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Sep 14
A logistical tornado: Border Health services – capacity-strengthening in SADC countries

​By: Joslyn Walker (SA SURE PRO Programme Manager), Magrieta Liebenberg (Project Manager), Michael Burnett (Senior Researcher), Judith King (Health Systems Strengthening Copy and Content Editor)

The final regional meeting for strengthening cross-border co-operation and information-sharing was held in Cape Town in September 2022 with participants from Botswana, eSwatini, Lesotho, Mozambique, Namibia, South Africa, Zambia and Zimbabwe. Also in attendance were representatives from ECSA-HC, WHO, Africa-CDC, SADC, IOM, and the South African Institute for Communicable Diseases (NICD). The meeting was co-ordinated by HST with technical support from the CDC Global Border Health team

Responding to the gap in planning for border health services exposed by the COVID-19 pandemic, Health Systems Trust (HST) and the United States Centers for Disease Control and Prevention (CDC) Division of Global Migration and Quarantine (DGMQ) have jointly implemented a multi-country learning programme to develop a stronger network for collaboration in implementing public health emergency response strategies.

Through highly focused, in-depth engagement with health and non-health sectors (including Ministries of Health, International Relations, Interior, Agriculture and Veterinary Services), the project was designed to strengthen border health systems between eight southern African countries, namely Botswana, Eswatini, Lesotho, Mozambique, Namibia, South Africa, Zambia and Zimbabwe.

We have learnt the importance of co-ordinating response systems with neighbouring countries, and the project enabled countries to deliberate on initiating and strengthening co-ordination mechanisms which will ultimately provide a better platform for all countries to collaborate on cross-border health issues. The project has highlighted the critical need to align cross-border surveillance strategies for co-ordinated public health surveillance, communication, preparedness and response amongst all participating countries. 

Conceptualisation, planning and setup

The project has entailed close collaboration between HST's two primary Directorates ‒ Health Systems Strengthening and Health Systems Research. These two units have worked closely with the Atlanta-based International Center for Emerging and Zoonotic Infectious Diseases, which houses the DGMQ, to design and implement this intense capacity-building programme.

The project was conceptualised in 2020, but implementation was delayed due to the travel and meeting restrictions necessitated by the COVID-19 pandemic. This resulted in a shortened delivery period that required all hands being on deck. Within seven months, HST's logistics, programme and Global Border Health teams delivered a training programme that was planned for implementation over 24 months. This was a noteworthy feat, which required HST and all participating countries to be responsive, proactive and adaptable. With the support of the CDC technical team, the high-quality training programme and cascaded training roll-out were accomplished in record time. As an organisation, we are deeply grateful for the commitment of all participants, without which this would not have been possible.

Field work and workshops

The first Regional Meeting was held in Victoria Falls, Zimbabwe from 20 to 24 June 2022, with five participants from each country as well as representation from five key organisations – the International Organization for Migration (IOM), the East, Central and Southern Africa Health Community (ECSA-HC), the World Health Organization (WHO), CDC Africa, and the Southern African Development Community (SADC).

Dr Themba Moeti welcomes delegates to the regional Border Health meeting in Victoria Falls.

Facilitated by the Global Border Health team, this working meeting supported robust engagement between the countries and regional partners. Dr Themba Moeti, HST's CEO, welcomed the delegates to this meeting held along the banks of the Zambezi River. Here the delegates had their feet on Zimbabwean soil, but were looking across at Zambia, as the river flowed by on its journey through Angola, Zambia, Namibia, Botswana, Zimbabwe, and Mozambique before reaching the sea ‒ perfectly illustrating that what happens in one country affects us all.

The breakaway sessions enabled the countries to apply theory into practice to identify priority areas for collaboration, and to discuss communication channels and ways to improve data-sharing and surveillance for communicable diseases in the region. This laid the foundation for the multi-country and in-country training sessions. What followed was three months of training – five multi-country training sessions and 15 individual country training sessions.

Country teams map priority points of entry and the services and activities that affect population movement in the border regions

These regional training sessions have been cascaded in the individual countries by the Master Trainers, thus expanding the footprint of the programme beyond the 70 main participants to include multiple levels of the Port Health authorities, immigration services and veterinary services. Feedback from Antoinette Hargreaves ‒ Deputy Director: Coastal Regions, South Africa ‒ is that "the training has empowered staff who went back to their workplaces and refined the training materials to make them applicable in their context. It has changed the perspective of all stakeholders and given Port Health a voice at points of entry".

Ms Philomena Ochurus, Director for Health Information and Research from Namibia, applauded the efforts of the organising team. "It didn't matter what time we called or e-mailed, HST was always responsive. I asked myself whether they worked 24/7, and it seems to be the case. It has been so rewarding being part of this project and watching how we have all learnt from each other, applying best practices shared at the different meetings," she said.

The project outcomes demonstrate that it is possible to achieve continued engagement, refinement of standard operating procedures, and multilateral agreements that enable country priorities to be balanced with the global health requirements. Ongoing analysis and refinement of country workplans is needed to assess similarities and differences in priority identification, which will guide future training and development of regional strategies to build stronger border health systems.

Implementing this project has been a complex and layered exercise, working with multiple stakeholders and countries, and requiring nimble action from the HST support team, as well as our corporate services, health systems research, and health systems strengthening teams to deliver a successful programme for optimal execution. Together we navigated the tornado and built relationships and started the process towards collaboration in a fascinating and rewarding programme.


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