Provincial Health Department Research Articles

Choosing Privacy over Interaction: Restructuring Expectations and Interpretations of Community Integration in Canadian Small-House Long-Term Care Settings

In Nova Scotia, Canada, the small-house model of care has been introduced as an alternative to institutional care settings, and the province has funded and built 11 new long-term care (LTC) communities in the small-house model. Each of the new facilities was built with multiple cottages housing 12 to 15 residents; each cottage features private bedrooms and a residentially scaled kitchen and dining area. Through smaller numbers of residents living in home areas, the goal of the Provincial Department of Health was to encourage relationship building, as well as to provide opportunities for autonomy and choice in resident daily living. A qualitative case study was conducted in one of these small-house communities, focusing on the model's impact on resident interaction and community integration. Thematic analysis revealed that while resident social patterns were directly impacted by the physical environment and culture of care in the new model, interpretations of these patterns by staff and family members were influenced by preexisting expectations of community integration rooted in institutional care models of the past.

Household Smoke Exposure as Risk Factor of Low Birth Weight among Infants in Gianyar

Background and purpose: The Bali Provincial Health Department reported that in 2013, 24 per 1000 live births were underweight, with the regency of Gianyar ranked 4th the highest (31 per 1000 births). Data from Riskesdas 2010 indicated that 31.0% of individuals 15 years and over smoked, 68.1% of them reported smoking in the household. This study aimed to investigate the relationship between household smoke exposure, pregnant women and low birth weight (LBW) in Gianyar. Methods: This study was a case control where low birth weight as a case and birth with normal weight as a control. Study sample was 116, consisting of 58 cases and 58 controls. Dependent variables were low birth weight, independent variables were smoke exposure. Data was obtained by interviewing the mothers, and secondary data was collected from community health centre records. Data was analysed using bivariate and multivariate analysis. Results: Bivariate analysis indicated that OR of 6.370 (95%CI: 2.836- 14.309) for exposure to husbands smoke and an OR of household smoke exposure was 6.577 (95%CI: 2.894-14.948). Multivariate analysis indicated that adjusted OR of exposure to husbands smoke was 7.479 (95%CI: 2.058-27.175), adjusted OR exposure to household smoke was 9.002 (95%CI: 9.002-33.286), and adjusted OR combined exposure to smoke from both husband and household members was 9.333 (95%CI: 3.417-26.201). Conclusion: Household smoke exposure significantly increased risk of low birth weight among infants in the regency of Gianyar.

Exploring corruption in the South African health sector.

Recent scholarly attention has focused on weak governance and the negative effects of corruption on the provision of health services. Employing agency theory, this article discusses corruption in the South African health sector. We used a combination of research methods and triangulated data from three sources: Auditor-General of South Africa reports for each province covering a 9-year period; 13 semi-structured interviews with health sector key informants and a content analysis of print media reports covering a 3-year period. Findings from the Auditor-General reports showed a worsening trend in audit outcomes with marked variation across the nine provinces. Key-informants indicated that corruption has a negative effect on patient care and the morale of healthcare workers. The majority of the print media reports on corruption concerned the public health sector (63%) and involved provincial health departments (45%). Characteristics and complexity of the public health sector may increase its vulnerability to corruption, but the private-public binary constitutes a false dichotomy as corruption often involves agents from both sectors. Notwithstanding the lack of global validated indicators to measure corruption, our findings suggest that corruption is a problem in the South African healthcare sector. Corruption is influenced by adverse agent selection, lack of mechanisms to detect corruption and a failure to sanction those involved in corrupt activities. We conclude that appropriate legislation is a necessary, but not sufficient intervention to reduce corruption. We propose that mechanisms to reduce corruption must include the political will to run corruption-free health services, effective government to enforce laws, appropriate systems, and citizen involvement and advocacy to hold public officials accountable. Importantly, the institutionalization of a functional bureaucracy and public servants with the right skills, competencies, ethics and value systems and whose interests are aligned with health system goals are critical interventions in the fight against corruption.

A program evaluation report of a rapid scale-up of a high-volume medical male circumcision site, KwaZulu-Natal, South Africa, 2010-2013.

BackgroundMale circumcision can provide life-long reduction in the risk of acquiring HIV infection. In South Africa, the KwaZulu-Natal Provincial Department of Health committed to rolling out circumcision programs to address the HIV epidemic. The Department of Health enlisted the help of St. Mary’s Hospital in Mariannhill and the Operation Abraham Collaborative.MethodsSt. Mary’s Hospital and the Operation Abraham Collaborative partnered to establish a voluntary medical male circumcision facility, called Asiphile, and to train surgeons, nurses and health clinic staff to serve KwaZulu-Natal.ResultsOver the course of the implementation period, 9,980 circumcisions were conducted at the Asiphile facility. The uptake numbers increased throughout 2010 and 2011 and began to level off as the demand of early adopters may have been met. Uptake spiked during school vacations and staff training sessions. Additionally, 92 % of clients returned for post-operation follow-up and only 2 % of clients experienced any adverse event.ConclusionSt. Mary’s Hospital and the Operation Abraham Collaborative were able to cooperate and successfully implement a voluntary medical male circumcision facility in KwaZulu-Natal. Although uptake was lower than projected, lessons learned from efforts to overcome challenges in recruitment, transportation, and coordination can help inform and improve new and existing population-based male circumcision programs.

Use of Problem Based Scenarios to Prepare Nursing Students to Address Quality Improvement in Health Care Unit: North West University Experience

Preparation for quality health care must begin in the basic education and should be integrated in the clinical education to be more meaningful. The aim of the study is to explore and describe the opinions of nursing students regarding the use of PBL scenario in addressing quality improvement in the health care unit; Problem based scenario was used to address quality improvement at unit level for the level 4 nursing students and followed collaborative assessment after placement in the clinical services for four weeks preparing for quality inspection. Sequential explorative mixed method was used. Purposive sampling was used to recruit the participants in the qualitative component and convenient sampling in quantitative strand. Ethical clearance was obtained from NWU ethics committee (Ethics No. NWU-00033-11-A9) and permission to conduct the study was obtained from North West Provincial Health Department. Themes that emerged from the interviews included: empowerment from Problem Based Learning (PBL) scenario and clinical project; preparedness to address quality improvement in clinical setting; contribution to the unit readiness for quality improvement; and strengthening of inter-institutional and interdisciplinary collaborations. PBL scenarios are very effective teaching quality improvement and in closing the theoretical and clinical learning gaps and collaboration in assessment of students benefit students.

Improving access to medicines through centralised dispensing in the public sector: a case study of the Chronic Dispensing Unit in the Western Cape Province, South Africa.

BackgroundThe Chronic Dispensing Unit (CDU) is an out-sourced, public sector centralised dispensing service that has been operational in the Western Cape Province in South Africa since 2005. The CDU dispenses medicines for stable patients with chronic conditions. The aim is to reduce pharmacists’ workload, reduce patient waiting times and decongest healthcare facilities. Our objectives are to describe the intervention’s scope, illustrate its interface with the health system and describe its processes and outcomes. Secondly, to quantify the magnitude of missed appointments by enrolled patients and to describe the implications thereof in order to inform a subsequent in-depth empirical study on the underlying causes.MethodsWe adopted a case study design in order to elicit the programme theory underlying the CDU strategy. We consulted 15 senior and middle managers from the provincial Department of Health who were working closely with the intervention and the contractor using focus group discussions and key informant interviews. In addition, relevant literature, and policy and programme documents were reviewed and analysed.ResultsWe found that the CDU scope has significantly expanded over the last 10 years owing to technological advancements. As such, in early 2015, the CDU produced nearly 300,000 parcels monthly. Medicines supply, patient enrollment processes, healthcare professionals' compliance to legislation and policies, mechanisms for medicines distribution, management of non-collected medicines (emanating from patients’ missed appointments) and the array of actors involved are all central to the CDU’s functioning. Missed appointments by patients are a problem, affecting an estimated 8 %–12 % of patients each month. However, the causes have not been investigated thoroughly. Implications of missed appointments include a cost to government for services rendered by the contractor, potential losses due to expired medicines, additional workload for the contractor and healthcare facility staff and potential negative therapeutic outcomes for patients.ConclusionsThe CDU demonstrates innovation in a context of overwhelming demand for dispensing medicines for chronic conditions. However, it is not a panacea to address access-to-medicines related challenges. A multi-level assessment that is currently underway will provide more insights on how existing challenges can be addressed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1164-x) contains supplementary material, which is available to authorized users.

Cost and impact of scaling up interventions to save lives of mothers and children: taking South Africa closer to MDGs 4 and 5

BackgroundSouth Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved.DesignWe modelled the impact of maternal, newborn and child interventions using the Lives Saved Tools Projections to 2015 and used realistic coverage increases based on expert opinion considering recent policy change, financial and resource inputs, and observed coverage change. A scenario analysis was undertaken to test the impact of increasing intervention coverage to 95%.ResultsBy 2015, with realistic coverage, the maternal mortality ratio (MMR) can reduce to 153 deaths per 100,000 and child mortality to 34 deaths per 1,000 live births. Fifteen interventions, including labour and delivery management, early HIV treatment in pregnancy, prevention of mother-to-child transmission and handwashing with soap, will save an additional 9,000 newborns and children and 1,000 mothers annually. An additional US$370 million (US$7 per capita) will be required annually to scale up these interventions. When intervention coverage is increased to 95%, breastfeeding promotion becomes the top intervention, the MMR reduces to 116 and the child mortality ratio to 23.ConclusionsThe 15 interventions identified were adopted by the National Department of Health, and the Health Minister launched a campaign to encourage Provincial Health Departments to scale up coverage. It is hoped that by focusing on implementing these 15 interventions at high quality, South Africa will reach Millennium Development Goal (MDG) 4 soon after 2015 and MDG 5 several years later. Focus on HIV and TB during early antenatal care is essential. Strategic gains could be realised by targeting vulnerable populations and districts with the worst health outcomes. The analysis demonstrates the usefulness of priority setting tools and the potential for evidence-based decision making in the health sector.

Development and validation of a Chinese outpatient satisfaction questionnaire: evidence from 46 public general hospitals and 5151 outpatients

ObjectiveTo develop and test a reliable and practical self-administrated questionnaire in Chinese to evaluate outpatient satisfaction in China. DesignIn order to ensure content validity, the 19 items of this questionnaire were generated based on literature review, interview and group discussion. Acceptability was tested by the percentage of missing item responses and the time and operability of administration. Construct validity was evaluated using principal component exploratory factor analysis and item-total correlations. The reliability of the questionnaire was assessed using Cronbach's alpha coefficient and inter-subscale correlation. SettingThis study was conducted in 46 public general hospitals that report directly to the Provincial Health Department in Hunan Province, China. SubjectsIn total, 5151 outpatients were selected at random and asked to complete the questionnaire after they finished their medical procedures in the outpatient area. ResultsThe extremely low rate of missing data (0–0.04%) suggested good acceptability of the questionnaire. Factor analysis generated six dimensions, and all item-total coefficients were >0.8. Cronbach's alpha exceeded 0.7 for all dimensions, and the inter-subscale correlation coefficients were all lower than the Cronbach's alpha coefficients of the corresponding scale. According to the results, outpatients were least satisfied with waiting time (86.8%) and most satisfied with the quality of medical care (90.1%). ConclusionThe Chinese outpatient satisfaction questionnaire has good acceptability, validity and reliability. It was effective and efficient for measuring outpatient satisfaction in a Chinese population.

The maternal healthcare landscape around Grabouw, South Africa: Setting the stage for information systems development

Background and Purpose : The purpose of the paper is to depict the most essential aspects of the “landscape” of authorities, organizations and service flows related with maternal healthcare from the viewpoint of the local communities in the small town of Grabouw in Western Cape, South Africa. Understanding the wider landscape is needed for understanding the “close-up” view of the maternal healthcare services and activities in place in Grabouw, which in turn is a prerequisite for co-designing ICT based tools for the caregivers. Methods : The methodology for depicting information systems landscapes was applied in guiding the data collection and in analyzing the data. Data was collected from public sources (government documents, web sites, literature) and from administrators and educators with general knowledge.. Results : The geo-political structure around Grabouw consists of municipalities, districts, and the province of Western Cape within the republic of South Africa, all of which have elected structures with overall political authority. The structure of healthcare authority differs from the structure of political authority – the provincial Department of Health and not the local municipality is in charge of all healthcare facilities. The flow of healthcare services beyond Grabouw is defined by the referral system, which in principle is aligned with the political structure but is adjusted to particular geographic factors. Within the Grabouw community the service flow is guided by proximity of care and the preferred services. Conclusions : The results show that it is vital to understand the ‘healthcare landscape’ and the context around maternal care in Grabouw. There is an overlap of geo-political and healthcare authority structures, and information systems developers need to aware in order to develop useful, effective and efficient ICT solutions. The landscape model has proven to be successful in understanding the different elements of a ‘landscape’ around a community.

Canadian vaccine research networks: Vaccine safety resources for Canada.

The Public Health Agency of Canada / Canadian Institutes of Health Research Influenza Research Network (PCIRN), established in 2009 to undertake evaluative research to inform public health decision making in Canada, is now being replaced by the Canadian Immunization Research Network (CIRN), which will retain the mandate of PCIRN but expand it to all vaccines including influenza vaccine. CIRN is organized as a network of networks focusing on undertaking research in the areas of vaccine safety, adverse events following immunization (AEFIs), vaccine hesitancy, vaccine effectiveness, and vaccine coverage. CIRN's networks include: a clinical trial network; a laboratory network; a modelling and economics network; a network of social science and humanities researchers; a vaccine safety surveillance network; a hospital-based surveillance network; a clinic network to evaluate serious AEFIs; and a network that links vaccine research capacity in provincial health agencies and departments. PCIRN has contributed to Canada's vaccine safety surveillance system and has facilitated the translation of safety research into policy. Vaccine safety surveillance and research will remain a focus of the newly formed Canadian Immunization Research Network.

Utilisation and costs of nursing agencies in the South African public health sector, 2005–2010

Background Globally, insufficient information exists on the costs of nursing agencies, which are temporary employment service providers that supply nurses to health establishments and/or private individuals. Objective The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. Design A survey of all nine provincial health departments was conducted to determine utilisation and management of nursing agencies. The costs of nursing agencies were assumed to be equivalent to expenditure. Provincial health expenditure was obtained for five financial years (2005/6–2009/10) from the national Basic Accounting System database, and analysed using Microsoft Excel. Each of the 166,466 expenditure line items was coded. The total personnel and nursing agency expenditure was calculated for each financial year and for each province. Nursing agency expenditure as a percentage of the total personnel expenditure was then calculated. The nursing agency expenditure for South Africa is the total of all provincial expenditure. The 2009/10 annual government salary scales for different categories of nurses were used to calculate the number of permanent nurses who could have been employed in lieu of agency expenditure. All expenditure is expressed in South African rands (R; US$1 ∼ R7, 2010 prices). Results Only five provinces reported utilisation of nursing agencies, but all provinces showed agency expenditure. In the 2009/10 financial year, R1.49 billion (US$212.64 million) was spent on nursing agencies in the public health sector. In the same year, agency expenditure ranged from a low of R36.45 million (US$5.20 million) in Mpumalanga Province (mixed urban-rural) to a high of R356.43 million (US$50.92 million) in the Eastern Cape Province (mixed urban-rural). Agency expenditure as a percentage of personnel expenditure ranged from 0.96% in KwaZulu-Natal Province (mixed urban-rural) to 11.96% in the Northern Cape Province (rural). In that financial year, a total of 5369 registered nurses could have been employed in lieu of nursing agency expenditure. Conclusions The study findings should inform workforce planning in South Africa. There is a need for uniform policies and improved management of commercial nursing agencies in the public health sector.

Relationship of academic courses and clinical internships to performance on the National Qualified Examination for Registered Professional Nurses (NQEX-RPN)

BackgroundSuccess in the National Qualified Examination for Registered Professional Nurses (NQEX-RPN) is a critical issue for each nursing student and every nursing school. However, to date, little research has been conducted regarding the degree of risk for licensure failure associated with specific academic courses and clinical internships in Mainland China. ObjectiveThis study aimed to explore the relationship of academic courses and clinical internships to performance on the NQEX-RPN in Mainland China. MethodsThis was a retrospective descriptive study. Two hundred twenty-eight new graduates were recruited from a four-year baccalaureate nursing program in Mainland China. The scores of academic courses and clinical internships were recorded from the Teaching and Learning administration of the university. The NQEX-RPN performance data was collected from the Provincial Health Department. Personal information was collected from the participants. Multiple stepwise regression was used to identify predictors of the NQEX-RPN. ResultsTwenty-three courses and four clinical internships were positively associated with NQEX-RPN performance. Surgical nursing, Medical nursing, Computer basics and Community health care explained the 36.2% of the total variance of Theoretical Knowledge (F = 31.313, p = 0.000); clinical internships of obstetrics and gynecology nursing, pediatrics and surgical nursing explained the 28.1% of the total variance of Application Skills (F = 28.852, p = 0.000). ConclusionSurgical-medicine nursing, Community health care, Computer basics and clinical internships are beneficial in assisting students and educators to identify the risk of students' performance in the NQEX-RPN.

Tele-education in South Africa.

Introduction: Telemedicine includes the use of information and communication technology for education in the health sector, tele-education. Sub-Saharan Africa has an extreme shortage of health professionals and as a result, doctors to teach doctors and students. Tele-education has the potential to provide access to education both formal and continuing medical education. While the uptake of telemedicine in Africa is low, there are a number of successful and sustained tele-education programs. The aims of this study were (i) to review the literature on tele-education in South Africa, (ii) describe tele-education activities at the University of KwaZulu-Natal (UKZ-N) in South Africa, and (iii) review the development of these programs with respect to current thinking on eHealth project implementation.Method: A literature review of tele-education in South Africa was undertaken. The development of the tele-education services at UKZ-N from 2001 to present is described. The approaches taken are compared with current teaching on eHealth implementation and a retrospective design-reality gap analysis is made.Results: Tele-education has been in use in South Africa since the 1970s. Several forms of tele-education are in place at the medical schools and in some Provincial Departments of Health (DOH). Despite initial attempts by the National DOH, there are no national initiatives in tele-education. At UKZ-N, a tele-education service has been running since 2001 and appears to be sustainable and reaching maturity, with over 1,400 h of videoconferenced education offered per year. The service has expanded to offer videoconferenced education into Africa using different ways of delivering tele-education.Conclusion: Tele-education has been used in different forms for many years in the health sector in South Africa. There is little hard evidence of its educational merit or economic worth. What it apparent is that it improves access to education and training in resource constrained settings. The development of local and international tele-education at the UKZ-N has not followed what is currently considered to be best practice but shows how programs can develop if there is a real need and the solution assists in meeting the need. Further work is required to analyze the economics of these tele-education endeavors.

Policy symbolism and air pollution in Toronto and Ontario, 1963–1967

In 1967, jurisdiction over clean air policy in Toronto and the rest of Ontario's municipalities was transferred to the provincial government. Even though the municipalities had obtained extensive authority to regulate air pollution within their own boundaries nine years earlier, the vast majority (apart from Toronto) had not developed clean air programmes. Yet air pollution was a highly salient issue that aroused considerable public attention and local activism. This paper provides an account of the provincial takeover in air pollution, focusing on two factors enabling the Ontario government to pass two statutes transferring authority from municipalities to the provincial Department of Health. First, despite resistance in Toronto, the policy change was favoured by industry, which had more influence in the provincial government than across municipalities. Second, the inherently symbolic features of clean air policy allowed the provincial government to satisfy public demand for action while not appreciably creating more stringent regulations. These findings are consistent with studies of US clean air policy displaying a similar tendency among industry to support regulatory standardization across broad political scales.

The Western Cape Government's new Integrated Provincial Violence Prevention Policy Framework: Successes and challenges

In August 2013, the Western Cape Government adopted an Integrated Provincial Violence Prevention Policy Framework initiated by the provincial Department of Health in response to the unusually high incidence of, and health burden arising from, interpersonal violence. The policy framework encompasses a more comprehensive intersectoral approach to the prevention of violence than the traditional criminal justice and security-centred approach typically promoted in South Africa as the conventional wisdom. It aims to bring coherence and clarity to the government's objectives in the field of violence prevention by way of a whole-of-government approach encompassing all sectors. The Policy Framework attempts to balance short-term evidence-based interventions, such as reducing the availability and harmful use of alcohol, with longer term interventions that require the state and all citizens to take active responsibility in addressing more holistically the complex social norms that support violence. It is consonant with a “whole-of-society” approach current in the South African polity to policy formulation and implementation, and is underpinned by the public health-centred guidelines set out by the international Global Campaign for the Prevention of Violence. The policy framework supports evidence-based approaches for violence prevention and a review and consultation process aimed at aligning existing performance priorities and deliverables across departments. One year after its adoption we review the uptake of this policy and reflect on some of its early successes as well as barriers to its implementation. We identify early resistance arising from its conflict with intra-departmental priorities, the impact of competing policies and directives, and we propose a research agenda to support its uptake.

Clinician's Perspective on the Management of Asthma and Chronic Obstructive Pulmonary Disease (COPD) Care at Primary Health Care Settings in Pakistan; Context Analysis

Aim of the Study : This study aimed to highlight the barriers in Asthma and Chronic Obstructive Pulmonary Disease (COPD) management in Pakistan. Place and Duration of Study: Primary health care facilities (18 in total) of rural areas in Punjab province, conducted on January 2014. Methodology: A cross sectional study is designed with a convenience sample of 18 primary health care facilities of rural areas in Pakistan. Structured interviews were conducted with health care providers and observational checklist of selected services was made for management of asthma and COPD care. Results: It was observed that there were no proper standardized guidelines and protocols available for clinical assessment, diagnosis and treatment, life style counseling, follow up, recording and reporting system and referral for asthma and COPD management. Conclusions: Provincial and district health departments should take initiatives to ensure

Evaluation of Rapid Syphilis Tests in KwaZulu‐Natal

Despite the considerable decrease in the seroprevalence of syphilis in South Africa, with an estimated prevalence of 1.5% in 2010, the disease remains a threat particularly to pregnant women, hence there is a need for a rapid, reliable, and affordable screening and diagnostic test. A laboratory evaluation study was conducted in response to a call by the KwaZulu-Natal (KZN) Provincial Department of Health that is considering using rapid point-of-care syphilis tests. The performances of the Hexagon and the SD Bioline syphilis tests were compared with the Treponema pallidum hemagglutination assay (TPHA) reference test using 297 (142 positive and 155 negative) serum specimens. Both assays demonstrated good performance with negative and positive concordance of 97 and 94% for the Hexagon assay and 98 and 90% for SD Bioline assay, respectively, when compared to the TPHA. The Hexagon test was quicker and easier to read than the SD Bioline test. Although the rapid syphilis tests performed favorably, a number of issues need to be considered prior to their use for syphilis screening in the public sector of South Africa.

E Cape's corruption-busting DG finally ousted

Dr Siva Pillay, the IT-savvy, corruption-busting Nelson Mandela Bay doctor and millionaire businessman, has been edged out as Superintendent-General of the controversy-riddled Eastern Cape Health Department, after a long-standing feud with his Health MEC, Sicelo Gqobana. His (acting) replacement is Mahlubandile Qwase, a teacher, former MEC for Education, former chair of the provincial health portfolio committee and former deputy director-general in Premier Noxolo Kieviet’s office. Counting MEC Gqobana, this puts two teachers at the helm of the provincial health department.

Inspanning all the oxen – new Health Foundation

The Western Cape is pioneering an independent fund-raising foundation that will help its provincial health department to reduce the regional burden of disease through wellness programmes, infrastructure upgrades and mutually beneficial public-private partnerships. Initially aimed at reducing, among other things, what Health MEC Theuns Botha estimates as a R1 billion backlog in infrastructure maintenance, the multi-faceted strategy (as embodied by the new Health Foundation) is a ‘holistic, all hands on deck’ approach. Speaking at the opening of the Foundation’s offices in Stellenbosch on 4 February this year, its CEO, Dr Joshua Fisher, said accelerating and spreading wellness programmes through employer programmes at the workplace and at schools, replicating the hugely successful Red Cross Children’s War Memorial Hospital fund-raising model at other facilities, and up-skilling (or merely rendering functional) health facility boards would be pivotal. The Foundation was also positioning itself to broker ‘significant deals with private companies’ to enable the generation of rental income and fees.

High uptake of Gardasil vaccine among 9 - 12-year-old schoolgirls participating in an HPV vaccination demonstration project in KwaZulu-Natal Province

Cervical cancer is linked to infection of the cervix by oncogenic human papillomavirus (HPV) subtypes. The quadrivalent Gardasil vaccine (against HPV types 6, 11, 16, 18), recommended in girls 9 - 12 years of age, has been shown to be safe, immunogenic and efficacious, with minimal or no side-effects. To demonstrate the capacity of school health teams to carry out vaccinations within a school environment. To assess the uptake of 3 doses of the vaccine, document lessons learnt and provide recommendations for a national rollout of school-based HPV vaccination for learners. Female learners (age 9 - 12 years) from 31 primary schools in Nongoma and Ceza districts (KwaZulu-Natal province, South Africa) were identified for inclusion in the vaccination programme. The 3 doses of vaccine were administered by existing school health teams. Education and training sessions were held with all stakeholders: provincial departments of health and education; school health teams; primary healthcare nurses; hospital doctors and nurses; private practitioners; school principals, teachers and governing bodies; parents; and community and traditional leaders. The overall uptake of the vaccine was found to be high: 99.7%, 97.9% and 97.8% for the first, second and third doses respectively (N = 963). No adverse events were attributed to the HPV vaccine. This project demonstrated the successful implementation of HPV vaccination among learners (ages 9 - 12 years) using school health teams.