Role of FBO health services in contributing to universal health coverage in Africa

Universal health care is a difficult challenge in developing countries, and calls for governments to work with faith based organisations and NGOs to reach remote under-served areas, and the poor.

Role of FBO health services in contributing to universal health coverage in Africa.
Some experiences from South Africa.
Sr Alison Munro, Southern African Catholic Bishops’ Conference
SACBC AIDS Office
February 2015

SOUTH AFRICA
• South Africa remains the country with the highest number of people living with HIV, an estimated 6,4 million.
• Approximately 2,7 million people are on ARV treatment, but the Department of Health aims to double this number over the next five years, in part through raising the CD4 level at which treatment is offered from 350 to 500. Earlier treatment serves as a means of HIV transmission prevention.
• South Africa has made gains with PMTCT. The numbers of infants born with HIV have been radically reduced.
• What remains a challenge is the testing and treatment of children, with many guardians through ignorance and fear of discrimination refusing the necessary consent for the testing of children.
• The country has also succeeded in signing tenders for the supply of generic ARV drugs at far lower prices than was the case historically. The prices are lower for these drugs than was the case for the patent drugs purchased in the PEPFAR funded programme until approximately two years ago.
SACBC AIDS OFFICE: AIDSRELIEF TREATMENT PROGRAMME
• The SACBC was a sub-recipient of a grant awarded to CRS in 2004 for antiretroviral treatment in 9 countries.
• Treatment in South Africa through the SACBC was subsequently provided in 22 places, many of them home-based care sites, only two of them hospitals.
• The first PEPFAR transition was from CRS to the SACBC in 2008, with the SACBC becoming the direct recipient of the grant.
• The second transition, largely completed, was from the SACBC to the Department of Health of South Africa.
• In practice this has meant in the majority of cases that patients have been transferred over a period of time to Department of Health clinics in their catchment areas.
• Over the lifespan of the treatment programme approximately 49 000 people were initiated on ART.
• Some examples of the actual and hoped-for transition of ART programmes from PEPFAR to the Department of Health follow.

a) BLESSED GERARD CLINIC

• The Blessed Gerard site north of the city of Durban continues to operate as a treatment site, receiving Department of Health drugs and laboratory services, and private funding for staff salaries.
• Blessed Gerard is a good example of a public private partnership in the provision of treatment.
• Blessed Gerard, no longer an SACBC site, is a good example of the FBO contribution to universal health coverage, serving a population that would otherwise need to be fully absorbed by the Provincial Department of Health system.

b) NAZARETH HOUSE CLINIC

• Nazareth House, at one time, one of the biggest treatment sites of the SACBC, began a major transition of patients to Department of Health Clinics from the end of 2012 when it was expected that the PEPFAR grant would end in May 2013.
• The programme was given a stay of execution when the SACBC was granted two no cost extensions, the second due to end in May 2015, allowing it to continue, though with fewer patients.
• An evaluation of it and the surrounding Department of Health clinics at the request of the National Department of Health has recommended that the Gauteng Provincial Department of Health take on the staff costs and allow the site to scale up numbers of patients to previous levels (which are more cost effective than at smaller levels)
• A final decision is awaited in this regard from the National and Provincial Departments of Health ahead of May 2015.
• If the decision is favourable, the Nazareth House programme will be fully funded by the Department of Health, a truly good collaboration between a church programme and the Provincial Department of Health. It will no longer be an SACBC site.

c) TAPOLOGO CLINIC
• Negotiations are also underway to have the Tapologo site, once also one of the biggest SACBC treatment sites, continue with Provincial Department of Health funding, beyond the drugs and laboratory costs now received (and previously funded by PEPFAR).
• Officials in the North West Provincial Department of Health have not all been co-operative, expressing doubt concerning the findings of the study requested by the National Department of Health. The study had recommended that Tapologo continue providing treatment, and help alleviate the pressure of patient numbers on the provincial clinics.
• Should the province decide not to support Tapologo fully, the current patients will need to be absorbed into those provincial clinics.
UNIVERSAL HEALTH CARE
• Universal health care remains a challenge for South Africa because of constraints around human resources, facilities distances patients have to travel for services and related costs, supply chain management issues, political will, and cultural and religious belief systems among other factors.
• FBOs have a vital role to play in outreach to far-flung and under-resourced areas, admirably demonstrated in the success of the SACBC AIDS Office ART programme. Evidence of good adherence rates are largely attributable to close monitoring of patients and the commitment of FBO staff in their work.
• Continuing challenges around access to funding for such programmes challenge the FBO NGO sectors. It is feared that many of the gains made in the country will be lost because of inadequate follow up.