South African group leads effort to improve national substance abuse services

The South African drug epidemic continues to grow rapidly, fueled by abuse of prescription opioids, novel opium concoctions and heroin. Contributory factors include a very high national unemployment rate and pervasive poverty. Yet, the country continues to struggle to implement a much-needed national system to assess the quality and effectiveness of drug abuse services.

For the past seven years, development work has been underway, spearheaded by the South African Medical Research Council (MRC)--the South African National Institutes of Health--to test, pilot narrowly, and then pilot broadly a system of Service Quality Measures (SQM) for adults receiving substance abuse services. The system includes a small, yet rigorous set of administrative and consumer perception measures that address care access, care quality and care outcome. Information also is solicited on HIV testing and treatment. The pilot work on the SQM now has been completed quite successfully, and the SQM is ready for national implementation.

On March 9, a nationally representative Advisory Group gathered in Cape Town, South Africa, to learn the results from the pilot work and to outline national implementation steps. Pilot results are both very promising and very interesting. For example, pilot results showed no major differences in access, quality and outcomes for all Africans, an amazing finding in a country where apartheid was the legal norm just a half century ago.

The National Advisory Group also proceeded to outline next steps toward national implementation. Although, ideally, the SQM should be implemented nationally by the National Department of Health and the National Department of Social Development, with the continuing support of the MRC, appropriate relationships with these departments need to be developed for this to occur.

Two avenues appear to be very promising to foster these essential relationships. First, the National Drug Council is preparing a strategic plan and a core set of recommendations. One of these recommendations can give high priority to the national implementation of the SQM. Second, because drug use is so closely associated with HIV onset, it will be essential to use the SQM to develop better understanding of how to improve HIV prevention and treatment. Both of these avenues appear to be very promising for implementing the SQM nationally.

Although many miles still remain before the SQM will be implemented nationally in South Africa, the work of the MRC, and especially that of its SQM project director, Dr. Bronwyn Myers, are especially deserving of accolades. Also to be noted is Dr. Rajen Govender of the University of Cape Town, chair of the National Advisory Group, who has contributed essential leadership of the project during his two-year tenure.

Our hats are off to Dr. Bronwyn Myers, Dr. Rajen Govender, the MRC staff and the entire SQM National Advisory Group for their vision, effort and leadership in championing and defending a much-needed substance abuse performance assessment system for South Africa. Industry experts in the United States can learn much from the example of their effort in South Africa as we address our own substance abuse epidemic.