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.
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.
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.