Author Archives: kpollak

US Investments in South Africa and Zambia

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 are briefed by staff at the Trucking Wellness Center in Limpopo. Photo credit: Bright Phiri/MSH.

Delegates are briefed by staff at the Trucking Wellness Center in Limpopo. Photo credit: Bright Phiri/MSH.

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

Pharmaceutical supplies at a Medical Stores Limited center in Zambia. Photo credit: Zambia Daily Mail.

Pharmaceutical supplies at a Medical Stores Limited center in Zambia. Photo credit: Zambia Daily Mail.

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.

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.