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.

Welcome and About the Tour

Next week, Congressional staff will gain first-hand exposure to the local impact of U.S. funded health capacity strengthening in South Africa and Zambia during our study tour.  During the trip, MSH will display local health capacity building through pharmaceutical management and technical and managerial development opportunities for local health workers.  During the week, delegates will visit sites, meet with local health leadership, and participate in panel discussions with local experts that will highlight how international development funding, local government-led initiatives, and programs initiated by local partners have led to better health outcomes for communities.

The delegates will gain an in-depth understanding of the pharmaceutical supply chain and management mechanisms by visiting regional and local pharmaceutical procurement and distribution centers.  Visits to Mokapane hospital, the Limpopo Pharmaceutical Depot, the Tshikuwi Clinic, loveLife support site, and Medical Stores, LTD., among others, will give staffers deep insight into the on-the-ground implementation of pharmaceutical management and civil society engagement in health programs.   Delegates will learn about the implementation of the Pharmaceutical Leadership Development Programme (PLDP), Community Service Pharmacist program (CSP), RxSolution, and other pharmaceutical management and capacity building programs implemented through the USAID-funded, MSH-led Systems for Improving Access to Pharmaceuticals and Services (SIAPS) Program and Building Local Capacity for Delivery of HIV Services in Southern Africa (BLC) Project.

As middle income countries, South Africa and Zambia offer a unique perspective into the impact of health systems strengthening and the increasing capacity of the national ministries of health to manage health delivery systems.  One of USAID’s largest health programs takes place in South Africa and focuses on leadership, governance, and capacity building.  South Africa showcases a growing network of civil society and local governments, as well as significant health initiatives, including National Health Insurance.  Additionally, South Africa has become a model of decentralization in the health sector, providing staffers an opportunity to explore the unique benefits and challenges posed by decentralization.   Zambia is at a critical stage of its development as it establishes its footing as a lower middle income country while taking on additional country ownership efforts in the health sector.  Staffers will learn the challenges in building health systems in a relatively weak national health system with major deficits in its healthcare workforce and infrastructure.

Stay tuned throughout the week to learn more about the study tour, capacity building, and pharmaceutical management as we post daily recaps, blogs, and photos.