Inspiring change: Remco Peters, the lead clinical researcher for the Foundation for Professional Development, is enjoying the job of improving the lives of people in the Eastern Cape by strengthening the health service.
Well under the radar of any media, the Foundation for Professional Development (FPD) lead clinical researcher in the Eastern Cape, and extraordinary professor at the University of Pretoria, Remco Peters, is making a slow but profound difference to local health systems.
While adapting national policies to local conditions to render them more effective and creating local ownership and relevance, the FPD research unit has a single mantra: improve patient outcomes and strengthen and support quality healthcare delivery.
This is achieved through strong partnership with the local department of health, non-governmental and community-based organisations, and other stakeholders.
The projects have a community advisory board in place where the relevant structures are represented to ensure that projects are locally relevant and culturally appropriate.
Peters’ FPD clinical research team has an administrative office in East London, a clinical trial site at Ndevana near Qonce (previously called King William’s Town) and sexually transmitted infections research infrastructure at five facilities in the Buffalo City region. It consists of some 60 staff, including nurses, field and trial site workers, doctors and lab technicians.
“Most of our work is in sexual health — a good example being a project of rapid diagnostic testing for STIs [sexually transmitted infections] in pregnancy. We’re helping them implement it effectively by screening women for STIs and providing same-day treatment. For example, if a pregnant woman is positive for syphilis — a major contributor to stillbirth — we help her access the relevant drugs by sourcing where there are no stock-outs and using our leverage to get them to her clinic,” Peters says.
The emphasis is on a holistic upliftment approach as demonstrated at its Ndevana site where HIV prevention trials are conducted. The team provides support in crafting and printing CVs for participants and assists with registration for further education, so they can more easily find work.
“It’s the small things that work, really, really well,” observes Peters.
Another string to the FPD bow is its holistic mental health programme, whose data the health department at national level leveraged to formulate and implement a specific mental health objective in the National Strategic Plan for HIV, TB and STIs, 2023-28.
The soft-spoken Dutch-born researcher, who has lived and worked in South Africa for more than 15 years, is a member of several national and international technical working groups, including at the World Health Organisation.
In the four years he’s been there, he has established the Ndevana clinical trial site to ensure that Eastern Cape population is included in ground-breaking research and has early access to potential new products, implemented projects of rapid diagnostic testing for STIs and detection of antimicrobial-resistant gonorrhoea, and run other projects looking at optimising antiretroviral treatment adherence in key populations.
Peters has little time for foreign outfits that ignore their ethical responsibilities when conducting research in impoverished rural communities.
“Often there are good concepts, ideas and data generated at a local level which can be used for service improvement. But there is a genuine risk that someone else takes the idea, gets a big grant and makes money out of it. You see research coming in, for example from the US, with bags of money, doing the work and taking the results. It’s a form of exploitation or colonialism. There’s little recognition, feedback or translation to anything relevant to local people. This really puts a strong responsibility on researchers and donors to ensure that local capacity building and benefit is appropriately recognised and included in grants,” he says.
“Also, we need to be careful that incentives for study participation do not become too coercive in our population.”
Global medico-political developments have an underrated effect on local healthcare delivery, he contends, citing the political influence in the US wanting to bar the President’s Emergency Plan for Aids Relief (Pepfar) from partnering with any foreign organisation that lobby for abortion rights or provide abortions, referrals or information about it.
The threat of barring, previously supported by former US president Donald Trump, has re-emerged with threats to knee-halter Pepfar in Congress by voting against its funding unless it disassociates itself from such groups. Doing so would have a huge effect on global service delivery; termination of pregnancy is only one aspect of what many such partner groups do.
Since its creation, Pepfar has enabled the delivery of more than 2.2 million HIV-negative babies with HIV-positive mothers, facilitated prevention through 15.2 million voluntary male circumcisions, reduced HIV infection rates in adolescent girls and young women in the highest HIV-burden communities in 10 African countries by 25% to 40%, delivered care to 6.4 million orphans and other children, trained 250 000 health workers, and contributed to health system strengthening in recipient countries.
In 2017 alone, it provided HIV testing services to 85.5 million people. It is by far the most consequential initiative ever launched against HIV/Aids, with the US having spent more than $70 billion so far.
In a small but significant way, the FPD research project in the Eastern Cape is punching well above its weight by using knowledge gleaned over the years on what works and what does not.
Its STI projects leverage its own infrastructure to conduct sexual health training in clinics, building on the knowledge gained through its research, while insights from the HIV pre-exposure prophylaxis studies help strengthen awareness and service delivery.
“I’m really enjoying the job,” says Peters.
He found the biggest barrier in the first few months of the job to be staff members’ reluctance when confronted with “the enormity of the STI burden out there”.
“But slowly they’ve realised how much the people out there really need help in a field that’s not always comfortable to work in. You know, if it’s from the waist down, it doesn’t exist,” he said in describing the all-too-common healthcare worker and patient attitudes.
“They initially struggle to work with things like genital ulcers. But they get a lot of appreciation in return — and they find a lot of serious pathology. Slowly they’ve realised that they’re making a big difference. It’s so cool to see staff enjoying working with sexual health,” said Peters.
“I mean, they can be dealing with anything from infectious diseases to cancer, from sexual violence to happy couples that are pregnant. You never know what you’re going to get.”
Peters says the FPD tries to position its research and programme implementation resources at the interface of community development, service delivery and systems strengthening.
As his team so well knows from making a huge difference in a single patient’s life, just telling the Foundation for Professional Development’s story will hopefully put them more firmly on the radar, to the benefit of all in the Eastern Cape’s struggling healthcare sector.