The Transformative Impact of Community-Led Monitoring in the South African Health System: A Comprehensive Analysis.

Objectives: Community-led monitoring (CLM) is an emerging approach that empowers local communities to actively participate in data collection and decision-making processes within the health system. The research aimed to explore stakeholder perceptions of CLM data and establish a CLM Data Value Chain, covering data collection and its impact. Methods: Qualitative data were collected from stakeholders engaged in health programs in South Africa. Data analysis involved a collaborative workshop that integrated elements of affinity diagramming, thematic analysis, and the systematic coding process outlined in Giorgi's method. The workshop fostered joint identification, co-creation of knowledge, and collaborative analysis in developing the data value chain. Results: The findings showed that CLM data enabled community-level analysis, fostering program advocacy and local collaboration. It enhanced program redesign, operational efficiency, and rapid response capabilities. Context-specific solutions emerged through the CLM Data Value Chain, promoting sustainable and efficient program implementation. Conclusion: CLM is a powerful tool for improving program implementation, quality, and advocacy in South African healthcare. It strengthens accountability, trust, and transparency by involving local communities in data-driven decision-making. CLM addresses context-specific challenges and tailors interventions to local needs.

Understanding health outcome drivers among adherence club patients in clinics of Gauteng, South Africa: a structural equation modelling (SEM) approach.

BACKGROUND: There has been growing interest in understanding the drivers of health outcomes, both in developed and developing countries. The drivers of health outcomes, on the other hand, are the factors that influence the likelihood of experiencing positive or negative health outcomes. Human Immunodeficiency Virus (HIV) continues to be a significant global public health challenge, with an estimated 38 million people living with the aim of this study was therefore to develop and empirically test a conceptual research model using SEM, aimed at explaining the magnitude of various factors influencing HIV and other health outcomes among patients attending Adherence Clubs. METHOD: This was a cross sectional survey study design conducted in 16 health facilities in the City of Ekurhuleni in Gauteng Province, South Africa. A total of 730 adherence club patients were systematically sampled to participate in a closed ended questionnaire survey. The questionnaire was assessed by Cronbach's alpha coefficient for internal consistency. The proposed model was tested using structural equation modelling (AMOS software: ADC, Chicago, IL, USA). RESULTS: A total of 730 adherence club members participated in the study. Of these, 425 (58.2%) were female and 305 (41.8%) were male. The overall results indicated a good reliability of all the scale involved in this study as Cronbach alphas ranged from 0.706 to 0.874, and composite reliability from 0.735 to 0.874. The structural model showed that the constructs health seeking behavior (ß = 0.267, p = 0.000), health care services (ß = 0.416, p = 0.000), stigma and discrimination (ß = 0.135, p = 0.022) significantly predicted health outcomes and explained 45% of its variance. The construct healthcare service was the highest predictor of health outcomes among patients in adherence clubs. CONCLUSION: Patient health seeking behaviour, healthcare services, stigma and discrimination were associated with perceived health outcomes. Since adherence clubs have been found to have a significant impact in improving patient outcomes and quality of life, there is a need to ensure replication of this model.

Flooding and poverty: Two interrelated social problems impacting rural development in Tsholotsho district of Matabeleland North province in Zimbabwe.

Flooding and poverty are the two social problems that have coexisted within the rural communities of Tsholotsho district. As a result, both problems have negatively affected and disrupted the everyday pattern of lives of people living in the district. This study sought to highlight how the two problems combine to impact human societies. The objectives that the study sought to fulfil were to establish the impact of flooding on the development of rural communities, to analyse how poverty manifests itself in rural communities, to analyse the relationship that exists between flooding and poverty and to suggest ways for dealing with the two problems. A qualitative research approach, using interviews and observations, was used to gather data from the research participants. The study findings were that flooding impeded development through shifting of human populations, destruction of crops, shelter and livestock. Floods also affected human capital through causing injuries to members of the community. Poverty manifested itself in three ways - as a development barrier, a vulnerability amplifier and a non-discriminatory agent. The study further found that a strong relationship exists between flooding and poverty because of the fact that flooding causes or worsens poverty, whereas poverty increases flood vulnerability. The study concluded that the poor need government assistance to reconstruct shelter destroyed by floods. Furthermore, programs aimed at improving livelihoods of the poor are an indispensable imperative. This study informs policymakers and offers a methodological significance to development and disaster practitioners. It also adds to the body of literature on flooding and poverty.

Managing flood disasters on the built environment in the rural communities of Zimbabwe: Lessons learnt.

This article is about managing flood disasters affecting the built environment in the rural communities of Zimbabwe. Using Tsholotsho district in Matabeleland North province as a case study, the authors argue that flooding has adversely impacted the built environment through destroying infrastructure. The principal objectives of this study were to establish the impact of flood disasters on the built environment, to demarcate factors that perpetuate communities' vulnerabilities to flooding and to delineate challenges that negate the management of flood disasters in the built environment. This qualitative study was based on a purposive sample of 40 participants. Data were collected through semi-structured interviews and observation methods. The findings were that floods can damage human shelter, roads, bridges and dams. Locating homesteads near rivers and dams, using poor-quality construction materials, and lack of flood warning were found to perpetuate vulnerability to flooding. Poverty and costs of rebuilding infrastructure, lack of cooperation between the communities and duty-bearers, and failure to use indigenous knowledge were found to be impeding the management of flood disasters. The study concluded that flood disasters can wipe out community development gains accumulated over many years. Further, community vulnerability to flooding in the built environment is socially constructed. The study posits that addressing the root causes, reducing flood vulnerability and avoiding risk creation are viable options to development in the built environment. Lastly, reconstruction following flood disasters is arduous and gruelling, and not an easy exercise.

Expanding the prevention armamentarium portfolio: a framework for promoting HIV-Conversant Communities within a complex, adaptive epidemiological landscape.

The article describes a design journey that culminated in an HIV-Conversant Community Framework that is now being piloted in the Limpopo Province of South Africa. The objective of the initiative is to reduce the aggregate community viral load by building capacity at multiple scales that strengthens peoples' HIV-related navigational skill sets-while simultaneously opening a 'chronic situation' schema. The framework design is based upon a transdisciplinary methodological combination that synthesises ideas and constructs from complexity science and the management sciences as a vehicle through which to re-conceptualise HIV prevention. This resulted in a prototype that included the following constructs: managing HIV-prevention in a complex, adaptive epidemiological landscape; problematising and increasing the scope of the HIV knowledge armamentarium through education that focuses on the viral load and Langerhans cells; disruptive innovation and safe-fail probes followed by the facilitation of path creations and pattern management implementation techniques. These constructs are underpinned by a 'middle-ground' prevention approach which is designed to bridge the prevention 'fault line', enabling a multi-ontology conceptualisation of the challenge to be developed. The article concludes that stepping outside of the 'ordered' epistemological parameters of the existing prevention 'messaging' mind-set towards a more systemic approach that emphasises agency, structure and social practices as a contribution to 'ending AIDS by 2030' is worthy of further attention if communities are to engage more adaptively with the dynamic HIV landscape in South Africa.