a model for transforming healthcare
in South Africa and beyond
The Enable solution is simple: integrated, door-to-door, health interventions by trained Mentor Mothers, providing access and referrals to clinics and hospitals.
The Enable project targets the most vulnerable – expectant mothers and children up to the age of five – through door-to-door visits. One to One Children’s Fund empowers local women, many of them HIV positive, equipping them with skills and knowledge to carry out basic health checks.
They arrange regular visits to monitor their health, provide support and advice and, if further medical care or drugs are required, refer them on to a clinic. Where needed, they can help with transport.
To date, our Mentor Mothers have accumulated a caseload of 1,452 clients of which 669 are children, and a further 36,905 members of the community receive health and awareness-raising sessions, addressing issues such as family planning, HIV and treatment adherence, and child and maternal health.
In addition, 3,340 children have been weighed and are monitored until the age of 6. The stand-out achievement of the project so far has been an almost 0%
MAJOR ACHIEVEMENTS TO DATE
members of the community benefited from health and awareness-raising sessions, of which 18,453 are children
mothers-to-be, babies and children directly cared for by Mentor Mothers
transmission rate of HIV from mother to child
people trained, educated and counselled
ENABLE PHASE II
We launched Enable Phase II in April 2019 and the key developments are:
Overcoming barriers to clinic access
Home-based interventions are crucial in improving health outcomes for expectant mothers and children under 5, however, clients also need to be referred to quality clinical services in order for the project to maximise its impact. Enable overcomes barriers to accessing clinics by early diagnoses and referral and providing transport or transport fees to access the nearest clinic or hospital. Our Mentor Mothers and Community Health Workers accompany clients to appointments to ensure they are seen, and a Mentor Mother is based at the hospital to provide additional support.
Training Government Community Health Workers
Unfortunately, the national policy of government-employed Community Health Workers conducting outreach services from health clinics is not being translated into reality. So far, we have trained 27 Community Health Workers in the Mentor Mother methodology with four-weeks of classroom training and two weeks of observed field training, and they will receive continued supervision, support and training so they can realise their professional potential and save lives.
Extending outreach services
By resourcing and training Community Health Workers to provide comprehensive community-based services we can demonstrate the positive impact this has on health outcomes, particularly in remote, rural areas. The project will build an existing evidence base with which to lobby the Department of Health; invest in more supervision, training and equipping of Community Health Workers, and adopt the One to One model.
“The Mentor Mother first came to me when I was five months pregnant. I only started taking my medication after she encouraged me to. I wouldn’t be here if it wasn’t for her. I think I would be dead by now.”
“In 2003, I tested positive for HIV. I was discriminated by my community, even by my family. Being a Mentor Mother makes me feel like a helper. I advise people by making them realise that this (HIV) is not the end of the world for them. They can still get up and go on to achieve their dreams and not just sit around waiting for the day they will pass away.”
CASE STUDY: MENTOR MOTHERS ZANELE AND VUYOKAZI
By Miranda Prynne
We joined Mentor Mothers Zanele and Vuyokazi on a visit. The mother is nine months pregnant, due any day, and is complaining of swelling in her legs and pain in her hips. She is 35 years old but looks a lot older. She is weighed, her blood pressure checked, and she talks to Zanele and Vuyokazi as they update her files. She has their mobile numbers to ring if she needs any help. They advise her to ring the clinic if the pain in her hip gets worse and she must arrange to go to the clinic the moment she goes into labour. They hand her a sealed package containing antiseptic and wipes to clean the umbilical cord, just in case.
The advice from the Mentor Mothers is simple enough – breastfeed your babies, feed your children a varied diet with fruit and vegetables when possible, ensure your children are immunised, if you carry HIV, do not stop taking your antiretrovirals, ever.
The simplicity of the Enable model is its secret. This is no glamorous vanity project. It is a practical, low-cost solution to a problem.
NEW INITIATIVES STARTED BY MENTOR MOTHERS
Our Mentor Mothers are always looking for ways they can help mothers and children in Mankosi live their healthiest lives. Here are some new activities they have started in the past six months.
REACHING YOUNG PEOPLE
Mentor Mothers have identified three schools where they can run teen health and HIV-prevention classes for 11-17 year olds
HIV SUPPORT GROUPS
Mentor Mothers have formed two support groups for mothers affected by HIV where they can help them address psychosocial issues and take control of their own and their children’s health.
CLOSER TIES WITH LOCAL HOSPITALS
Mentor Mothers will alternate two days a week in the local hospital to better coordinate patient care, and offer breastfeeding classes to women who have recently delivered in the hospital.
We feel we are in a strong position to take this proven community health model to scale in neighbouring areas of the Eastern Cape, bringing in Community Health Workers as well as Mentor Mothers. We are also expanding our intervention to include sexual reproductive health and mental health, and using mobile technology to improve effectiveness. If we secure funding, we aim to reach 2,400 families directly and bring improved access to healthcare for thousands more.
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