March 25, 2021

Good Nutrition for Good Immunity: A Q&A with Rebone Ntsie (IPPHL Fellow, Cohort 2)

The International Program in Public Health Leadership (IPPHL) team recently had the chance to have a conversation with Ms. Rebone Ntsie, a Cohort 2 Fellow, about her work and the influence IPPHL has had on her growth as a leader. As the Nutrition Director at the National Department of Health, South Africa, Rebone recently led the 2020 National Nutrition and Obesity Week, and shared some of her insights on the campaign with us.

Could you give us a brief overview of the campaign and the goals you aimed to achieve?

We have had this campaign every year for at least two decades now. It has been documented on the website since 2011. And this year it was around June that we started to say look we need to focus on COVID, but what about COVID? Nutrition was very important. People everywhere were talking about boosting your immune system, but not really understanding how to do so, and getting a lot of misinformation. So we wanted to guide the public in terms of what is critical.

One of the issues that came across very strong was that of food insecurity. In our country we have always known that we have food insecurity, but during COVID it became much clearer. Some people could no longer go to work, they didn’t have anything to eat. And what was concerning is that we knew already that those people who are worst affected by COVID are those that have NCDs. We know that unhealthy diet is one of the major risk factors for NCDs. We also know that the immune system is affected by nutrition, hence the theme of the campaign was Good Nutrition for Good Immunity.

We wanted to use this opportunity to assist people in terms of what they can actually do to boost their immune system. We emphasized the health benefits of choosing healthy whole foods from a variety of mostly plant-based foods such as vegetables and fruit, legumes and minimally processed starchy foods, encouraged consumers to make healthy, affordable food choices and most importantly we provided consumers with practical tips when planning, buying, preparing and eating food during and after the COVID-19 pandemic. And we included messages on promotion of breastfeeding, which we know is the most nutritious and affordable food for infants and young children. So those are the tips we focused on. Educating people about healthier food choices, how to buy healthy food with less income. Speaking a lot on home cooked meals, with recipes and tips on how to buy in bulk. We even had a two week menu with a list of groceries, and one of the organizations we worked with had developed nutrient dense recipes with affordable foods. Just to give people practical tips.  And I think it resonated well with a lot of people. We wanted to educate them that boosting your immune system is not this thing that you do today; you drink this concoction, and your immune system is boosted. It’s something you need to invest in, that you need to do continuously.

What additional challenges did COVID present?

The campaign is in October, so from January, we were already thinking and starting to prepare. What was different this year? We had prepared the concept document, and already started working on evidence, agreed on what we want to focus on, which was nutrition labeling. Then come March, we realized that COVID is becoming serious. We continued thinking maybe by June it will have ended, but around May we realized we would be appearing stupid, to be honest, if come October we’re still talking about nutrition labeling when people are concerned about COVID. So we needed to be relevant.

We’re also used to having these physical events, and especially in local events, we usually gather people to do demonstrations and exhibitions. So we were not sure about how then to do this campaign. On our own, honestly, we wouldn’t have managed, but because we had different people in the team with different expertise, that helped us a lot. For example, one of the target groups we wanted to reach was youth and through UNICEF we managed to get them involved as well, and to use methods that are exciting to them. UNICEF has 2,000 volunteers across universities, and we prepared material for them to share easily. The material was also sent to dietetics university students to share. And I can tell you that we received a lot of financial support for this campaign. We could actually get organizations that we were working with to invest in our campaign, because they saw it as a benefit for them as well. It was at a time when everybody really wanted to contribute.

What was your role in the campaign?

My main role was to provide strategy and leadership; guiding all collaborators in terms of what to do, what’s next, and how to get there. What I was doing was mainly coordinating all the activities, chairing all the meetings, and negotiating with different organizations. But it was truly a team effort to bring the campaign to fruition. I would certainly want to recognize my colleague, Ms. Maude de Hoop, who was the secretariat of the whole campaign and played a major role in the creation of essential materials such as the concept document and Q&A.

What were some of the organizations you worked with?

Besides the Department of Health in all provinces in the country and the South African Military Health Service (SAMHS), we had a lot of non-governmental organizations we had already worked with (Association of Dietetics in South Africa, Nutrition Society of South Africa, Heart and Stroke Foundation SA, Cancer Association of SA, Consumer Goods Council SA), and new ones (Grow Great, UNICEF, Clinton Health Access Initiative). We also had two individual volunteers. Ms. Liezel Engelbrecht who volunteered to develop the communications strategy, was involved with us for the first time as well. So, some were new but they did an excellent job.

We also have been working with the Department of Basic Education for some time because school-going children have always been one of our targets. But for the first time this year we also worked with the Department of Social Development, because we knew that food insecurity is an issue and they are the ones responsible for social protection measures. A lot of their clients are on social relief programmes, so these are the people that are worst hit. We thought a lot about how we can package this in a way that’s sensitive to the needs of these people, and about how do we include them in our campaign? So Social Development came in very handy to really reach people that we usually don’t reach and that need us most.

How did you balance all the different organizations?

What was key was to reach consensus, which frustrated some of our collaborators, especially the new ones who were not familiar with how we work. It takes a little bit of time to reach consensus but for us that is important because once all of us have bought in we are all able to move forward on the same page. We needed to make sure we were all aligned and communicating the same messages. We used tested messages, we didn’t just take them from anywhere, so this was very important.

We also created a collaborators checklist because we wanted all collaborators right from the beginning to indicate who they were, what their role would be, what we should expect from them in this campaign, and declaration of any conflicts of interest. And that’s something that worked well and we plan to build on it and make it even better.

Could you tell me a little more about your plans for evaluation of the campaign?

We have always wanted to have a proper M&E framework to look at what it is we want to achieve and check at the end of the campaign if we’ve done that. We lack the resources and capacity to do it, but it’s something we still want to do. However, now on an annual basis we have a feedback meeting to see how the campaign went in terms of material, if things happened on time, and what we can do better next year. For the first time this year we have the informal measures about what we’ve done. We developed a short template that our collaborators can fill out to give us an idea of what happened, how many people we reached, where, and so on. Also for the first time this year a team of experts piloted a tool they have developed to do a Social Behavioral Communication Change (SBCC) evaluation on our campaign. We are hoping this campaign changes behavior, but we don’t have the mechanisms to check if it really does. So the SBCC evaluation will identify opportunities for improving the campaign in the future in terms of planning, designing, implementation, and monitoring and evaluation.

What skills did you gain from IPPHL that you found relevant or useful for the campaign?

Bringing in organizations reminded me of the elevator pitch that we did. Because one had to think quickly to identify the relevant organization and what to say. The stakeholder analysis that we did as well; who are the stakeholders, who are likely to bring progress rather than derail, and defining their role. And then with that I could then be able to explain to them what this campaign is, how it enhances the work that they’re doing, and what type of help we need from them. And they did even more than we could have expected within a very short period of time.

I think more than any one thing that I learned from IPPHL, what IPPHL has done for me was to provide me with the confidence that I needed. In IPPHL I have been given the skills and have been capacitated to lead and influence others. So, I knew what to do, and I was confident in what I was doing. I think because of that I was able to work with others very well and inspire passion in people; really influence them to drive the change that we all want to see. This program really has benefitted me; it has enriched me I must say.

Have you interacted with the other IPPHL alumni near you?

I used to work with Mr. Daddy Matthews at the provincial level, and now I moved to national, but we collaborate on a very regular basis. We exchange information and plan activities. And Dr. Eva Mulutsi is my friend; we work at the national level together. We don’t work together closely because she works in forensic mental health, but we support each other in terms of strategy and management issues and leadership; share ideas and draw on each other.

Do you have any advice for women looking to become leaders in public health?

The main thing for me is I think as women we don’t have to doubt ourselves. We have the capacity to lead. And let me mention one thing that came very handy from IPPHL: adaptability. In your mind you know that things are not stagnant; and so you have to think of when you will need to adapt and how to do that. And that’s one thing that’s prepared me. I wasn’t resistant to change and I can tell you that all technical staff in the nutrition directorate have now adapted to working from home remotely. We came up with tools and we actually think that maybe we should continue this way because we have adapted to these new ways of working. One of the things that I still do is I read the articles from CCL, and a lot of material that they post talks about change, adapting in the environment, so that has also helped me. And some of those things I share with colleagues as well.