COVID-19, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly transmissible, with a high mortality in vulnerable individuals and no known disease-specific treatment or vaccine. [1] On 11 March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak to be a pandemic, making global recommendations to reduce transmission, prepare and be ready. [2] As anticipated, it continued to spread and is now prevalent in South Africa (SA) and other African countries, [1] putting healthcare systems under severe pressure.Healthcare workers (HCWs) are the most important resource in both the COVID-19 response and in maintaining essential services. [3] HCW motivation and empathy are critical to effective and compassionate healthcare. Mental health conditions may compromise work performance and increase risk of burnout, absenteeism and resignations. [4,5] Fatigue, emotional exhaustion or poor concentration are likely to increase clinical error, including breaches in infection control, impacting on patient care and staff infections. Protecting the mental health and wellbeing of HCWs is therefore of paramount importance during an infectious disease outbreak.Such outbreaks cause high levels of psychosocial stress, [6] related to uncertainty regarding risk of infection and prognosis, loss of loved ones, and the social impact of measures instituted to contain the spread of disease. Being at the frontline in disease detection and management, HCWs are vulnerable, exposed to infection, high workloads and difficult working conditions. Resource constraints, including shortages of personal protective equipment (PPE), limit individual capacity to provide appropriate patient care and heighten the mental health risk. Being quarantined appears to convey particular stress. [7] The Gauteng Province Department of Health's research and evaluation workstream therefore requested evidence-based recommendations regarding the potential impact of the COVID-19 pandemic on the mental health of HCWs and their protection. This article describes the process behind, and builds upon, a presentation made to the senior leadership of the Gauteng Department of Health's COVID-19 response team in April 2020, for which we sought to answer two questions: (i) what may be expected regarding the psychological impact of the COVID-19 outbreak on HCWs; and (ii) what interventions could be considered in order to protect and support the mental health and wellbeing of HCWs during the crisis. MethodsWe conducted a rapid scoping review of published literature on mental health of HCWs exposed to infectious disease outbreaks. Literature search and study selectionTo gain an understanding of the topic, we conducted a preliminary search and screen of the PubMed and Cochrane databases on 7 and 8 April 2020, respectively, using terms (healthcare workers OR medical doctors OR nurses OR community health workers) AND This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Background Health advocacy (HA) is a core competency of transformed, socially- and contextually-responsive, 21st century medical graduates though remains challenging for medical educators, including in South Africa. The optimal delivery of HA education has been vulnerable to vague definitions, lacking distinct or measurable dimensions, varied judgement, and poor prioritization in curricula which balance competing interests. We aimed to clarify HA definitions and explore current practices of HA pedagogy. Methods A step wise, scoping review approach was adopted, for evidence on HA and HA pedagogy. This included electronic database searches of published literature, and internet searches for non-journal publications, from 2000 to 2020 and limited to reports published in English. Websites of relevant regulatory bodies and professional organizations were also explored. Inductive thematic analysis was used to analyze the data. Results Sixty-four total articles and documents were included. Majority emerged from North America, the field of health education, and medical disciplines of family medicine, internal medicine, and pediatrics. HA compels graduates to be change agents and activists, at both the individual and community levels, and to promote equitable access to quality healthcare. It is increasingly associated with social accountability, consideration of the social determinants of health, and progression from advocating with, rather than for, individuals and populations. Various curricular approaches were evident, including didactic and experiential learning, and longitudinal and integrated designs. Conclusions Although HA is a core competency for medical graduates in South Africa, there is little evidence related to HA pedagogy in the country and the African continent. Despite distinct variability in current instructional approaches, there is potential for consolidation, contextual relevance, enhanced HA pedagogy, and improved HA competencies. Key messages HA is a core medical graduates’ competency but HA education is often sub-optimally engaged with and delivered. Enhanced, contextually relevant HA pedagogy could empower medical graduates to be better health advocates and more confident change agents for patients and communities they serve.