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

Objectives

The South African National Integrated Men’s Health Strategy 2020–2025 provides a national framework to ensure that every South African man and boy is supported to live a long, healthy life. Its overarching aim is to improve men’s and boys’ health and wellbeing through a comprehensive, integrated package of care across the life course, using a gender-informed approach that recognises diversity and the social, economic, cultural and structural determinants of health.[1][2][3]

• Empower men and boys to optimise their own health and wellbeing, support one another, participate in their health care, reduce stigma around care-seeking, improve health literacy and strengthen community ownership of integrated men’s health services.[2][4][5]
• Strengthen health-system capacity to provide accessible, appropriate and male-centred preventive care, including health promotion, screening, early detection, referral, treatment and follow-up.[2][6][7]
• Ensure treatment, care and support for chronic conditions through multiple entry points and integrated service packages, including services for HIV, tuberculosis, sexually transmitted infections, diabetes, hypertension, cardiovascular disease, mental health, substance use, sexual disorders, and prostate and testicular cancer.[8][9]
• Build the evidence base for men’s and boys’ health by strengthening data systems, standardising reporting and indicators, tracking implementation, supporting operational research and developing an evaluation framework.[6][9][10]
• Apply a life-course approach covering adolescents, young adults, older men, ageing men and high-risk men and boys, with prevention, early intervention, treatment and self-care opportunities tailored to age, risk profile and critical life events.[2][11][12][9]
• Address priority risks and inequities, including harmful gender norms, violence and injuries, unsafe sexual practices, substance use, unhealthy lifestyles, mental and psychosocial wellbeing, and barriers to health-seeking behaviour.[13][14][15]
• Promote gender equality through men’s engagement in self-care, responsible sexuality, fatherhood, unpaid care, violence prevention, sexual and reproductive health, and supportive roles within families and communities.[13][15]
• Use guiding principles that acknowledge gender influences on health, provide male-centred information and services, build on existing initiatives, prioritise prevention across the life course, and deliver integrated packages and consistent messaging.[6]

Implementation

Implementation is designed to integrate men’s health policies, programmes and services into existing primary health-care systems, service platforms and budgets, initially leveraging voluntary medical male circumcision as a high-volume entry point and expanding towards other health and community settings. The Strategy combines demand-side action, strengthened service supply and an enabling environment, with delivery tailored to men’s age, circumstances, preferences and barriers to care.[13][8][4]

• Deliver minimum, mid-level and expanded service packages according to service-site capacity, disease burden and long-term sustainability, beginning at voluntary medical male circumcision sites and extending to other points of care.[16][8]
• Provide a minimum package comprising health information, screening for blood pressure, weight, HIV, tuberculosis, diabetes and sexually transmitted infections, assessment of lifestyle, substance use and mental health, and age-appropriate screening for cardiovascular disease and prostate and testicular cancer.[8]
• Expand care through chronic-condition treatment, counselling, support groups, community-support links, integrated on-site treatment, strengthened referrals, longer clinic hours, fast-lane chronic medicine collection, longer refills and simpler collection points.[8][9]
• Use diverse entry points, including outpatient departments, HIV and sexually transmitted infection services, men’s health clinics, general practitioner networks, mobile and outreach services, workplaces, schools, youth-friendly services, specialised centres and pop-up sites.[17][16]
• Reduce access barriers by offering flexible clinic hours, affordable services, confidentiality, male-friendly care, male health professionals where preferred, community-based services and culturally safe, inclusive programmes.[17][4][18]
• Reach men and boys through mainstream and digital media, community dialogues, radio, peer education, clinic advisory boards, outreach, workplace and school programmes, and age-specific men’s groups.[5][7]
• Strengthen provider and facility readiness through infrastructure, supplies, documentation systems, curriculum review, voluntary medical male circumcision training, nursing-college and professional-association engagement, and in-service training on men’s health across the life course.[16][7][18]
• Develop referral networks by mapping nearby providers, introducing referral policies and feedback mechanisms, using unique identifiers to track completion, and improving practical support such as phones, internet access, transport and medical-record transfer.[7][9]
• Coordinate action across national, provincial and local government, health and other sectors, non-governmental organisations, community-based and faith-based organisations, traditional health practitioners, researchers, technical experts, communities, families, and men and boys themselves.[11][9][18]
• Establish a Technical Working Group to monitor implementation and mitigate risks, while strengthening governance, management, accountability, data use and evidence-based policies and guidelines.[4][10]
• Stage implementation by prioritising infrastructure, workforce training, expanded screening at voluntary medical male circumcision sites, governance arrangements, an evaluation framework and national public-awareness planning in the initial year, followed by coordinated digital campaigns and wider scale-up.[19]
• Cost the Strategy and allocate an implementation budget, including investment in health promotion and illness prevention; the supplied material does not provide quantified allocations, funding sources or financing gaps.[19]

Monitoring & Evaluation

The Strategy establishes a monitoring, evaluation and accountability agenda centred on stronger data systems, standardised indicators, integrated reporting, implementation tracking, operational research and an overarching evaluation framework.[6][9][10]It also envisages governance arrangements that use monitoring evidence to identify bottlenecks, improve services and refocus implementation priorities.[10][19]

• Strengthen data availability by updating data systems, standardising data elements and indicators, and identifying priority measures for inclusion in a national dataset.[6][10]
• Integrate men’s health data collection and reporting with the District Health Information System, clarify data flows, and support reporting from facility to national level.[9][10]
• Develop a cascade of indicators and an integrated men’s health monitoring system through which priority measures can be collected, collated and reported using Department of Health mechanisms.[10]
• Establish an overarching evaluation framework to track progress, identify gaps and bottlenecks, assess improvements, and inform programme adaptation.[10][19]
• Conduct regular reporting against the evaluation framework and undertake a midpoint review to assess implementation progress and refocus priorities or actions where necessary.[19]
• Establish a Technical Working Group involving key stakeholders to monitor implementation and mitigate risks, within broader arrangements for governance, management and accountability.[4][10]
• Build managers’ capacity to interpret indicators, identify problem areas and develop solutions, while conducting and disseminating operational research to improve programme management and outcomes.[10]
• Use mobile-health technology for client feedback and real-time service-delivery monitoring, and apply unique identifiers within referral systems to establish whether clients complete referrals.[5][7]
• Track implementation progress as part of the objective to build the evidence base for men’s and boys’ health and wellbeing.[6][10]

Expected outcomes include greater community participation and ownership of integrated men’s health services, followed by stronger social mobilisation to support scale-up.[5]Longer-term delivery outcomes include integrated preventive, screening, treatment, referral and follow-up services linked with voluntary medical male circumcision, HIV and other health programmes.[7]The supplied material does not provide quantified targets, individual indicator definitions, a surveillance design, a detailed reporting timetable, or a named body responsible for formal evaluation.[4][5][7][19]

Costing & Financing

Financing is framed principally as an implementation requirement: the Strategy should be costed, supported by an allocated budget, and resourced through integration with existing primary healthcare systems, budgets and service-delivery platforms.[13][19]It calls for adequate human and financial resources, with particular attention to affordability barriers affecting men in lower socio-economic groups.[4]

• Cost the Strategy and allocate an implementation budget, including a significant commitment to health promotion and illness prevention.[19]
• Prioritise investment during the initial implementation year in infrastructure, health-care-worker training, expanded screening at voluntary medical male circumcision sites, evaluation, governance mechanisms and national public-awareness campaign planning.[19]
• Build on existing health policies, resources and service-delivery platforms while adding prevention, screening, referral and retention initiatives.[19]
• Integrate men’s health policies, programmes and services within existing primary healthcare systems and budgets to expand coverage.[13]
• Allocate adequate human and financial resources for men’s health, while addressing the affordability of services and cost-related barriers to access.[4]
• Consider long-term sustainability, site capacity and disease burden when determining whether services provide minimum, mid-level or expanded packages.[17][16]

No quantified budget, cost estimate, financing envelope, funding source, funding gap, costing methodology or economic assumption is provided in the supplied material.[9][10][19]Chronic conditions are noted as potentially imposing a significant financial burden on men, and the cost of care is recognised as one dimension of access.[3]