Health Champions in the Eastern Cape

I saw 3 giraffes and 2 warthogs on my way to work yesterday….not something you see every day but what a great start to an informative and inspiring day spent with Lucy O’Keeffe and Kath Court from the Angus Gillis Foundation (AGF). AGF are based in Grahamstown in the Eastern Cape, considered to be the poorest province in the country with 72% of the population living in poverty and a third (32%) of households having an income of less than R200 (£20) per month.

Like Altogether Better, the AGF takes an empowerment approach, as illustrated in this quote from their website:

“The Angus Gillis Foundation facilitates and does not drive development in communities because we believe that, with the right support, community champions can drive their own development, thus bringing about genuine and lasting change” (Angus Gillis Foundation, 2011)

The AGF works with 12 communities in the Eastern Cape and facilitates development using asset based approaches which emphasise people's existing skills and capacities. They take a truly holistic approach operating 4 key programmes: 1) Self-help groups 2) Education 3) Economic Development and 4) Health.

Whilst the health and social needs in the Eastern Cape are very different to those in Yorkshire, AGFs Positive Health programme, facilitated by Kath Court, has many similarities with Altogether Better. They even have their own Community Champions and Positive Health Champions! I was keen to meet some of them and find out about their work. Kath told me that the Positive Health programme aims to, “provide communities with as much information as possible, to enable them to achieve optimal physical, mental and spiritual well-being. It's about presenting methods of preventing illness and staying healthy.”

Lucy (left) and Kath (right) from AGF with Health Champion, Novulo
in the herb garden at the Community Centre

The Health Champions are people from within the community who have leadership potential, have good language skills and have developed the necessary health related knowledge. Kath told me how the self-help groups (SHG) which AGF established are often where the Champions are identified and first emerge. Through the SHGs, the women  begin to start sharing their problems and discuss social issues in the group. This helps a new relationship of trust and togetherness to develop so the SHGs  become a breeding ground for social capital as well as future community champions!

We travelled to the Brandeston community (situated within a private game reserve) to meet with Noluvo, a Positive Health Champion working in the community. Noluvo showed me around their community centre which housed a number of facilities for use by community members including a simple gym, a knowledge centre/library, a crèche and pre-school, a herb garden, and the workshop of the Siyakhula Doll Cooperative, run by women from the local area as a means of generating income.  Kath later explained to me how, before her involvement with the self help group and becoming a Health Champion, Noluvo would not have had the confidence to talk to a stranger such as me, "the strides she has made in terms of her knowledge, confidence and ability to engage with others have been huge."

We arrived at the Centre lunch time as the children were tucking into a healthy meal. Kath explained how the Centre used to provide the food mixed together, like in a stew or a soup, but that she had worked with the Champions and the children to explain the different food groups and why each was important in health terms. The children were proudly able to tell me that carrots were good for their eyesight, that the potato (carbohydrate) gave them energy and that the chicken (protein) made them strong. Kath had encouraged the workers to serve the food on a plate with separate sections which helped remind the children about the importance of different food groups (see photo above).

We then went on to a nearby community, Kalkeni, to meet Nomhlobo (see photos left and below), a retired nurse who had grown up in the area and moved back in recent years. She now works as a Positive Health Champion and told me how she helped with a range of health issues in the community including child health, nutrition, keeping active and sexual health. Nomhlobo felt strongly that people should be encouraged to help themselves and be self-sufficient, not always relying on help from outside. She explained how she had a role in encouraging people to grow and cook their own food and showed me the goats they were breeding which were then sold on to generate income.

Positive Health Champion - Nomhlobo

Our last stop was to meet Lindi in Glenmore (see photo to the left) – a community of around 2000 people. Lindi, in addition to working at the community run bakery, is also a Positive Health Champion. She attends the local health clinic (staffed by 3 nurses) every day to provide advice and support to people, she also runs workshops for community members on a range of different topics including child development, hygiene, gardening skills and parenting. She also provides 1:1 support and advice to people in their own homes when they are too sick to attend the clinic. Lindi told me how her own knowledge and confidence had grown enormously since becoming a Champions - and how she got great satisfaction from sharing her knowledge to help people.

On the way back, we stopped by at one of the safe play places for children. Kath explained how they had been taught about the importance of hand washing and, on Kath's instruction, all the children rushed outside to the hand washing bucket and duly washed their hands. Kath  explained how the children  were also 'champions' and in teaching them about basic health and hygiene, they will grow up as a future generation who value the importance of health and of keeping healthy and also understand and share what they can do to help with this.

Waiting in line to wash their hands.

There is much to be learnt from the AGF asset based approach to development. They deliberately avoid using any external material resources in the initial stages as this is seen as contrary to the Self Help concept. Although the people AGF work with are very poor, their personal assets and natural potential to manage their lives is identified and mobilized.  AGF see development as, "not about resources but about unlocking human potential". Conventional approaches often assume that poor people have no assets, AGF is clear that this is not the case and that they must first work with the assets people have and affirm them that they can do it. Then when they are strong, material resources can be introduced responsibly.

Worker in the Dolls Workshop

“As outsiders we cannot empower the weaker section, only they can empower themselves, to make choices or to speak out on their own behalf. We can walk alongside them, introduce resources responsibly when they are needed, and provide necessary training, support and motivation.” (Angus Gillis Foundation, 2011)

Wise words and important learning for us in the UK, especially at a time when external resources are scarce, and where the culture is often one of 'provider' and 'client' rather than one of  true empowerment.

The Valuable Role of the Community Health Worker in South Africa

Housing in Jackson

Yesterday, I visited two communities in the Eikenhof suburb, around 20km outside of Johannesburg. First stop was Jackson, an ‘informal’ settlement made up of mass of small, self-built, single story dwellings made of corrugated iron, wood, plastic and any other materials people can lay their hands on. The only Government provision is a few porta-loos and a handful of water tanks placed every few hundred meters. There is also a school, housed in a number of portacabins, funded by the local NGO and the ‘Hope Centre’ which is run by a local catholic nun and provides soup once a day to people in the community. Our second stop was to Lehaye, a community of public housing not far from Jackson. Here the housing is single story, built from breeze blocks, and has more amenities in terms of water, sanitation and electricity. This housing is for those people earning less than R1000 (around £78)per month.

Housing in Lehaye

Access to health care services is problematic for the people of Jackson and Lehaye due to the location and the lack of public transport. However, a small, basic, health clinic serves both communities. 

The Health Clinic that serves Jackson and Lehaye

The clinic is staffed by 9 nurses and has a TB ‘centre’ (housed in a shipping container), where people can be tested for TB and receive treatment and a new HIV ‘centre’ (another portacabin) where people can be tested for HIV, receive counselling and pick up their treatment.

Eleven Community Health Workers (CHWs) also use the clinic as a base. As well as undertaking basic health promotion activities, the Community Health Workers fulfil a number of important roles for the community including delivering medicines to people too ill to get to the clinic, identifying possible symptoms of disease and alerting clinic staff, identifying any social needs beyond health care and signposting people to other services and sources of help.   

Housing in Jackson

We spent the morning with one of the CHWs, Glenys, and visited some of the people she supports. Glenys lives in Lehaye and has been working as a CHW since 2004. Glenys main task of the day was delivering food (in the form of porridge mix) to some members of the community who are HIV positive. Anti-viral medication for HIV needs to be taken with food, otherwise it causes the person to feel very nauseous and many people avoid taking the medication when they have not eaten for this reason. Food poverty (or a lack of food) can therefore mean that the symptoms of AIDs progress much faster as medication is not taken as and when it should be.

One man, who had recently been diagnosed with HIV, had travelled by taxi (which he could ill afford) to a clinic some distance away to collect his medication. He was worried he would have to find money to pay for a taxi each time he needed more medication. Glenys was able to advise him that he could collect his medication from the local clinic instead.

Glenys delivers porridge mix to a HIV patient in Jackson

Another man, who lived alone, had suffered serious burns to his upper body in an accident 12 months ago and has not been able to work since. He has been unable to claim any disability grant to which he may be entitled, and so needed help to get this.

There are around 40,000 CHWs in South Africa. They are recruited from the communities in which they work so they have an understanding of the communities needs.  They receive 69 days of training after which time they are (in theory at least) employed by a local NGO and  paid a stipend for the work they do. However, many CHWs still work as volunteers as arranging payment can be problematic. Also, as this is low paid work, there tends to be a high staff turnover.

Whilst the context, health issues and the inequalities here in South Africa are very different to the UK - CHWs, not unlike Community Health Champions, have a vital role in helping address the barriers to accessing services for many people. Nonhlanhla Nxumalo, a researcher from the Centre for Health Policy at the University of Witswatersrand, told me how CHWs can also be a crucial link and an enabler in communities and a facilitator for the identification of community resources and assets. They can also be a conduit for the development of social capital through identifying and enabling connections and building networks which help people get what they need. In South Africa, even more so than in the UK, there is a clear need for adequate resources, training and support to enable CHWs to continue the valuable role they have in helping those in most need. Nonhlanhla explained how, "a lack of support and resources can undermine the CHWs standing in a community - as well as their ability to make a difference." There is also ongoing debate about the role of the CHW within the wider primary health care system meaning that CHWs often go unrecognised and are under-utilised by health professionals.

Children as 'Agents of Change' in South Africa

We know it can be difficult to shift the behaviour patterns of adults. In view of this, Soul City, a non profit health and development communication organisation based in Johannesburg, has been working with children aged 8 - 14 to raise awareness of issues affecting their health and development.

 

Through the Soul Buddyz programme , children are encouraged children to be ‘agents of change’ in their own environment and in all settings, including school and home. It has four interlinked elements:

•  A TV show shown on National TV which addresses Soul City campaign issues (e.g. HIV/Aids, alcohol, violence, sexual health). [This is ‘Edutainment’ – entertainment with an educational message].
• Printed Materials (e.g. magazines, educational resources)
• Radio shows
• Soul Buddyz Clubs
I was keen to learn more about the Soul Buddyz clubs as it sounded like Soul Buddyz could be Community Health Champions in the making! 



Mural on the school wall painted by the school children.



There are over 8000 Soul Buddyz clubs in primary schools across South Africa with a total of 178,422 members. Around 50% of the clubs are in rural areas, 20% are in townships and a further 20% are in urban areas. Each individual club has up to 25 members and so some schools have more than one club (one school has 8!!). Clubs meet once a week after school and are facilitated by a teacher, who Soul City provide with relevant training. Soul City also provides the materials (magazines, DVDs, education unit guides) for the clubs to use and keeps a database of all members so they can keep in touch.

I heard about some great examples of projects the clubs are undertaking to influence change in their communities by helping both individuals and the community as a whole. Here are just a few:

1)       In one area, a busy road next to the school was resulting in many children being injured or killed. The Soul Buddyz met with local councillors to explain the problem and discuss what could be done. As a result of this action, there are now speed bumps along the road and the number of injuries has reduced.

2)       In one school, a boy was missing school as he was caring for his ill mother. The club members got together to provide food parcels for the home, found a grant they could access to help with support needs, arranged for the health clinic to provide input to help with the care of the mother – all of which meant the child could come back to school, knowing that his mother’s needs were being attended to.

3)       In another school, the Soul Buddyz got together to provide clothing, bedding and other house hold items to help the family re-build what they had lost after a fire at the family home.

4)       At the Sesethu Primary School in King Williams Town, club members noticed that many of the younger children were arriving at school upset due to conditions at home. The Soul Buddyz decided to help by greeting the children at the gates at the start of the day and have “put the smiles back on their faces”.

Soweto View

I was lucky enough to visit one club at the Winnie Ngwekazi Primary School in Soweto. The school is based in a township and surrounded by low level, very basic housing. We were welcomed on arrival at the School by the Club Facilitator, Lindi, and the Club’s secretary who took us to meet the club members. A rousing Soul Buddyz chant greeted us from a group of around 20 children who sang so loudly I thought the roof would be raised off the classroom! Following a PT demonstration and a couple more  songs, we sat down to chat. I asked what the Soul Buddyz liked about the club – a sea of hands shot up as children were desperate to share their views. Some responses were, “I like doing PT”, “I like learning new things”, “I like the respect we have for one another”,  “I enjoy doing the projects”, and all the members were clear that the club gave them lots of activities to do and had allowed them to make new friends.

I asked them what they liked about their community – a resounding reply was. “the Soul Buddyz club”! It clearly is a great resource and asset which they value and cherish. They then went on to tell me about the things they didn’t like so much about their community – the problems associated with alcohol and drugs, the violence, the fact that people don’t help each other or talk nicely to each other, the rubbish, the thieving that goes on – even at school.

But they have also been working had to try and address some of theses issues through thier Special Projects....

They told me about their work on the alcohol campaign where they had wanted to do something to influence levels of drinking in the area as this was leading to a lot of problems. The ‘Shabeens’ in township areas are the main suppliers of alcohol, often staying open late at night  resulting in heavy drinking and associated violence. The members worked with the group facilitator to raise their concerns about the issue and did a campaign across the school to highlight the dangers of drinking and the link to teenage pregnancy and violence. They also asked the facilitator to take their concerns to the Shabeen owners. Whilst these are all issues the club members have tried to address in some way – they are significant problems and clearly still remain a concern.

The club is also preparing for an intergenerational project  to celebrate and thank the grandmothers of the community. Much of the caring of the children is done by Grandmothers as many mothers are either out working or have problems of their own (e.g. drink / drug problems). Later this week, they are holding an event where the Grandmother’s will come into the school so the children can say thank you for all the work they do.

They showed me the ‘Healing Centre’ in the grounds of the school, a place where children and parents can come for help, support and counselling. They showed me the soft toys that were available to greet children using the service, telling me how, "just a cuddle from one of these can make you feel so much better."





With members of the Soul Buddyz Club, Winnie Ngwekazi Primary School, Soweto

By building awareness of common issues and problems in communities and encouraging a positive response – and by planting the seeds of cooperative working– the Soul Buddyz clubs are building adults of the future who will contribute to society and who are a real asset to current and future generations. They have an understanding of what matters – and that they can have a role on helping to address many issues. Soul Buddyz are true agents of change and Community Champions!

Bound for South Africa!

In just under a weeks time I will be flying to Johannesburg to begin Part 2 of my fellowship. I will spend 3 weeks in the country and visit a number of organisations to learn more about community engagement and development, well-being and asset based approaches in a very different context. 

I will be visiting the following organisations during my 3 week trip:

1) The Soul City Institute for Health & Development Communication, Johannesburg

 “The Soul City Institute is about improving lives; about changing situations for the better. It is about health communication; about individuals and communities focusing on human development. Soul City South Africa is about you – about showing you what is possible, what you can do, what social change means and how to achieve great things for your own health, your own quality of life and for those around you.”

 http://www.soulcity.org.za/

2) Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg
To learn about their work on 'Community Health Workers' as part of comprehensive primary health care in South African communities.

http://www.wits.ac.za/chp/

3) Ikhala Trust, Port Elizabeth

 Vision: Self reliant, secure and vibrant communities are built through a holistic, sustainable and positive intervention.

 www.ikhala.org.za

4) Angus Gilles Foundation, Grahamstown

Positive Health Champions and Positive Health Programme.

"This programme provides communities with as much information as possible, to enable them to achieve optimal physical, mental and spiritual well-being. The ‘Positive Health’ programme focus is more about presenting methods of preventing illness and staying healthy."

 http://www.angusgillisfoundation.co.za/index.php?p=127

 www.angusgillisfoundation.co.za

5) Community Development Resource Association, Cape Town

"Our purpose lies in contributing to the effectiveness and long term efficiency of organisations that do not marginalise but include, that maximise the value of diversity and that counter the tendency to use power to undermine and exploit in ways that diminish creative potential organisations that are empowering in their impact on society and in themselves. Our ultimate purpose is to contribute to building a society that is sustainable and civil. We promote organising principles, processes and practices that promote inclusion, dignity and development."

 http://www.cdra.org.za/

6) Reciprocity, Cape Town

Enterprise development work , inclusive business models and economic activity which increase social capital. http://www.reciprocity.co.za/micro-energy-aliance-mea.html

Reciprocity “the practice of exchanging  ideas, goods or services between two entities for their mutual benefit”

7) ABALIMI

An urban agriculture and environmental action association operating in the socio-economically neglected townships. Abalimi means: "the Planters" in Xhosa, the predominant language among our target community. We assist individuals, groups and community based organisations to initiate and maintain permanent organic food growing and nature conservation projects as the basis for sustainable lifestyles, self-help job creation, poverty alleviation.

www.abalimi.org.za

www.harvestofhope.co.za
www.farmgardentrust.org

8) GOLD Peer Education Development Agency

"A non-profit organisation playing a key role in the transformation of under-served communities through the roll out of a long term youth peer education model in collaboration with community based organisations." "It's about young people realising their value and being empowered to make informed decisions about the challenges they face. It's about equipping influential young people to impact their peers through positive peer pressure."

http://www.goldpe.org.za/

9) Dockda Rural Development Agency

Makes grants available to community projects and initiatives and strengthens community organisations and civil society through a dedicated Wellness Programme. We seek to promote links so that we can share mutual concerns and experience to enhance community's solution-finding capacity.

 http://www.dockda.org.za/about.htm

10) University of Cambridge Programme for Sustainability Leadership  (South African Office)

www.cpsl.cam.ac.uk / www.cpsl.co.za