In 2014, the United States Government (USG) spent an estimated $5.3 billion on foreign assistance funding for health worldwide. The vast majority of this – about $3.1 billion – went towards slowing the HIV/AIDS epidemic. Throughout the Southern Africa region, the USG also supports projects focused on water supply and sanitation, orphans and vulnerable children, tuberculosis, palliative care, the health workforce, and developing information sharing platforms for evidence-based decision-making and capacity development. Recently, our study tour delegates got to sit down with USG representatives and local leaders to hear about the impact of US investments in health and see what this funding is achieving.
South Africa: Low, middle income country
South Africa is the second highest recipient of USG assistance for HIV/AIDS assistance worldwide, falling only slightly behind Kenya. Since 2004, PEPFAR has invested $4.2 billion in the South African response to the dual epidemics of HIV/AIDS and tuberculosis, and despite plans to decrease the level of aid going to South Africa, the amount spent has remained fairly steady over the past five years. Even with such significant US support, South Africa funds more than 80% of the budget for antiretroviral therapy and the majority of its own HIV/AIDS programs – spending more than $1 billion annually. In addition to supporting health service delivery, US investments in South Africa promoted greater sustainability of the health system through capacity building, leadership and civil society engagement.
Delegates saw this firsthand through their visit to the Corridor Empowerment Project’s Trucking Wellness Center, in Limpopo province. Truck drivers are at significantly higher risk for acquiring HIV, but making time for routine testing or treatment adherence is a challenge for on-the-go drivers. The delegates saw how one organization is addressing this issue by meeting the drivers where they are. The Corridor Empowerment Project participated in our Building Local Capacity in Southern Africa project and is now eligible for USG funding, which allows them to provide HIV testing and counseling through 22 roadside and mobile clinics.
Zambia: Moving out of debt into middle income status
US funding in Zambia also focuses heavily on HIV/AIDS, accounting for 75% of the $174 million in health assistance in 2014. In addition, health funding targets malaria, maternal and child health, family planning and reproductive health, nutrition, and water and sanitation. The US also supports governance, law and policy changes to support people living with HIV/AIDS. Our
delegates toured Medical Stores Limited (MSL), an autonomous government agency that stores, transports and distributes drugs and medical equipment throughout the country. Through US investment, MSH has helped Zambia build a robust supply chain for medications and equipment, which helps strengthen the overall health system and improves access to high quality essential medicines for people with both chronic and acute health needs.
US support of global health projects in Southern Africa has led to significant improvements in access to care and affordability of life-saving medications. Just as important, South Africa and Zambia now have the human and technological capacity to support and improve their own health systems through domestic resource mobilization and policy reform.