'Economic crisis driving vulnerable youth into exploitive relationships': shelter movement
'In their relationships, they want a sense of security, which makes them vulnerable to a man who appears as a provider.'
Her research highlighted that the young women in intergenerational relationships become psychologically affected because the men sometimes want them to perform acts which they feel are degrading but, because of the lack of resources, the young women find it difficult to leave these relationships.
While formal research has not been conducted on the impact of older women's relationships with young boys and whether they contribute to gender-based violence, Sibanyoni said it could be safe to assume that the psychological impact is the same if there is a form of emotional abuse.
Sibanyoni proposed interventions — to be provided by schools, government agencies, businesses and NGOs — to counter the vulnerability and risk to young women.
These include 'psychoeducation (primary education at school level), comprehensive assessment (brief evidence-based psychotherapy for girls who are already showing signs of distress), and intensive evidence-based psychotherapy (for the severely affected who have possibly experienced gender-based violence)'.
'It is a critical situation, some of these young girls are at the intensive psychotherapy level and are presenting with symptoms of anxiety, depression, suicidal ideation and have psychosis due to substance abuse,' said Sibanyoni.
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Mail & Guardian
a day ago
- Mail & Guardian
Unsafe and substandard. Is that what public healthcare in SA looks like?
'Unsupervised, unstructured, non-standardised, unsafe and altogether substandard.' This is what was said about the care at two public hospitals in the Northern Cape last year. But is the way quality is measured a fair test? (Delwyn Verasamy) 'Unsupervised, unstructured, non-standardised, unsafe and altogether substandard.' This is how the Two later died and one was left with permanent brain damage. In the same week as the ombud's report, politicians' comments about the 'alarming number' of patients who Mention the This is where the The basic idea is that inspectors visit clinics and hospitals, run through a long list of requirements that have to be met, award a score for each one and then write up a report to say whether quality is up to scratch. If so, a certificate of compliance — valid for four years — is issued; if not, the facility is re-inspected later and, if still not in the clear, it gets a written warning. But, says Susan Cleary, a health economist and head of the School of Public Health at the University of Cape Town, the measures defined in these scorecards make it 'almost impossible' for an establishment to pass the test. Scoring a facility's service quality according to measures they have little control over is unfair, she says. 'The last thing you want to do is give people a job that's impossible to do.' Yet, given the way the inspection system tests whether a facility complies with each of the 'Is it then really a question of what the quality of service is,' she asks, 'or is it a question of what is being measured?' In a series of analyses, we're diving into the OHSC's inspection reports to get a sense of what the benchmarks are — and what they say about the state of affairs at clinics, community health centres (CHCs) and hospitals. In this first story, we're looking only at the public health sector — not because we think things are perfect in private establishments, but because with And as with getting universal health coverage in place, we have to start somewhere. Come with us as we look at the numbers. The lay of the land South Africa has 3 741 public health facilities, of which about 90% are clinics and CHCs. Hospitals make up the remaining 10%. Because the different facilities offer different services, the detailed list of requirements they have to meet doesn't look the same for each place — although they all have to adhere to the same broad set of 23 standards. For example, four For this reason, one day is budgeted for Counting and compliance Between 2019 and 2023, the OHSC inspected 3 093 public health facilities — about 83% of the total to be assessed. Scores for the last 17% — 648 facilities — are still outstanding. (The latest inspection results Getting to every health facility in the country is a mammoth task. For example, 734 inspections in 2023 works out to two a day — and with But the task seems even more overwhelming when the compliance rate is added into the mix. In 2022 (the latest year for which results are available), only four out of 10 public facilities passed the test and so have to be re-inspected later, meaning that the backlog builds. To be rated as compliant, a facility has to get full marks for a set of so-called non-negotiable measures — things the It's an unfeasible system, Cleary says. 'I think that's a large part of what's happened to our public sectors. [People] get given unfunded mandates all the time. But just because a standard has been set unrealistically high, it doesn't mean that [service] quality is terrible; it may simply mean that hitting the bar is unaffordable given the money or staff available.' Star struck or star stuck? If we convert public health facilities' compliance rates to a star rating — like you'd give a service provider on an online review — no province got more than three stars in 2022. Looking at these results, it seems that, at best, three out of five facilities would make the cut — and it happens only in Gauteng. In KwaZulu-Natal and the Western Cape, chances are that every second facility might meet the OHSC's list of requirements, with the other provinces struggling to get more than one out of five facilities compliant. In fact, in the Northern Cape and Limpopo, so few of the inspected facilities could pass the assessments that their scores wouldn't even translate to a single star. But these are the results on paper — and likely give a warped picture of what is happening in practice because of the way performance is measured. A trimmed list of requirements — 'something that 90–95% of facilities can actually meet' — could give a more realistic view, says Cleary. This doesn't mean compromising on quality, but rather that decision-makers have to think more carefully about what the priorities really are. 'It's partly a matter of 'cutting your coat according to your cloth',' she says and working from there to improve step by step — with the money to make it happen. Says Cleary: 'We have to let go of this idea that we can have everything and that it all has to be perfect otherwise it's not good enough.' Stats that are shocking Something like the non-negotiable measures in the OHSC's scorecards could give a fairer idea of what healthcare quality really looks like. These are three things a clinic has to have in place to make the grade; the same three things in the emergency, obstetrics and clinical services units of a CHC and eight things in a hospital. They cover only statements related to handling a medical emergency, having a system in place for supplying lifesaving medical gas (like oxygen) to patients and getting patients' consent the right way. Viewing the quality of public healthcare from this angle really does paint a shocking picture — and could give decision-makers a concrete place to start to get to grips with claims of inadequate service. In 2022, only two provinces — Gauteng and the Western Cape — managed to have these minimum lifesaving measures in place in at least seven out of 10 clinics and CHCs and half the district hospitals inspected. (We didn't include regional hospitals in our analysis because at most two of these were assessed in a province. A score of, say, 50% would therefore not have been a fair reflection of reality.) In two other provinces — Mpumalanga and North West — half of either clinics or CHCs met these minimum requirements. The other provinces didn't come close. The health ombud's investigation Looking only at these measures, the This story was produced by the . Sign up for the .
Mail & Guardian
6 days ago
- Mail & Guardian
Guardians of the Green: Conserving South Africa's medicinal heritage through the pepper-bark tree
The pepper-bark tree project incorporates collaboration with traditional healers, traders and harvesters (EWT Pepper-bark Project) For thousands of years, Africa's landscapes have yielded plants with healing powers, sustaining not only In South Africa, these Historically, cultural rituals, protocols and practices and a profound cultural reverence for nature helped manage plant harvesting sustainably, explains But as human populations have grown and rural populations migrated to urban areas, demand has increasingly outstripped the available sources of many plant species. This, together with the erosion of harvesting controls and extensive habitat transformation through other human activities, has placed considerable pressure on numerous medicinal plant species. South Africa alone One of the most iconic medicinal plant species among them is the ( Warburgia salutaris ), long revered in Southern Africa for its healing properties. It is used for everything from respiratory ailments to digestive issues. In 2019, the EWT launched an integrated conservation project focused on this species in Limpopo, later expanding the scope of the project to include additional species and geographic locations in KwaZulu-Natal, Mpumalanga and Gauteng. Native to montane forests, thickets and woodlands in these regions, the pepper-bark tree has also been found in Mozambique and eSwatini but is believed to be extinct in the wild in Zimbabwe. The Native to montane forests, thickets and woodlands in these regions, the pepper-bark tree has also been found in Mozambique and eSwatini but is believed to be extinct in the wild in Zimbabwe. Its bark, roots and rootbark have historically been in high demand for traditional medicine across Southern Africa. Encouragingly, more recently, many of its therapeutic properties have been corroborated scientifically. 'From a conservation perspective, its leaves were found to contain the same phytochemicals as the other plant parts that were traditionally used for medicine,' Botha says, noting that the substitution of leaves for bark, roots or rootbark significantly reduces harvesting impact. 'We're starting to see healers and others, also in the local markets, also start using the leaves because people are finding that they are as effective in medicinal treatments as the bark and the root in many cases … One species will be used for very diverse, different uses in many cases and the pepper-bark isn't an exception.' Over the past three decades, national and regional conservationists have partnered with traditional healers and private sector players to mitigate over-harvesting through cultivation. More than 80 000 seedlings have already been distributed to traditional practitioners and community members. The Pepper-bark Tree Project incorporates collaboration with traditional healers, traders and harvesters to increase the diversity of species that are being cultivated in many areas. 'In addition, we are implementing strategies alongside private and communal landowners to protect and restore habitats. A seed viability assessment has also been conducted as the species germination rates in some populations are low,' Botha says. To secure habitat for the pepper-bark tree and other species, the EWT has collaborated with the Limpopo department of development and tourism and private landowners to secure formal protection of land through South Africa's Biodiversity Stewardship Programme. More than 70 hectares of invasive vegetation has been cleared from pepper-bark tree habitats, an effort that has triggered the reappearance of tree seedlings in areas where they had long been absent. 'We are also engaging with several communities in areas where pepper-bark trees and other medicinal species are being intensively harvested to explore opportunities to support them to improve harvesting controls and remind people of the importance of their biocultural heritage.' Harvesters frequently come from outside the area 'and, where possible, we invite them to join this national effort' to improve the sustainability of medicinal plants for now and for future generations. The EWT has engaged with about 300 traditional healers from more than 20 communities in Limpopo to identify strategies to reduce threats to wild medicinal plant populations. Training and education are vital pillars of the programme. In February and March, the programme collaborated with the South African National Biodiversity Institute (Sanbi) to develop and implement training on the cultivation of medicinal plants. 'This training will gradually be implemented across all our project areas to support cultivation and lay the foundation for scaling up these production efforts over time.' Following visits to Sanbi's The training incorporated demonstrations of various cultivation and propagation techniques, discussions on legislation and the permitting system and engagement on challenges people are facing in accessing medicinal plants. Each participant received seedlings and a starter pack to begin growing medicinal plants immediately. 'Our team follows up with the groups regularly to monitor the survival of plants and any challenges that they may be experiencing. We are also in the process of sourcing additional species for them to start growing,' Botha says. She notes how, in many rural communities, traditional harvesting was once guided by strict controls to ensure wild plant populations thrived. While some of these have faded under modern pressures, the knowledge and values remain. 'There's also an open commons challenge. You'll find that people will go to a site that is open access and then they know that, if they don't harvest those plants, then somebody else is going to come in and do it.' Traditional healers themselves still try to follow very strict harvesting protocols and 'there are a lot of cultural protocols associated with harvesting that are very, very important'. 'There are some types of plants that need to be collected from the wild but a lot of the healers whom I knew were growing plants before we started, whether it was in this project or projects I've worked on in Mpumalanga or other areas.' Many medicinal plant species are slow-growing or 'sometimes the seed may be recalcitrant' and it can be difficult to actually propagate them. 'The work that we're doing is helping the healers and other stakeholders to strengthen their cultivation skills and then also to provide the diversity of species that they actually need.' This is because most healers use a very diverse suite of species, Botha says. 'It's really important that they're able to access them legally without having to worry about being arrested if someone is caught with a bag of plants.' Hope lies in collaboration and the pepper-bark project is proof that the EWT is not only conserving a species but also reinforcing community agency, cultural heritage and sustainable livelihoods. Crucially, this conservation initiative is not about imposing modern conservation ideas — it's about reawakening ancient knowledge and co-creating solutions. 'Traditional healers are as passionate about sustainability as we are and in fact, I found that most community groups are,' Botha says. 'It's a myth that people don't actually care about the environment because they come from a different background, whether it's socio-economic or cultural. The healers are as enthusiastic about the work we do as we are.' This deep ancestral and spiritual connection with nature runs through most traditional healers' views of the environment. 'People, generally, in our modern society are losing our connections to nature because of technological advancements etcetera. More of us are more fixated on our phones or the latest gadget than we are concerned about walking in nature and experiencing nature in the way that perhaps was more easily accessible to people in the past.' One part of the programme's mission is to help people reconnect with nature, whether through visiting a botanical garden or walking in a local nature reserve. 'That deep spiritual connection that people have with the land, in this case particularly the healers … it's a case of reconnecting with nature and rekindling those relationships so that we in that way are able to foster more care for the planet.' It's incredibly inspiring work, she says. 'I don't think there's been a day where I haven't learned something new or a day where I haven't met amazing people or reconnected with amazing people from all walks of life.' Plants have been valued for their curative powers for millennia, not only as traditional medicines, but also in conventional medicine. 'Achieving our goals to reduce threats to species of conservation concern at scale will clearly take time and collaborative efforts across partner organisations and sectors to enable us to synergise our resources and share the knowledge, understanding and collective effort that is required to avert extinctions.' Critically, the needs of the poorest consumers, who depend on these plants for their healthcare, must be at the forefront. 'Many simply cannot afford more expensive alternatives and it is vital that we co-develop strategies to cultivate plants that are both affordable and aligned to the cultural protocols associated with the use of these medicines, so that their therapeutic values are retained or even, in some instances, restored.' People from all walks of life, including traditional healers, don't want to see the loss of their own natural resources. 'They value them in most cases for the intrinsic value of the plant as well as the fact that it is part of their livelihoods,' Botha adds.
Mail & Guardian
7 days ago
- Mail & Guardian
Here's what SA's teen girls want you to know about their state of mind
We talked with 50 teenage girls and young women from communities with high rates of HIV, early pregnancy and school drop-out rates to hear what's stressing them out — and how they are keeping it together. (Eric Ward/Unsplash) Think of a young woman's world like a series of circles, each one influencing the next. At the centre is the girl herself — her thoughts, feelings and personal struggles. Around her are her relationships with family and friends, and with school and the community. And then there's the bigger picture — a society fraught with inequality and impossible expectations. Our The data is limited, but what we do know shows numbers that are staggering. A 2022 Our earlier work highlighted what we called a We sat down with over 50 young women between the ages of 15 and 24 from two communities — one in KwaZulu-Natal and the other in North West — with high rates of HIV, early pregnancy and school drop-outs. What they shared with us showed how stress doesn't just come from one place — it strikes from every angle. But they also told us how, despite the challenges they face, they somehow manage to keep it together. I break down four things that influence their mental health and five ways to cope. Four things that hurt young women's mental health Individual-level struggles: Girls described low self-esteem, academic pressures and discrimination related to being gay, lesbian or bisexual as daily worries, fuelling bad coping strategies, like substance use. Early pregnancies made many feel future opportunities had slipped away. As one young woman put it, 'We blame and judge ourselves even before other people can blame us,' capturing the internalisation of shame and guilt that heightens isolation. Interpersonal problems: A striking number felt emotionally isolated, citing a lack of trusted people to confide in. Trouble talking with parents or caregivers and a general lack of people they feel safe opening up to makes girls more likely to struggle with mental health problems. Peer dynamics added to this stress: bullying, gossip, body shaming and the huge social pressure to 'fit in'— whether through clothing or material items — led to girls taking risks, sometimes leading them into relationships with 'We want to do things that parents cannot afford … a girl might end up doing everything they say because she wants to impress her friends,' one young woman told us. Home and family troubles : Domestic strife — like conflict, heavy drinking or parents neglecting or abusing their children — further undermined young women's mental and emotional foundations. Girls also said they felt powerless to oppose gendered burdens like unpaid housework or caring for relatives, which left them with less time for school work and looking after themselves. Environmental hardships: Poverty, unreliable access to enough food and feeling unsafe — especially when it comes to gender-based violence — means ongoing anxiety is built into girls' environment atop an already challenging teen world. Societal norms privileging male siblings and persistent gender inequality added to the load girls carried, leaving them with little say in what happens at home. Five ingredients for coping Despite these daunting odds, many young women found ways to cope and push forward. Their stories painted an inspiring picture of remarkable resilience. These new findings echo themes from Positive mindset and self-care: Some girls described consciously focusing on positive experiences, from enjoying music or sports to simply getting a good night's sleep. Journalling and compartmentalising stresses — keeping school problems separate from home issues — emerged as effective self-regulation tools. Finding meaning and identity : For some, faith and being part of a religious community gave them a safe place and sense of belonging, helping them feel calmer and more hopeful in uncertain times. Reaching out: The ability to confide in friends, family or trusted adults was transformative. 'I do talk to my close friend … I talk to her about everything I need to,' shared one girl, underlining the healing role of open communication. Older peers and adults who had faced similar problems became role models and gave helpful advice, especially for younger girls working their way through the emotional storms of their teenage years. Psychosocial support: Being able to see a social worker — though they weren't always available — was seen as an important ingredient for coping. Girls who got this help described meaningful improvements in mood, confidence and skills for coping with the future. The gamechanger: Perhaps the most hopeful findings stem from recent programmes that combined mental health support with sexual and reproductive health services. Girls who had participated in the One participant of the programme told us: 'I have never been so happy in my life … [Now] I am happy.' Empathetic programme staff, coaches and social workers made a big difference: 'I was able to open up and share my story … I am a happy person, I'm free and I am enjoying the life I am living now'. What next? Collectively, these stories and data point to clear recommendations for policymakers, practitioners and communities: Given the strong link between psychological distress and risky behaviours, every programme for adolescent girls and young women — at schools, in clinics or through nongovernmental organisations — should include a mental health component. Effective support targets the individual, the relationships around them (family, friends, teachers) and takes into consideration the wider socio-economic adversities like violence, poverty and gender inequality. Fostering environments where girls can voice their emotions, ask for help, and can be part of solving problems increases both competence and self-confidence. Training teachers and setting up peer or mentor groups work particularly well. Expanding social work support, making the public sector more reliable and investing in community-led projects will help young women to not slip through the cracks at the moments they need it most. Even with big challenges like poverty and gender inequality that stack the odds against these young women, the right support at home, at school and in the community, can help them reclaim their voices and build a generation defined not by struggle, but by strength. Zoe Duby is a socio-behavioural researcher at the South African Medical Research Council . She specialises in sexual and reproductive health research in South Africa. This story was produced by the . Sign up for the .
