By all accounts, Maritzburg’s Hasina Subedar is who you call when you need to roll out, well, anything new in public health
By all accounts, Maritzburg’s Hasina Subedar is who you call when you need to roll out, well, anything new in public health Hasina Subedar , who is overseeing the health department’s introduction of pre-exposure prophylaxis, or PrEP medication, lenacapavir, has a more informal title: South Africa’s queen of PrEP roll-outs.
spread across the country stand trained and ready to receive and administer the drug, which has been found to beNow is not the time to drop the ball, to use another cliche, but many in the HIV space take comfort in the knowledge that the person responsible is Hasina Subedar, the health department’s senior technical adviser in HIV prevention. Getting Subedar to give an interview took some convincing , but she ultimately took a call on a Saturday afternoon in late April, with LEN all but ready to launch.
After some connectivity issues — “Is this better? Hang on, I’ll move closer to the modem. Hello, Hello, He-LO-HO… ” — Subedar tries to minimise the achievement.
Before LEN, Subedar oversaw the roll-out of a once-a-day HIV prevention pill for HIV-negative South Africans wanting to protect themselves against infection, becoming, former health department director-generalWith the drugs now in the country, the next step is getting LEN to those most likely to benefit from it, a challenge made markedly trickier by the Trump administration’s HIV funding cuts. When I exclaim about the responsibility she must have to shoulder, Subedar chuckles and says, “I don’t get stressed easily.
I am on a high all the time. I just have to keep moving, and things have to run like clockwork. ” She works from 6am to 11pm every day, and typically only takes off from the day of reconciliation each year until January 3. Last year, however, she worked through.
“I had to sit and finish all the training materials , while worrying over consignments of drugs that still needed to come into the country,” says Subedar, who for the past nine months has met weekly with all of the organisations involved in supplying the drug, a process she describes as “immensely complex and at times quite fraught”. “Relax your grip, and there’s a chance the drugs will simply not make it into the country.
I have had to become a very hard taskmaster for people who don’t do the things they’re supposed to be doing,” she says. With the drugs now in the country, the next step is getting LEN to those most likely to benefit from it, a challenge made markedly trickier by the Trump administration’sand partners in April, have undermined much of the infrastructure — such as community-based testing and field recruitment for HIV prevention services — needed to create demand for LEN.
How will such yawning gaps be bridged?
“Previously, with the oral PrEP roll-out, we had donors telling us, ‘This is where you must implement. These are the populations you must implement for’. It was initially led by them , and this often resulted in fragmented service delivery. With LEN, I was determined that it would be government-led, and not rolled out by partner-funded projects but instead integrated within public primary healthcare from the outset.
” If questions remain about the viability of the plan , her competency is widely acknowledged. Francois Venter, executive director of Ezintsha at the University of the Witwatersrand, recognised Subedar’s work ethic and “absolute integrity”. Desmond Tutu Foundation CEO Professor Linda-Gail Bekker praised her ability to work well with a spectrum of role-players, “doing so with grit, grace and humour”.
“I’m from Pietermaritzburg,” Subedar begins, as if this on its own answers the question. “I was born there, in Edendale Hospital. My father was a tailor who wanted a boy, but instead my mother had five girls, so I was often dressed like a boy from the time I was little,” she says. Subedar’s parents — Hajira and Goolam Subedar — were both largely self-taught people, denied education by family circumstances.
“It was important to them that we should receive the education they were denied. My father always said, ‘The one thing you must always do is educate yourself, because nobody can ever take away your education,’ which is so true. ” The Subedar family lived towards the bottom end of East Street , near the mosque.
For junior school the girls attended the Nizamia School, 200 metres from their home, but had to walk much farther for senior school, to Pietermaritzburg Indian Girls High School, on Berg Street.
“You had to find a way of ducking out somehow or other,” she says. As the middle child, she was often left to fend for herself, never quite included in the alliances of her two older and two younger sisters. This would prove consequential.
The Subedars were a political family who often shared what little they had with the families of Robben Island detainees like“My older sisters flat out refused, and since my younger sisters were too young, it pointed at me,” says Subedar, admitting that she resented the imposition initially, but came to appreciate the experience.
“Our own home was a tiny little place, with the bathroom and toilet separate outside, and for hot water you had to make a fire below a copper geyser, but when I went to live with Nina and her boys I had my own room, and I learned a lot. I became more politicised around this time, which wasn’t unique to me. It was a common experience in the areas and communities we lived in, but it shaped my thinking.
There wasn’t this thing of we are Indian and they are African. We were very integrated in lots of ways. ” Hasina found her high school years 'interesting, not least because the staff were a mix of races, and one struggled to relate to some of them'.
“My father’s work completely dried up when I was at high school, so I had to work to support myself,” says Subedar, who dropped out of a social work degree after just one year due to a lack of funds. Her choice to study nursing was born mainly out of need — she would be able to study and earn, enabling her to support the family — but there was something else.
“When I was 18 years old I was attacked by a man who tried to kill me. I was left badly injured: two of my fingers were completely severed, and a third was left non-functional,” she recalls. Amid the chaos of that emergency, the nurses who attended to Subedar in hospital provided a refuge of calmness and kindness.
“My hair had lots of glass and sand in it, and one of the nurses said, ‘Let me wash your hair for you. ’ And that meant so much to me,” she says, confirming that these experiences of care strongly factored in her decision to study nursing.
Subedar says she emerged from the experience a more compassionate person, “especially towards those experiencing rupture in their lives”, and strongly resolved to move forward “without any self-pity — without ever talking about it, in fact — while finding ways to compensate for the considerable loss of functionality in my left hand. ”Within a month of applying to train as a nurse, Subedar was on her way to Cape Town, to learn and work in Groote Schuur Hospital, where “there was a black section and a white section, and you stayed on your side!
” (Ever the non-conformist, Subedar found ways of undermining workplace apartheid, playing squash late at night “at the white residence where we were not allowed to be”. In Pietermaritzburg, Subedar had been well aware of the inequality in the education system. Now she saw it up close in the health system.
“One of the things I did as a student was go into Langa to train people in first aid. Ambulances weren’t going into Langa at night, and in many instances people died at the police station for want of basic care.
” Subedar qualified as a professional nurse and spent some time working in intensive care units, until her son was born, at which point she returned to Pietermaritzburg to be closer to her family, taking a position as a mental healthcare nurse at Fort Napier, the psychiatric hospital, and later as part of an outreach team in Durban communities like Chatsworth, Phoenix and Merebank.
“It was a refreshing change, more humane in many respects, because I could spend time with people who were dealing with life in all of its complexity,” she says. When she was granted long leave in 1989, Subedar used it to further her studies at the University of KwaZulu-Natal, where she was ultimately offered a post providing clinical training to student nurses in both psychiatry and midwifery.
Having left Cape Town with a diploma in nursing, Subedar managed, by 1993, to complete a basic degree, a qualification in nursing education, an honours in psychology and a master’s in mental health nursing, all while working and raising a son as a single parent.
“Shame, I moved around and this poor child moved everywhere with me. At one point he said to me, ‘Mom, you are very lucky you have me as a son’, and that is so true because he never complained, he just adjusted every time.
”After South Africa’s first democratic elections in 1994, Subedar, who had participated in some of the strategic teams that had been set up in advance to look at the transformation of healthcare, decided to move back to the Western Cape, feeling that of all the provinces, its mental health services were the most in need of transformation, concentrated as they were in psychiatric hospitals like Valkenberg, Lentegeur, Stikland and Alexandra.
“One of the reasons I left academia to go back into the system was to contribute to the realisation of the idea that basic services should be taken out of hospitals and made available in communities,” says Subedar, who spent three hopeful years — 1997-2000 — working on the establishment of community mental health services in the Western Cape, only to become frustrated with the province’s see-saw politics. “We had three health MECs in that period with different political affiliations, and I think this influenced the direction in which we went, which was not what I had envisaged,” she says.
“I was the first female registrar, and the first person of colour to hold that position,” says Subedar, recalling that the discourse on transformation when she entered the council, “was at the level of worrying about what new pictures to put on the walls, and which building names should change, not about the profession and what needed to happen to transform it! ” “We had this changing health system, which is also needing to respond to new challenges like the HIV/Aids pandemic.
For me, one of the priorities was making sure that our professionals are able to work in such a system,” says Subedar, who instigated a review of the scope of practice of nurses, with appropriate adjustment to their education.was largely based on the new frameworks Subedar developed, and she believes it “quite clearly defines what nurses should be doing, and what the regulations are, and making sure that those regulations enable the nurses to do what they have to do. ”“That’s the part that …” she starts to say, but her voice peters out.
She doesn’t need to describe the crisis in nursing education in South Africa currently, which has been well publicised. Instead of necessary transformation, nursing education has been compressed by the closure of several nursing colleges, and choked by changing qualification requirements, contributing to a situation in which nearly half of all nurses registered with the Subedar’s time at the council ended badly. In 2008, controversially, her contract was not renewed, leading her to take legal action.
She was reinstated for a short time but departed in 2009.
“I didn’t know what to do at that point, but an opportunity arose to come back into the department to assist with the healthcare re-engineering process. It was this question of ‘how do we restructure primary healthcare, and make it more functional in the current system? ’”So began her time “of sort of developing stuff for the department and delivering for them”.
When she was asked to roll out HPV vaccination in 2012, it was a one-line instruction: “You will roll out the HPV vaccination, it will be in March 2013, and a treasury allocation will be made available, but only in April 2013,” Subedar recalls mirthfully.
“There was no pilot, yet we had to reach every public school within 20 days, campaign style. I learned a few valuable lessons in all of that. You need to know how many people are required for the work, and to understand who is going to do what. Your people need to be competent, and they need to be supported.
Do they understand their role? Do they have job aids ? Those campaigns were scripted to the T,” she says, adding, “the beauty of all of this is that people, once they have direction and know what they need to do, they get it done, especially at the province level. ” Typically, whenever she has taken on a new project for the department, Subedar has started in complete unfamiliarity.
“On the day I was approached about HPV vaccination, I did not know what it was. I did not know how it needed to be administered. I knew nothing, but this was a strength because I needed to systematically grasp the subject.
I learned from scratch on PrEP, too,” says Subedar, who advocates, “seeking out the experts and literature on the clinical trials and studies, and getting them to provide you with all the technical information that is required for the direction that you need to go, and then just shaping it, so that it will work in the real world in which you want to implement. ” This consultative approach has not been without its challenges.
“With oral PrEP, I sat in the very first meeting with these incredibly forceful HIV researchers, and everybody was doing their own study and had their own ideas about what should be done and which population we should be focusing on, be it men who have sex with men, adolescent girls, sex workers or transgender people. Disappointment was guaranteed,” says Subedar, insisting her personal motto remains “collaboration”.
“I might not agree with you, but I will listen. All stakeholders should have a space to give their view, including civil society. It doesn’t come naturally to the department of health, but if anybody tries to create animosity, or start excluding people, I would intervene,” she says before politely ending the conversation. A difficult problem has arisen, and for once it has nothing to do with her work.
“I am renovating, and the contractor failed to cover my room, so everything — my clothes, my linen, my floors — is coated in a fine layer of dust. ”
Hasina Subedar Lenacapavir Yogan Pillay Prep HIV
United States Latest News, United States Headlines
Similar News:You can also read news stories similar to this one that we have collected from other news sources.
We pay for services not symbolism: a citizen’s plea to local governmentCitizens call for action as leaders prioritise visibility over service delivery
Read more »
Arsenal escape scare to restore Premier League title lead, with VAR callArsenal's narrow 1-0 win over West Ham on Sunday resulted in them regaining a five-point lead in the race for the Premier League title, but the match was marred by a controversial VAR decision.
Read more »
Arteta commends 'brave' officials for decisive call in Arsenal's Premier League title tilt; calls it 'rollercoaster of emotions'Mikel Arteta, Arsenal manager, praised the referee and VAR officials for their 'brave' decision to disallow Callum Wilson's equaliser for a 'clear foul' in stoppage-time, which denied West Ham a draw and Arsenal a potential title blow, ultimately setting the stage for the North London club to secure their first Premier League title in 22 years, with two games to spare. Arteta singled out David Raya and Martin Odegaard for their invaluable contributions in the crucial match, highlighting their impact in Arsenal's title bid.
Read more »
Peake handed first Australia white-ball call-upUp-and-coming 19-year-old batsman Oliver Peake and all-rounder Liam Scott were on Monday given their first call-ups to Australia's white-ball squads, but veteran T20 all-rounder Glenn Maxwell was left out.
Read more »
South African sports minister Gayton McKenzie announces PSL supporter competition final callAfter disqualifying one winner, the sports minister announces a final call for the remaining supporters to enter a competition for three Premier Soccer League clubs. The winners will watch Bafana Bafana's opening match against Mexico in the 2026 World Cup. The Yahoo News coverage focuses on this announcement by the sports minister, revealing details including the entry requirements and the name of the new winner after a disqualification due to passport eligibility. Additionally, the sports minister sparks outrage over her visit to France, and an error regarding the Orlando Pirates' entrant is also mentioned.
Read more »
Four Labour ministerial aides resign over Keir Starmer's leadership, citing lack of authority, and calls for PM's resignation growKeir Starmer faces increased criticism and pressure after four ministerial aides step down and over 60 lawmakers call for his resignation after a disastrous local election defeat. The prime minister struggles to regain authority amidst growing dissent.
Read more »