Africa: An Enduring Commitment

I arrived in South Africa in January 2010 in the middle of the summer rainy season, when every afternoon brought a thunderstorm that raged with rain and lightning and knocked out the phone lines at our office before clearing away an hour later as if it had never happened. I was seeking to find my place in South Africa and CHAI was still to solidify its role in the concert of efforts gathering around the country's ambitious HIV/AIDS treatment and testing program.

A new set of policies expanding access to treatment to a larger set of people living with AIDS were to go into effect on April 1, and the world's largest HIV testing campaign in history would launch later that month, with the aim of testing 15 million South Africans in 15 months. 500 additional public health facilities were to be identified as antiretroviral treatment sites and were to begin initiating antiretroviral therapy (ART) as the new treatment guidelines were activated. The ultimate goal is to enroll just over half a million new people onto treatment in the next year, eventually fulfilling 80 percent of the need for ART.

As momentum gathered around a deepened sense of urgency, our team was pulled in to work directly with the National Department of Health (NDOH) to help organize and implement the treatment scale-up from the national level down.

We were told, "Half the people you talk to will tell you this is impossible. We cannot talk about problems. It's the difference between saying, 'It can't be done,' and asking, 'How can we do it?' We have to act as quickly as possible, and the faster we act the more lives we save." We moved in to the NDOH offices in Pretoria where we worked with the Department to analyze and streamline their programmatic work plan and to establish a system for managing its implementation. We dispatched delegations to the provinces and districts to help develop and carry out their localized plans and facility preparations. Expert CHAI staff in operations research, human resources for health, communications, and project management were pulled from all over the world to Pretoria at a day's notice to lend their skills to our team.

From day one, we worked around the clock, because we knew that we were part of an effort that warranted the urgency. With NDOH and the South African National AIDS Council, we established a centralized "nerve center" from which the government orchestrated the country's scale-up process, and engaged with the provincial governments to respond to challenges and ensure effective implementation on the ground. The team at large met every day at 4:00 p.m. to take stock of red flags and make decisions.

CHAI staff paired themselves with NDOH officials whom they assisted with commodities forecasting, drug procurement, nurse training coordination, lab services, and administrative management, and our team at large responded to challenges as they arose. We were never working towards an end-point, but preparing for a beginning. When April came, and President Zuma and Minister of Health Aaron Motsoaledi took the stage in Gauteng to announce the launch of the HIV Counselling and Testing campaign, I was humbled by where this journey had taken me- not because we had at that point helped to accomplish something great, but because we had found ourselves at the starting line of a great and inestimable effort.

Chelsea Plyler is a CHAI staff member in South Africa.