Project Rationale

New structures for control of communicable disease were put into place in Mpumalanga Province in 1996. Mpumalanga Province was divided into 21 districts and for each district a Communicable Disease Control Coordinator (CDCC) was needed to oversee the day to day running of disease control. The Coordinators were directed by Dr David Durrheim, as Consultant in Communicable Disease Control to the province. The CDCCs were mainly black African nurses with extensive experience in clinics and hospitals in the "old" health system, but little experience in disease control and in public health. The communicable disease control network at inception lacked the knowledge and skills needed to function adequately, and also lacked a coherent team identity. Click here to open a map of Mpumalanga Province in a separate window (79 Kb).

This project was designed to provide expert training in some of the skills and knowledge needed by the CDCCs and to help the network function at a high level of effectiveness in the control of communicable diseases in Mpumalanga Province.

The project also helped to address gender and racial inequalities since the majority of the CDCCs were black female nurses who had little opportunity for advancement under the former regime.

Project Goals

The project had the following goals:

1. To develop the capacity of districts to plan and evaluate infectious disease programs.
2. To enable district staff to appropriately respond to outbreaks of infectious disease.
3. To strengthen the surveillance system in Mpumalanga Province.
4. To develop a provincial team, comprised of district Communicable Disease Control Coordinators (CDCCs), who understand and optimise the use of available data sources.
5. To pilot this model for potential expansion to other district programs and provinces.
6. To work towards establishing a training course of sufficient academic standard to enable the course to be accredited towards partial fulfilment of a higher degree(s) in public health at the two participating academic institutions; and to negotiate with these institutions to have the course recognised academically.

Project Partners

The partners in this project are the School of Public Health and Tropical Medicine, James Cook University, Townsville, Australia, the Department of Community Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa, and the Ministry of Health, Mpumalanga Province, Nelspruit 1200, South Africa. James Cook University has a contractual arrangement with the University of Witwatersrand, and the latter has a contractual arrangement with the Department of Health, Mpumalanga Province. The Department of Health played the major role in implementation of the project with input from the other partners. The School of Public Health and Tropical Medicine played the major role in interactions with IDP. Additional details on the round one partners are available at this site.

Project Components and Implementation

The major element of the project was increasing the level of functioning of the CDCCs by formal teaching sessions, exams, and real life assignments dealing with their work. Another major element was building team identity by the shared learning and work experiences which highlighted the value of collaboration.

Teaching consisted of:

1. one day sessions held monthly that addressed various topics and evaluated team and individual performance in district disease control
2. five day teaching blocks held on 6 occasions
3. formal assessment by exams and assignments in 4 "subject" areas. Material used in teaching was prepared in modular format.

The functioning of communicable disease control province wide was improved by the CDCCs training facility staff, by production of an Outbreak Manual, and by implementation of an outbreak reporting system which involved infection control nurses in district hospitals and the South African army.

Collaboration between Australian and South African academics was encouraged by joint planning of training, visits of staff of SPHTM to South Africa to participate in the CDCC training blocks including joint teaching and face to face meetings, by collaborative research in South Africa, by participation of staff from SPHTM in province and national disease control meetings. Staff from University of Witwatersrand and DOH also visited Australia, and assisted with teaching in Australia.

Historical overview of project

The project commenced in March 1997 and all objectives in the original contract were met by March 1999. Additional objectives were set in March 1999 and most of these were met by September 1999. The key player in the project has been Dr David Durrheim of the DOH who played the main role in ongoing training through day long monthly training sessions and ongoing supervision of activities of the CDCC. A total of 6 teaching blocks of 5 days duration were taught mainly by Mary Edginton (DCM), David Durrheim (DOH), Rick Speare (SPHTM), and Maggie Grant (SPHTM). At least 10 other staff from the DOH were involved in teaching. On average 2 staff from the SPHTM travelled to Mpumalanga Province twice a year while David Durrheim travelled to Australia on 3 occasions and Mary Edginton on one occasion.

The Australia - South Africa Joint Links project to train Communicable Disease Control Coordinators in Mpumulanga Province, South Africa has provided a cohort of highly skilled and knowledgeable health professionals to oversee disease control in the Province. In addition, the project has served as a model for training of disease control personnel in other provinces in South Africa and possibly the region.

All 6 project targets were achieved by March 1999:

1. To develop the capacity of districts to plan and evaluate infectious disease programs.
2. To enable district staff to appropriately respond to outbreaks of infectious disease.
3. To strengthen the surveillance system in Mpumalanga Province.
4. To develop a provincial team, comprised of district Communicable Disease Control Coordinators (CDCCs), who understand and optimise the use of available data sources.
5. To pilot this model for potential expansion to other district programs and provinces.
6. To work towards establishing a training course of sufficient academic standard to enable the course to be accredited towards partial fulfilment of a higher degree(s) in public health at the two participating academic institutions.

An additional 3 targets beyond the contracted targets were set in March 1999, and by September 1999 had largely been achieved:

1. To increase the extent of training for all CDCCs to be academically equivalent to four diploma of public health subjects
2. To expand the collaboration between Australian and South African institutions.
3. To investigate further opportunities in southern Africa for involvement between SPHTM and academic institutions.

This project has been highly successful. It has achieved all objectives, and more. The coherent nature of the disease control team in Mpumalanga and its effective functioning has helped to keep the communicable disease control network intact in the face of pressures within the health system. The relationship between the South African organisations and the Australian organisation have been productive with significant tangible outcomes and products. The project has also given SPHTM opportunites to expand the focus of the project into related areas in collaborative teaching and research as well as development of health policy at provincial and national level.

The major lessons learnt were that project success depended greatly on the individuals involved, particularly on their ability to recognise and respond positively to opportunities and challenges, and their ability to motivate colleagues and subordinates; that success and sustainability of this project depended on recognising and meeting operational needs; that formalising training of field personnel results in higher standards; that training a complete team as a unit is a powerful tool in building team identity and cohesion; that formal administrative hurdles (such as delayed contract signing) should be accurately assessed, and not allowed to impede the progress of a project if the key players in the project wish to proceed.