Experience in this Country
- Technical Assistance Service Contract II for Tuberculosis (TASC II-TB) Project 2004–2008
- Integrated Primary Health Care (IPHC) Project under TASC II 2004–2008
- Rational Pharmaceutical Management Plus Program 2000–2008
- Advance Africa 2002–2004
- EQUITY, an Integrated Primary Health Care Project in South Africa 1997–2003
- Strengthening Pharmaceutical Systems (SPS) Program 2007–2012
Technical Assistance Service Contract II for Tuberculosis (TASC II-TB) Project
2004–2008As a TASC TB partner, MSH works with the University Research Corporation (URC) to assist the South African National Tuberculosis Program to enhance TB control at the district and municipal levels, while simultaneously strengthening the health system as a whole. Specific areas of focus include:
- Improving the quality of services;
- Increasing both access and demand for these services;
- Improving the management systems that support these integrated TB services; and
- Enhancing the involvement of the private sector in the continuum of care.
Integrated Primary Health Care (IPHC) Project under TASC II
2004–2008The IPHC Project builds on the successes of the EQUITY Project (1997-2003), which focused on improving primary health care services, including those for HIV & AIDS. IPHC focuses on working hand-in-hand with the Department of Health and local partners to improve access to, and use of, child health, reproductive health, and HIV & AIDS services. With an emphasis on strengthening management systems in planning, financial management, human capacity development, and quality assurance, the project ensures that EQUITY achievements are sustained, and, in collaboration with local stakeholders, that long-term improvements continue under local management.
IPHC works in five of the country's nine provinces, contributing to effective decentralization and ultimately resulting in stronger community-based approaches to health, especially in HIV & AIDS services and support. This includes a roll-out of antiretroviral drugs, the introduction of new approaches to performance-based management in the public sector, the establishment of a system of "district charters," and the creation of district-to-district mentoring and support systems.
Rational Pharmaceutical Management Plus Program
2000–2008RPM Plus works in more than 40 developing countries to provide technical assistance to strengthen pharmaceutical and health commodity management systems. The program works to improve the availability and use of quality medicines, supplies, and basic medical equipment in the public and private sectors and to promote practical, sustainable changes in pharmaceuticals management by developing capacity within cooperating countries and fostering collaboration between countries.
The RPM Plus Program is collaborating with USAID/South Africa through the President's Emergency Plan for AIDS Relief to assist the government of South Africa in strengthening systems for pharmaceutical management in support of HIV & AIDS scale-up activities.
Under this effort, RPM Plus assists in national-, regional-, and facility-level capacity development for the delivery of prevention of mother-to-child transmission (PMTCT) and antiretroviral therapy (ART) services, and in ensuring access to and rational use of basic PMTCT/ART medicines and other health supplies. Interventions include: 1) strengthening the policy and legal framework and the national pharmaceutical management support systems for HIV/AIDS-related pharmaceuticals and commodities, 2) improving information management systems for HIV & AIDS-related pharmaceuticals and commodities at the institutional and district levels, and 3) strengthening the rational use of HIV & AIDS-related pharmaceuticals and the availability of comprehensive pharmaceutical care in treatment facilities in support of the provision of PMTCT and ART services.
Advance Africa
2002–2004Advance Africa was a family planning/reproductive health service delivery project designed to increase access to and improve the quality of clinical and nonclinical programs in sub-Saharan Africa. The project worked to increase capacity for informed decision-making by clients and communities, and for the public sector to sustain quality family planning/reproductive health service delivery programs. Advance Africa also worked with USAID missions to scale up existing efforts by closing gaps in service delivery, and building partnerships among public and private health and nonhealth organizations. The project implemented innovative approaches to revitalize family planning programs within the broad context of Africa’s HIV/AIDS pandemic. MSH was the prime of a consortium of six international organizations that managed implementation of the Advance Africa project.
ADVANCE Africa wrote a paper to assess the state of family planning and HIV/AIDS services in South Africa to utilize the South African experience because the country has a high level of contraceptive use as well as a high level of HIV/AIDS. Therefore, it is hoped that exploration of issues within this context will be illustrative of questions that are present but perhaps less evident in countries where family planning programs are less well developed.
EQUITY, an Integrated Primary Health Care Project in South Africa
1997–2003Soon after the 1994 elections that brought a democratic government to power following decades of apartheid rule, the Government of South Africa, with the assistance of USAID, established the EQUITY Project. The goal of the project is to enable South Africa to address the health problems of all its 40 million citizens with a strategy of "primary health care for all." Management Sciences for Health (MSH) was selected to provide technical assistance and in early 1997 fielded a team of 18 professionals to work alongside South African counterparts.
The project initially focuses on improving the health care system in the Eastern Cape Province, which encompasses the former homelands of Transkei and Ciskei. In addition to two large urban centers, the province also has extensive rural areas where malnutrition, tuberculosis, parasites, and high maternal mortality prevail.
There is an emphasis on community structures, including volunteer health workers; mobile outreach; and high coverage in essential areas such as immunization, family planning, tuberculosis, and control of sexually transmitted diseases. The MSH team is focusing on the development of district management teams, which would make major management decisions to create and control budgets, initiate personnel actions, improve quality of care through objective supervisory methods, and develop improved information systems to allocate and control health resources as well as measure outcomes.
An integrated package of essential services has been designed and introduced in all 650 clinics. This includes appropriate referral guidelines for the 75 rural hospitals serving the 6 million inhabitants of the Eastern Cape Province. Improved drug management and standardized training of clinical staff has resulted in both cost savings and better quality of care in the treatment of common illnesses. The information system functions at all levels and enables monitoring and evaluation of project outcomes as well as costs.
Lessons from the Eastern Cape are spreading to the rest of the country. The drug supply system, for example, is being picked up by other provinces, and the monthly information reporting system is being evaluated and adapted to the needs of other provinces. The baseline survey has been adopted on a national level, and clinical training materials are being developed jointly with South African educational institutions for nationwide use.
Project subcontractors, Program for International Training in Health (INTRAH), University of North Carolina and the Society for Family Health (an affiliate of PSI), are actively involved in extending clinical training and public communication and mobilization especially aimed at the control of sexually transmitted diseases and AIDS. The management innovations introduced under the EQUITY Project are contributing to the movement towards a more equitable and efficient health care system for all in South Africa.
Strengthening Pharmaceutical Systems (SPS) Program
2007–2012Strengthening Pharmaceutical Systems is a follow-on to the Rational Pharmaceutical Management (RPM) Plus Program. MSH is pleased to announce that the US Agency for International Development has awarded us the Strengthening Pharmaceutical Systems (SPS) Leader with Associates Cooperative Agreement. SPS will focus on four key results:
- Improve governance in the pharmaceutical sector
- Strengthen pharmaceutical management systems to support public health services
- Contain the emergence and spread of antimicrobial resistance
- Expand access to and improved use of essential medicines
To help meet goals relating to the key result areas, the SPS Program is building on the successes of RPM Plus while expanding the range of technical areas to include financing, pharmacovigilance, pharmaceutical care, integration of new health technologies, and increased use of the private sector, among others. MSH will accomplish this enhanced program of activities by collaborating with a number of new partner organizations.
The SPS core partner team includes:
- BroadReach Healthcare
- Ecumenical Pharmaceutical Network
- The Lewin Group
- LMI Government Consulting
- University of Washington Department of Global Health
- WHO Collaborating Center in Pharmaceutical Policy: Harvard University/Boston University
- African Medical and Research Foundation
- American Society of Health-System Pharmacists
- Euro Health Group
- Infectious Disease Institute at Makerere University
- Joint Commission International
- London School of Hygiene and Tropical Medicine
