Speakers Target Zero at MSH Panel and Reception Event

Invite_Icasa_2_smaller_web3As the world looks to 2015 and beyond, MSH organized a panel and reception at ICASA 2013 highlighting how the global health community can best work together to achieve an AIDS-free generation with zero new infections among adults and children, zero deaths due to AIDS, and zero HIV-related discrimination. The event, entitled “Targeting Zero Together: What will it take?,” brought together experts and audience members from NGOs, civil society organizations, governments, donor organizations, and more, to discuss the steps it will take to meet the current Millennium Development Goals and propose ideas for a post-2015 agenda.

MSH South Africa Country Representative Bada Pharasi shared a brief introduction of

MSH’s work in South Africa as he welcomed everyone to the event and introduced moderator and MSH Global Technical Lead for HIV and AIDS Scott Kellerman.

From left to right: panelists Tracey Naledi (Western Cape Dept of Health), Steven Smith (US Dept of Health and Human Services), Lois Chingandu (SAfAIDS), and moderator Scott Kellerman (MSH). Photo credit: Sharon Gama/MSH

From left to right: panelists Tracey Naledi (Western Cape Dept of Health), Steven Smith (US Dept of Health and Human Services), Lois Chingandu (SAfAIDS), and moderator Scott Kellerman (MSH). Photo credit: Sharon Gama/MSH

Kellerman then opened the session, prompting panelist Lois Chingandu, executive director of SAfAIDS, with the question “How do you define vulnerable populations?” This led to a rich hour and a half long discussion between the three panelists about how we can best reach zero, both in vulnerable populations and overall.

Chingandu’s response was simple: follow the evidence, and the evidence says that the youth, ages 11-19, women of all ages, and men who have sex with men are the most vulnerable to contracting HIV. Panelist Steven Smith, health attaché and regional representative for Southern Africa with the US Department of Health and Human Services, continued the discussion, emphasizing the role of evidence in shaping HIV prevention and treatment. Agreeing with her fellow panelists, Director for Health Impact Assessment with the Western Cape Department of Health Tracey Naledi explained how building upon evidence and increasing the use of geographic targeting has helped South Africa target those who need services the most.

Building upon the importance of evidence-based approaches, the panelists discussed the role of health systems in shaping prevention and treatment interventions. Smith emphasized the management piece of health systems, stating that we must strengthen the capacity of each country’s health system to respond to something new. Relying on past methods and a treatment-side approach no longer works – we must go into the community and promote a prevention-focused approach.

The conversation easily transitioned into the importance of breaking social and cultural barriers to better reach vulnerable populations and reduce stigma. Chingandu explained that only once these barriers are broken and individuals from key populations, such as sex workers, feel comfortable enough to come forward for treatment without fear of stigmatization, only then will we see progress towards reaching zero new infections. She continued, stating that we can no longer have a moral umbrella around HIV – we need to promote the idea that every sexual act you have must be protected, regardless of the act and who you have it with.

An audience member asks the panelists a question during the audience Q&A portion of the event. Photo credit: Bright Phiri/MSH

An audience member asks the panelists a question during the audience Q&A portion of the event. Photo credit: Bright Phiri/MSH

As the event opened up to audience questions, the theme continued to focus on the role of change in our fight to reach zero. One audience member posited the question of how best to implement behavior change communication in HIV interventions. Naledi responded with an example from her work with the Western Cape Department of Health to reduce inter-generational sex. After working with other disciplines, such as communications and marketing professionals, to review posters discouraging inter-generational sex, she and her colleagues found that the department’s posters were conveying a conflicting message and were instead encouraging young women to engage in relationships with much older men. Naledi explained that to best incite behavior change, the global health community needs to work with other disciplines, like the department of health did, to create stronger communications materials and build a stronger message.

Wrapping up the panel portion of the evening’s event, one audience member asked “What

Panelist Lois Chingandu (left) and MSH Director of Policy and Advocacy Crystal Lander. Photo credit: Bright Phiri/MSH

Panelist Lois Chingandu (left) and MSH Director of Policy and Advocacy Crystal Lander. Photo credit: Bright Phiri/MSH

really works? What drives people to seek treatment?” Chingandu’s responded back with, “Why is it that every morning we wear underwear?” She continued, saying, that once we can determine why that is natural to all of us – why we all engage in wearing underwear every morning without thinking twice – then we will know what drives people to change their behaviors and seek treatment.

Click here to listen to the full panel and learn more about how we can work together to target zero new infections in a post-2015 world.

Opportunities Abound at ICASA

Most of my time at ICASA has been spent behind our exhibition booth. Before you start to feel sorry for me, however, I need to tell you that I have probably met more people from a wider variety of countries and contexts than most other delegates. It has given me a greater appreciation of the incredible array of individuals and organizations involved in all aspects of the HIV response in Africa. ICASA is providing a unique opportunity for all of these people to come together to share, network, and learn.

Johanna Theunissen and fellow MSH South Africa staff member Corry van der Walt at the MSH booth. Photo credit: Michele Alexander/MSH

Johanna Theunissen (right) and fellow MSH South Africa staff member Corry van der Walt at the MSH booth. Photo credit: Michele Alexander/MSH

To engage with those passing by the booth, I frequently open with asking people where they are from and what they do, to better gauge their interest and tools/products we have which may assist them. This has been fascinating and educational – people are responding to the needs of specific population groups in unique ways. Many of those I have met work at very high levels – people it would be hard to access under different circumstances. Yet, every delegate I have met has been friendly and open (and willing to listen to me trying to convey the breadth of what we do in two sentences).

I also have an enhanced perspective of my own organization, Management Sciences for Health (MSH). Working on a specific project in our regional office in Pretoria, South Africa, I vaguely knew that MSH was working in many countries around the world, but I have now experienced firsthand people from Ethiopia, Kenya, Nigeria, and Uganda, among others, sharing how they have partnered with MSH in their countries or know of our work there. All of the feedback has been positive.

We are having MSH staff attending ICASA work in shifts at our booth, and this has provided opportunities for those of us from different projects and countries to mix together in ways we haven’t before, building relationships that I believe will bear fruit in the future. We don’t have the most prominent booth location, but this has enabled us to enter into deeper and more meaningful conversations with people.

Johanna Theunissen is a Senior Communications Associate with MSH’s Building Local Capacity for Delivery of HIV Services in Southern Africa Project in South Africa

Remembering Nelson Mandela at ICASA

The first of Nelson Mandela’s memorial services was held yesterday in Johannesburg with more than 100 heads of state and dignitaries and tens of thousands of South Africans in FNB Stadium. I saw it much like the rest of the world – from the TV – since I am in Cape Town for the International Conference for AIDS and STIs in Africa (ICASA), conference where more than 5,000 people from all over the world come to discuss the latest developments in the field of HIV and AIDS. But, mostly, ICASA is a conference for people to get together, to meet old friends and make new ones, to advocate for a particular cause that you are passionate about and have people in the audience support you, to protest injustices that are happening throughout the world, and, most of all, to be together in solidarity for the fight against this debilitating, deadly disease.

Photo credit: NMF Photo/Matthew Willman

Photo credit: NMF Photo/Matthew Willman

This has also been a week of remembering the father of South Africa and probably the greatest statesman that I will see in my lifetime. To share stories of how Madiba touched our lives, how his sacrifice and then his tolerance and forgiveness really did heal a nation. And for me personally how his foresight to call for reconciliation, forgiveness, and a peaceful transition has led to me living in South Africa. I probably would not have decided to work in South Africa if apartheid had continued or if a bloody civil war had taken place. He and so many others involved in the struggle have made it possible for me to meet my partner – who is South African/Indian from Durban. During apartheid it would have been illegal for us, as a mixed race couple, to be together.

All of the flags are at half-mast and there are flowers laying at each small statue of Nelson Mandela or on the streets that are named after him – or where people have memories of meeting or seeing Madiba.

As we begin the process of saying goodbye to this tremendous leader I hope that we can all remember what he stood for and asked of all of us.

Kathryn Reichert is the Associate Project Director and Director of Monitoring, Evaluation and Communications of MSH’s Building Local Capacity for HIV Delivery Services in Southern Africa Project in South Africa

ICASA Presentation on Pediatric HIV Screening Raises Further Questions

By Hloniphile Mabuza
Building Local Capacity for Delivery of HIV Services in Southern Africa Project, MSH South Africa

Earlier this week, I attended a session on monitoring and evaluation, and one of the presentations was on “Analysis of the effect of universal PITC [provider-initiated testing and counseling] of all babies at 18 months of age regardless of history of HIV exposure.” This was a pre/post study conducted in the Ugu district in KwaZulu-Natal, South Africa. The Department of Health in Ugu developed a protocol to test all babies at 18 months when they come for their measles immunization. The study revealed that in the nine months before the protocol was introduced (from October 2011-June 2012), only 18.1% of babies were tested and the HIV prevalence among babies 18 months old was 1.03%. During the nine months after the protocol was introduced (July 2012-March 2013), 42.8% of babies were tested and the HIV prevalence increased to 1.68%. There was no mention if this was statistically significant or not. The study recommended robust implementation of universal HIV testing at 18 months regardless of HIV exposure.

As I listened to the presentation and discussion, more questions came to mind: Is this really the best way to conduct pediatric HIV screening? How much would it cost South Africa to implement this strategy, and is it the most efficient use of funding, considering the HIV prevalence both before and after the study protocol was less than 2%?

Let’s hear other thoughts – reply below to join the discussion.

The Advantages and Challenges of Point-of-Care Laboratory Machines

By Luigi Cicció
Strengthening TB and AIDS Response – Eastern Region Project, MSH Uganda

In yesterday’s ICASA satellite session on “Laboratories and Facilities,” all presenters emphasized that point-of-care (POC) laboratory machines are both useful and possible. Their usefulness was never in question, but their feasibility was.

There are now several laboratory machines that can be used by trained personnel at primary health care level to perform tests that have traditionally been carried out by referral laboratories. They can help in providing cluster of differentiation 4 (CD4) count, viral load (VL) and bio-chemistry tests, all necessary for determining antiretroviral therapy (ART) eligibility and monitoring its effectiveness in the long term. It is an emerging market where companies are investing and competing with one another, thus making costs for purchasing and installing these POC machines more affordable.

Their advantages are evident: they can contribute to scaling up ART services and thus, reach out to more people in need with minimal referral to higher level sites (decreasing losses to follow up). The tests are not complex and can allow for task shifting to a lower laboratory cadre, results can be delivered in few minutes and do not require clients to turn up again, costs of reagents are acceptable, and maintenance is limited. Also, proficiency testing of POC laboratories can be accomplished for quality assurance.

All these programmatic benefits do not come without challenges though.

In rural places with limited (and erratic) availability of power, these machines may not reach their expected efficiency level. Shortage of consumables is another serious obstacle that is often under-estimated along with the logistical chain of ordering, procuring and distributing to remote areas. The increased number of clients attending ART clinics will translate in an increased number of tests and eventually in overburdening the existing laboratory personnel.

Some obvious yet crucial questions remain: according to the new World Health Organization guidelines, the VL is the test recommended for ART patient monitoring. But how acceptable is the performance of our ART sites with POC CD4 machines? How many tests per client per year do they provide? How many new ART clients are enrolled based on their CD4 test? And how many are still enrolled with a CD4 count below 100?

Three of the countries that have started implementing the option B+ approach, namely Malawi, Swaziland and Uganda, shared their recent experiences in a well attended plenary session on “Integrated Service Delivery Models,” where respective Ministry of Health (MOH) representatives described the significant modifications, adaptations, and innovations they had put in place for delivering prevention of mother to child transmission (PMTCT) and early infant diagnosis (EID) services.

In Malawi, the MOH took almost one and half year from policy formulation to actual implementation. This was necessary to plan for resource mobilization, training and procurement; to produce guidelines, training manuals and data tools; to institute a procurement process for antiretrovirals (ARVs); to conduct capacity building, and to initiate mentorship of health workers at all levels.

Their model highlighted the importance of integrating ART into maternal, newborn, and child health (MNCH) care through provision of HIV testing, ART, and clinical follow up of mothers and exposed infants in one setting.

The main threats to retention were found to be: ART initiation on the same day of detection of the HIV positive status; too much information given to mothers (about HIV, PMTCT, drug adherence, need for follow up, etc.); and the fact that many mothers were still healthy to accept lifelong treatment. Also, male involvement was not adequate (how could it be any different, since men need to reach eligibility status to qualify for ARV?). However, option B+ approach was scaled up and Malawi graduated as the pioneer country and their implementation model inspired others.

The Swaziland MOH ensured that PMTCT services were totally free of charge; completed the accreditation process of primary health unit (PHU) clinics to allow the scale up; provided POC CD4 machines in most facilities and recommended task sharing and shifting.

To promote retention, they put in place the following:

  • All services were made available in each facility (no referral)
  • CD4 test results were delivered the same day
  • Mother and infant clinic appointments were synchronized to happen the same day under the same roof (“family day” in ART clinics)
  • Children were discharged from the MNCH care point at 24 months of age (and they are considering to extend this to 5 years of age for continuity)
  • They used SMS technology and community health workers (CHWs) for follow up and tracing of missed appointments

Though the uptake of ART by pregnant mothers and children younger than 15 years of age increased from 45% to 75% and from 55% to 70% in three years respectively, they recognized some challenges:

  1. PHU clinics are becoming overcrowded
  2. Infrastructures are not suitable to accommodate the added services
  3. There is high burn out of CHWs
  4. SMS use is limited by hampered availability of mobile phones
  5. The human resources needed for the follow up are not sufficient

The Uganda presentation described their approach on the demand side and specifically the community engagement. Communities were seen as resources to generate service demand, strengthen linkages, reduce the human resource constraints, and addressing MNCH care bottlenecks like mobilizing people, following up and involving males.

The First Lady stepped in as the ending mother to child transmission of HIV (eMTCT) champion attending all 4 regional launches. People living with HIV/AIDS (PLHIV) networks were also involved; community resource people like village health teams and traditional birth attendants became linkage facilitators; family support groups were instituted in most facilities; and mentor mothers were trained and deployed to assist their peers.

Among the preliminary results, 94% of women attend antenatal care at least once (but only 17% during their first trimester); and last year about 88,000 HIV+ mothers received ART (51,000 option B+, 25,000 HAART and 12,000 option A) out of 120,000 detected cases.

Several challenges still persist: only 50% of facilities have an established FSG, adherence monitoring is limited, men involvement at PMTCT setting is at 15%, and community data collection tools are inadequate to capture all activities taking place.

Surprisingly, none of the presenters quoted any figure on the retention of mothers enrolled into option B+. Nor did they mention data issues as one of the implementation challenges. Yet, this was one of the most sensitive concerns that were cited at a B+ review meeting recently held by the Uganda MOH.

PMTCT data tools in Uganda have been changing much faster than the adapting attitude of health workers. Instructions for data recording have been modified and more indicators added, increasing the complexity of the whole exercise and perhaps compromising the overall accuracy of the data.

Could we simply have not more than 10 indicators for the PMTCT-EID cascade and make an effort to capture them correctly?

Now More Than Ever – ICASA Opens in Cape Town

The 17th International Conference on AIDS and STIs in Africa (ICASA) officially opened yesterday on a very sombre note as the world mourns and celebrates the life of global icon and former South African president Nelson Mandela who died Thursday, December 5.  More than 7,000 delegates from all over the world observed a minute of silence in his honor at the start of the opening session.

Photo credit: ICASA

Photo credit: ICASA

While some worried the conference may be cancelled, there could be no better way to celebrate Mandela’s legacy than by continuing to host ICASA and address the global HIV and AIDS epidemic. In a statement released by ICASA, the organizers honored Mandela, saying “We are reminded of the immeasurable contribution Mr Mandela made to the cause. Without his input and guidance many of the successes we have achieved would not have materialised. His legacy will live forever because of his commitment in the many years before his passing.”

All of the opening speakers extolled the role played by Mandela in the fight against HIV, urging all conference delegates to emulate him.

Without taking away anything from all the speeches delivered, I passionately single out those that sought to protect women and girls from acts of sexual violence. This, in South Africa, coincides with the release of several news articles detailing the unpalatable acts of some men raping babies and children as young as six weeks.

Annie Lennox delivers the ICASA opening address. Photo credit: Bright Phiri

Annie Lennox delivers the ICASA opening address. Photo credit: Bright Phiri/MSH

“Madiba walked his talk, we need to do the same today: walk our talk and act now more than ever,” said Annie Lennox, renowned singer, women’s  activist, and UNAIDS international goodwill ambassador. Delivering her speech during the opening ceremony, Lennox argued that while we celebrate the fact that 98% of children today are born HIV negative, the same children are at risk of being sexually assaulted and raped. Sexual violence, she posited, is a cause and consequence of HIV infections.

Lennox emphasized that we need to collectively stop violence against women and children. She challenged everyone to be accountable and help change attitudes of men and boys towards women and girls if we are to reach zero new infections. She closed by stating that we owe it to Mandela that this dream should be fulfilled – that all children are born free of HIV and live a full life.

First Lady of Zambia Christine Kaseba-Sata calling for more SRHR support. Photo credit: Bright Phiri

First Lady of Zambia Christine Kaseba-Sata calling for more SRHR support. Photo credit: Bright Phiri/MSH

Echoing Lennox’s opening and the importance of protecting women and children, Zambia’s first lady, Dr. Christine Kaseba-Sata, urged conference delegates to uphold sexual and reproductive health and rights (SRHR) in order to get to zero deaths. She noted that there is no need for women in Africa to continue to die during child birth and that no child should be allowed to die at birth. Hence, a strengthened focus on SRHR would help address gender inequalities issues that fuel HIV infections.

Indeed, MSH’s goal of saving lives and improving health for all resonates well with each of the opening speakers’ sentiments and our vision of “A world where everyone has the opportunity for a healthy life” epitomizes Mandela’s dreams.

As the conference gets in full swing, one cannot help but to support the statement that “it is fitting that we honour Mr Mandela’s legacy by ensuring our conference makes every effort to ensure meaningful dialogue is matched by tangible outcomes…the inspirations we have received from Mr Mandela are not wasted. We need to guard against complacency at a time when action is most needed .”

Bright Phiri works with MSH’s Systems for Improved Access to Pharmaceuticals and Services Program in South Africa.

MSHers from Around the World Gather at ICASA

Last night, Management Sciences for Health staff from four countries, representing six different projects, met to prepare for a week full of conference sessions, exciting events, and networking with global health and international development peers, donors, and government officials.

MSH ICASA 2013 Staff Picture

MSH staff pose for a group picture at the ICASA 2013 welcome staff meeting.
Photo credit: Michele Alexander/MSH

MSH South Africa Country Representative Bada Pharasi kicked off the meeting, welcoming all MSH attendees while Jackie Sallet from the South Africa Sustainable Response to HIV & TB Services (SA SURE) Project, Global Technical Lead for HIV/AIDS Scott Kellerman, Director of Policy & Advocacy Crystal Lander, and Michele Alexander from Strategic Development and Communications discussed MSH’s goals and messages for the conference.

Jackie Sallet, from the MSH project SA SURE, shares the key messages about MSH's HIV and AIDS work.

Jackie Sallet, from the MSH project SA SURE, shares the key messages about MSH’s HIV and AIDS work.
Photo credit: Bright Phiri/MSH

Overall, the South Africa, Uganda, Zambia, and US-based MSHers shared ways to maximize MSH’s conference presence – most importantly through our exhibit booth, #21, and our panel and reception event on Monday, December 9 from 6-9PM (click here for more details and to RSVP).

Global Technical Lead for HIV and AIDS Scott Kellerman takes a look at the MSH ICASA Orientation Book.

Global Technical Lead for HIV and AIDS Scott Kellerman takes a look at the MSH ICASA Orientation Book.
Photo credit: Crystal Lander/MSH

ICASA Kicks Off with High Level Speakers

The conference kicked off with artistic performances followed by high level speakers from civil society, government, and international organizations. Some of these are included below:

Titica, Angola’s first prominent transgender artist, opened the evening.

Titica, Angola’s first prominent transgender artist, opened the evening.

Scottish singer and activist Annie Lennox complimented South Africa on its progress in the response to HIV and AIDS but cited the need for more action and accountability, especially in the fight to end sexual violence. Photo by Johanna Theunissen.

Scottish singer and activist Annie Lennox complimented South Africa on its progress in the response to HIV and AIDS but cited the need for more action and accountability, especially in the fight to end sexual violence.

"78 countries still condemn same-sex relationships," shared Cyriaque Ako, an HIV-positive activist from Cote D'Ivoire. He emphasized the need for the global community to advocate for marginalized communities.

“78 countries still condemn same-sex relationships,” shared Cyriaque Ako, an HIV-positive activist from Cote D’Ivoire. He emphasized the need for the global community to advocate for marginalized communities.

"The solution to the [HIV and AIDS] epidemic lies with women," said Her Excellency Christine Kaseba-Sata, first lady of Zambia, as she stressed the need to integrate HIV and AIDS services with family planning and reproductive health services.

“The solution to the [HIV and AIDS] epidemic lies with women,” said Her Excellency Christine Kaseba-Sata, first lady of Zambia, as she stressed the need to integrate HIV and AIDS services with family planning and reproductive health services.

Acting Global AIDS Coordinator Deborah von Zinkelnagel shared PEPFAR's vision for the future and its achievements in the areas of ART, PMTCT, and VMMC.

Acting Global AIDS Coordinator Deborah von Zinkelnagel shared PEPFAR’s vision for the future and its achievements in the areas of ART, PMTCT, and VMMC.

Executive Director of UNAIDS Michel Sidibé advised delegates: "do not be scared of shaping our future - where no one is left behind" and called for the inclusion of the epidemic on the post-2015 agenda and an end to AIDS by 2030.

Executive Director of UNAIDS Michel Sidibé advised delegates: “do not be scared of shaping our future – where no one is left behind” and called for the inclusion of the epidemic on the post-2015 agenda and an end to AIDS by 2030.

Concluding the evening, Deputy President of South Africa Kgalema Motlanthe stated the importance of investing in health as an essential part of development. “We have the tools necessary, all we have to do is deploy them” to reach our goals.

Concluding the evening, Deputy President of South Africa Kgalema Motlanthe stated the importance of investing in health as an essential part of development. “We have the tools necessary, all we have to do is deploy them” to reach our goals.

All photos credit of Johanna Theunissen/MSH.

MSH Mourns Death of Nelson Mandela, Fearless Advocate for Health and Human Rights

Photo credit: Nelson Mandela Centre of Memory

MSH is deeply saddened by the loss of Nelson Mandela (“Madiba”), South Africa’s iconic first black president who fought to overthrow the oppression of apartheid. Madiba’s unwavering commitment to reconciliation, peace, and human dignity were hallmarks of his  legendary “long walk to freedom.” In 1993, he shared the Nobel Peace Prize.

In later years after his retirement, Mandela revealed that his son and daughter-in-law had died due to HIV & AIDS and became a courageous advocate, defying the government’s denial of the epidemic.

At the XII International AIDS Conference in Durban, South Africa, during the week of July 9-14 2000, he delivered the closing address, “this is the one event where every word uttered, every gesture made, had to be measured against the effect it can and will have on the lives of millions of concrete, real human beings all over this continent and planet. This is not an academic conference. This is, as I understand it, a gathering of human beings concerned about turning around one of the greatest threats humankind has faced, and certainly the greatest after the end of the great wars of the previous century….We need, and there is increasing evidence of, African resolve to fight this war. Others will not save us if we do not primarily commit ourselves.”

Madiba worked tirelessly to end stigma and shame for those living with HIV & AIDS and became a strong supporter of increased prevention and treatment for the thousands living with the disease in South Africa and around the world. Health and human rights became the primary focus of his family foundation’s work as he worked to improve health care for the most disadvantaged.

Nelson Mandela was 95 years old.

“I am only one of thousands of young South Africans who left our country in our teen years, fleeing persecution for our political beliefs and actions, and believing that by leaving our country we would regroup and come back to contribute to the overthrow of the apartheid, racist regime,” said Bada Pharasi, MSH’s Country Representative in South Africa. “ Did we really believe that would happen? I must say that the overwhelming urge for us to go on with the struggle and belief was the specter of Nelson Mandela addressing us in “Freedom Square” one day soon. I speak on behalf of all of our staff of MSH South Africa when I say that Madiba’s passing has deeply saddened us, but that we will draw inspiration from his life.”

“Nelson Mandela was a singular, elegant remarkable man. Without equal. Of course, he knew nothing about me, but boy oh boy, did he mean something to me as I became aware of what I needed to do in the world. He was carving out a presence through sheer force of will and certain brilliance and served as this sort of distant light,” said Scott Kellerman, MD, MSH’s Global Technical Lead on HIV & AIDS and a pediatrician attending the 17th ICASA conference, to begin this weekend in Cape Town.

“A person of Nelson Mandela’s quiet strength, personal warmth, moral compass, and vision for a world of universal equality comes along only once in every few generations. His passing provides a moment for all of us to be re-inspired by his life and legacy,” said Jonathan D. Quick, MD, President and CEO of MSH.

MSH IN SOUTH AFRICA

South Africa has made substantial development gains and boasts a growing economy. Despite these achievements, South Africa still faces the largest HIV-positive population in the world. Apartheid is no longer law, yet the health system still retains many inequities from that era. A major challenge for the government of South Africa is improving the accessibility and quality of basic health services.

MSH started to provide technical assistance to the South Africa Government in 1997 under the USAID-funded EQUITY Project. EQUITY worked toward primary care for all and focused on an integrated package of essential services. Since then,  MSH has been providing technical assistance to strengthen health services with a particular focus on primary health care, district development, leadership development, management information systems, family planning, orphans and vulnerable children, medicines supply and pharmaceutical services, and priority health programs such as HIV/AIDS and Tuberculosis. This has been done with funding support from USAID, CDC, the Global Fund, and in close collaboration with the National Department of Health. The MSH approach has been to build local capacity of national, provincial and local decision makers, and transfer knowledge.

With the implementation of the National Health Insurance, the South Africa Government is taking on this new major challenge and MSH is expected to be one the partners that will provide technical assistance and support toward universal health coverage.

(This statement was originally published by Management Sciences for Health at msh.org.)

Remembering Madiba

Nelson Mandela, former President of South Africa, accepts the offer to wear an HIV-Positive T-shirt. Photo credit: Eric Miller

by Olehile Maurice Bada Pharasi 

I am only one of thousands of young South Africans who left our country in our teen years, fleeing persecution for our political beliefs and actions, and believing that by leaving our country we would regroup and come back to contribute to the overthrow of the apartheid, racist regime.

Did we really believe that would happen?

I must say that the overwhelming urge for us to go on with the struggle and belief was the specter of Nelson Mandela addressing us in “Freedom Square” one day soon. What was most amazing about Madiba is that, for decades, we led protest marches all over the world without even knowing what he looked like, for the regime had banned all pictures of him and all we had was an artist’s impression of what he should have looked like.

In recent months, we all knew Madiba was about to depart, as we could see his frailty and hospitalization. We should, therefore, accept that he deserves his rest, and we should accept that he had to depart from our midst.

I have been associated with MSH for a lot more than the almost 10 years that I have worked for the organization. I therefore know and deeply appreciate that MSH’s fight to ensure health for all and its fight for greater health systems for all have always taken into consideration our unique conditions in South Africa. I thank all of you for the support we have had as a nation over all the decades. Thank you, thank you. I would not be exaggerating by saying that MSH has been a conscious and deliberate participant in our struggle over the decades.

I know I speak on behalf of all our staff of MSH South Africa when I say that Madiba’s passing has deeply saddened us, but that we will continue to draw inspiration from his life. His well-documented ideals for a democratic South Africa will continue to inspire all.

(Cross-posted on the MSH Global Health Impact Blog.)

Nelson Mandela was joined by celebrities at a concert in London to celebrate his 90th birthday and promote his HIV/Aids charity, 46664. Photo credit: Getty Images.

Olehile Maurice Bada Pharasi (Bada Pharasi), M Pharm, is the MSH Country Representative for South Africa.