Tag Archives: South Africa

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.

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.