wanga Zembe (wanga.zembe@mrc.ac.za)

Strengthening the impact of South Africa's COVID-19 Social Relief Distress Grant among unpaid caregivers of adolescents living with HIV.

This project is a collaboration between the Health Systems Unit and Simon Fraser University in Canada. It evaluates a cash transfer plus a gender-transformative economic livelihoods intervention for improving psychological wellbeing and gender equality among woman caregivers of children and adolescents living with HIV (CALHIV) in KwaZulu-Natal, South Africa. The mixed-methods research approach consists of a cluster randomised trial among HIV clinic caregivers of CALHIV. Intervention clusters will receive a monthly cash transfer and undergo a 10-session economic livelihoods intervention while the control clusters will only receive the monthly cash transfer. Qualitative interviews on economic evaluation will assess the feasibility, acceptability and cost-effectiveness of the intervention.

The expected results include assessing pre- and post-intervention impacts on outcomes of psychological wellbeing, intimate partner violence, depressive symptoms, gender attitudes and earnings. The results will improve understanding of economic livelihood-based interventions in strengthening caregivers’ psychological wellbeing and the evidence generated will inform and strengthen the government’s COVID-19 recovery efforts.

The project is supported by Women’s health and economic empowerment for a COVID-19 Recovery that is Inclusive, Sustainable and Equitable (Women RISE), a partnership between the Canadian International Development Research Centre, the Canadian Institutes of Health Research, and the Social Sciences and Humanities Research Council. Its aim is to support global action-oriented, gender-transformative research by researchers from low- and middle-income countries and Canada.

Collaborating institutions:

• Simon Fraser University-Canada
• University of Exeter- United Kingdom
• Stellenbosch University-South Africa
• Project Empower- South Africa
• IDRC - International Development Research Centre (idrc-crdi.ca)

Journal articles

1. Carries S, Mkhwanazi Z, Sigwadhi L, Moshabela M, Nyirenda M, Goudge J, Govindasamy D. Using The feasibility, preliminary effectiveness, and costs of an economic incentive package for improving caregiver wellbeing during the COVID-19 in South Africa: results form a pilot RCT. 2025. PloS Global Health. https://doi.org/10.1371/journal.pgph.0003799
2. Carries S, Mkhwanazi Z, Sigwadhi L, Moshabela, M, Nyirenda M, Goudge J, Govindasamy D. 2023. An economic incentive package to support the wellbeing of caregivers of adolescents living with HIV during the COVID-19 pandemic in South Africa: a feasibility study protocol for a pilot randomised trial. Pilot and Feasibility Studies, 9, 3. https://doi.org/10.1186/s40814-023-01237-x
3. Govindasamy, D, Shai N, Mwandacha N, Carries S, Sithole N, Closson K, Bhana A, Sigwadhi L, Washington L, Kaida A. A cash transfer plus gender transformative economic empowerment intervention seeking to improve the wellbeing of caregivers of children and adolescents living with HIV in South Africa: a feasibility study protocol for a pilot cluster randomised trial. 2025. BMC Pilot and Feasibility Studies. 11, 52. https://doi.org/10.1186/s40814-025-01643-3

Conference and workshop presentations

1. Mkhwanazi Z, Sithole N, Carries S, Sigwadhi L, Nyirenda M,Govindasamy D. The acceptability of an economic incentive package among young caregivers of adolescents living with HIV (ALHIV) during COVID-19 in KwaZulu-Natal, South Africa. SA AIDS 2023. South Africa
2. Carries S, Mkhwanazi Z, Sigwadhi L, Moshabela M, Nyirenda M, Goudge J,Govindasamy D. Using The feasibility, preliminary effectiveness, and costs of an economic incentive package for improving caregiver wellbeing during the COVID-19 in South Africa: results form a pilot RCT. International Health Economics Association World Congress. Cape Town, South Africa. 2023
3. Mkhwanazi Z, Carries S, Sigwadhi L, Moshabela M, Nyirenda M, Goudge J, Govindasamy D. 2022. Using Human Centred Design to Develop an Economic Incentive Package to Improve Caregiver Wellbeing of Adolescents Living with HIV during the Covid-19 epidemic in South Africa. PHASA 2022
4. Bahta A, Carries S, Sigwadhi L, Govindasamy D. The association between food insecurity and depressive symptoms among caregivers of adolescents living with HIV(ALHIV) during COVID-19 in KwaZulu-Natal, South Africa. PHASA. 2023.
5. Sithole N, Carries S, Mkhwanazi Z, Sigwadhi L, Govindasamy D. The correlates and experiences of HIV-related intersectional stigma among caregivers of adolescents living with HIV in KwaZulu Natal, South Africa: results from a mixed method study. 12th IAS Conference on HIV Science, Brisbane, Australia, 2023.
6. Govindasamy D, Shai N, Mwandacha N, Carries S, Sithole N, Closson K, Bhana A, Sigwadhi L, Washington L, Gibbs A, Kaida A. Early lessons learned from a cash transfer + gender transformative economic intervention seeking to improve wellbeing among caregivers of CALHIV in South Africa. African Workshop on HIV & Women, Kenya, 2024.
7. Sithole N, Carries S, Mkhwanazi Z, Shai N, Mwandacha N, Closson K, Bhana A, Sigwadhi L, Washington L, Davids EL, Kaida A, Govindasamy, D. A cross-sectional study on the correlates and experiences of intersectional stigma among female caregivers of children and adolescents living with HIV (CALHIV) in South Africa. PHASA 2025
8. Govindasamy D, Carries S, Shai N, Sithole N, Moyo A, Closson K, Bhana A, Sigwadhi L, Washington L, Gibbs A, Kaida A. The Cost and Cost-effectiveness of a Cash Transfer Plus Economic Empowerment Intervention for Promoting Caregiver Wellbeing in South Africa. International Health Economics Association World Congress. Bali, Indonesia. 2025
9. Govindasamy D, Shai N, Carries S, Sithole N, Moyo A, Closson K, Bhana A, Sigwadhi L, Washington L, Gibbs A, Kaida A. Results of a cash transfer plus economic empowerment intervention on caregiver wellbeing: a pilot cluster randomised trial in South Africa. AIDS IMPACT 2025. Morocco

Articles in newsletters

1. Research in Action article: Voices for positive change: South African women tell their stories https://idrc-crdi.ca/en/research-in-action/voices-positive-change-south-african-women-tell-their-stories
2. Who cares for the caregivers? Addressing the needs of HIV/AIDS caregivers in South Africa https://www.mrc.ac.za/news/who-cares-caregivers-addressing-needs-hivaids-caregivers-south-africa
3. SAMRC’s Job Shadow Programme - Generation Science (Gen S)- VISIT OF THE CWEL+ TRIAL SITE https://www.samrc.ac.za/news/gen-s-2024-empowering-future-generation-health-scientists
4. CWEL+ project overview:Bophelo Life Magazine (The Community Issue-March 2024) https://www.samrc.ac.za/BOPHELO/index.html

Community engagement videos

• CWeL+ project background - https://youtu.be/SC091LZR03o
• CWeL+ project impact - https://youtu.be/ooJQgiHqvHM

Media outputs

• HIV care cascade: Burden of HIV among young people and impact on carers. TV SABC News. https://www.youtube.com/watch?v=O0ipF9anzZw&t=111s
• HIV Infected Children Caregivers Require More Support: Govindasamy. TV SABC news.  https://www.youtube.com/watch?v=S20QaVqJe24&t=1s
• HIV Infected Children Caregivers Require More Support: Govindasamy. Online news articles
  • Africa. https://www.theafrica.co.za/africanews/hiv-infected-children-caregivers-require-more-support-govindasamy-45334229
  • News 365. https://news365.co.za/hiv-infected-children-caregivers-require-more-support-govindasamy

Depression and anxiety among young people are a major public-health concern in South Africa. The country lacks child and adolescent mental health provincial policies, and the population is exposed to multiple factors (e.g. income inequality, poverty, unemployment, crime, and violence) that heighten their risk of mental health problems. The COVID-19 pandemic increased young people’s exposure to multiple social determinants of mental-health problems. There is a need to identify young people at risk of depressive and anxiety symptoms and link them to appropriate care. There is scarce research on the predictors of young people’s mental health at the individual, household, and community level in sub-Saharan Africa. There is need to understand the predictors of depressive and anxiety symptoms to inform community-based screening tools among young people. This knowledge can help us better design positive mental-health interventions such as screening tools and community-based programmes to reduce the burden of mental-health conditions in this population.

The aim of this study is to analyse the predictors of depressive and anxiety symptoms among young people aged 14-24 years using existing longitudinal data from three surveillance sites in South Africa.

Journal articles

1. Moyo A, Sigwadhi L, Carries S, Sithole N, Moyo R, Bhana A, Nyasulu P, Theresa M, Maposa I, Govindasamy D. The prevalence and correlates of common mental health disorders among adolescents and young adults in rural South Africa: analysis of household survey data. Accepted BMC Public Health.
2. Carries S, Sigwadhi L, Moyo A, Wagner C, Mathews C, Govindasamy D. The association between household food insecurity and mental health among adolescent girls and young women (AGYW) during the COVID-19 epidemic in South Africa. Adolescents, 4(1):185-199

Conference presentations

1. Moyo A, Sithole N, Dubazana SE, Bantjes J, Peer N, Munyombwe T, Maposa I, Govindasamy D. The relationship between cardiovascular health and common mental disorders among young adults: A systematic review of observational studies. Cardiometabolic Health and Diabetes Africa Congress 2025, Cape Town, South Africa.
2. Moyo A, Sigwadhi L, Carries S, Sithole N, Moyo R, Bhana A, Nyasulu P, Theresa M, Maposa I, Govindasamy D. Identifying correlates of depressive or anxiety symptoms among adolescents and young adults in South Africa using household survey data. World Congress of Epidemiology 2024, Cape Town, South Africa.
3. Moyo A, Sithole N, Sigwadhi L, Carries S, Moyo R, Bhana A, Nyasulu P, Maposa I, Govindasamy D. Engaging with young people with mental health lived experience to inform the statistical analysis of a large South African dataset. 2024 SA-ACAPAP Congress, Cape Town, South Africa (PhD student awarded best poster)
4. Bodzo P, Alaba O, Carries S, Muhwava L, Davids E, Govindasamy D. Determinants of psychological and subjective wellbeing among adolescents and young people in sub-Saharan Africa – a systematic review. African Health Economics and Policy Association (AfHEA) Conference. 2025, Kigali, Rwanda
5. Chazanga L, Sigwadhi L, Moyo A, Carries S, Govindasamy D. The association between depressive symptoms and psychological wellbeing among adolescent girls and young women (AGYW) during COVID-19 in South Africa. ICASA 2023
6. Carries S, Sigwadhi L, Moyo A, Wagner C, Mathews C, Govindasamy D.  The association between household food insecurity and mental health among adolescent girls and young women (AGYW) during the COVID-19 epidemic in South Africa. PHASA 2022

Newsletter articles

• Reflections from the Positive Mind’s Study. https://www.samrc.ac.za/other/reflections-positive-mind%E2%80%99s-scientific-team?bc=285

The PAMHoYA (Co-development of a Mental Health Data Discovery Platform and Harmonisation of Mental Health Measures for Young People in South Africa) Project was launched in 2025. A first for mental-health data science on the African continent, this project brings together a multidisciplinary team of health economists, epidemiologists, psychologists, data scientists and lived experience experts from the University of Witwatersrand (co-lead), Stellenbosch University, Sol Plaatje University and University College London. It is one of 20 projects funded under the Mental Health Data Prize Africa initiative, funded by African Population and Health Research Center (APHRC) in partnership with Wellcome, United Kingdom.

The project focuses on the need for Big Data to improve on the accuracy and representativeness of research findings regarding mental health in young people.  The project aims to narrow the research gap by pooling and standardising measures from various South African datasets to paint a more accurate picture of the mental-health burden and trends among young people.

Media outputs

PAMHoYA project launch. Online - Mail & Guardian. https://mg.co.za/partner-content/2025-06-26-pamhoya-project-where-data-science-meets-youth-voices/

Young people in sub-Saharan Africa encounter health and livelihood challenges which compromise their wellbeing. Understanding how their wellbeing is defined could strengthen wellbeing policies. This project investigated perceptions and experiences of young people's wellbeing, and whether these aligned with existing wellbeing models specifically Ryff's psychological wellbeing (PWB) model.

Our findings indicate that wellbeing for young people living with and without HIV is primarily cultivated within social networks. Whilst perceptions and experiences of young people's wellbeing encompassed intra-personal elements included in Ryff's PWB model (i.e. self-acceptance, self-worth, autonomy), these were more strongly rooted in social integration and social contribution, dimensions aligned with the social-wellbeing model.

This highlighted that further evaluations of social wellbeing models and measures underpinned by this model are needed in this setting.

Journal articles

1. Govindasamy D, Seeley J, Olaru ID, et al. Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review. Health Qual Life Outcomes 18, 120 (2020). https://doi.org/10.1186/s12955-020-01352-w
2. Govindasamy D, Maruping K, Ferarri G, Mathews C, Seeley J. A qualitative enquiry into the meaning and experiences of wellbeing among young people living with and without HIV in KwaZulu-Natal, South Africa. 2020. Social Science and Medicine. https://doi.org/10.1016/j.socscimed.2020.113103

Conference presentations

1. Govindasamy D, Bärnighausen T, Neuman M, Bodzo P, Mathews C, Seeley J, Ferrari G. Effect of district ART access on young people’s wellbeing in South Africa: an econometric analysis of panel data. AIDS 2022 (Virtual)
2. Govindasamy D, Neuman M, Bärnighausen T, Bodzo P, Mathews C, Seeley J, Ferrari G. The association between mental health and wellbeing among young people in South Africa: evidence from a panel survey, 12th IAAH World Congress in Adolescent Health-2021 (Virtual)
3. Govindasamy D. HIV and mental health among young people in sub-Saharan Africa. Improving the prevention and management of multimorbidity in sub-Saharan Africa. Workshop. The Academy of Medical Sciences UK and Academy of Science South Africa (5-6 September 2019)
4. Govindasamy D, Seeley J, Olaru I, Wiyeh A, Mathews C, Ferrari, G. Informing the Measurement of Wellbeing Among Young People Living with HIV in sub-Saharan Africa for Health Economic Policy Evaluations: A Mixed-methods Systematic Review.  International Health Economics Association- World Congress, 2019 Basel, Switzerland
5. Govindasamy D, Maruping K, Ferarri G, Mathews C, Seeley, J. 2019. “Happiness I would say is to live well, to be accepted”- A qualitative enquiry into the meaning and lived experiences of wellbeing among young people living with and without HIV in KwaZulu-Natal, South Africa. 14th AIDS Impact Workshop. London, United Kingdom.

Maximising health-related quality of life (HRQoL) is regarded as an important HIV-programme goal, aligned with Sustainable Development Goal 3 (improving health and wellbeing). There is therefore a need to monitor HRQoL in HIV programmes and measure this outcome in routine programme monitoring and in evaluations to capture the broader benefits of integrated HIV policies and interventions seeking to promote quality of life. However, there is lack of guidance on appropriate HRQoL scales that could be used in HIV programmes and evaluations in sub-Saharan Africa, particularly among adolescents living with HIV (ALHIV) who are at persistently high risk for HIV-related morbidity and mortality. The EuroQol five-dimensional youth HRQoL scale with five response levels (EQ-5D-Y-5L) has proven to be feasible among acute and chronic disease paediatric populations in developing countries. No study has compared its psychometric performance against the earlier 3L version and other generic adolescent HRQoL scales, such as the CHU9D among ALHIV aged 10-15 years.

Via a mixed-methods study, this project aimed to assesses cognitive understanding of the EQ-5D-Y 5L vs. 3L and CHU9D among ALHIV; to establish the reliability and validity of the HRQoL scale, EQ-5D-Y 5L, vs. 3L and CHU9D among ALHIV; and, to explore the acceptability and feasibility of implementation of the EQ-5D-Y 5L vs. 3L and CHU9D for use in HIV clinics from the perspective of HCWs and study staff.

Report

The feasibility, reliability and validity of the EQ-5D-Y-5L versus the EQ-5D-Y-3L and CHU9D in routine healthcare settings among adolescents living with HIV in KwaZulu-Natal, South Africa: a mixed-method study. https://medat.samrc.ac.za/index.php/catalog/55

Conference presentations

1. Carries S, Sigwadhi L, Mkhwanazi Z, Verstraete J, Lombard C, Moshabela M, Penton H, Finch A, Jelsma J, Govindasamy D. The feasibility, reliability and validity of the EQ-5D-Y-5L versus the EQ-5D-Y-3L and CHU9D in routine healthcare settings among adolescents living with HIV in KwaZulu-Natal, South Africa: a mixed-method study. 2nd EuroQol Africa Academy Meeting 2022 (Virtual)
2. Carries S, Mkhwanazi Z, Sigwadhi L, Govindasamy D. The psychometric performance and correlates of health-related quality of life measure (CHU9D) among adolescents living with HIV in KwaZulu-Natal, South Africa: a mixed-method study. International Health Economics Association World Congress. Cape Town South Africa. 2023

The World Health Organisation’s (WHO) key population-based strategy for ending the human immunodeficiency virus epidemic is universal HIV test and treat (UTT) along with pre-exposure and post-exposure prophylaxis. Despite the successful scale-up of this strategy in sub-Saharan Africa, the quality of life (QoL) of people living with HIV (PLHIV) remains sub-optimal. Poor QoL in PLHIV may threaten the UNAIDS 95-95-95 programme targets. Monitoring QoL of PLHIV has become a key focus of HIV research among other outcomes to understand health-related QoL (HRQoL) profiles and identify interventions to improve programme performance.

This study aimed to describe HRQoL profiles and identify their predictors in PLHIV in KwaZulu Natal, South Africa and has shown that a combination of old age (60 years and above), any disability and comorbidities had a considerable effect on HRQoL among PLHIV. The findings support the recommendation for an additional fourth UNAIDS target focusing on ensuring that 95% of PLHIV have the highest possible HRQoL. Psycho-social support interventions are recommended to improve the HRQoL of PLHIV.

Journal articles

1. Moyo RC, Sigwadhi LN, Carries S, Mkhwanazi Z, Bhana A, Bruno D, Davids EL, Van Hout MC, Govindasamy D. Health-related quality of life among people living with HIV in the era of universal test and treat: results from a cross-sectional study in KwaZulu-Natal, South Africa. HIV Research & Clinical Practice 2023, 25(1): 2298094. https://doi.org/10.1080/25787489.2023.2298094

The Mental Health Investment Case for South Africa, commissioned by the National Department of Health in November 2019, represents the result of three years of sustained dialogue and collaboration with the National Department of Health, involving key provincial partners, clinicians, financing experts, patient rights and community advocacy groups and prominent academics, all of whom are committed to upholding the rights of persons living with Mental, Neurological and Substance use Disorders in South Africa.

The purpose of the Mental Health Investment Case is to share a 15-year vision for meeting the mental health and economic needs of South Africa, offering concrete recommendations for how to achieve these gains. This Investment Case draws significantly on the guidance of Global actors including the World Health Organization (WHO), the World Bank (WB) and the United Nations Development Program (UNDP). The Investment case conducted an analysis to estimate the expected return-on-investment (ROI) over a 15-year period from scaling up interventions targeting anxiety, depression (including perinatal depression), psychosis, bipolar disorder, epilepsy, idiopathic developmental intellectual disability, behavioural disorders, dementia, alcohol, and drug use as well as risky alcohol and substance-use. The investment case examines the costs and benefits of scaling up treatment for these conditions, and quantifies the infrastructural, human resource and programmatic requirements that should be in place for the achievement of mental health service scale-up.

The timing of the MHIC Task Team’s work has overlapped with the passing of the NHI Bill, the ongoing development of the Service Benefits Framework (SBF), the drafting of the next Non-communicable Disease (NCD) National Strategic Plan, the Life Esidimeni Arbitration Award and the publication of the Report on the National Investigative Hearing into the Status of Mental Healthcare in South Africa.

View The Mental Health Investment Case for South Africa Research Report

Methods for valuing health benefits for economic evaluations in adult populations are well developed. However, there is a lack of guidance on appropriate measures and methods to use when valuing health interventions for adolescents, despite the existence of several health-related quality of life (HRQoL) measures for adolescents. These measures that exist were developed in high-income countries (HICs) specifically for adolescents in those countries. Their application among adolescents in sub-Saharan Africa remains a point of contention because they might not fully capture the context of wellbeing of adolescents living in countries in Africa.

The purpose of this study is to co-develop a new wellbeing scale for ALHIV and psychometrically evaluate it with the goal of using it in health economic evaluations of multi-sectoral programmes and interventions for ALHIV in SSA.

The specific objectives of this study are:

1. To synthesise and appraise the literature to identify appropriate dimensions for the development of a wellbeing scale for ALHIV from SSA
2. To co-develop a new adolescent wellbeing scale and assess its face and content validity
3. To assess adolescent cognitive understanding and acceptability of the wellbeing scale
4. To measure the reliability, convergent validity and factor structure of the new wellbeing scale

This work is being conducted in collaboration with the Gender and Health Research Unit. It will be conducted in four diverse sites in South Africa with women who have experienced severe intimate partner violence and their children. This study aims to help us to understand what places women at risk of the most severe impacts of intimate partner violence, including loss of life, and to describe the myriad of ways in which their experiences, and attempts to protect themselves and their families, impact their health, social circumstances and finances. It also aims to help us understand how children are impacted by growing up in a home with violence and what may influence whether they go on to use violence themselves in their lives. It is hoped that the results will guide femicide prevention nationally and build understanding of what is needed to prevent the worst outcomes and enable recovery among exposed women and children.

The Cochrane Nutrition Field is under the leadership of Health Systems Research Unit, the South African Medical Research Council, and the Centre for Evidence-based Health Care (CEBHC), Faculty of Medicine and Health Sciences, Stellenbosch University, along with international partners.

Cochrane Nutrition aims to coordinate activities related to nutrition reviews within Cochrane; to ensure that priority nutrition reviews are conducted with rigorous methodological approaches; and, to promote the use of evidence from nutrition systematic reviews to inform healthcare decision making.