Over the weekend, President Obama and his family flew from Senegal to South Africa, marking the second leg of his Africa trip. With Nelson Mandela’s health looming large over the visit, President Obama used the visit to highlight progress on global health and the partnerships formed between the US and South Africa. Here are a few of our quick reactions to this portion of his trip:
Who we’re glad Obama saw:
South Africa and its leadership. We were glad that President Obama selected South Africa for a health site visit, because the country presents such a unique case study full of progress achieved and big challenges ahead. Its leadership (particularly Minister of Health Motsoaledi) has been instrumental in scaling up the responses to HIV/AIDS and tuberculosis, and has demonstrated real financial commitment to tackling these health challenges with its own resources.
The South African government is now paying for the vast majority of its citizens’ antiretroviral drugs, relying on donor assistance for health systems strengthening and technical capacity-building on the margins. Of course, South Africa still has massive disease burden and related socio-economic challenges, but its growing ownership of the health response deserved to be recognized on the global stage with Obama’s visit.
Desmond Tutu. A long-time champion for global health and development efforts, Archbishop Tutu has a charisma unlike any other, and has a special way of calling attention to the world’s inequities—including in global health—and holding world leaders’ feet to the fire to work together to make things right.
What we’re intrigued he announced:
Investment in male circumcision. Through a fact sheet, the Administration quietly committed an additional $10 million to support South Africa’s ongoing efforts to expand medical male circumcision services. It’s not clear if this is actually new money, or if it’s simply being reprogrammed from other PEPFAR activities, but it’s an interesting move to strengthen this important prevention service. During a visit to South Africa in February, one of the most striking experiences we had was to the Winnie Mandela Male Sexual Health Clinic—a well-staffed, state-of-the-art male circumcision clinic that was having success in all aspects except the most important one: getting men to come in and have the surgery. This left staff frustrated, knowing that they had all the tools ready but weren’t able to hit the targets set for them. It will be fascinating to track how the new resources will be spent, and to see whether or not South Africa can improve socialization efforts to encourage more men to have the procedure.
The South Africa “transition.” In his University of Cape Town speech, Obama noted “I’m proud that by the end of my presidency, South Africa has determined it will be the first African country to fully manage its HIV care and treatment program.” Rhetorically this was quite exciting, and the line deservedly generated much applause from the audience. But, consistent with other Administration statements and documents on the topic of transition, it’s still not yet clear exactly what they mean. By 2016, will South Africa pay for care and treatment but still rely on donors to pay for prevention and technical capacity gaps? Will South Africa fully transition away from external aid for HIV/AIDS? Or something in between? Providing definition and clarity on this topic will be extremely important, both for enabling accountability and also for managing the expectations of donors (including Members of Congress voting on US HIV/AIDS funding) and the South African government.
What we wished he had seen or said:
Global Fund. While many other African countries receive more Global Fund support than South Africa, it seemed like a real missed opportunity for the US to barely name check the Global Fund at a moment when all eyes were watching Obama and the media was poised to write about global health. Visiting a Global Fund-supported site visit, or at least mentioning how the Fund helps pave the way for countries like South Africa to transition in the long-term, could have gone a long way to signal to other donors just how important it is to keep the Fund well-resourced later this year.