4 HEALTH BUILDING CAPACITY & KNOWLEDGE - BIENNIAL REPORT 2012 2013 - Wits University
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BUILDING CAPACITY & KNOWLEDGE
4 HEALTH
BIENNIAL REPORT 2012 - 2013
Wits School of Public Health | Biennial Report 2012-2013
TABLE OF CONTENTS Page
LIST OF ABBREVIATIONS AND ACRONYMS 4
MESSAGE FROM THE HEAD OF SCHOOL 7
LEADERSHIP AND GOVERNANCE 9
WSPH Executive 9
School-wide Meetings 9
Annual School Lekgotla 9
PUBLIC HEALTH RESEARCH AND KNOWLEDGE LEADERSHIP 11
Research Overview 12
An Enabling Culture for Knowledge Generation 14
Publication Highlights: 2012 - 2013 15
TEACHING AND LEARNING 21
Public Health and the Graduate Entry Medical Programme 22
Diploma in Occupational Health 23
Master of Medicine 23
Master of Public Health 24
Master of Science (Epidemiology) 24
Demography and Population Studies 25
Phd Programme 26
Consortium for Advanced Research Training in Africa 27
STRATEGIC PARTNERSHIPS AND NETWORKS 29
Wits, Colorado, Brown, and APHRC Colloquium 29
Multilateral Association for Studying Health Inequalities and Enhancing North-South and 29
South-South Cooperation
Graduate Training of Research Data Managers 30
Wits Trains UNICEF Communication Officers 30
Round Table on Non-communicable Diseases 31
Indepth International Scientific Conference 32
PRICELESS Partnerships 33
CHP Health Policy and Systems Mini-symposia 33
Partnerships to Support Health Policy and Practice 33
South-South Collaboration in Biostatistics 36
SERVICE AND ACADEMIC CITIZENSHIP 37
Service Learning Projects 37
Building the Field of Public Health 38
Witsies at PHASA 2013 38
WSPH Staff Membership on Local and International Boards 41
ORGANISATIONAL DEVELOPMENT AND SUPPORT SYSTEMS 44
New School of Public Health Building 44
New Agincourt Buildings 45
Substantial Research Grants 45
Academic Meetings 46
Health System Seminars 47
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Wits School of Public Health | Biennial Report 2012-2013
Epidemiology and Biostatistics Seminars 47
Participation in Congresses 47
STAFF APPOINTMENTS, PROMOTIONS AND ACCOMPLISHMENTS 49
New Appointments: 2012 - 2013 49
Staff Promotions 55
Awards and Achievements 56
GRADUATIONS 58
PUBLICATIONS 68
2012 68
2013 76
ANNEXURES 86
Annexure 1: SPH Executive 86
Annexure 2: Map of CHP Collaborations 87
Annexure 3: Map of Agincourt Unit Collaborations 88
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Wits School of Public Health | Biennial Report 2012-2013
LIST OF ABBREVIATIONS AND ACRONYMS
AFPHA African Federation of Public Health Associations
AIDS Acquired Immune Deficiency Syndrome
AISA Africa Institute of South Africa
APHRC African Population Health Research Centre
ART Antiretroviral Treatment
ASPHA Association of Schools of Public Health in Africa
CARTA Consortium for Advanced Research Training in Africa
CHEPSAA Consortium for Health Policy and Systems Analysis in Africa
CHP Centre for Health Policy
CHW Community Health Worker
CMD Cardio-metabolic disease
CPHM College of Public Health Medicine
DENOSA Democratic Nursing Organisation of South Africa
DfID Department for International Development (UK)
DHS Demographic and Health Survey
DOH Department of Health
DOHET Department of Higher Education and Training
DPHRU Wits/MRC Developmental Pathways for Health Research Unit
DPS Demography and Population Studies
DRC Democratic Republic of Congo
DSD Department of Social Development
DST Department of Science and Technology
EDCTP European & Developing Countries Clinical Trials Partnership
EPICOH Conference on Epidemiology in Occupational Health
GEMP Graduate Entry Medical Programme
GIS Geographic Information Systems
HDSS Health and Demographic Surveillance System
HIV Human Immunodeficiency Virus
HOS Head of School
HPSR Health Policy and Systems Research
HRH Human Resources for Health
HSRC Human Sciences Research Council
ICOH International Congress on Occupational Health
IDASA Institute for Democracy in South Africa
IDRC International Development Research Centre
iHEA International Health Economics Association
INDEPTH International Network for the Demographic Evaluation of Populations and Their Health
INTREC INDEPTH Training and Research Centers of Excellence
IUSSP International Union for the Scientific Study of Population
JAS Joint Advanced Seminar
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Wits School of Public Health | Biennial Report 2012-2013
LINC Learning, Information dissemination and Networking with Community
LMICs Low-and middle-income countries
LSHTM London School of Hygiene and Tropical Medicine
MASCOT Multilateral Association for studying health inequalities and enhancing North-South and
South-South cooperation
MBA Master of Business Administration
MBBCh Bachelor of Medicine and Bachelor of Surgery
MBL Master of Business Leadership
MDG Millennium development goal
MDGs Millennium development goals
M&E Monitoring and Evaluation
MHSAR Maternal Health Systems in South Africa and Rwanda
MPH Master of Public Health
MRC Medical Research Council
MTT Ministerial Task Team
NDoH National Department of Health
NGOs Non-governmental organisations
NHI National Health Insurance
NHLS National Health Laboratory Service
NIH National Institutes for Health
NIOH National Institute for Occupational Health
NCDs Non-communicable diseases
NRF National Research Foundation
NSDA Negotiated Service Delivery Agreement
ODMWA Occupational Diseases in Mines and Works Act
OHSC Office of Health Standards Compliance
OSD Occupation Specific Dispensation
PEECHI Programme on the Economic Evaluation of Child and Maternal Health Interventions
PHASA Public Health Association of South Africa
PHATIC Public Health and Tropical Medicine Interview Committee
PHC Primary Health Care
PhD Doctor of Philosophy
PHILA Public Health Innovation and Lifetime Achievement
PRICELESS Priority Cost Effective Lessons for Systems Strengthening
REACH Researching Equitable Access to Health Care Services
RESYST Research on Resilient and Responsive Health Systems
RESON Research on the State of Nursing
RUDASA Rural Doctors Association of South Africa
SADC South African Development Community
SAIOH Southern African Institute for Occupational Hygiene
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Wits School of Public Health | Biennial Report 2012-2013
SAKAI Wits Electronic Learning Environment
SAMA South African Medical Association
SARCHi South African Research Chairs Initiative
SBCC Social and behavioural change communication
Sida Swedish International Development Agency
SPARC Strategic Planning and Allocation of Resources Committee
StatsSA Statistics South Africa
STIs Sexually Transmitted Infections
TB Tuberculosis
UHC Universal health coverage
UK United Kingdom
UNAIDS Joint United Nations Programme on HIV/AIDS
UNESCO United Nations Organization for Education, Science and Culture
UNICEF United Nations Children’s Fund
USA United States of America
USAID United States Agency for International Development
UWC University of the Western Cape
WBCA Wits, Brown, Colorado & APHRC
WFPHA World Federation of Public Health Associations
WHO World Health Organization
WHO/TDR Special Programme for Research and Training in Tropical Diseases
WSPH Wits School of Public Health
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Wits School of Public Health | Biennial Report 2012-2013
MESSAGE FROM THE HEAD OF SCHOOL
It has been a privilege to assume the position of Head of the Wits
School of Public Health (WSPH) in January 2012.
I want to take this opportunity to acknowledge my predecessors,
Professors John Gear, William Pick and Sharon Fonn, for their
visionary leadership in developing and consolidating the School’s
teaching, research and service excellence, its intellectual strengths,
and its responsiveness to national and regional imperatives.
At the beginning of 2012, we commenced a consultative and
participatory strategic planning process that included all WSPH
staff. We finalised our strategic framework in June 2012, which
sets out the goals of the WSPH to pursue for the five-year period
from 2012 until 2016. The framework also coincides with my tenure
as Head of School (HOS). The framework takes into account Wits
University’s goals and plans to assert itself as an internationally leading research-intensive university,
the Faculty of Health Sciences vision and strategic intentions, and global and national public health
developments. We agreed that five strategic priorities will inform the work of the WSPH from 2012
until 2016: public health research and knowledge leadership; teaching and learning that is student-
centred, innovative and of high quality; strategic partnerships and networks; service and academic
citizenship; and organisational development and support systems.
I take pleasure in introducing this biennial report, which summarises the remarkable achievements
of staff and students of the WSPH for the two-year period from 1 January 2012 to 31 December
2013. The theme of this biennial report is Building Capacity & Knowledge 4 Health, drawing on
the theme of the symposium to celebrate the opening of our new, state-of-the art building, and the
theme of the special journal issue of Global Health Action. Importantly, the theme acknowledges
the importance of good health, and highlights the core purpose of our modern new building with its
stunning views of Johannesburg - that of enabling the achievement of good health for all through
teaching and promotion of learning, knowledge generation and dissemination, and public health
leadership and advocacy. The biennial report is structured around the five strategic priorities listed
above.
As can be seen from the accompanying report, the past two years have been remarkable in more
than one way, and we have much to celebrate. We have moved into new spacious premises that
continue to be the envy of many. By bringing scholars, their research programmes and teaching
together in a single, cohesive intellectual community, we are able to create a synergy that amplifies
the contributions of the WSPH to health and development in South Africa, the Africa region and
other parts of the globe. To paraphrase the speech of the Minister of Health, honourable Dr Aaron
Motsoaledi, at the opening of the international symposium, “now is the time to accelerate capacity
building in public health. We need to work together to develop the capacity to lead and manage the
transition from a curative, expensive, hospital-centric and unsustainable health system to one that
focuses on prevention of disease, the promotion of health and one that provides universal access to
good quality care”. Importantly, the building is a resource for the entire University and public health
community at large.
As can be seen from the details in the report, the School has continued its track record of strong
public health leadership, enhanced by the move to our new premises at the end of 2012. The
R10 million funding obtained from the Atlantic Philanthropies at the end of 2012 for enhancing
research and teaching in the WSPH has put the achievement of our strategic goals on a firm footing.
The generous funding highlights the Atlantic Philanthropies’ strong support for public health in South
Africa.
During the review period, our academics have excelled in many ways and have been very
productive, with more than 200 publications. Our two research entities, the MRC/Wits Rural Public
Health and Health Transitions Research Unit (Agincourt) and the Centre for Health Policy (CHP)
were re-affirmed as national assets when they were reviewed by expert panels of the South African
Medical Research Council (MRC). Both these units have an international reputation, and a long track
record of supporting population health and health sector transformation initiatives which predates the
transition to South Africa’s democracy.
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Wits School of Public Health | Biennial Report 2012-2013
Similarly, our students have excelled both on the national and international fronts. We continue with
our impressive postgraduate throughput with 87 master’s and 19 PhD graduates during the review
period. Since the opening of the building, we have hosted several high profile events, starting with
the international public health symposium in January 2013, and ending with the PhD and CARTA
symposium (and graduation) on 10 December 2013.
The achievements listed in this biennial report would not have been possible without the support
of the executive, all staff members, students, funders and partners of the WSPH. The full list of
more than 500 donors that made our new building a reality is mounted on the wall of the resource
centre, and their investment and foresight are gratefully acknowledged. I want to thank the staff-full-
time, part-time, honorary, visiting, academic and administrative- and students for their hard work,
dedication and commitment to public health and to the ongoing development of the School. Thank
you to our partners in government, our collaborators, funders and other colleagues in the Faculty of
Health Sciences and the University at large for their support and encouragement.
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Wits School of Public Health | Biennial Report 2012-2013
LEADERSHIP AND GOVERNANCE
WSPH Executive
In January 2012, Professor Laetitia Rispel assumed the leadership of the WSPH. The School Executive
brings together all the heads of research entities, departments, divisions and programmes, as well
as a representative of the public health medicine registrars (Annexure 1). Student membership will
be expanded on the executive during 2014. The executive meetings are held monthly, and serve as
a strategic forum to: discuss school policies (where relevant) and financial matters; provide feedback
on achievements and challenges of research entities, departments, divisions or programmes; and
track progress on decisions agreed to at the previous meeting.
From left to right: Associate Professor Stephen Tollman, Mrs Angeline Zwane, Dr Julia Moorman, Associate Professor
Gillian Nelson, Mrs Losh Naidoo, Adjunct Professor Shan Naidoo, Professor Laetitia Rispel, Dr Nicola Christofides,
Professor David Rees, Associate Professor Tobias Chirwa & Dr Jane Goudge.
(Not in picture: Associate Professor Kathleen Kahn & Professor Ian Couper)
School-wide Meetings
The school-wide meetings are held monthly on the last Friday of every month. The meetings bring
together all staff, and provide a forum to exchange ideas and learn about the work of the different
‘entities’ that make up the WSPH. During 2012, the school meetings focused inter alia on the use of
electronic library resources and criteria for academic staff promotion. During 2013, we learned more
about the work of each research entity, department, division or programme-their achievements, as
well as their academic and administrative challenges. These meetings are well attended, with at least
70% of staff members at any one meeting.
Annual School Lekgotla
This meeting, which is held for a whole day, serves as an annual retreat to reflect on our progress
and challenges, and to map out key priorities for the upcoming year. The lekgotla replaces one of the
monthly school meetings, and is not an optional event for WSPH staff. In 2012, the meeting mapped
out the strategic direction of the School.
The 2013 lekgotla was a historic occasion for several reasons: the lekgotla was addressed by the
outgoing Vice-Chancellor and Principal, Professor Loyiso Nongxa, who has been a champion of public
health during his tenure at Wits and has always acknowledged the innovation and accomplishments
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Wits School of Public Health | Biennial Report 2012-2013
Professor Loyiso Nongxa (Wits Vice-Chancellor 2003 – 2013) at the 2013 WSPH lekgotla
of the WSPH. It was a significant occasion that he spent some of his last day in office with us in
the School. The lekgotla was also addressed by the current Wits University Principal and Vice-
Chancellor Professor Adam Habib, who brought interesting perspectives on broader strategic issues
for consideration at the lekgotla. It was also the first time that we held a lekgotla in our new premises.
10Wits School of Public Health | Biennial Report 2012-2013
PUBLIC HEALTH RESEARCH AND KNOWLEDGE LEADERSHIP
In January 2013, the WSPH celebrated the move to its new, state-of-the-art building across the road
from the Wits Medical School by hosting an international public health symposium entitled Building
Capacity 4 Health. Professor Loyiso Nongxa, reiterated the importance of public health when he
welcomed the 400 public health experts, professionals and academics to Wits.
Demonstrating our knowledge leadership, and in light of the global profile of Wits University, the
symposium programme dealt with critical issues that are relevant at both national and global levels.
We showcased the collective work of the WSPH. The first session focused on research as a tool
to improve health. In addition to providing an international perspective on how research makes
a difference to health policy development and/or to the communities or populations with whom
the research is conducted, this session highlighted the comparative strengths of the WSPH in
demographic and population health surveillance and in occupational health research.
The second session of our symposium put the spotlight on the linkages between research, policy,
practice and implementation. Drawing primarily on research done in the WSPH, the session highlighted
the value of independent, high quality and relevant research, collaborative networks, policy advocacy,
and active engagement with government and with civil society. Our third session focused on building
the next generation of public health leaders.
The goal of this session was to share teaching
innovations at the WSPH, ranging from new
tracks in our Master of Public Health (MPH)
programme, our strengths in measurement “Public health matters. It
sciences and public health medicine has always been a peripher-
training, through to our Africa-wide PhD
programme that aims to build a vibrant African al issue, but in recent years
academy able to lead world-class, it has become clearer that
multidisciplinary research that makes a positive
impact on public and population health. in many ways, public health
is central to the success of
Our final session recognised the critical
imperative to improve the effectiveness and our response to health
and efficiency of the health system. The care.”
presentations interrogated the implementation
of the national health insurance (NHI) system Professor Loyiso Nongxa
in South Africa and drew attention to the
importance of addressing fraud and corruption
in the health sector.
The Vice-Chancellor with acting and permanent heads of the WSPH since 1979:
From left to right: Professors Mary Edginton, Michael Rudolph, Sharon Fonn, Loyiso Nongxa, William Pick,
Laetitia Rispel and John Gear
11Wits School of Public Health | Biennial Report 2012-2013
Research Overview
One of the hallmarks of the WSPH is our relentless quest to build capacity and new knowledge for
health. We encourage an environment where researchers set their imaginations free, raise new
questions and ways of thinking, and challenge the status quo, in order to improve population health
and the performance of the health system.
The two research entities in the WSPH, Agincourt and CHP, continue as MRC/Wits extramural,
flagship research units.
The start of the 2013 census in the Agincourt HDSS (singing Nkosi Sikelel’ iAfrika)
The mandate of Agincourt is “To better understand the dynamics of health, population and social
transitions in rural South (and southern) Africa in order to mount a more effective public health, public
sector and social response”. A health and socio-demographic surveillance system (HDSS), covering
31 villages and around 110,000 people living in the Agincourt sub-district, provides the foundation for
the research and other scholarly activities of the Unit. Significant achievements of key Agincourt staff
for 2012 and 2013 include the appointment of Professor Stephen Tollman as chair of the Wellcome
Trust Public Health and Tropical Medicine Interview Committee (PHATIC), as principal scientist of the
International Network for the Demographic Evaluation of Populations and their Health (INDEPTH), as
Chair of the External Advisory Committee to the Public Health Foundation of India, and as a member
of the advisory committee to the editors of the Disease Control Priorities in Developing Countries (third
edition). Professors Kathleen Kahn and Peter Byass (Honorary Professor in the School) contributed to
the World Health Organization (WHO) expert consultations on verbal autopsies that produced the new
WHO standard tools and manuals. (see:www.who.int/healthinfo/statistics/verbalautopsystandards/
en/ and www.interva-4.net).
The Agincourt team was awarded the 2013 INDEPTH prize for extraordinary research in population
and health for a publication in PLoS Medicine (see Clark SJ, Kahn K, Houle B, Arteche A, Collinson
MA, Tollman SM, Stein A. Young Children’s Risk of Dying Before and After Their Mothers’ Death:
A Rural Southern African Population-Based Surveillance Study. PLoS Medicine 2013; 10(3):
e1001409).
The mandate of CHP is “To conduct research that advocates for and promotes health policies in
support of equity and social justice; provide learning opportunities which build and strengthen capacity
in health policy and systems research; support and engage with a variety of stakeholders to promote
appropriate health policy analyses; and advance the field of health policy by developing meaningful
national and international relationships”. Significant achievements of the two-year period include
12Wits School of Public Health | Biennial Report 2012-2013
the: award of the South African Research Chairs Initiative (SARCHi) in Health Policy and Systems
Research (HPSR) by the National Research Foundation (NRF) and the Department of Science and
Technology (DST); more than doubling in the number of peer-reviewed papers; involvement in key
national health policy and health sector reform processes; development of an extensive network of
national and international collaborators and partners; and graduation of five PhD and ten master
students in the field of health policy and systems research.
During the period of this biennial
report, the Agincourt unit (2012)
and CHP (2013) were reviewed by
MRC expert panels. The primary
purpose and expectations of the
five-year, on-site review of an MRC
Extramural Research Unit are to
assess the following: the quality,
productivity, and impact of the
Unit’s research programmes; the
research programmes, outputs,
and translational achievements of
the Unit, not only in the context of
national and international recognition,
but also in relation to the research
agenda of the MRC; commitment to
CHP staff engaging in discussion and debate
capacity development as measured
by numbers of registered and recently graduated postgraduate students; and implementation of
recommendations originating from the previous MRC review.
Both units were reaffirmed as national assets and the MRC will continue to support Agincourt for a
further five years and CHP for a further two years. This is because CHP has already received MRC
support for a period of 15 years, which is the maximum period recommended by the MRC for an
extramural unit.
The PRICELESS programme (Priority Cost Effective Lessons for Systems Strengthening) focuses on
evidence in health-policy making, particularly economic evaluation. In 2012 and 2013, the programme
published journal articles on measles control in sub-Saharan Africa and full economic evaluation of
a child health delivery platform. Work continued on the cost-effectiveness of a screening programme
for diabetic retinopathy, and the programme investigated the cost-effectiveness of different feeding
strategies for infants with HIV positive mothers. A literature review on cost-effective strategies to
prevent traffic injuries was also completed. The highlight of PRICELESS’ scholarly endeavours is
the ground-breaking research on salt reduction which had a big impact on government policy. The
research paper entitled: “Reducing sodium content in high salt foods: Impact on cardiovascular
disease in South Africa” contributed to the publication of draft health regulations to reduce the salt
content in bread and other foodstuffs, with clear targets set for food manufacturers to reach by 2016
and 2018.
Our research in occupational diseases, specifically those related to mining exposures such as asbestos,
silica and manganese, has advanced public health knowledge in South Africa. Silicosis rates in gold
miners remain a national concern and a focus of government. Much of the silica and silicosis research
in mining and other industrial sectors in the country is conducted by WHSP staff. This was the topic of
two PhD theses of staff members who graduated in 2012. One thesis showed that rates of silicosis
have increased 10 fold in black gold miners in the last 30 years; the other thesis highlighted the risk of
silica dust exposure in agricultural workers, a workforce that has been neglected in health research.
Other lesser researched groups of workers on whom health data were obtained and analysed were
platinum and diamond mine workers. The latter group is potentially exposed to asbestos due to the
geology of the areas in which diamonds occur. The WSPH occupational health group continues to
search for and identify exposures to the lethal asbestos fibres – mainly in the environment - long after
the mines closed and the use of asbestos was banned in South Africa. Characterising the health
effects of manganese exposure is a relatively new focus and important international collaborations
have been forged in this area. The autopsy database at the National Institute for Occupational
Health (NIOH) continues to provide rich data for research into occupational diseases in all mining
commodities, and several papers were published in 2012 and 2013.
13Wits School of Public Health | Biennial Report 2012-2013
During the review period, the
Department of Community Health
specialists and registrars published
several peer-reviewed articles
in national and international
journals. Of particular interest is the
research published in the journal
Environmental Research in 2013
on “Lead poisoning among young
school children in a South African
subsistence fishing community”. The
research highlighted the continued
problem of lead poisoning in
vulnerable groups in South Africa. Dr
Ruxana Jina continued her research
in the prevention and management
of sexual violence. She published
in the prestigious Best Practice &
Research Clinical Obstetrics and
Gynaecology Journal on the “Health
consequences of sexual violence
against women”. Drs Taskeen Khan,
Health effects of manganese exposure requires the analysis of brains of
deceased miners using highly sophisticated equipment
Leena Thomas and Professor Shan
Naidoo published a paper entitled
“Analysing post-apartheid gender
and racial transformation in medical education in a South African province” in the special issue
of Global Health Action. The public health medicine registrars presented several oral papers and
posters at the 2012 and 2013 Public Health Association of South Africa (PHASA) conferences.
The Division of Epidemiology and Biostatistics has made noticeable progress in strengthening
research in infectious and non-communicable diseases and advancing epidemiological and
biostatistics research methodology. The latter includes development of spatio-temporal surveillance
methods to support tuberculosis control in South Africa, health education and awareness model
for early tuberculosis diagnosis in resource-limited settings and sexual practices of women and
their partners during and after pregnancy. For non-communicable diseases, research has included
effectiveness of strengthened facility services and patient outreach groups for hypertension
treatment. The Division’s focus has also been on secondary data analyses using national datasets.
The Division has excelled in both local and international collaborative research and notable examples
include collaboration internally with Agincourt and CHP, and externally with the Wits Department of
Paediatrics and Child Health, Warwick (UK) and Washington Universities, St. Louis, Missouri, (USA)
and the Swiss Tropical Public Health Institute. Both staff and students have published widely during
the review period.
An Enabling Culture for Knowledge Generation
In line with our vision to be the leading School of Public Health in Africa, at the end of 2012 we
established a Research Training and Innovation cluster to coordinate research capacity-building
initiatives and to encourage innovation.
In 2012, we allocated R100 000 for seed-funding or top-up funding from the School’s operational
(151) budget. The goal of the initiative is to encourage every academic to be research-active and
to use the money to ‘jump-start’ scholarly endeavours. All academic staff members are eligible to
apply for seed-money up to a maximum amount of R10 000, subject to clear spending and reporting
guidelines. During 2012, seven awards were made. Four out of the seven awards were made to
women, two out of seven supported PhD research of staff members, and four out of seven supported
pilot research projects of emerging academics. All recipients indicated that the seed-funding enabled
faster progress with their research. During 2013, five awards were made, two to public health
medicine registrars to support their MMed research projects, and three supported PhD research of
staff members.
14Wits School of Public Health | Biennial Report 2012-2013
Postgraduate students and academic mentors at the 2013 boot camp
In 2013, we introduced our first writing ‘boot camp’ for graduates to encourage publication of their
research in a scientific journal. Funding was obtained from the Strategic Project and Resource
Allocation Committee (SPARC). At the boot camp, graduates were taken through the process of
scientific writing and publication with their supervisors or senior academics as mentors. Attendance
was conditional upon them submitting an article for publication in a peer-reviewed journal. During
2013, nine papers were submitted to peer-reviewed journals. The boot camp concept was met with
much enthusiasm from all involved and will be institutionalised.
We encourage all our academics to apply for a rating with the NRF when they are ready. Two staff
members, Dr Charles Chasela and Dr Alisha Wade, received NRF ratings of Y and C respectively
during the two-year period. Professors Gill Nelson, Kathleen Kahn and Stephen Tollman applied for
NRF ratings at the end of the reporting period, and will receive the outcome during 2014.
Publication Highlights: 2012 - 2013
The WSPH publication outputs increased by
37% from 210 journal articles in the previous
biennial period to 288 for 2012 and 2013. Of
importance is the increasing numbers of young
academics publishing in peer-reviewed journals.
An innovative programme of writing retreats and
‘boot camps’ allows for mentorship, twinning of
ideas and systematic progress on scientific writ-
ing and publications.
Drawing global attention to the work of the
WSPH, a special issue of the international
peer-reviewed journal, Global Health Action,
was launched at the gala dinner following the in-
ternational symposium. The building was formal-
ly opened by the Minister of Higher Education
and Training, honourable Dr Blade Nzimande.
The special journal issue features 23 articles by
staff and students, of which 15 (63%) were authored by postgraduate students or junior academics.
Six papers were by first-time authors, all of whom are black and five are women. This highlighted
15Wits School of Public Health | Biennial Report 2012-2013
the supplement’s theme of ‘Building new knowledge’ to nurture and develop the next generation of
African scholars, a critical human resource challenge in sub-Saharan Africa.
The 23 research articles focused on the following themes: the centrality of the measurement
sciences to the discipline of public health; improving the health of communities and of workers;
understanding population health risk factors; concerns with policy design and implementation;
challenges related to human resources for health; and optimising health system performance.
Global Health Action is an open access publication, allowing for the widest possible dissemination of
research in over 110 countries. The full supplement can be found at: http://www.globalhealthaction.
net/index.php/gha/article/view/20445
Professors Sharon Fonn, Loyiso Nongxa, Laetitia Rispel, Dr Blade Nzimande and Professor Ahmed Wadee
at the launch of Global Health Action
Integrating vertical HIV monitoring and evaluation into health systems: a
case study from South Africa
Efforts to improve population health in low and middle-income
countries (LMICs) have often been characterised by tensions
between vertical (targeted) and horizontal approaches. Vertical
approaches aim to improve health outcomes for a single disease,
often through dedicated human resource, budgets, drug delivery and
management systems. While these rapidly increase the coverage
of disease control interventions, research evidence shows that
they undermine the capacity of general health systems to improve
health. An example is how staff are taken away from general health
services through the vertical approach to providing HIV treatment.
The horizontal approaches, on the other hand, tackle health
problems on a wide front through investment in general health
systems such as human resources, drug delivery and financing,
which are required for sustained overall health improvements.
Dr Mary Kawonga
Dr Mary Kawonga, Professor Sharon Fonn and Dr Duane Blaauw examined the extent to which
the HIV programme monitoring and evaluation function is integrated within the overall health system at
district level in South Africa. To measure administrative integration, an existing methodology referred
to as ‘decision-space analysis’ was adapted. New measurement scales were developed to measure
the degrees to which horizontal and vertical managers exercised authority over HIV programme
monitoring and evaluation (M&E) activities, for instance data collection, collation, analysis and use.
The study found that: the M&E function of the HIV programme is not integrated within the health
system; horizontal managers exercise a low degree of authority over the utilisation of HIV data for
monitoring and management decisions; and HIV managers rarely play the role of technical advisors
by providing HIV M&E support to their horizontal counterparts. The authors conclude that the existing
M&E model of HIV programmes contradicts district health system development. They recommend
that policy-makers consider alternative programme arrangements that advance strengthening of the
district health system.
Kawonga M, Fonn S & Blaauw D. Administrative integration of vertical HIV monitoring and evaluation
into health systems: a case study from South Africa. Global Health Action 2013; 6: 19252 –
http://dx.doi.org/10.3402/gha.v6i0.19252
16Wits School of Public Health | Biennial Report 2012-2013
Community health worker outreach services to improve access to health care in
South Africa
Many LMICs face growing health inequities and have made insufficient progress towards the
millennium development goals (MDGs). This has been attributed to the poor performance of the
health system as well as barriers to care, experienced by poor and vulnerable communities. The lack
of access to transport, clean water, sanitation, and nutrition limit health improvements.
Community health worker (CHW) programmes aim to improve access to care by providing outreach
services. Being a link between poor communities and the formal health system, CHWs have a crucial
role in assisting households to overcome barriers to care. Although there is growing evidence of the
effectiveness of CHWs to facilitate improvements in certain health outcomes, programmes often fail
because of insufficient skills or support.
CHP’s Drs Nonhlanhla Nxumalo, Jane Goudge and Liz Thomas
examined factors that facilitate success (and failure) in providing
outreach services which assist households to overcome poverty-
related barriers to health care. Using case studies, they compared
the functioning of three South African CHW programmes with
differing institutional contexts: a small local non-governmental
organisation (NGO), a local satellite of a national NGO, and a
government-initiated service.
The study highlighted that the role of CHWs needs to be
conceptualised with an understanding of the social determinants of
ill-health for them to facilitate access and reduce poverty-related
barriers to care. The success and sustainability of CHW programmes
require the ongoing commitment of resources, including investment
Dr Nonhlanhla Nxumalo
in quality training, supervision, mentoring and organisational
support. In addition, CHWs need resources to help them navigate government services. Ultimately,
strengthening health districts and sub-districts is crucial for effective government-led CHW
programmes. Policy makers should ensure sufficient capacity for CHWs to operate effectively at the
interface between community and the health system.
Nxumalo N, Goudge J & Thomas L. Outreach services to improve access to health care in South
Africa: lessons from three community health worker programmes. Global Health Action 2013; 6:
19283 - http://dx.doi.org/10.3402/gha.v6i0.19283
Policy implementation and financial incentives for nurses
in South Africa: a case study on the occupation specific
dispensation
In 2007, the South African government introduced the occupation
specific dispensation (OSD), a financial incentive strategy, to
attract, motivate, and retain health professionals in the public sector.
Implementation commenced with nurses. Prudence Ditlopo, Dr
Duane Blaauw, Professor Laetitia Rispel, Dr Steve Thomas and
Posy Bidwell conducted a study to examine implementation of the
OSD for nurses using Hogwood and Gunn’s policy implementation
framework. The study found that there were several implementation
weaknesses. The information systems required for successful policy
Prudence Ditlopo implementation, such as the public sector human resource data
base and the South African Nursing Council register of specialised
nurses were incomplete and inaccurate, thus undermining the process. Insufficient attention was
paid to time and resources, dependency relationships, task specification, and communication and
coordination. The authors concluded that the implementation of financial incentives requires careful
planning and management in order to avoid loss of morale and staff grievances.
Ditlopo P, Blaauw D, Rispel L, Thomas S & Bidwell P. Policy implementation and financial incentives
for nurses in two South African provinces: A case study on the occupation specific dispensation
Global Health Action 2013; 6: 19289 - http://dx.doi.org/10.3402/gha.v6i0.1
17Wits School of Public Health | Biennial Report 2012-2013
Dengue burden higher than previously reported
Honorary Associate Professor Osman Sankoh co-authored an
article on the global distribution and burden of dengue that was
published in Nature in April 2013.
Dengue is a systemic viral infection that is transmitted by Aedes
mosquitoes and usually results in a wide range of clinical symptoms,
from mild fever to severe fatal dengue shock syndrome. For some
patients, dengue is a life-threatening illness. Current knowledge of
the global distribution of the risk of dengue virus infection and its
public health burden were poorly known. The study estimated that
the global burden of dengue is around 390 million infections per
Associate Professor Osman Sankoh
year, three times higher than the figure reported by the WHO.
To date there are no effective antiviral agents for the treatment of dengue, or a licensed vaccine for
infection prevention. This study established new risk maps and infection estimates which provide
novel insights into the public health burden posed by dengue. The article concludes that the maps
could spark a wider discussion around dengue and help to guide improvements in disease control
strategies using vaccine, drug and vector control methods and in their economic evaluation.
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, Drake JM, Brownstein JS,
Hoen AG, Sankoh O, Myers MF, George DB, Jaenisch T, Wint GR, Simmons CP, Scott TW, Farrar
JJ, Hay SI. The Global Distribution and Burden of Dengue. Nature. 2013 Apr 25;496(7446):504-
7. doi: 10.1038/nature12060. http://www.nature.com/nature/journal/vaop/ncurrent/full/nature12060.
html?WT.ec_id=NATURE-20130411
Young children’s probability of dying before or after their
mother’s death
Until now, little was known about the increased mortality risk of
children with seriously ill mothers. The School’s Professor Kathleen
Kahn and co-authors Professor Samuel Clark (Washington
University), and Professor Alan Stein (Oxford University) – both
of whom hold honorary appointments in the School – published
a study in PLoS Medicine which indicates that in LMICs, young
children have a higher risk of dying in the months before their
mother’s death, when she is seriously ill, and also in the period after
her death.
In this rural South African population-based surveillance study, the
Professor Samuel Clark
research team analysed 15 years of data (1994-2008) during which
1 244 children died (3% of the total population studied). The data came from the health and socio-
demographic surveillance system run by the MRC / Wits Rural Public Health and Health Transitions
(Agincourt) Unit.
The researchers found that the period in which children are more likely to die began 6 to 11 months
before their mother’s death, and importantly, there were three distinct periods with a much higher
chance (odds) of death: the period 1 to 2 months before their mother’s death (7-fold increase in
odds of dying), the month of her death (12-fold increase in odds of dying) and the period 1 to 2
months following her death (7-fold increase in odds of dying). The authors wrote that, “When a
mother becomes very ill and is unable to care for and feed her child, whether by breastfeeding
or providing substitute or complementary feeding, the risks to the child rise substantially”. These
findings are important as they highlight the urgent need for proactive and co-ordinated community-
based interventions to support families, especially vulnerable children, when a mother becomes
seriously ill, not just in the period following her death.
Clark SJ, Kahn K, Houle B, Arteche A, Collinson MA, Tollman SM, and Stein A. Young Children’s
Probability of Dying before and after Their Mother’s Death: A Rural South African Population-
Based Surveillance Study. PLoS Medicine, 2013; 10 (3):e1001409. http://www.plosmedicine.org/
article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001409
18Wits School of Public Health | Biennial Report 2012-2013
Dying in their prime – adult mortality in rural
South Africa
Adult mortality in many developing countries has received little at-
tention in recent decades, particularly in contrast to child mortality.
This is especially pertinent in sub-Saharan Africa where the risk of
dying before the age of 60 years remains exceptionally high. Adult
mortality is a vital indicator for planning health care interventions,
but this critical data is often lacking. To shed some light on this im-
portant and neglected group, Dr Benn Sartorius and Professor
Kathleen Kahn conducted a study utilising data from the Agincourt
Unit in Bushbuckridge, north eastern Mpumalanga.
Dr Benn Sartorius
The study results showed that adult mortality increased significant-
ly from the mid-1990s to mid-2000 due to HIV, prior to local an-
ti-retroviral therapy (ART) rollout in 2007. Since then, adult mortality has decreased significantly,
highlighting the positive impact of the ART programme. The researchers also found an increase in
non-communicable or “life-style” deaths over the study period. Many parts of sub-Saharan Africa
are experiencing an upsurge in non-communicable diseases and this is projected to increase. The
researchers observed a definite spatial element to adult mortality, which suggests that risk is not uni-
formly distributed. This has important policy as well as equity implications. Attributable determinants
of adult mortality in this rural population were male, low education, unemployment, circular (labour)
migrants, partner deceased and residents in households with members who had died, poor house-
holds or young female-headed households.
Sartorius B, Kahn K, Collinson MA, Sartorius K, and Tollman SM. Dying in their prime: deter-
minants and space-time risk of adult mortality in rural South Africa. Geospatial Health 2013; 7 (2):
237-249. http://www.geospatialhealth.unina.it/articles/v7i2/gh-v7i2-07-sartorius.pdf
Autopsy services for posthumous occupational lung
disease compensation among South African
mineworkers
In the South African mining sector, cardiorespiratory-specific autop-
sies are conducted under the Occupational Diseases in Mines and
Works Act (ODMWA) on deceased mineworkers to determine eligi-
bility for compensation. However, low levels of autopsy utilisation
undermine the value of the service. Dr Audrey Banyini conduct-
ed a study as part of her PhD to explore enablers and barriers to
consent that impact on ODMWA autopsy utilisation for posthumous
monetary compensation. She was supervised by Professors Da-
vid Rees and Leah Gilbert from the WSPH and the Wits Depart-
ment of Sociology respectively. In-depth interviews were conducted
Dr Audrey Banyini
with mineworkers, widows and relatives of deceased mineworkers
as well as with traditional healers and mine occupational health practitioners.
The study identified a range of socio-cultural barriers to consent for an autopsy, thus adding to our
understanding of the utilisation of the autopsy services. These barriers were largely related to gen-
dered power relations, traditional and religious beliefs, and communication and trust. Understanding
these barriers presents opportunities to intervene so as to increase autopsy utilisation. The study
recommended engagement with healthy mine-workers and their families and a re-evaluation of the
permanent removal of organs.
Banyini AV, Rees D & Gilbert L. “Even if I were to consent, my family will never agree’’: exploring
autopsy services for posthumous occupational lung disease compensation among mineworkers in
South Africa. Global Health Action 2013, 6: 19518. http://dx.doi.org/10.3402/gha.v6i0.19518
19Wits School of Public Health | Biennial Report 2012-2013
A view from the salt mines
Professors Karen Hofman and Stephen Tollman from the
Agincourt Unit co-authored a commentary published in the Lancet
Global Health in August 2013. The article is entitled “Population
health in South Africa: a view from the salt mines”.
In what is a first for Africa and could potentially affect population
health regionally, South Africa’s Minister of Health passed regula-
tions on the salt content of processed food in March 2013. Beginning
in 2016, it is expected that these regulations will be a key weapon in
the fight against the rising burden of hypertension and stroke.
Professor Karen Hofman
The authors describe the process by which South Africa regulations
were passed. The original research published in the South African
Medical Journal (2012), suggested that mostly by reducing salt in bread, South Africa could avert 7
400 cardiovascular deaths (2 900 from stroke) and save 4300 lives from non-fatal stroke annually.
The savings from reduced numbers of hospital admissions of patients with non-fatal strokes alone
could save R300 million per year.
Providing senior policy-makers with this compelling economic evidence on lives saved was important
in the process towards regulation. Restricting salt in processed food is an example of why ensuring
that healthy choices are available, and is inherently more equitable since it provides an opportunity
for an entire population to attain their full health potential. This is particularly relevant in SA where
many people with hypertension are either not diagnosed or treated and health services are overex-
tended.
Hofman KJ, Tollman SM. Population health in South Africa: a view from the salt mines. The Lancet
Global Health - 1 August 2013; 1 (2): e66-e67 DOI: 10.1016/S2214-109X (13)70019-6. http://www.
thelancet.com/journals/langlo/article/PTTS2214-109x(13)70019-6/Fulltext.
Investing in African research training institutions creates sustainable capacity for
Africa
Sub-Saharan Africa accounts for 11 percent of the world’s population, yet the continent bears 24%
of the burden of global diseases. The WSPH offers a Master of Science (MSc) in epidemiology that
focuses on the principles and practice of epidemiology, biostatistics and data management. Epidemi-
ology provides the tools to learn more about the aetiology (causes) and risks of disease, the opportu-
nities for prevention, the costs and effectiveness of various diagnostic and therapeutic approaches,
and the health status of populations or sub-groups within populations.
A study to evaluate this MSc programme was undertaken by Dr Ron-
el Kellerman, Professor Kerstin Klipstein-Grobusch, Dr Renee
Weiner, Steven Wayling and Professor Sharon Fonn. They con-
ducted a cross-sectional survey of the 70 students registered for the
MSc in epidemiology and biostatistics from 2000-2005. Data were
collected from self-administered questionnaires, and 60% (42/70) of
students responded. At the time of the survey 19% of respondents
changed their country of residence after completion, 14% migrated
within Africa and 5% migrated out of Africa.
The evaluation showed that investing in African training institutions
provides a regional training resource, with graduates remaining in Af-
rica. A good proportion of the graduates work in research positions,
Dr Ronel Kellerman have contributed to research outputs, and have gone on to further
studies. Over 200 students have been admitted to the programme
over a 10-year period. Government investment in higher education is central to sustainability.
Kellerman R, Klipstein-Grobusch K, Weiner R, Wayling S and Fonn S. Investing in African re-
search training institutions creates sustainable capacity for Africa: The case of the University of the
Witwatersrand School of Public Health Masters programme in epidemiology and biostatistics. Health
Research Policy and Systems 2012, 10:11 http://www.health-policy-systems.com/content/10/1/11.
20Wits School of Public Health | Biennial Report 2012-2013
TEACHING AND LEARNING
The WSPH prides itself as a leading African institution which has attained world class standards
and international recognition for its teaching, research, academic citizenship and partnerships. Our
undergraduate and postgraduate teaching programmes embrace a range of public health disciplines,
including community health, epidemiology and biostatistics, health policy, health systems, occupa-
tional health, rural health, and social and behavioural change communication (SBCC) - the only
School of Public Health in Africa to offer this course.
MPH classroom session
In pursuit of one of the School’s strategic priorities that seeks to ensure that teaching and learning
is student-centred, innovative and of high quality, we developed a teaching and learning road map,
one of the highlights of this reporting period. The timeous acquisition of the R10 million Atlantic
Philanthropies grant over a three-year period with one of its focus areas of strengthening teaching
and learning, gave further impetus to this endeavour. The seven outcomes of our teaching and
learning road-map are highlighted in the box below.
Desired outcomes from the WSPH teaching and learning road-map,
2013-2016
1. Enhanced and/or increase resources for teaching and learning
2. Talented and passionate WSPH staff members who are committed to life-long learning
and meeting the needs of students
3. Teaching curricula that are cutting-edge and that prepare graduates for a rapidly changing
world
4. Recruitment and selection of high quality students and promotion of student responsibility
for their learning
5. Enhanced support for student development and learning
6. An enabling teaching and learning environment and a culture of inclusivity
7. Graduates who make a difference in all spheres of public health research, management
and who can make a positive impact on public and population health
21Wits School of Public Health | Biennial Report 2012-2013
Public health and the Graduate Entry Medical Programme
The WSPH contributes to the next generation of medical doctors by training 800 medical students
per year in the four final years of their training. In 2012, the School took the lead in organising a
national workshop to focus on the public health component of undergraduate medical training. The
workshop was made possible by a special grant from the Deputy Vice-Chancellor (Academic) for
activities that facilitate intellectual engagement to improve teaching and learning. The rationale for
the workshop is summarised below.
South Africa is faced with a quadruple burden of disease: HIV & AIDS, violence and injuries, non-com-
municable diseases and high maternal and child mortality rates. The importance of public health
interventions in addressing these challenges is increasingly recognised. The Health Professions
Council of South Africa regulations for approved medical training institutions recommend that public
health “shall figure prominently throughout the curriculum”. Undergraduates are expected to under-
stand strategies for health promotion, methods of disease prevention and be equipped with the skills
to determine community needs and promote community participation. Undergraduates should also
be able to define environmental and social factors which contribute to poor health and evaluate the
effectiveness of medical interventions.
Academic departments responsible for the public health education of undergraduate medical
students have met during the previous PHASA conferences to discuss the appropriate content and
location of public health education, and how to implement these recommendations. These discus-
sions highlighted much variability among medical schools in public health education and significant
challenges faced by educators responsible for delivering the content. A study undertaken at Wits
University, for example, highlighted that only 2% of curriculum time is allocated to public health.
Public health is seen by Faculties and students as less important than clinical disciplines.
Responding to these challenges was given further impetus in light of the global focus on social
accountability of health science faculties, the need for faculties to respond to current and future
health needs, and the need for universities to reorient their education, research and service priorities
accordingly.
Participants at the national workshop to discuss public health and undergraduate medical education, August 2012
The 2012 workshop brought together all the academic departments responsible for undergraduate
medical education, with the exception of Walter Sisulu University and MEDUNSA. The workshop
enabled an intellectual debate about the principles of public health undergraduate education, the
required resources for education and maintaining excellence in teaching. Following extensive de-
liberations over two days, core competencies for undergraduate public health medical training were
developed.
22Wits School of Public Health | Biennial Report 2012-2013
Diploma in Occupational Health
All the doctors who completed the two-year Diploma in Occupational Health in 2013 passed the
examinations and were awarded the Diploma. The intention is to produce diplomats sufficiently skilled
to contribute meaningfully to protecting and promoting the health of workers. The Diploma covers
traditional and modern hazards of working life and includes theoretical and practical components. A
large number of former students who are now in practice teach on the programme.
Master of Medicine
The School of Public Health offers a Master of Medicine (MMed) programme to train medical
graduates in the specialty of Community Health. Two fields of study are offered for the MMed in
Community Health: (1) the field of Occupational Medicine (in partnership with the NIOH) and (2) the
field of Public Health Medicine (lead by the Department of Community Health).
During the review period, four registrars were enrolled in the MMed (Occupational Health)
programme, and two of them intend to complete the degree in 2014. The rotations for the programme
were further developed in 2013 to provide registrars with a comprehensive training platform in clinical
occupational medicine.
This MMed (Public Health Medicine) was started in the late 1980s, in response to the growing need
for medical professionals with public health training who could contribute to disease prevention and
strengthening of health care delivery. It is a four-year full-time specialist training programme that
admits medical graduates with some clinical experience in public health sector services.
The training programme comprises largely of experiential learning but our registrars also take courses
in public health, epidemiology and biostatistics. As part of experiential learning registrars complete
eight six-month long field attachments under supervision at various public health entities. These
include the district health services department, academic hospitals, provincial health department, the
Medical Research Council, and National Institutes for Occupational Health and for Communicable
Diseases. Our curriculum and training approach are aligned to other public health medicine training
programmes in the country as well as to international programmes such as those in the United
Kingdom, Hong Kong and the Australasian Colleges of Medicine.
Our registrars have to complete an MMed research report and pass national exit qualification exams
convened by the College of Public Health Medicine (CPHM) of South Africa, a constituent college
of the Colleges of Medicine of South Africa in order to quality as a public health medicine specialist.
In the reporting period, the programme had a full complement of registrars. Dr Charlotte Mlangheni
and Dr Carmen Whyte joined the Department of Community Health as public health medicine
registrars in January 2012.
There were numerous achievements during the reporting period. Some of our registrars continue
to play a significant role in the building and running of PHASA and in the South African Medical
Association (SAMA).
Dr Taskeen Khan was first author on two papers, one entitled “Preventing diabetes blindness:
Cost effectiveness of a screening programme using digital non-mydriatic fundus photography for
diabetic retinopathy in a primary health care setting in South Africa” published in the journal Diabetes
Research and Clinical Practice and a second entitled: “Analysing post-apartheid gender and racial
transformation in medical education in a South African province” published in the special issue of
Global Health Action. She also delivered an oral presentation at the Ahmed Kathrada Foundation
Conference in October 2013.
Dr Pieter de Jager was first author on a paper “Cost and cost-effectiveness of conventional and
liquid-based cytology in South Africa: A laboratory service provider perspective” published in the
South African Journal of Obstetrics and Gynaecology”. He won the best oral presentation at the Wits
Faculty of Health Sciences 2012 research day in the theme: “education, policy and systems”.
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