In South Africa (SA), just like in most other parts of the world, there are many challenges. You probably have an idea if you read a newspaper from time to time. There’s a lot of political and economic instability, and you probably also heard about Cape Town’s water predicament recently. In addition, even after policy reforms aimed at reducing inequality, there is also still great social division in SA (check out our phenomenal GINI coefficient ). Yet, despite all these challenges, South Africa, the land I have come to love and cherish, is slowly but surely becoming a role model for Africa. It is the leading African economy ( ahead of Nigeria – although not every economist is convinced of that, and probably millions of Nigerians neither) – and the only African country in the BRICS and the G20. SA also plays an important role in the development of Africa. My country is not just a recipient of global health interventions and initiatives (PEPFAR for example) but it also plays an active role in global health diplomacy and activism. Against this backdrop, it is apt to examine some of SA‘s successes and involvement in global (and regional) health diplomacy. In this short editorial I won’t aim to be comprehensive, but will just give some examples of the past few years to give you an idea of how South Africa had (and has) influence in global health, including in the Southern African Development Community (SADC) and in the Sub-Saharan Africa (SSA) region.
Given SA ’s political and economic weight in the SADC and African Union (AU), the country plays an important leadership role on various global fora, ensuring in this way also that African countries have an active role in setting the global health agenda. In the past, SA has been invited to participate in G7 meetings, though rarely. This was made up by the country’s inclusion in the G20 and the BRICS club. Both are increasingly important in the global health governance architecture, and for South Africa’s global health influence, it’s thus a good thing to be part of them. Even more so now that Xi Jinping’s “Health Silk Road” (in the slipstream of One Road, One Belt) seems to be taking off. Will be interesting to see whether South Africa can play a role as a broker in the coming years in Africa (together with Ethiopia and Rwanda perhaps), SA certainly seems well-positioned in “South-South” Co-operation. And with PEPFAR money less sure than before, to some extent Chinese funding might also come in handy. As for South-Africa’s role in WHO, by way of example, it is rumoured that SA (via former Pres. Zuma) was very influential in the strong AU support for Dr Tedros, and thus part of the reason for the victory of Tedros (the first African DG of WHO).
What about SA’s role then with respect to some of the major diseases in the region?
HIV/AIDS remains one of the greatest obstacles to achieving the SDG health goals in Sub-Saharan Africa. In the past, we have witnessed SA‘s strong leadership in HIV access as the largest single country contributing to the number of people on antiretroviral treatment globally (via its civil society groups, in partnership with the global advocacy movement). As you know, the current strong South-African (government) leadership on universal access to ARV treatment, and health care as a human right, wasn’t always there, sadly, but it is a role model now for Africa, much like its civil society.
South Africa has also been a strong promoter for affordable medicines and has lead with resolutions and other activities to create and improve affordable medicines, especially for HIV/AIDS. In addition, SA has contributed to lowering the cost of ARVs by about 50% for its domestic purchases. This helped other countries in Africa to also purchase at lower costs. SA has also been a strong advocate and taken leadership in the area of TB, advocating for activities and funding for TB and the ‘STOP TB’ work internationally. It has also purchased large numbers of TBXpert kits (for TB diagnostics); these large purchases have helped reduce costs.
This country has also played a role in a number of key global responses , eg. more recently in initiating the Ebola resolution at WHO in 2015 and coordinating with other member states to push this process forward. Along with others, during the Ebola crisis in West Africa, the South African Cabinet committed close to $3 million to set up the first mobile P4 laboratories and also contributed safe suits to affected countries. The country also sent some health professionals to deal with the epidemic, and the Ebola Response Fund, a joint initiative of the South African government and the private sector, raised 1 million USD in cash and resources. This work eventually helped trigger the global programme on Health Emergencies at WHO which plays a vital role now in outbreaks.
In terms of assessed contributions, South Africa is also the biggest African contributor, in line with the size of its economy. However, now that some of the former key donors from the West seem increasingly reluctant to continue to take the lead, perhaps South Africa (and other BRICS countries) could and should step up?
Some examples of SA’s (more regional) health diplomacy then, zooming in more on the SADC and SSA. End of April 2015 the South African Health Minister, Minister Aaron Motsoaledi, welcomed delegates from across Sub-Saharan Africa to a three-day regional consultation on Global Health Sector Strategies for HIV, sexually transmitted infections (STIs) and viral hepatitis. Motsoaledi emphasized the importance of ensuring that the global strategies build on experiences and ideas from Sub-Saharan Africa – the region in the world most affected by HIV, STIs and viral hepatitis.
Malaria and HIV are major problems in the SADC and South Africa is playing an important role in joint efforts to tackle them. In November 2017, Dr Aaron Motsoaledi hosted five other Ministers of Health from Angola, Botswana, Namibia, Swaziland and Tanzania at a commemoration held under the theme “Strong cross border collaboration is key to malaria elimination”. This event involved several activities including giving mosquito pesticide sprays to households and awareness activities on preventing malaria. The Republic of South Africa is working with Mozambique and Swaziland through the MOSASWA (Mozambique, South Africa and Swaziland) Cross Border Malaria Initiative whose target is to accelerate the transition from pre-elimination to elimination of malaria in Swaziland and South Africa and to accelerate from control to pre-elimination in southern Mozambique in order to achieve zero local transmission in Swaziland, South Africa and Maputo province by 2020. Just a few days ago, the Financial Times reported on the “Elimination8 plan” , of which the aim is “to end malaria by 2020 in four so-called frontline states where transmission levels are already low — below 10 per 1,000. These are Botswana, Namibia, South Africa and Swaziland. Four higher-transmission, “second line” countries — Angola, Mozambique, Zambia and Zimbabwe, where transmission rates can climb as high as 400 per thousand — have until 2030 to get the job done.”
When it comes to UHC, a key target of health SDG goal 3, SA has released some major policies on National Health Insurance, although they are currently (still) being contested by private interests. South Africa’s Minister of Health Aaron Motsoaledi is also among the global advocates of UHC, at various international fora and flagship events. If UHC were to work (well) in SA, no doubt that would propel the current UHC movement in Africa even more. SA can also create a platform to work with other African Countries on policy implementation.
In many other ways, the health related challenges that South Africa faces (social determinants (cfr. the water crisis in Cape Town, situation in the slums, …); NCDs & tackling the commercial determinants of health (for example, Big Alcohol in Cape Town); not to mention planetary health, are challenges that most other countries in the world face, and certainly in SSA. In many ways, you can say that South Africa is a key SDG battleground (for example when it comes to tackling its massive inequality). Hopefully, SA can also take the lead in Africa with respect to many of these new global health challenges. The recently introduced soda tax, a first in Africa, was certainly a nice start!