In the informal settlements of Tshwane District, community health care workers (CHWs) are increasingly recognised as vital bridges between vulnerable populations and essential health services. This was the key finding presented by University of Pretoria graduate Rebaone Madzivhandila during the School of Health Systems and Public Health Research Day on July 3, 2025.

Madzivhandila’s study focused on Melusi informal settlement, also known locally as “Gomorrah,” a rapidly growing township in Pretoria West with approximately 8,000 households and thousands of residents living under challenging conditions. Faced with limited access to formal healthcare facilities - often located far from their homes - many residents rely heavily on CHWs who deliver care directly to households.

“Community health care workers, as defined by the World Health Organization, provide healthcare at the household level, which is critical in areas where clinics are scarce or difficult to reach,” Madzivhandila explained.

Using qualitative, descriptive research methods, she conducted in-depth interviews with community members aged 18 and above who had previous interactions with CHWs. The findings were clear: residents highly value CHWs for their role in health promotion, disease prevention, and direct care delivery.

“They help with health checks and testing right at home,” said one participant. “Most people are afraid of going to the clinic, so having CHWs come to us is a blessing.”

Participants highlighted several key roles CHWs play, including conducting HIV and pregnancy tests, monitoring blood pressure, assisting with medication adherence, and providing crucial referrals to clinics and hospitals. Their communication skills and ability to engage positively with households were widely praised, fostering trust and improving health outcomes in the community.

However, the study also revealed barriers hindering CHWs’ full effectiveness. Some residents expressed concerns about confidentiality, given that CHWs often live within the same community, making personal health information potentially more exposed. This lack of trust sometimes leads to resistance or hostility when CHWs attempt home visits.

To overcome these challenges, Madzivhandila recommended several actionable steps:

• Strengthen CHW capacity and community trust through enhanced training focused on confidentiality and communication.
• Implement flexible CHW working hours to reach working residents more effectively.
• Increase public awareness about the roles and importance of CHWs through community workshops and meetings involving both CHWs and residents.
• Integrate CHWs more fully into the formal healthcare system, ensuring adequate resources, funding, and policy support from the Department of Health.

“This study confirms that community health workers are not just frontline healthcare providers -they are essential agents of social support and empowerment in underserved areas,” Madzivhandila concluded. “However, for them to succeed fully, we must address trust issues, expand resources, and adapt their roles to meet the unique needs of different communities.”

As South Africa continues its efforts to improve healthcare access and equity, the voices of communities like Melusi highlight both the promise and the challenges of delivering healthcare where it’s needed most - at people’s doorsteps.

Gaps in Type 2 Diabetes Management at private clinics in Harare

Despite relatively high access to healthcare resources in private primary health care clinics in Harare, a recent study reveals that optimal management of type 2 diabetes mellitus remains a significant challenge for many patients.

Dr. Abigail Pachena,highlighted critical issues in diabetes control at private clinics operated by a holding company across Harare. The study, which analysed medical records of 252 adult patients living with type 2 diabetes, found that while clinic visits and laboratory monitoring were frequent, glycaemic control and screening for complications were alarmingly inadequate.

Globally, diabetes affects 10.5% of adults, with 90% of cases being type 2 diabetes. The burden is rising fastest in developing regions, including sub-Saharan Africa, where 24 million adults aged 20 to 79 years live with the disease. However, fewer than half achieve good glucose control, often resulting in serious complications such as stroke, kidney disease, blindness, and cardiovascular problems.

Data showed that  the median patient had four clinic visits and one HbA1c test (a key measure of long-term blood glucose control). However, lipid monitoring was sparse -over half of the patients had no lipid tests in 2023. The prevalence of diabetes complications was notable: 21% of patients showed signs of neuropathy (nerve damage), and 33.4% had nephropathy (kidney damage), although none had progressed to renal failure. Despite frequent monitoring, only 42.7% achieved good glucose control, and just 25.2% maintained healthy lipid levels. Even more concerning, among those assessed for all indicators - glucose, lipids, and blood pressure - only 10 out of 109 patients met optimal control standards.

Comorbid conditions were common, with 61% of patients also suffering from hypertension, 41% classified as obese, and 74.8% with dyslipidaemia (unhealthy blood lipid levels). Alarmingly, about one-third had uncontrolled blood pressure above recommended thresholds, heightening the risk of severe complications.

Statistical analysis showed that patients aged 50 to 59 and those living outside Harare were more likely to have poor glucose control. Additionally, patients on insulin therapy alone or insulin combined with oral medication had poorer control compared to those on oral treatment alone. This may indicate issues with insulin dosing or management within the clinics.

Pachena noted, “The frequency of visits and laboratory testing is commendable, reflecting good accessibility. However, this did not translate into better diabetes outcomes.” Screening rates for eye and foot complications were especially low - only 12% and 15% respectively - potentially due to clinical oversight or systemic gaps.

In conclusion, Dr. Pachena stressed the urgent need for more robust, standardised treatment protocols and enhanced clinician training to close knowledge and practice gaps. She recommended leveraging existing healthcare resources more effectively - using frequent patient contact to detect poor control early and intervene promptly. As diabetes continues to pose a growing threat to public health in Zimbabwe, studies like this illuminate critical areas for improvement and provide a roadmap for better care strategies that could reduce complications and improve quality of life for thousands of patients.

Decline in HIV Testing Among Adolescent Girls and Young Women in Sierra Leone

Reitumetsi Sitoboli’s study revealed worrying trends in HIV testing among adolescent girls and young women (AGYW) in Sierra Leone, underscoring critical barriers that hinder access to life-saving services.

Presenting findings from her MSc in Epidemiology and Biostatistics study, Sitoboli, revealed that despite some progress, HIV testing rates among AGYW aged 15 to 24 years remain insufficient, with a notable decline observed in recent years.

Adolescent girls and young women in sub-Saharan Africa disproportionately bear the burden of new HIV infections, accounting for 77% of new cases in their age group. Early HIV testing is a cornerstone in the global fight against the epidemic, enabling timely treatment and reducing transmission risk, central to the UNAIDS 95-95-95 goals.

Sitoboli’s research revealed a decline in HIV testing rates from 93% in 2013 to 84% in 2019, a drop particularly pronounced among adolescent girls aged 15 to 19 compared to young women aged 20 to 24. One key barrier identified is the legal age of consent for HIV testing, currently set at 18 in Sierra Leone, which requires girls under 18 to obtain permission before testing, a hurdle that discourages many from accessing services. Pregnancy emerged as the strongest predictor: girls who had been pregnant were eight times more likely to have tested. Urban residence, knowledge about HIV, and understanding of mother-to-child transmission also positively influenced testing rates.

Despite these insights, overall testing among AGYW remains low, especially in rural areas where stigma, limited access, and lack of youth-friendly services exacerbate the problem. Notably, only about 75% of pregnant AGYW had tested, a rate lower than similar cohorts in Zimbabwe and Uganda, highlighting gaps in antenatal HIV services.

Her recommendations include:

• Reviewing the legal age of consent to allow younger girls to test independently.
• Developing confidential, supportive, and accessible youth-friendly HIV testing services.
• Integrating comprehensive HIV education into school curricula to empower girls with knowledge.
• Expanding outreach efforts in underserved rural areas.
• Leveraging antenatal care visits as critical opportunities for HIV testing.

As Sierra Leone strives to meet global HIV targets, Sitoboli’s study shines a spotlight on the gaps that must be addressed to protect vulnerable young women and curb new infections.