Special Reports

Boosting health systems in Africa

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Strengthening the health systems of African countries in the sub-Saharan region, will help move beyond the tipping point in their epidemics.

Strengthening the health systems of African countries, particularly those in the resource-scarce sub-Saharan region, will go a long way in helping move toward and beyond the tipping point in their epidemics.

This was the message in the President's emergency plan for Aids relief (PEPFAR) blueprint announced by United States Secretary of State Hillary Clinton, calling for the achievement of an Aids-free generation, where virtually no children are born with HIV.

The blueprint reinforced the various initiatives that international organisations like PEPFAR, the Centers for Disease Control and Prevention (CDC), the World Health Organisation and others have been driving in Africa for the past decade.

Effective diagnostic laboratory services lie at the heart of strengthening healthcare systems and various programmes are in place to build capacity, particularly in resource-limited countries with high burdens of infectious disease like HIV, tuberculosis, malaria and yellow fever.

In response to this need, the South African National Health Laboratory Service and the National Institute for Communicable Diseases established the African Centre for Integrated Laboratory Training with the support of CDC using PEPFAR funds.

The centre develops and presents training courses for frontline laboratory staff, programme managers, strategic planners and policy makers so that critical laboratory issues are understood and appropriately supported by host governments.

It acts as a regional training centre and has developed and provided courses to more than 813 participants from some 29 African, Asian and Caribbean countries.

In 2010 the National Institute for Communicable Diseases and CDC South Africa set up a global disease detection centre. This centre boosts the capacity of the country's health systems to detect and respond to emerging communicable diseases; reduce childhood mortality from respiratory and diarrheal diseases; support implementation of international health regulations; and train young "disease detectives" or epidemiologists.

  Two other notable initiatives that boost health systems in Africa are the field epidemiology training programme (FETP) and the field epidemiology and laboratory training programme (FELTP).

These programmes help countries develop, set up and implement dynamic public health strategies, regional surveillance and laboratories to improve and strengthen their public health systems and infrastructure.

Since 1980, CDC has helped establish 37 epidemiology programmes that now operate independently, and has implemented epidemiology and laboratory training programmes in Ethiopia, Ghana, Kenya, Nigeria, South Africa and Tanzania. These programmes select and train young professionals in epidemiology and laboratory work.

The monitoring and control manager for the North West provincial office of the department of health, Thejane Motladiile, recently published his SA-FELTP work in the Southern African Journal of Epidemiology and Infection. His findings showed the multi-drug resistant Acinetobacter baumannii was a major cause of hospital-acquired infections, causing high mortality and prolonged stays of infected patients in the intensive care unit of a private hospital in the North West province.

Motladiile and his co-authors recommended enforcing infection control procedures, improved case notification using surveillance data; and better communication and collaboration between public and private sectors to avoid and prevent outbreaks of hospital-acquired infections.

The various programmes have produced more than 2 100 graduates, of which 80% remain in the public health sector.

Others take up leadership positions in their countries' health systems.

These include programme chiefs, national directors of epidemiology and heads of national and regional surveillance departments.

The resident advisor for the South African field epidemiology and laboratory training programme (SA-FELTP), Dr Seymour Williams, said the skills gained while conducting surveillance, investigating outbreaks and analysing laboratory data are invaluable to SA-FELTP graduates and residents and help inform public health policy and practice.

South Africa, as a hub of international travel and host to large international events like the soccer world cup and the Africa Cup of Nations, has to be at the cutting edge of epidemiological and laboratory work.

"Diseases don't respect boundaries. Outbreaks can create opportunities to bring public health awareness and parties together to solve problems," said Williams.

Data can help save lives. As with many countries in sub-Saharan Africa, epidemiology and laboratory work are burgeoning. Epidemiologists and laboratory workers in South Africa are increasingly recognised for their role in providing critical data that supports a well-functioning public health system.

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