The South African National Integrated Men's Health Strategy 2020-2025

Objectives

The National Integrated Men’s Health Strategy 2020–2025 seeks to ensure that every South African man and boy can live a long and healthy life through a comprehensive, integrated and gender-informed package of care across the life course.[1][2][3]It combines health promotion, prevention, early intervention, treatment, care, support and self-care, while recognising that men and boys have diverse identities, circumstances, health needs and barriers to using services.[4][5]

• Empower men and boys to optimise their own and each other’s health and wellbeing, increase health literacy, reduce stigma, and encourage timely health-seeking behaviour.[1][6][7]
• Strengthen health-system capacity to provide quality, integrated preventive, screening, treatment, referral and chronic-care services that are accessible and appropriate for men across the life course.[1][8]
• Ensure treatment, care and support for chronic conditions, including human immunodeficiency virus, tuberculosis, sexually transmitted infections, non-communicable diseases and mental health conditions.[3][9]
• Build the evidence base for men’s health through improved data availability, standardised indicators and reporting, operational research, and implementation tracking.[1][9]
• Reduce premature mortality from non-communicable diseases and intentional and unintentional injuries, reduce inequalities in physical and mental health, and improve gender equality through engagement in self-care, fatherhood, unpaid care, violence prevention, and sexual and reproductive health.[10][4]
• Address priority health issues including HIV and AIDS, tuberculosis, sexual health, chronic conditions, cardiovascular disease, prostate and testicular cancers, and mental health.[5][2]
• Promote healthy lifestyles and healthy ageing through age-appropriate action on diet, physical activity, substance use, sexual health, treatment adherence, screening, and prevention and management of diabetes, cardiovascular disease, cancer, chronic respiratory disease and mental illness.[11][12]
• Integrate men’s health policies, programmes and services within existing primary health-care services, systems and budgets, building on national frameworks and established service-delivery platforms.[10][3][13]

Implementation

The Strategy applies a supply-demand-enabling environment model, combining more available and better-quality services with stronger health systems, supportive policies and social norms, and increased knowledge and demand for care.[6]Implementation is intended to be coordinated across government, health and non-health sectors, communities, civil society, researchers, technical experts, and men and boys themselves.[1][14]

• Deliver integrated men’s health services through multiple entry points, including voluntary medical male circumcision sites, outpatient departments, HIV and sexually transmitted infection services, men’s health clinics, general practitioner networks linked to primary health clinics, workplaces, schools, higher-education institutions, mobile services and community outreach.[15][16][8][9]
• Use voluntary medical male circumcision as a key entry platform for broader comprehensive men’s health services, initially implementing the minimum basic package at high-volume sites and expanding to other delivery points over time.[17][18]
• Provide minimum, mid-level and expanded service packages, with the minimum package covering health promotion, screening and treatment; mid-level provision adding chronic-care treatment, psychosocial support and community linkages; and expanded provision offering male-friendly care, extended hours, fast-lane medicine collection and trained providers.[18]
• Reduce access barriers through flexible clinic hours, male-centred care, access to male health-care professionals where preferred, stand-alone and community-based services, workplace outreach, digital health, improved confidentiality, affordability measures and stigma reduction.[15][6]
• Tailor interventions to age, risk profile and local context, including comprehensive sexuality education, condom access, healthy and non-violent relationship skills, and action on masculinity, alcohol and substance misuse for adolescents.[4][19]
• Engage young adult men through interventions that promote protective sexual behaviours, prevent intimate partner violence, reduce substance misuse, modify harmful gender attitudes and reduce sexually transmitted infections.[11]
• Strengthen community demand through social and behaviour change communication, mass media, peer education, community dialogues, community radio, national awareness campaigns, clinic advisory boards and mobile health technology.[6][7]
• Train health-care workers by reviewing skills gaps, broadening voluntary medical male circumcision curricula, engaging nursing colleges and professional associations, and developing in-service training modules.[8]
• Establish personalised referral pathways connecting facilities, community health workers, outreach workers, government departments, community-based organisations, non-governmental organisations, faith-based organisations and traditional health practitioners.[9]Support these pathways with phones, internet access, transport, medical-record courier services, standardised referral policies, unique identifiers and referral feedback mechanisms.[7][8]
• Develop partnerships with traditional health practitioners and organisations to co-identify solutions, deliver health education and biomedical services, and link men and boys to care.[15]
• Coordinate staged implementation by addressing infrastructure, workforce training, expanded screening at voluntary medical male circumcision sites, evaluation planning, communications and public awareness before later coordinated digital campaigns.[13]
• Establish a Technical Working Group of key stakeholders to monitor implementation and mitigate risks, alongside governance arrangements that allocate responsibilities, identify implementation partners and track progress.[6][9][13]

Monitoring & Evaluation

The Strategy establishes an evidence, monitoring and learning agenda for integrated men’s health, centred on strengthened data systems, standardised indicators, routine reporting, periodic evaluation and implementation oversight.[3][9][14]It aims to build the evidence base for improving men’s health and wellbeing while tracking delivery progress across the life course.[1][3][9]

• Strengthen data systems by ensuring data are current, available and used for decision-making.[3][6]
• Create a standardised list of data elements and indicators with the voluntary medical male circumcision programme, and incorporate these into the national dataset.[9]
• Develop a cascade of indicators, monitoring plans and an overarching evaluation framework to assess men’s health outcomes and implementation progress.[9][14]
• Clarify data flows across service-delivery levels, link collection to the District Health Information System, and report key indicators through standard Department of Health mechanisms.[9]
• Establish an effective standard reporting system intended to provide quality data from facilities to national level.[9]
• Conduct annual operational research with substantial qualitative components, disseminate findings, and use results to improve programme management and outcomes.[9]
• Build managers’ capacity to use indicators to identify problems and develop remedial solutions.[14]
• Conduct regular reporting against the evaluation framework, undertake a midpoint review, and complete further reviews at key intervals to reassess progress and refocus priorities.[13]
• Establish a Technical Working Group of key stakeholders to monitor implementation and mitigate risks.[6][9]
• Support accountability through governance, management and leadership; assign responsibilities across sectors and implementation partners; and track progress against prioritised actions.[6][13]
• Establish standardised referral arrangements with feedback mechanisms, unique identifiers and mapped provider directories to enable referral tracking.[7]
• Use mobile health technology to collect feedback and facilitate real-time monitoring of service delivery.[7]

The Strategy also calls for clear implementation plans and active communication of progress over time.[20]However, the available excerpts do not provide a complete indicator set, indicator definitions, numerical targets, reporting timetable, evaluation design, surveillance protocol or formal enforcement arrangements beyond the monitoring, reporting, referral-feedback and governance mechanisms described.[6][7][9][14]

Costing & Financing

Financing is framed primarily as integration of men’s health within existing primary health-care systems and budgets, supported by adequate human and financial resources and an implementation budget following costing of the Strategy.[10][6][13]The excerpts prioritise investment in health promotion and illness prevention and recognise affordability as a barrier to access, particularly for men in lower socio-economic groups.[6][13]

• Integrate men’s health policies, programmes and services into existing primary health-care services, systems and budgets.[10]
• Cost the Strategy and allocate an implementation budget with significant commitment to health promotion and illness prevention.[13]
• Ensure adequate human and financial resources to support an enabling environment for men’s health.[6]
• Address affordability barriers that can limit access to care for men in lower socio-economic groups.[6]
• Consider cost, alongside service availability, quality, workforce capacity, demand, waiting times and distance, when implementing services.[12]

No monetary budget, costed allocation, costing methodology, funding source, resource-mobilisation target, funding gap, economic assumption or programme-specific expenditure is specified in the supplied excerpts.[6][8][9][13]