A unique model of public interest health journalism

  Marcus Low argues that it is entirely possible for a media service to align closely with advocacy organisations, as Spotlight does; and that it can lead to demonstrable benefits and quality improvements, while maintaining journalism principles and integrity.  

Marcus Low is the Editor of Spotlight, published by SECTION27 (a public-interest law centre) and the Treatment Action Campaign (an HIV advocacy organisation). Spotlight produces compelling, in-depth public-interest health journalism, and distributes it as widely as possible.

Editorial independence and transparency are key to managing close links with civil society. South Africa faces extreme health challenges. Around 13% of the population are living with HIV; every year, an estimated 360 000 people fall ill with tuberculosis (TB); and rates of diabetes, heart disease and some cancers are on the increase.

The country is also deeply unequal, in that over 80% of people are dependent on an often dysfunctional public healthcare system – less than 20% have access to the much better-resourced private healthcare sector. In such a severely unequal society, those with enough money to pay for private healthcare are also more likely to be in a position to pay for media. 

The economic incentives are thus not particularly strong for for-profit media to cover health issues that affect mostly poor people. Add the fact that newsrooms in the country have shrunk – some have disappeared altogether – and that the economic model that has sustained journalism for most of the last century is in crisis, and the outlook for public-interest health journalism is bleak.

Whatever the reasons may be, over the last decade our perception has been that many important public interest health issues are insufficiently covered in mainstream media. This is the gap that Spotlight sets out to fill. Filling this gap is critically important for accountability in the healthcare system, and for the health of our democracy.

‘Filling the gap’ has at times meant doing investigative journalism (as with Spotlight’s impactful Health4Sale series on corruption in four provincial departments of health). Often it has meant reporting on why a new TB prevention medicine is not yet available in the public healthcare system, or why government has failed to publish important new health data. It has meant creating the space for experts to write opinion pieces on critical issues in the healthcare system, and making the latest HIV, TB and Covid-19 science accessible to the general public. At times it has meant turning HIV data into accessible data visualisations, and helping readers get a more accurate picture of the state of our various epidemics.

Mlu Mluleki Morongo, a former legal researcher at Section27, interviewing the community in Eastern Cape on the availability of ambulance services. (Photo: Anso Thom)

In some respects Spotlight is typical of early 21st-century donor-funded public interest journalism. It is a small operation, with few staff. It receives its funding from just a few international donors. Articles are published under open Creative Commons licences, and payment-free re-publication in mainstream media is encouraged. There is no paywall, and no economic incentive beyond maintaining donor funding. The mandate is clear and simple – produce compelling, in-depth public interest health journalism, and get it read as widely as possible. 

In 2020, Spotlight produced over 250 original articles, over 200 of which were republished on popular South African mainstream websites such as News24, Daily Maverick and AllAfrica – reaching millions of readers in the process.

While typical of donor-funded journalism in some respects, Spotlight is unique in other areas. Most notably, it provides an example of how high journalistic standards can be maintained in a context of close links with advocacy organisations – Spotlight is published by SECTION27 (a public interest law centre) and the Treatment Action Campaign (an HIV advocacy organisation).

The first critical element to making such a relationship with advocacy organisations work is the fact that Spotlight has been given complete editorial independence – an independence that the editors guard jealously.

This is to say that much as the editorial teams of most newspapers are structurally shielded from the newspaper’s publishers, Spotlight too is structurally shielded from its publishers, which happen to be two NGOs rather than a trust or a large media company. As in any media organisation, having such a firewall between the editorial team and the publisher is critical to avoid the perception – and the actual risk – of a publication becoming a mouthpiece for its owners.

The second critical element to managing this relationship is maximum transparency to readers. Whenever SECTION27 or the Treatment Action Campaign are mentioned in a Spotlight article, a note is added to the article disclosing the connection. Again, this is much the same as what happens when a newspaper reports on its parent company and discloses that connection.

While they are essential, internal measures such as the above, and clearly distinguishing reporting from editorial content, are not sufficient on their own, and should ideally be balanced by external checks and balances. That is why Spotlight is also a member of the South African Press Council, and therefore subject to the country’s system of media self-regulation. In essence, this means that Spotlight has undertaken to abide by the South African Press Code, and the adjudication processes associated with the code. Among other consequences, this means that Spotlight could be ordered to publish apologies or retractions, should rulings be made against it by South Africa’s Press Ombud.

Families of the Life Esidimeni disaster listen to evidence being led at the Alternative Dispute Resolution. It emerged that more than 144 Mental Health Care Users had died when facilities were closed down by the provincial government. Many went missing and over 1,250 were affected. SECTION27 led much of the advocacy on this case. (Photo: Joyrene Kramer)

Of course, even if all of the steps above are taken, public trust and a reputation for credible journalism are things that must be earned, and things that take time to establish. It is by reading a publication’s work over time that the public, and people in the media or health sectors, form views on the credibility of that publication. A recent independent evaluation of Spotlight’s work suggests that since its launch in mid-2016, it has succeeded on this front – a view that is supported by the willingness of leading mainstream media partners to republish Spotlight’s work. In short, journalistic credibility and editorial independence have both been established, and been seen to be established.

As an aside, additional context worth noting is that both SECTION27 and the Treatment Action Campaign also have public-interest mandates, and that these mandates are broadly aligned with those of public interest journalism. In this sense, the potential conflicts of interest that have to be managed are not as many or as serious as they would be, had Spotlight’s publishers been for-profit private companies active in the healthcare sector.

Benefiting from civil society networks

Provided that relationships are appropriately managed from a journalistic perspective, as described above, Spotlight’s links with advocacy organisations also provide unique benefits. Perhaps most usefully, Spotlight benefits from the rich network of individual and organisational contacts that SECTION27 and the Treatment Action Campaign have across South Africa’s nine provinces. 

The Treatment Action Campaign, for example, has a network of around 200 branches across the country – most of which have adopted local healthcare facilities to monitor, and who have invaluable local know-how. Being linked to such networks gives Spotlight unique access to the coalface of healthcare service delivery in South Africa, and has assisted in Spotlight being able to produce high-quality on-the-ground reporting. 

These various networks, in addition to the deep institutional memory of these organisations, also meant that when Covid-19 struck South Africa in March 2020, Spotlight was well-positioned and ready for it. There were pre-existing links with community healthcare worker groups that made it easier to cover this group of people’s need for personal protective equipment than it would have been without these links. 

Similarly, there were years of experience monitoring the performance of the National Health Laboratory Service, something which would turn out to provide invaluable background when the country struggled to keep up with Covid-19 testing demand. And of course, there were long-established relationships with many researchers and clinicians across the country – relationships built on years working on HIV, TB and public healthcare services more generally.

Of course, from a journalistic perspective there is a risk that this kind of special access to existing networks could lead to bias. However, this risk can easily be managed – in the first place, by recognising that the risk exists; but also by making explicit efforts to cultivate alternative sources, and by strictly upholding core journalistic principles such as fairness, the right to reply, transparency, and editorial independence. It also helps, in this regard, that Spotlight works with a variety of freelance journalists from a diverse set of backgrounds and with varying levels of experience – these freelancers being yet a further step removed from Spotlight’s links with advocacy organisations.

Coming from journalism backgrounds, the Spotlight editors are also keenly aware that readers will judge Spotlight harshly for any whiff of bias in the publication’s reporting. Accordingly, avoiding bias in Spotlight’s reporting has been a top priority for its editors from day one.

To summarise: Spotlight shows that high journalistic principles and journalistic integrity can successfully be maintained in a context where there are close links to advocacy organisations – provided that strict internal and external journalistic rules and checks and balances are put in place. Of the various measures discussed here, the codifying of editorial independence is probably the most important.

The history behind Spotlight 

From the early 2000s to 2012 (when funding for it dried up) the Treatment Action Campaign published a magazine called Equal Treatment. The magazine, often translated into four different languages, explained in an accessible manner the science of HIV and TB, and people’s rights in the healthcare system, and was used as a form of mass education and empowerment within the Treatment Action Campaign and partner organisations. At its peak it was published five times per year, with 70 000 copies printed of each edition.

In 2011 SECTION27 and the Treatment Action Campaign launched a second publication, called the NSP Review. The focus of the NSP Review was on monitoring South Africa’s HIV and TB response, rather than the specific type of mass education aimed for in Equal Treatment. In time, however, it was recognised that the NSP Review’s reach was somewhat limited – partly because it was explicitly an NGO publication. For this reason the NSP Review was shut down early in 2016, and a decision was made to launch Spotlight.

From the beginning, the idea behind Spotlight was to create a journalistic entity that is editorially independent from SECTION27 and the Treatment Action Campaign. It thus represented a move away from NGO publications such as the NSP Review and Equal Treatment, to a more traditional journalistic entity that plays by the accepted rules of journalism and fully subjects itself to the South African Press Code. 

In order to make this move, key leaders at SECTION27 and the Treatment Action Campaign had to be convinced that relinquishing control (by agreeing to full editorial independence for Spotlight) was a necessary step to ensuring that people would take Spotlight more seriously than they did the NSP Review. Of course, people from SECTION27 and the Treatment Action Campaign could still have opinion pieces published in Spotlight; but these would be clearly marked as ‘comment and analysis’, and opinion pieces from people at these two organisations would get no special treatment compared to anyone from other organisations.

Behind this shift was a growing realisation and consensus that public health issues in South Africa were not being covered sufficiently by existing mainstream media, and that this shortcoming could only be addressed by increasing media capacity. That is to say, there was a recognition that supporting the expansion of independent public interest journalism capacity would result in systemic benefits that would assist all efforts to improve access to quality healthcare, be they from government, advocacy organisations, service delivery NGOs, multinational health agencies, or international donors. It would both increase health sector accountability, and deepen public understanding of health issues – in short, it would serve the public interest. 

1 March 2021