ENABLE
BEYOND THE HALO
19th Jan 2022
The Enable solution is simple: integrated, door-to-door, health interventions by trained Mentor Mothers, providing access and referrals to clinics and hospitals.
In South Africa, half of child deaths occur within the first month of life and 24% of pregnant mothers are HIV positive.
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 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% mother-to-child transmission of HIV rate after more than 500 births, despite the fact that nearly 24% of the mothers we work with are HIV+.
MAJOR ACHIEVEMENTS TO DATE
1,452
mothers-to-be, babies and children directly cared for by Mentor Mothers
36,905
members of the community benefited from health and awareness raising sessions, of which 18,453 are children
0%
transmission rate of HIV from mother to child
615
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 classroom training and two-weeks 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; to invest in more supervision, training and equipping of Community Health Workers, and to adopt the One to One model.
The Mentor Mother first came to me when I was 5 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.
MENTOR MOTHERS ZANELE AND VUYOKAZI
Case study 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, 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.
Until meeting the Mentor Mothers, this expectant mother had no birth papers. As far as the South African government was concerned, she did not exist. This would have meant she could not register the birth of her new baby and apply for the child support grants she dearly needs.
The Mentor Mothers help with the paperwork. They help local women navigate the bureaucracy necessary to access government support. They provide the vital missing link between the government services and the Xhosa villagers.
Other members of our group met entire families whose livelihood had been saved from disaster by the early diagnosis and intervention of the Mentor Mothers. One party ended up making an emergency dash to the hospital after arriving to find a mother in labour.
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. A solution that, with the right backing, could be applied on a much wider scale through government community health workers to improve the wellbeing of millions of young children and mothers.
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.
LOOKING FORWARD
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.
