MAXIMIZING POSITIVE SYNERGIES - World Health Organization

(ND1). Some donors have identified districts without this expertise and respond by seconding staff
to those specific districts (GHI2).
The state also lacks proposal-writing capacity in applying for Global Fund grants, though it has
received technical support from UN agencies. No direct technical support has been forthcoming
from the Global Fund, with technical expertise being imported from other countries instead of
training local people in an effort to build capacity (ND5).
Medical Products, Vaccines, and Technologies
Donor funding for medical technologies has focused on the provision of disease‐specific
pharmaceuticals and equipment, as well as support for the strengthening of the pharmaceutical
regulatory system. In the past decade there has been a notable improvement in diagnosis and
treatment practices for malaria. Global Fund funding enabled the MRC in 2000 to introduce a
diagnostic test that reduced the time required for results from one or three days to ten minutes
(D3). This has improved treatment practices as patients receive a definite diagnosis and initiate
treatment in one visit. The enhanced malaria treatment and control measures resulted in large
reductions in malaria incidence rates in the highest malaria risk border areas of South Africa,
Swaziland and Mozambique. Malaria incidence in this region decreased from 250 per 1000 in the
1999/2000 baseline year to less than 20 per 1000 in 2006/2007 [20]. Malaria incidence has
dramatically reduced by over 99% in KwaZulu Natal and over 86% in Mpumalanga (D3).
Donors generally regard South African’s pharmaceutical regulatory system as strong, though
PEPFAR procures ARVs independently of state supply channels (GHI1, ND5). Both DFID and the
CDC fund training initiatives for state pharmaceutical services at national and sub‐national levels
in South Africa. DFID, together with the WHO, has supported pharmaceutical regulation at national
and provincial levels since 1997 through the South African Drug Action Program (D5). However,
strong policies do not necessarily translate into effective supply management.
Donors work with the South African government to improve its laboratory capacity, and in
introducing new diagnostic techniques (GHI1). These efforts are partly directed towards
diagnosing and treating MDR and XDR TB cases, with the collaborative Regional International
Training and Research Centre in operation since 2006.
South Africa is also one of the centres for HIV vaccine research in Africa, though much of the
funding for these initiatives is channelled through the MRC or NGOs, and not the NDOH.
Information
Health services in South Africa are under pressure to develop information systems that will
respond to the challenges of managing the public health care sector and ensure accountability.
Our data show that there is an increasing demand for health information to inform policies (D1),
priority setting (GHI2), resource allocation, and to guide impact assessments of health
programmes (ND4). The lack of clear national policy and guidelines, common indicators or
common reporting systems, and little feedback to staff at lower levels of health care were
mentioned as negatively affecting the quality of data. The NDOH is aware of these issues and
recently organized a meeting to develop common indicators for integrated TB/HIV management
(ND4). Informants identified severe shortages in health information skills and expertise as another
problematic issue.
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