South Africa
In the summer of 2001, guided by David Bradley’s long-time business partner Jeffrey Zients and his wife, South African Mary Menell Zients, the Bradley family toured South Africa. Moved by the extreme conditions they found in children and families suffering from AIDS, the Bradleys established a new CityBridge practice area with a $750,000 budget. The CityBridge mandate was to identify and support a leveraged intervention that would benefit South Africans with HIV and AIDS.
Faced with a steep learning curve, a complicated funding field, and a country (then) not officially acknowledging the connection between the HIV virus and AIDS, CityBridge (in typical form) spent a year of research to identify an appropriate intervention. At the time, President Bush’s President's Emergency Plan for AIDS Relief (PEPFAR) funding was likely to be enacted, so CityBridge chose two projects that, we hoped, would lay important groundwork before the introduction of significant funding for antiretroviral (ARV) treatment with the PEPFAR program. These interventions were in nurse education and ARV treatment.
Training South African Nurses and Health Professionals
CityBridge anticipated that the single largest obstacle to widespread ARV treatment would be the lack of trained, ready nurses to diagnose AIDS patients, to administer complicated drug regimens, and to ready patients and families for the significant commitment necessary to successfully use ARV treatment. CityBridge established a funding partnership with the Foundation for Professional Development (FPD), a South African-based for-profit company specializing in physician education and headed by Gustaaf Wolvaardt. CityBridge provided them with grant money and technical support to adapt their ARV physician training for nurses. Kathy Dennill, formerly the president of South Africa’s Community Nursing Association, was hired to run the country-wide nurse training program, recruiting through local leaders she already knew well.
CityBridge’s international program manager Andrea Flynn also worked with JHPIEGO, an international health affiliate of the Johns Hopkins University, and the Johns Hopkins School of Nursing, to develop and refine the protocols used for the South African course. In March 2004, the program launched with six over-subscribed courses training 600 nurses from all nine South African provinces. As the initial sessions took place, CityBridge and FPD invited local health officials, as well as representatives from international relief and funding organizations, to attend the trainings. All nurse attendees were evaluated to ensure that the course was providing them with the knowledge needed to administer and manage ARV pharmaceuticals.
In August 2004, the United Nations Development Fund contracted with FPD to train an additional 600 nurses; in December 2004, the recently-launched US PEPFAR Program administrators chose the Foundation as the primary training organization for South African nurses. FPD has continued to be a prime PEPFAR contractor. To date, more than $18 million in PEPFAR funds has been committed to the nurse training program, with nearly 20,000 nurses to benefit over the next five years.
ARV Treatment
CityBridge’s second South Africa project was inspired by Doctors Without Borders/ Médecins Sans Frontières (“MSF”)’s successful ARV treatment site in the township of Khayelitsha outside of Cape Town, South Africa. In 2001-2002, while CityBridge was researching options for successful projects, MSF’s site was the only large-scale, public ARV treatment site in the country. Funded by MSF, the project defied international expectations, proving that semi-literate or illiterate Africans could and would adhere to the rigid treatment protocols necessary with ARV therapy. CityBridge believed a second public site providing successful ARV treatment for large numbers of patients would solidify the case: Poor South Africans were candidates for this demanding, but effective and life-prolonging, treatment.
In 2004, CityBridge partnered with Dr. Robin Wood and Dr. Linda-Gail Bekker, two doctors from the University of Cape Town who were collaborating with officials at the Ministry of Health in the Western Cape at a public health clinic in the township of Gugulethu. A private British charity, Crusaid, had donated funds to build a separate AIDS clinic on the grounds of a large Gugulethu public health facility. Staffed by Department of Health workers, the clinic had capacity to begin treatment for several hundred patients with advanced HIV infections. At that point, however, neither the government of South Africa nor the US PEPFAR program was ready to fund ARV patients. CityBridge planned to fund treatment for the first 150-200 patients for two years—our best guess as to the amount of time it would take for public and PEPFAR sources to step up. Shortly after the program’s launch, however, and at the request of the Ministry of Health, CityBridge accelerated our timetable to get as many patients as possible on the ARV treatment protocol. In December 2004, the Ministry took over complete funding responsibility for these patients’ treatment—more quickly and more completely than we had anticipated was possible. The Ministry continues to fund ARV treatment for patients; PEPFAR funds supporting services and medical staff training.
Lessons from South Africa
Some projects perform above our highest expectations. South Africa was one. We are grateful for having had superb, talented partners, a fair amount of lucky timing, and wise counsel from PEPFAR officials.
