Dopamine neurons, the cells that drive reward and motivation while we’re awake, become surprisingly active during nonrapid eye movement sleep right after we learn something new.
According to a new University of Michigan study, this night surge that is synchronised with memory-boosting sleep spindles, helps strengthen motor memories and improves motor skills.
The findings challenge long-held assumptions about dopamine’s role in the brain, showing that these neurons don’t just support learning during the day – they actively help lock in new skills while we sleep, said study co-author Ada Eban-Rothschild, U-M associate professor of psychology.
“As alterations in dopamine signalling are associated with neurodegenerative diseases that also involve motor deficits and sleep disturbances, understanding these links could pave the way for improved therapeutics and advancements in human health,” she said.
The study focused on specific midbrain dopamine neurons that become active after learning, but only during nonrapid eye movement, or NREM, sleep. This burst of activity helps the brain fine-tune and reinforce newly learned movements, contributing to more precise motor performance once awake.
Understanding how dopamine supports motor learning at night also sheds light on the broader importance of sleep in shaping behavior, said Eban-Rothschild and colleagues.
“The findings highlight that sleep is an active biological period during which key neural circuits strengthen the skills and patterns we rely on every day,” she said.
By revealing how dopamine helps consolidate motor memories during sleep, the researchers say the findings open a new window into brain health: It may eventually guide the development of therapies that target both sleep and dopamine pathways, offering new hope for improving motor function and quality of life in affected individuals.
The study was published in the Journal Science Advances. In addition to Eban-Rothschild, the study’s authors are Bibi Alika Sulaman, Eric Chen, Aaron Crane, Sangjin Lee and Gideon Rothschild
#InsideTheBox is a column by Dr Andy Gray, a pharmaceutical sciences expert at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice. (Photo: Supplied)
By Andy Gray
There has been much confusion and misunderstandings about how cannabis and associated products are regulated in South Africa, with government’s own missteps adding to the uncertainty. In his last #InsideTheBox column for the year, Dr Andy Gray clearly sets out the current legal and regulatory situation and where we’re heading.
There is a fundamental assumption that underpins much of the legislation relating to pharmacologically active substances, especially those that have neuropsychiatric effects. Some are recognised as having legitimate medicinal uses, in humans and/or animals, and so are regulated as medicines. Others are deemed to have no legitimate medicinal uses, and so their possession and use is prohibited or even criminalised. Some of these substances are obtained from natural sources, such as plants or fungi, and some have been recognised and used since antiquity, precisely for their effects, both for pleasure and ritual.
Cannabis is a prime example, which grows on all continents other than Antarctica and has been used for a wide variety of purposes, both for its pharmacological actions and for its physical attributes, as a source of fibre and nutrition.
South Africa has a long and complex history with regard to cannabis. It was the South African government which proposed to the League of Nations Dangerous Drugs Committee in 1923 that cannabis be subjected to international regulation. That status remains in place, in terms of the Single Convention on Narcotic Drugs, 1961, to which South Africa is a signatory. Schedule I to the Convention, which is maintained by the International Narcotics Control Board, includes “the flowering or fruiting tops of the cannabis plant”, as well as “the separated resin, crude or purified, obtained from the cannabis plant”. Parties to the Convention are required to “adopt such measures as may be necessary to prevent the misuse of, and illicit traffic in, the leaves of the cannabis plant”. Cultivation of cannabis is to be regulated in the same manner as that applied to opium poppies, but with an important caveat: “This Convention shall not apply to the cultivation of the cannabis plant exclusively for industrial purposes (fibre and seed) or horticultural purposes.”
As a result, cannabis was for many years listed as a Schedule 7 substance in terms of South Africa’s Medicines and Related Substances Act, 1965, and also included in the “Undesirable Dependence-Producing Substances” in terms of the Drugs and Drug Trafficking Act, 1992. While exceptional access was allowed for research, analysis or use by a particular patient, substances in those categories could not ordinarily be possessed or sold.
That entire legal construct was overturned by a 2018 Constitutional Court judgment which declared the relevant sections of both laws unconstitutional “to the extent that they criminalise the use or possession in private or cultivation in a private place of cannabis by an adult for his or her own personal consumption in private”. The court allowed legislators a period of 24 months to remedy the situation.
THC and CBD
Although the cannabis plant contains over 100 identifiable chemical components, two are of particular importance. Tetrahydrocannabinol (THC) is the psychoactive component, whereas cannabidiol (CBD) is not psychoactive. At higher doses, cannabidiol has been shown to be effective in the management of some paediatric epilepsy syndromes.
The first change made to comply with the Constitutional Court judgment involved moving THC to Schedule 6 (alongside morphine, for example) and CBD to Schedule 4 (as a prescription medicine). The Schedule 6 inscription also included an exception to allow adult use, echoing the wording in the court judgment. The control measures applicable to a Schedule 6 substance (such as the need for a prescription) do not apply when “raw cannabis plant material is cultivated, possessed and consumed by an adult, in private for personal consumption”. The Schedule 4 inscription also allowed for low-dose CBD products (containing a maximum of 20mg per day and 600mg per pack) to be regulated as a complementary medicine, provided the labelling made only a low-risk claim (a general health enhancement or health maintenance claim or a claim of relief from minor symptoms).
The South African Health Products Regulatory Authority (SAHPRA) has issued just over a hundred licences for the cultivation and export of cannabis for medicinal purposes. These licences are for the preparation of the raw material from which medicines could be made, but no THC-containing products have yet been registered in South Africa. SAHPRA does not report on the number of section 21 permits issued to individual patients seeking access to THC-containing medicines, nor on the sources of unregistered medicines approved in that manner (section 21 permits allows for access to medicines not registered by SAHPRA).
SAHPRA’s cannabis cultivation permits do not allow the sale of cannabis products directly to the public. SAHPRA has not issued licences to any retail outlets for cannabis or cannabis-containing products. Retail outlets claiming to be licensed “dispensaries” are therefore operating illegally.
In 2024, the Schedules were again updated, with this exception inserted: “in raw cannabis plant material cultivated and possessed in accordance with a permit issued in terms of the Plant Improvement Act (Act 11 of 2018) and processed products manufactured from such material, intended for agricultural or industrial purposes, including the manufacture of consumer items or products which have no pharmacological action or medicinal purpose”.
The Plant Improvement Act, 2018, is intended to regulate the propagation and sale of particular plants, setting quality standards for economically important varieties, such as wheat. In November 2025, the Minister of Agriculture, Land Reform and Rural Development issued regulations in terms of this Act, setting a THC limit of 2% for the leaves and flowering heads of cannabis plants considered to be “hemp” (low-THC cannabis). That action provides the clarity required to interpret the Schedules to the Medicines Act and creates a process for the issuing of “hemp” permits for the cultivation and sale of low-THC cannabis for industrial applications.
‘A work in progress’
Bringing the Drugs and Drug Trafficking Act into alignment with the Constitutional Court judgment has been far more complex than the Medicines Act and is still a work in progress. The section of the Drugs Act which enabled the Minister of Justice to make schedules listing substances in different categories was found to be unconstitutional in 2020. Future changes to the schedules will require an Act of Parliament. Distinct from the Schedules to the Medicines Act, these lists designate which substances, for example are considered “Undesirable Dependence-Producing Substances”, the possession of which may be a criminal offence.
Instead, the Minister of Justice and Correctional Services tabled a separate Bill in 2019, which was finally passed as the Cannabis for Private Purposes Act, 2024. While that Act has been assented to by the President, it has not yet been promulgated and no regulations have been issued. The legislation is therefore not yet in operation. Regulations are needed, for example, to specify the amounts of cannabis that can be cultivated, possessed or transported. Most importantly, though enabling the possession or cultivation of cannabis in a private place, and therefore personal consumption by an adult, the Act does not enable the commercialisation of cannabis for “recreational” or “adult use”, as is the case with alcoholic beverages or tobacco products.
South Africa’s Cannabis Master Plan, which envisages three separate value chains, covering medicinal cannabis, hemp, and adult use, is now being driven by the Department of Trade, Industry and Competition (DTIC). The DTIC plans to submit a Hemp and Cannabis Commercialisation Policy to Cabinet by April 2026 and to table an Overarching Cannabis Bill by mid-2027.
The 2018 Constitutional Court judgment overturned almost a century of established practice. While the evidence for the medicinal value of cannabis and specific cannabinoids is still scanty, the assumption that such products have no medicinal value at all is no longer tenable. As with all pharmaceutical products, this is a highly regulated market with high barriers to entry.
An industrial market for low-THC cannabis is already well established and the necessary steps to enable its growth are now in place. However, the ill-informed ban on the inclusion of any cannabis components in foodstuffs, which was issued and then rapidly repealed in 2025, is indicative of the lack of coherence in government policy. The challenge remains the commercialisation of an adult use market, and whether that will enable the involvement of the small-scale rural growers who have traditionally met demand for the product.
Cannabis policy therefore remains in flux, and the entire legislative process has been marked by missteps, missed steps, reverses, ambivalence and confusion. Some pieces of the picture are in place, but others remain uncertain or incomplete.
*Dr Gray is a Senior Lecturer at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice. This is part of a series of #InsideTheBox columns he is writing for Spotlight.
Disclosure: Gray serves on three technical advisory committees at the South African Health Products Regulatory Authority and previously chaired the Cannabis Working Group.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
View of the spinal cord. Credit: Scientific Animations CC4.0
After a spinal cord injury, cells in the brain and spinal cord change to cope with stress and repair tissue. A new study from Karolinska Institutet, published in Nature Neuroscience, shows that this response is controlled by specific DNA sequences. This knowledge could help develop more targeted treatments.
When the central nervous system is damaged – for example, in a spinal cord injury – many cells become reactive. This means they change their function and activate genes that protect and repair tissue. However, how this process is regulated has long been unclear.
Researchers at Karolinska Institutet have now mapped thousands of so-called enhancers; small DNA sequences that act like “switches” for genes, turning them on or boosting their activity. By analysing individual cell nuclei from mice with spinal cord injuries using AI models, the researchers discovered that these genetic switches are activated after injury and instruct specific cell types to respond. The main cells affected were glial cells such as astrocytes and ependymal cells – support cells that help protect and repair the nervous system.
New opportunities for precision treatments
“We have shown how cells read these instructions through a code that tells them how to react to injury. This code combines signals from general stress factors with the cell’s own identity,” explains Enric Llorens-Bobadilla, researcher at the Department of Cell and Molecular Biology at Karolinska Institutet.
“This opens up the possibility of using the code to target treatments specifically to the cells affected by the injury,” says Margherita Zamboni, researcher at the same department and first author of the study.
The study is a collaboration between researchers at Karolinska Institutet and SciLifeLab, supported by the European Research Council (ERC), the Swedish Research Council, and the Swedish Foundation for Strategic Research. Some researchers have reported consultancy roles and patent applications related to the technology.
Nearly one million babies are stillborn in Africa every year. Behind every stillbirth is a mother, a family and a story left untold. Most of these are preventable, many unrecorded, and too often invisible. Each number hides a moment of heartbreak, and every uncounted loss represents a missed opportunity to learn and to act.
As a public health researcher specialising in maternal and newborn health, I have spent the past two decades working on strengthening health systems and quality of care across Africa. My research has focused on understanding how health systems can prevent stillbirths and provide respectful, people-centred care for women and newborns. Most recently, I was part of the team that led a new report called Improving Stillbirth Data Recording, Collection and Reporting in Africa. It is the first continent-wide assessment of how African countries record and use stillbirth data.
The burden of stillbirths in Africa is staggering. Africa accounts for half of all stillbirths globally, with nearly eight times higher rates than in Europe. Even stillbirths that happen in health facilities may never make it into official statistics despite every maternity registry documenting this birth outcome.
Part of the challenge is that there are multiple data systems for capturing births and deaths, including stillbirths, like routine health information systems, civil registration and other surveillance systems. But these systems often don’t speak to each other either within countries or between countries. This data gap hides both the true burden and the preventable causes.
Despite advances in several countries to prevent stillbirths, large gaps remain, especially on data systems. Only a handful of African countries routinely report stillbirth data to the UN, and many rely on outdated or incomplete records. Without reliable, comparable data, countries cannot fully understand where and why stillbirths occur or which interventions save lives.
Strengthening stillbirth data is not just about numbers; it is about visibility, accountability and change. When countries count every stillbirth and use the data for health system improvement, they can strengthen care at birth for mothers and newborns and give every child a fair start in life.
Findings
The report was based on a regional survey of ministries of health. This was followed by document reviews and expert consultations to assess national systems, policies and practices for stillbirth reporting and review.
The report reveals that 60% of African countries have national and sub-national committees responsible for collecting and using stillbirth data, which produce national reports to respective health ministries. But data use remains limited. Capacity gaps, fragmented systems and insufficient funding prevents many countries from translating information into action.
To guide investment and accountability, the report categorises countries into three readiness levels:
Mature systems needing strengthening, such as Kenya, Rwanda and Uganda. These countries have consistent data flows but need more analysis and use.
Partial systems requiring support, where reporting mechanisms exist but are not systematically implemented, like Ghana, Malawi and Tanzania.
Foundational systems still being built, including fragile or conflict-affected countries like South Sudan and Somalia. Here, policies and structures for data collection and use remain absent.
The findings show both progress and persistent gaps. Two-thirds of African countries now include stillbirths in their national health strategies, and more than half have set reduction targets. Nearly all countries report that they routinely record stillbirths through their health sectors using standard forms and definitions, yet these definitions vary widely. Most systems depend on data reported from health facilities. But the lack of integration between health, civil registration and other data systems means that countless losses never enter national statistics.
For example, if a woman delivers at home alone in Mozambique and the baby is stillborn, the loss is only known to the family and community. Without a facility register entry or civil registration notification, the death never reaches district or national statistics. Even when a stillbirth occurs in a health centre, the health worker may log it in a facility register but not report it to the civil registration system. This means the loss of the baby remains invisible in official data.
What this means
Stillbirths are a sensitive measure of how health systems are performing. They reflect whether women can access timely, quality care during pregnancy and at birth. But unlike maternal deaths, which are often a benchmark for health system strength, stillbirths remain largely absent from accountability frameworks.
Their causes, like untreated infections, complications during labour, or delays in accessing emergency caesarean sections, are often preventable. The same interventions that prevent a stillbirth also reduce maternal deaths. These improve newborn survival, and lay the foundation for better health and development outcomes in early childhood.
Accurate data on stillbirths can guide clinical care and direct scarce resources to where they are needed most. When data systems are strong, leaders can identify where and why stillbirths occur, track progress and make informed decisions to prevent future tragedies.
The analysis also highlights promising signs of momentum. Over two-thirds of countries now reference stillbirths in national health plans, an important marker of growing political attention. Several countries are moving from isolated data collection to more coordinated, system-wide approaches. This progress shows that change is possible when stillbirths are integrated into national health information systems and supported by investment in workforce capacity, supervision and data quality.
What’s needed
Africa has the knowledge, evidence and experience to make change happen.
The report calls for harmonised definitions, national targets and stronger connections and data use between the different data sources within and across African countries. Above all, it calls for collective leadership and investment to turn information into impact, so that every stillbirth is counted, every death review leads to learning and no parent grieves alone.
The author acknowledges and appreciates the partners involved in developing the report and the support from the Global Surgery Division at UCT.
Empowering Dignified Elder Care Through Compliant, Compassionate Staffing Solutions
Photo by Matthias Zomer on Pexels
For nearly seven decades, The Association for The Aged (Tafta) has been a cornerstone of care for senior persons in Durban and surrounding communities. Its services include assisted living, frail care, home-based care, meal delivery, and essential social work and advocacy programmes, all designed to support the dignity and well-being of older persons.
Delivering this level of care consistently requires the right professional healthcare staff and strong administrative support across Tafta’s multiple facilities.
The challenge: ensuring compliance and consistency Recruiting and managing trained Caregivers across several care units can be complex, particularly when strict compliance and accreditation standards must be met. Tafta needed a partner who could supply qualified staff while supporting operational efficiency and upholding care standards. Allmed, a specialist medical personnel solutions provider, with proven experience in healthcare staffing and administration, emerged as the ideal solution.
“At the time we were reviewing our contracts, we considered Allmed as one of the service providers to tender,” explains Yoshina Kistensamy, Divisional Manager: Operations of Tafta.
The requirements were clear: the partner needed to ensure all staff were fully compliant and accredited, while also providing responsive after-contract support. Financial flexibility was equally critical, enabling staffing to scale up or down according to operational realities without penalty.
Allmed provides layered support, with trained professionals backed by clinical facilitators, ensuring both quality care and peace of mind for residents’ families. This support is delivered across three key areas:
Strategic staffing: Ensures every facility has adequate, skilled personnel and optimises workforce allocation to meet varying needs.
Compliance oversight: Monitors adherence to healthcare standards, reducing risk and ensuring safe, consistent care practices.
Hands-on engagement: Provides practical support to staff and enhances day-to-day operations.
By combining these three areas, Allmed enables Tafta to operate efficiently while maintaining a strong focus on the quality and dignity of resident care.
The impact: lifting the burden, prioritising care The partnership has given Tafta the space to focus on its core mission: providing compassionate care. By outsourcing much of its care staff, Tafta has transferred complex HR responsibilities, including training coordination, on-site supervision, and disciplinary processes, directly to Allmed.
Allmed provides layered support, with trained professionals backed by clinical facilitators, ensuring both quality care and peace of mind for residents’ families. This support is delivered across three key areas:
Strategic staffing: Ensures every facility has adequate, skilled personnel and optimises workforce allocation to meet varying needs.
Compliance oversight: Monitors adherence to healthcare standards, reducing risk and ensuring safe, consistent care practices.
Hands-on engagement: Provides practical support to staff and enhances day-to-day operations.
By combining these three areas, Allmed enables Tafta to operate efficiently while maintaining a strong focus on the quality and dignity of resident care.
The impact: lifting the burden, prioritising care The partnership has given Tafta the space to focus on its core mission: providing compassionate care. By outsourcing much of its care staff, Tafta has transferred complex HR responsibilities, including training coordination, on-site supervision, and disciplinary processes, directly to Allmed.
“For us, the primary benefit lies in ensuring that our care staff remain fully compliant with all required accreditations and registrations, which supports our commitment to delivering quality care through trained professionals,” says Kistensamy. “In addition, Allmed manages the HR processes, supplementary training, and ongoing supervision for this team, allowing us to focus on expanding and strengthening care and support services for our residents and the broader eThekwini community.”
Allmed’s support goes beyond typical service agreements. They work alongside Tafta’s management and care teams. “Whether it’s a quick phone call, a WhatsApp message, or an on-site visit, Allmed is always available,” Kistensamy adds. “Knowing they are just a message away provides enormous peace of mind.”
Forging a partnership that goes above and beyond Tafta values the partnership for more than staffing consistency. At the organisation’s annual Sports Day for older persons, Allmed has donated essential items, provided an on-site nurse, and actively participated alongside staff and residents. “It’s not just about supplying caregivers – Allmed consistently shows up and supports our programmes,” says Kistensamy.
Allmed also contributes to Tafta’s fundraising and public-relations events, including the International Day of Care and Support, golf days, resident Christmas lunches, and donor gala dinners. Their willingness to engage with staff, residents, and fellow care partners reinforces Tafta’s values and demonstrates that effective healthcare partnerships are built on the seamless alignment of the organisation, its beneficiaries, and its supporters.
Flexible solutions for non-profit needs Agility has been a cornerstone of the Allmed–Tafta partnership. When budget pressures arose, Allmed offered alternative staffing rates without compromising service quality.
“They understand our sector and our challenges, and they work with us to make sure our residents are always cared for,” says Kistensamy. Three elements define the success of this collaboration:
Exceptional customer service: proactive support and responsiveness beyond contractual obligations.
Flexible staffing solutions: ability to scale services up or down based on resident needs and operational realities.
Through this partnership, Tafta can prioritise its core mission: ensuring every resident receives compassionate, dignified care. With Allmed providing expert staffing and compliance support, the organisation can operate smoothly while maintaining high-quality care standards.
