Monthly Archives: February 2015

Recap: Day 7 – Saturday, February 21

Before heading back to the cold and snow in Washington, DC, the delegates spent their final day in Zambia visiting Chilenje Clinic and the Lilayi Elephant Nursery.

At Chilenje Clinic, located in Lusaka, the delegates learned about key challenges in health equity and service delivery. As they toured the urban clinic, the delegates learned how staff and Zambian health workers work to address these challenges through improvements in pharmaceutical management, quality assurance and capacity building.

Baby elephants (calves) the delegates got to see at the Lilayi Elephant Nursery. Photo credits: Brigid Boettler/MSH.

Baby elephants (calves) the delegates got to see at the Lilayi Elephant Nursery. Photo credits: Brigid Boettler/MSH.

For the last site visit of the study tour, delegates traveled to the Lilayi Elephant Nursery in Lusaka. There, they received a briefing on key environmental issues faced by rural communities and learned how Game Rangers International (GRI), a local wildlife NGO, engages in interdisciplinary capacity building by investing in rural community health efforts. Lilayi Elephant Nursery is home to the youngest members of GRI’s rescued elephant calves. While at Lilayi, the calves receive the dedicated care they need to get through the vital, vulnerable early months and years of rehabilitation they need before they can be released into their new home in Kafue National Park.

After Chilenje Clinic and the Lilayi Elephant Nursery, the delegates reflected on trip experiences, key trends they observed, and the lessons learned from their week in South Africa and Zambia before packing up and departing for home.

Recap: Day 6 – Friday, February 20

The delegates started their second day in Lusaka bright and early with a breakfast discussion with representatives from Zambian non-governmental organizations. The delegates learned about the work of local organizations in improving and expanding access to quality health services in Zambia.

Following the breakfast meeting, the delegates received a quick site visit briefing before departing for Liteta Hospital in Chibombo District, located in Zambia’s Central Province. Chimbobo District is one of Zambia’s largest districts and is about an hour outside of Lusaka. The delegates toured Liteta Hospital, where they got to see a rural, district-level hospital firsthand. While there, they learned about key challenges in health equity and service delivery at the district-level. The hospital staff shared how they address these challenges through improvements in pharmaceutical management, quality assurance, and capacity building of laboratories.

While in Central Province, the delegates also visited Medical Stores, Ltd. (MSL) before returning to Lusaka. The delegates toured the MSL facilities and learned about US-funded pharmaceutical strengthening efforts, from strengthening internal quality control practices to implementing standard operating procedures and improving patient access to essential medicines.

The delegates spent their last evening in Zambia meeting with the National HIV/AIDS/STI/TB Council (NAC) over dinner. NAC is a broad-based corporate body in Zambia comprised of government, private sector, and civil society representatives. The delegates learned how NAC coordinates, monitors, and evaluates inputs, outputs, and the impact of HIV/AIDS, STI, and TB programs and interventions in Zambia.

Stay tuned for our final recap as the delegates visit Chilenje Clinic and the Lilayi Elephant Nursery in Lusaka before departing Zambia to return to Washington, DC.

South Africa’s Health System: From Race-Based to Rights-Based

By: Annette Sheckler

Since 1996, South Africa has been working to build an equitable public health system accessible to all out of the remnants of its apartheid past—essentially racially-based services delivered by a highly fragmented and bureaucratic system. Today’s approach to healthcare is rights-based with the goal of creating a comprehensive and integrated health system. Equitable access to quality medicines and medical products, vaccines and technologies that are safe, efficacious and cost-effective are one of the six building blocks of a proper health system. [i] The South African pharmacist, working alongside partners such as USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS), is playing a key role in building a first-class,  reliable public health system that can serve the needs of the South African people.

Delegates see a store room and learn about pharmaceutical management from SIAPS staff while visiting Mokopane Hospital in Limpopo Province, South Africa. Photo credit: Bright Phiri/MSH.

Delegates see a store room and learn about pharmaceutical management from SIAPS staff while visiting Mokopane Hospital in Limpopo Province, South Africa. Photo credit: Bright Phiri/MSH.

South Africa’s Pharmacists: On the Frontlines of Healthcare Reform
“The central challenge to the stability and well-being of our nation is reducing the deep inequality between rich and poor, between privilege and deprivation. This goes to the heart of South Africa’s future,” said South Africa’s Health Minister Aaron Motsoaledi. [i] The government of South Africa is committed to ensuring access to quality healthcare for all South Africans, regardless of their ability to pay. This is not easy in a country said to have one of the highest rates of inequality in the world.  South Africa’s healthcare system consists of a large, resource-constrained public sector and a small private sector for those able to pay premium prices for premium healthcare. The majority of South Africans, however, are largely uninsured and unable to pay for private healthcare. Although primary healthcare is free, specialized healthcare is available only in the private sector for those who can afford it.

In order to meet the challenge of expanding access to healthcare for all, the South African government has embarked upon an ambitious plan to implement a national health insurance (NHI) system.  Universal health insurance is expected to increase the consumer’s access to healthcare. However, equally challenging will be the quality of healthcare available to the consumer. Since 1994, South Africa has been putting resources in building its healthcare system—its health facility infrastructure, regulatory system, supply chain, and human resources.  In all of these efforts, pharmacists have made significant contributions from national initiatives to community care.

SIAPS in South Africa: Promoting Country Ownership and Sustainability
SIAPS’s systems-strengthening approach is based on a fundamental recognition that, in order to be sustainable, countries must lead the process of building  health systems within the context of country ownership. In South Africa, SIAPS developed a robust partnership with the South African government at all levels, as well as with a number of pharmacy schools and governing bodies such as the South African Pharmacy Council (SAPC).

Good governance drives quality service delivery. Good governance is a function of strong and viable institutions that can deliver public services equitably, transparently and efficiently. SIAPS, in partnership with the government, has worked to develop and implement systems for: standards and accreditation; pharmaceutical licensing; tender management; supply management ; pharmacovigilance; compliance with standard treatment guidelines; and pharmaceutical management information systems. These elements together work to build a unitary, comprehensive, equitable and integrated public health system that can deliver quality health care to all South Africans, regardless of ability to pay.

Delegates learn about pharmaceutical management at Mokopane Hospital from the Pharmaceutical Manager. Photo credit: Bright Phiri/MSH.

Delegates learn about pharmaceutical management at Mokopane Hospital from the Pharmaceutical Manager. Photo credit: Bright Phiri/MSH.

Looking Ahead
South Africa’s commitment to providing access to healthcare for all of its citizens through the NHI is a positive step forward in transforming the public health system. The challenges ahead are maintaining the momentum for building the health system infrastructure, creating the regulatory environment, and improving service delivery.  However, by investing in South Africa’s people with quality healthcare, South Africa will be able to take fulfill its economic, political and socially progressive potential on the global stage. SIAPS will continue to support these efforts.

[i] South Africa Unveils Universal Healthcare Scheme, BBC News (August 12, 2011).
[i] WHO Health Systems Framework


Annette Sheckler is the Communications Manager for the Center for Pharmaceutical Management at Management Sciences for Health.

Recap: Day 5 – Thursday, February 19

Today the delegates traveled to Lusaka, the capital of Zambia.  As one of the fastest growing cities in Southern Africa, Lusaka offers an expansive display of both the commerce and government sectors in Zambia.  The delegates learned more about national and community development projects in Zambia through meetings with key Zambian and United States government officials.

The delegates began their visit to Zambia by visiting the US Embassy in Lusaka, where they gained a deeper understanding of the role of US health and foreign assistance in Zambia.  The delegates met with the US Ambassador and representatives of US government agencies, including the USAID Mission, CDC, Peace Corps, and Defense.  Through these meetings, the delegates discovered how the different agencies coordinate and engage in Zambia’s health and development. Furthermore, the delegates learned more about the progress and challenges facing Zambia’s health systems.

Next, the delegates met with the Zambian Minister of Health and Permanent Secretary to better understand the Ministry of Health’s (MoH) priorities and health policy objectives.  Following their meeting at the MoH, the delegates met with the Permanent Secretary and Ministry of Community Development, Mother & Child Health (MCDMCH) representatives to learn about MCDMCH priorities. As the implementation arm of the national health system, MCDMCH plays a vital role in health systems delivery. Through these meetings, the delegates gained insight into the perspective of the Zambian government as a health system implementer and key policy initiatives related to the national health system.

The day concluded with a dinner and discussion with the Directors of the MoH and MCDMCH.  The dinner roundtable discussion centered on technical issues, including disease surveillance, human resources for health, and maternal child health in Zambia.

Recap: Day 4 – Wednesday, February 18

The delegates spent their last day in South Africa gaining a better understanding of capacity building and community development from a national level. While in Pretoria, delegates started their day with a briefing with US Embassy and USAID Mission staff. During this interagency briefing, delegates learned how different US government agencies coordinate and engage in South Africa’s health and development.

After meeting with Embassy and USAID staff, the delegates traveled to the National Department of Health to meet with Chief Director Gavin Steel and Deputy Director General Terrance Carter. Steel and Carter updated the delegates on the National Department of Health’s 2030 plan, which includes creating a national health plan; increasing life expectancy; reducing maternal, newborn and child morbidity; addressing non-communicable diseases; and reducing accidents and violence. Delegates also learned how the National Department of Health is addressing health systems strengthening and donor partnerships and investments.

The delegates’ final day in South Africa concluded with a Public Private Partnership Reception. During this reception, delegates conversed with public and private sector leaders and implementers and celebrated the importance of interdisciplinary and multisectoral partnerships for health and development.

Clockwise from top left: MSH Country Representative Bada Pharasi opens the reception; guests engage in conversation; delegates and US Embassy Deputy Chief of Mission Catherine Hill-Herndon. Photo credits: Johanna Theunissen & Bright Phiri/MSH.

Clockwise from top left: MSH Country Representative Bada Pharasi opens the reception; guests engage in conversation; delegates and US Embassy Deputy Chief of Mission Catherine Hill-Herndon. Photo credits: Johanna Theunissen & Bright Phiri/MSH.

MSH Country Representative Bada Pharasi, delegates and MSH Policy & Advocacy Director Crystal Lander. Photo credit: Johanna Theunissen/MSH.

MSH Country Representative Bada Pharasi, delegates and MSH Policy & Advocacy Director Crystal Lander. Photo credit: Johanna Theunissen/MSH.

Stay tuned for tomorrow’s update as the delegates head to Lusaka, Zambia for the remainder of the study tour!

Recap: Day 3 – Tuesday, February 17

While colleagues back home in Washington, DC were snowed in, the delegates visited more sites in Limpopo province, from the South Africa-Zimbabwe border to Vhembe and back to Polokwane, before returning to Pretoria.

truckstop

Truck stop on South Africa-Zimbabwe border where the Trucking Wellness Center is located. Photo credit: Bright Phiri/MSH.

The day started with a visit to a Trucking Wellness Center, which is supported by the Corridor Empowerment Project, at a truck stop on the South Africa-Zimbabwe border. Southern Africa has a long history of cross-border migration and internal migration. People migrate for political, social, and economic reasons. Highly mobile workers include cross-border traders and truck drivers, among many others. Although data on HIV prevalence among mobile workers and migrant populations is scarce, existing data shows that HIV prevalence among these populations is considerably higher than in national adult populations. Migrants and mobile communities are therefore identified as one of the priority populations needing targeted HIV prevention interventions. As they toured the Trucking Wellness Center, delegates learned how civil society organizations in the Migration Corridor use US funding to provide vital health services to long-distance truck drivers, female sex workers, and border communities. By bringing health services to the truck stop, larger populations can be reached to have a greater impact.

After visiting the Trucking Wellness Center, the delegates traveled to Vhembe in Limpopo to visit the Tshikuwi Clinic. There, they learned about pharmaceutical management at the local level as they viewed the primary healthcare clinic’s pharmacy and met with the clinic’s Community Service Pharmacist (CSP) and her mentor to discuss the clinic’s stock management challenges and the strategies they implement to improve management capacity.

Delegates and staff from the Tshikuwi Clinic in Vhembe, South Africa. Photo credit: Bright Phiri/MSH.

Delegates and staff from the Tshikuwi Clinic in Vhembe, South Africa. Photo credit: Bright Phiri/MSH.

Before returning to Pretoria for the night, the delegates visited a loveLife Support Site with MSH

loveLife peer counselors brief delegates at the loveLife support site. Photo credit: Bright Phiri/MSH.

loveLife peer counselors brief delegates at the loveLife support site. Photo credit: Bright Phiri/MSH.

staff from the USAID-funded Building Local Capacity for the Delivery of HIV Services in Southern Africa (BLC) project. loveLife is South Africa’s largest national HIV prevention initiative for young people. It combines a sustained high-powered campaign with nationwide community-level outreach and support programs to promote healthy, HIV-free living among South African teens. At loveLife, delegates met with organization leaders and peer counselors to learn how loveLife provides leadership development and educational opportunities for youth capacity in the Migration Corridor.

Recap: Day 2 – Monday, February 16

The delegates departed Pretoria bright and early on Monday to drive to Limpopo, South Africa’s northern-most province which shares its border with Botswana, Zimbabwe, and Mozambique.

During the drive to Limpopo, delegates received a briefing with MSH staff from the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) project on the innovative RxSolution pharmaceutical management system. RxSolution enables integrated stock management and ensures patients have access to essential medicines in South Africa.

Delegates learn about pharmaceutical management at Mokopane Hospital from the Pharmaceutical Manager. Photo credit: Bright Phiri/MSH.

Delegates learn about pharmaceutical management at Mokopane Hospital from the Pharmaceutical Manager. Photo credit: Bright Phiri/MSH.

Once in Limpopo, the first stop was a site visit to Mokopane Hospital in the town of Mokopane. There, delegates learned about pharmaceutical management at the regional level as they toured the hospital pharmacy and met with the Pharmaceutical Manager. The Manager discussed the hospital’s implementation of RxSolution through the Pharmaceutical Leadership Development Programme (PLDP).

After visiting Mokopane Hospital, the delegates learned about pharmaceutical management at the provincial level as they toured the Limpopo Pharmaceutical Depot in Polokwane, Limpopo province’s capitol city. There, they met with depot managerial and local government staff to discuss challenges and innovative strategies for building pharmaceutical capacity, including PLDP and the Community Service Pharmacist Program (CSP).

Delegates, MSH staff, and staff from the Limpopo Pharmaceutical Depot. Photo credit: Bright Phiri/MSH.

Delegates, MSH staff, and staff from the Limpopo Pharmaceutical Depot. Photo credit: Bright Phiri/MSH.

The day concluded with an intimate dinner and discussion with local implementers in Musina, the northern-most town in Limpopo province. Delegates discussed the progress made and challenges faced in strengthening delivery of and improving access to prevention, care, treatment, and support services for vulnerable populations with local civil society organization leaders.

Why Pretoria and Limpopo?

Map showing Pretoria (in Gauteng province) and Limpopo province where the delegates will travel while in South Africa. Map credit: Nations Online Project.

Map showing Pretoria (in Gauteng province) and Limpopo province where the delegates will travel while in South Africa. Map credit: Nations Online Project.

What comes to mind when you picture South Africa? Is it Table Mountain hovering over Cape Town’s city bowl, the Johannesburg concrete jungle, or thick brush hiding the big five in the Kruger National Park? Those are certainly a few of South Africa’s geographic highlights, but there is much more to this country than the typical tourist sees. But the geographic diversity of South Africa affects more than just the scenery; it leads to real differences in the health outcomes of residents, their ability to access medical care, and the design of successful health systems. This study tour aims to highlight South Africa’s geographic diversity and demonstrate how the country’s health system must adapt to address the needs of its citizens from coast to coast.

Skyline of Pretoria. Photo credit: WikiCommons.

Skyline of Pretoria. Photo credit: WikiCommons.

Gauteng province, home to Johannesburg and Pretoria, is best known for its metropolitan cities and as the economic hub of the country. Situated in the Highveld – a plateau 5,000 feet about sea level known as the Rand – the province was first carved apart by miners tapping into the deep gold reserves, but now attracts developers due to the expanding suburban sprawl that nearly unites the two cities. While Johannesburg is a bustling city 24/7, Pretoria is known for its suburban feel and urban gardens. Pretoria also serves as the executive and de facto national capital city, housing the South African Department of Health, US Embassy, and USAID Mission. While here, the delegates will meet with South African health leaders and US government officials to discuss health systems strengthening and capacity building at a national level. In both Johannesburg and Pretoria, the health systems must be designed to serve the unique requirements of urban populations. For Gauteng province and Pretoria, that means high volume clinics to serve the dense population and increasingly mobile residents. These both present challenges for coordinated, long-term care.

Migration Corridor in Limpopo Province. Photo credit: Bright Phiri/MSH.

Migration Corridor in Limpopo Province. Photo credit: Bright Phiri/MSH.

Limpopo, where the delegates will also be traveling this week, is South Africa’s northern most province, sharing borders with three other countries – Botswana, Zimbabwe, and Mozambique. The region is a mixture of grassland and trees – known as bushveld – and supports thriving ranching, agriculture and forestry industries. Known as the “garden of South Africa,” this province supplies a majority of the country’s mangoes, papayas, tomatoes, and avocados (which can often be purchased from vendors right off the main road). The N1 highway runs straight from Johannesburg to Musina, through the heart of Limpopo. While the population of Musina is constantly changing, the gigantic baobab trees that dot the surrounding landscape are permanent residents – some for nearly 500 years. Not so sedentary though is the constantly changing population, which fluctuates from 20,000 to 40,000 people. With the constant coming and going of Africans from all over the region, the health system here must be flexible. While in Limpopo, the delegates will meet with local civil society organizations, hospitals, clinics, and leaders to learn about capacity building and pharmaceutical management at both the regional and provincial levels. Trucking Wellness Centers like the ones delegates will be visiting cater to truck drivers who pass through daily on one of the busiest roads in Africa. These drivers – usually men – are particularly vulnerable to infections such as HIV, and may have trouble seeking routine care, getting medication refills, or receiving test results. To address these problems, the wellness centers are found all along the transport corridors of Southern Africa to provide coordinated care for drivers no matter where they are.

With so many factors affecting health outcomes – from education and poverty, to genetics and geography – there’s no such thing as a “one size fits all” health system. We hope that by seeing these two different provinces and the unique needs of their populations, the delegates will better understand the complexity South Africa’s health system and needs and the importance of building capacity to develop targeted health programs.

Recap: Day 1 – Sunday, February 15

After arriving in Pretoria late on Saturday night, the study tour officially kicked off on Sunday with a welcome breakfast and briefing on the week. In the evening, the delegates met with local US government health officials to discuss the big picture of health and local capacity building efforts in South Africa.

Day1_photo

The delegates and MSH staff after the opening briefing – looking forward to busy and productive week examining local capacity building, health systems strengthening, and pharmaceutical management. Photo credit: MSH.

SundayDinnergroup

Delegates, MSH staff, and local US government health officials after an evening discussing the big picture of health and local capacity building efforts in South Africa. Photo credit: Crystal Lander/MSH.

How Do You Get to Know a Country? You Start with its History

Today, the delegates joined MSH/South Africa staff on a tour of Johannesburg and Soweto to learn about the history of South Africa before embarking on a week dedicated to learning abut health in one of the fastest growing economies in the world.

The delegates and MSH staff outside of the Apartheid Museum in Johannesburg. Photo credit: Bright Phiri/MSH.

The delegates and MSH staff outside of the Apartheid Museum in Johannesburg. Photo credit: Bright Phiri/MSH.

The group’s first stop was the Apartheid Museum. While most people know the official

Inside the Apartheid Museum. Photo credit: Bright Phiri/MSH.

Inside the Apartheid Museum. Photo credit: Bright Phiri/MSH.

government system of the separation of people by race ended just over 20 yeas ago, the impact of the system is still evident today – especially in the health system. The old system was set up to take care of 10-20% of the population and now it must help the entire population. The current government is focused on not only addressing chronic health issues, like HIV/AIDS, but also creating a national health insurance system over the next fifteen years to help address the long term issues of health service access. It feels like a tall order, but this country has done a lot of things others didn’t expect, who knows what’s in store.

After a tour of various areas of Johannesburg, one can see the diversity of the city: big shopping malls, new housing developments, and shanty houses are all common.  After a local South African lunch, the group went to the home of the Father of South Africa, Nelson Mandela, in Orlando West in Soweto. The home is now encased in a building acting as a local museum for visitors from around the world. The building is a permanent reminder of the past and present of the country, a juxtaposition of the way things were and the way they are now.

At the Mandela House in Soweto. Photo credit: Crystal Lander/MSH.

At the Mandela House in Soweto. Photo credit: Crystal Lander/MSH.

One thing is clear: South Africa and Nelson Mandela are linked forever and one hopes the resilience and patience of Mandela will show as the South African democracy continues to grow.