Challenges of Working in a Vast, Scarcely-Populated Province in South Africa

Challenges of Working in a Vast, Scarcely-Populated Province in South Africa

The USAID-funded Strengthening Pharmaceutical Systems (SPS) program has been providing technical assistance to health facilities in the Northern Cape of South Africa, in partnership with the Provincial Department of Health, since 2005.

SPS addresses various areas, including: Pharmacy and Therapeutics Committees (PTCs), medicine supply management, patient adherence to antiretroviral treatment (ART), infection prevention and control, HIV/AIDS pharmaceutical management, pharmacovigilance, quantification, and compliance with the legislation relating to the supply of medicine.

About the Northern Cape, South Africa

Northern Cape

Northern Cape, South Africa

Northern Cape is the largest province in South Africa --- 372,889 square kilometers (km²) --- with a population of 1.15 million. It represents 30.5 percent of the total surface area of South Africa.

The average population density is only 3 inhabitants per km² -- by far the lowest density of all the provinces in the country. Surrounding provinces, such as Eastern and Western Cape, have 40 inhabitants per km², while the Free State (another province) has 22 inhabitants per km².

The weather is typical of desert and semi desert areas. The region is large and dry with fluctuating temperatures and varying topographies. The weather conditions are extreme -- cold and frosty in winter, with extremely high temperatures in summer. A narrow strip along the coast gets little rainfall in summer.

The Northern Cape province has five districts with a total of 27 local municipalities (sub districts).

There are 17 Hospitals, 29 Community Health Centers, 127 Primary Health Care Clinics, 26 Satellite clinics and 1,019 Mobile Service Points in the province.

Challenges of traveling, topography

Desert landscape, Northern Cape, South Africa

Desert landscape, Northern Cape, South Africa (Photo credit: Mupela Ntengu)

Implementing interventions in this environment has been challenging due to the weather, the topography and the enormous traveling distances between major towns and districts.

In the Northern Cape, road traffic accidents are the fourth leading cause of death for both men and women aged 15 to 44 years, closely following HIV/AIDS, tuberculosis and homicide.

The stress and risk of having a car breakdown on the road or accidents due to fatigue, crossing animals, heat, tiredness or loneliness is very high.

For example, to conduct an activity in the town of Upington in the Siyanda district, one had to take a one-hour and 20-minute flight from Johannesburg -- about 800 km from Upington or land in Kimberley, the provincial capital. Then, one had to self-drive for about five hours -- covering 450 km from Kimberley to Siyanda district -- in either extreme heat in summer or very cold weather during winter.

In the event of a car breakdown, the only option is to wait in the middle of nowhere for help, hoping that your mobile phone connectivity is maintained.

For an intervention to be conducted in the town of Springbok (Namakwa district), one had to drive for four hours from Upington (387 km), or nine hours from Kimberley (about 850km). Because Namakwa district is the largest in the province, any planned activity had to be conducted in Springbok. Within one or two days, one had to drive for another 410 km (5 hours) to provide the same assistance in Calvinia (Hatam sub-district).

Providing technical assistance and conducting site visits thus required careful planning.

Improvements in health, pharmaceutical services

Despite all these challenges, a number of achievements have been realized to improve health and pharmaceutical services in the province.

The achievements include: the establishment of one hospital (provincial) Pharmacy and Therapeutics Committee (PTC) and three district PTCs; the establishment of a provincial Clinical Resource Centre (medicine information centre) at Kimberley Hospital; implementation of inventory monitoring tools (stock cards) in hospitals, community health centers and primary health care clinics; and implementation of the Adherence to ART tool.

Skills have been transferred to government employees, and a strong relationship built with the Department of Health and in particular with Pharmaceutical Services.

As a result of the achievements -- and the excellent relationship that SPS has built with the Provincial Department of Health -- the demand for more technical support has increased. The SPS program recently opened an office in Northern Cape with a permanent Senior Program Associate based in Kimberley. Prior to the establishment of the provincial office, it was necessary to travel back and forth between the central office in Pretoria and the province.