Dispatches from the South Africa CODEL, Part 1

ONE’s Global Health Policy Director Erin Hohlfelder reports on her trip to South Africa with ONE and a Congressional delegation. 

Every time I travel abroad, I find myself thinking, “you should know by now there’s only so much you can learn about global health from behind a desk.”  This held true as recently as last week, when I had the privilege of helping staff a Congressional Delegation (CODEL) trip to South Africa. The CODEL, comprised of Senators Coons and Isakson and Representatives Bass and Sewell, was making its way through a whirlwind tour of the continent and they asked ONE and our partner CARE to help pull together a few site visits focused on health in South Africa. Though we only had a day with them, we were able to see incredible programs at work in the field, ask questions of practitioners and patients and get a better sense of how US foreign assistance was contributing, alongside many other partners, to the fight against AIDS in real time.

ONE kicked off the CODEL’s visit by organizing an AIDS expert roundtable. We asked the panelists to do more than just paint a rosy picture: we wanted them to be candid and open, sharing what was going well on the ground, but also what wasn’t. One by one, our experts Mark Heywood from Section 27, Dr. Coceka Mnyani from the Anova Health Institute, Mmapaseka ‘Steve’ Letsike from SANAC and Nokhwezi Hoboyi, an HIV+ activist, walked the CODEL through all that they had worked on and lived through. They pointed out policy and programmatic nuances that we might have missed had we only been tracking the issue from DC.

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Experts meet with CODEL to discuss improved methods for HIV/AIDS treatment and awareness. Photo Credit: Ilan Godfrey

Many spoke of the importance of why social factors—access to sex education, girls’ empowerment, power dynamics within relationships—were as important to preventing HIV as more routine and visible efforts such as condom distribution or improved treatment access. Mark also noted that “HIV is a critical litmus test for South African progress as a whole,” as it must effectively put to use limited budgets, resources and human capacity across the country. The CODEL members asked great questions, including what a transition of funding and leadership from US foreign assistance to South African leadership should look like. Most panelists cautioned that the US’ leadership must be sustained because the “progress is not secure, and the challenges remain very great,” but also drove home that the US can play a key role in working with the South African government to improve programmatic and financial management capacity, while also making headway on socio-cultural elements of the fight.

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The CODEL members listened closely to the needs of the community, learning how the shift of responsibility can change. Photo Credit: Ilan Godfrey

The CODEL then headed off to the Lenasia South Community Health Center, a beautiful facility receiving PEPFAR, CDC, USAID, South African Government and Anova Institute support, as well as previous technical support from the Global Fund (talk about coordination!). Upon arrival, after hearing a quick rundown of the clinic’s impressive statistics—serving a population of more than 50,000, providing ARV treatment access to more than 2,000 client, a mother-to-child transmission rate of less than 1 percent—they broke into two groups and were able to tour a number of wards within the clinic, including those for HIV and TB treatment, antenatal care, and medical male circumcision. The CODEL members had the chance to “play patient,” walking through each wing and experiencing for themselves what it would be like to arrive at the clinic and receive care from the facility.

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Senator Isakson visiting the Lenasia South Community Health Center. Photo Credit: Ilan Godfrey

Reflecting on all that he had seen and heard throughout the morning, Senator Isakson remarked that, at this stage in the fight, “we cannot claim victory [on AIDS], but we can claim successes.”  In many ways, his phrase captured both the immense progress seen in South Africa—including leadership for South Africans, by South Africans—but also the intense challenges that continue to face a middle-income country with more than 5.6 million people living with the disease.

We were grateful for the opportunity to be with the CODEL and to listen and learn alongside them. Stay tuned over the coming weeks for more posts from our visit, including coverage from CARE about their work, powerful lessons learned from a male circumcision clinic, and personal reflection from our US Government Relations Director, Jay Heimbach, who was with us on the ground.

Stay tuned for more updates on this trip next week!