Miranda Prynne documents her insights from her educational trip to see our Enable project in action.
I am sitting on a wooden bench in a draughty clay-built hut with a packed mud floor. There are no windows but a cold wind rattles through the gaps between the walls and corrugated iron roof. A second narrow wooden bench, small battered cupboard and mattress heavy with blankets constitutes the furniture. A fire smoulders in the corner, its smoke stinging the eyes. This basic shelter is home to a heavily pregnant mother, her husband and their two growing children. A couple of skinny pigs rootle in the dirt outside.
It is a scene of stark poverty. Yet, sitting shivering quietly on that wooden bench, I feel a rush of hope – and hope is a valuable currency. Hope leads to action.
I am in South Africa’s rural Eastern Cape, one of the most beautiful but deprived regions in a country of extremes. This is a world away from the stuccoed suburban palaces of Johannesburg and Cape Town.
We are visiting the expectant mother with the One to One Children’s Fund, a charity that is revolutionising healthcare in the remote Xhosa communities of Coffee Bay.
These rambling hilltop villages on the Wild Coast of the former Transkei Republic are beset with health issues – high infant mortality, malnutrition, HIV, TB and more.
Healthcare is hard to come by in an area where you must travel many miles on foot to reach a clinic or hospital. Once there, there is no guarantee the drugs you need will be available due to widespread shortages. Many people here have no ID papers as their births were never registered making access to government services even more problematic. HIV is still stigmatised forcing people to hide their antiretrovirals or worse, give up taking them.
One to One’s Enable project targets the most vulnerable – expectant mothers and children up to the age of five – through door to door visits.
But it is not white male doctors with a dozen qualifications to their advising these women. This project relies on the local women themselves to assess and support their peers.
It is a simple model and it works. A select group of women from the Xhosa communities are trained as ‘Mentor Mothers’ equipping them with the skills and knowledge they need to carry out basic health checks.
The women travel around their local villages to identify mothers-to-be and young children most at risk. 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.
The key aim was to dramatically reduce under-five infant mortality and illness with a focus on preventing mother-to-child transmission of HIV, improving nutrition, raising immunisation rates and supporting good maternal mental health.
Just 18 months in, the Enable project’s Mentor Mothers have worked with 4,692 mothers, babies and young children, reduced HIV mother to child transmission rates to less than one per cent in target households, increased attendance of antenatal appointments by 20 per cent, increased adherence to antiretroviral treatment by 25 per cent and rehabilitated 75 per cent of underweight babies.
“The first few years of a child’s life are the most critical,” explains David Altschuler, co-founder and chair of the One to One Children’s Fund which works to transform the lives of vulnerable children all over the world.
In South Africa under-five infant mortality remains very high. Studies show that without intervention, one in three babies born to HIV positive mothers will contract the virus either in the womb, at birth or while being breastfed. In a region where about 29 per cent of pregnant women are living with HIV this is a huge problem.
Even when uninfected with HIV, children born to mothers who carry the virus are twice as likely to die before reaching their first birthday. They are at higher risk of severe infection and suffer a higher rate of premature birth than those with mothers free of HIV. This is where the ongoing health checks and advice are vital.
Too few women attend antenatal checks due to poverty, lack of knowledge and cultural taboos which is why we are taking the checks directly to them to protect both mother and baby.
“Good health is the starting point to enable any child to become physically and mentally resilient, access education and do well later in life.”
Thanks to the Mentor Mothers, health issues are spotted early. Referrals, medical care and drugs get to the right people. The local women have someone they know and trust who they can contact for advice. Less people are dying since One to One came to Coffee Bay.
In an area rife with unemployment, many men move away to seek work in towns and cities leaving the family units and communities reliant on the women. Many of these men become infected with HIV and return to their rural homes passing on the virus to their spouses. Yet their children’s survival depends upon the mother’s continued good health.
Alongside its primary objectives, the Enable project is a tale of female empowerment. The Mentor Mothers are local Xhosa women, their homes are no different to the homes they visit, they face the same challenges, the same health issues, the same worries about how best to feed and care for their young children as those of their patients. Many of them are HIV positive.
But the Mentor Mothers command respect. When you meet them, you quickly understand why. These are 30 powerful women.
They greet us at One to One’s head office in Mankosi, near Coffee Bay, with an eruption of song and dance. There is chanting, clapping, laughter. These women have jobs in an area where employment is a rare commodity. Through the training, they have learnt how to look after themselves and their own children better. They are helping improve and save lives in their communities. These women are proud of what they do and rightfully so.
“When I was younger, I always wanted to be a nurse,” one Mentor Mother Zanele tells me as she explains why she joined the programme.
“I have learnt so much from doing this. I have learnt how to look after my children better, about better nutrition. I used to think if I fed them enough rice that was okay, but I now know they also need vegetables for good nutrition. We encourage all the local women we work with to grow their own vegetables to improve their family’s diets.”
We joined Zanele and fellow Mentor Mother Vuyokazi on a visit to two homes, which is how I find myself sitting on that bench, watching a quiet consultation unfold.
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.
We were visiting as part of an education trip with the UBS Optimus Foundation, the Swiss bank’s philanthropic arm which raised £47.6 million in 2017 to improve the lives of 2.1 million vulnerable children worldwide. This is one of the projects they support.
The Optimus team take a strategic approach to their work to ensure the greatest possible impact for each penny donated. Every project the Optimus Foundation works with is carefully vetted. They challenge partner programs to prove efficacy, value, scalability and sustainability with just five per cent of applicants meeting their standards.
Still in its pilot phase, the Enable project is working with the University of Stellenbosch to collect and independently evaluate data on programme outcomes and other findings unearthed during the regular health checks.
This should provide the One to One Children’s Fund team with the evidence base it needs to raise a further £2 million to scale up Enable over the next three years and lobby government to roll out this model. The first HIV treatment project for children and their mothers, run by One to One in South Africa’s Western Cape, was adopted by the provincial government to benefit thousands more in the scale up of antiretroviral treatment.
The philanthropic and charity sectors are often criticised for being too emotionally led, too ego-driven, creating dependence and lacking the sort of practical business thinking and evaluation that is needed to build long-term sustainable schemes.
Global problems are so widespread, complex and embedded, it is easy for people to feel overwhelmed, powerless and ultimately give up. When faced with a task as momentous as improving global health most of us don’t know where or how to start. The answer is simple: somewhere, anywhere.
David and his team are not attempting to solve all the world’s ills. They have identified a cluster of problems among one particularly vulnerable group and have set out to deal with that. But by working to improve maternal and early childhood health, they are indirectly supporting thousands more. Already more than 36,905 community members have gained from Enable services.
The ripple effect of such a project is enormous. If children can reach key developmental milestones in good health, their vulnerability is reduced and they are far more likely to thrive later in life. Whole communities and ultimately nations could benefit.
That is why, as I sit in the shadowy hut, watching the tired mother haul herself up off the bed to receive basic health checks ahead of giving birth to her third baby, I’m flooded with hope and humility.
With each small step, lives are saved and enhanced. For me at least, there is no longer any excuse for inaction.
By Miranda Prynne
This project is funded by UBS Optimus Foundation UK.
Justice Froneman obtained a B.A. degree from the University of Stellenbosch in 1974 and a LL.B degree from the University of South Africa in 1977.
After completing his pupillage at the Pretoria Bar he commenced practice as an advocate at the Eastern Cape Bar in Grahamstown in 1980. He obtained Senior Counsel status in 1990 and was appointed as a judge to the Eastern Cape High Court in 1994. In 1996 he was appointed as Deputy Judge President of the newly established Labour and Labour Appeal Courts, a post he held until 1999. In 2002 he acted for two terms in the Supreme Court of Appeal. In October 2009 Justice Froneman was appointed to the Constitutional Court.
Froneman was an extraordinary professor in public law at the University of Stellenbosch from 2003 to 2008 during which he participated in the specialised LL.M course in Human Rights by way of annual seminars. During periods of judicial leave he attended Harvard University (1999) and the Centre for Socio-Legal Studies, Oxford University (2008) in a visiting capacity. He has been involved in judicial training for new judges over a number of years and has also participated in practical training courses for magistrates, attorneys and advocates.
Rishda oversees the finance function of One to One Africa. She is a qualified Chartered Accountant and completed her articles at Ernst & Young Cape Town. She has a range of skills and experience in audit, financial management and corporate finance and across a range of industries, including Financial Services, Energy and Retail. She also has experience working with multi-national clients both in the UK and in South Africa.
Rishda has served on various professional, school and religious boards and committees over the years. After taking a break from her career to raise her children, she decided to utilise her skill set in the NGO sector. She joined the team of One to One Africa as a consultant in July 2019. She also currently serves as a director for the largest animal welfare organisation in the Western Cape.
Madeleine has a Masters in International Development from the University of Birmingham, alongside nine years’ experience working in the International Development sector. She began her career working for a $20 million health organisation to become Senior Business Development Manager and has since utilised this experience to consult for a range of organisations, specialising in strategy development, process and system design, and proposal development. This experience has culminated in her role as Business Development Manager at One to One Africa Children’s Fund.
Rochelle Carelse is an experienced Operational Manager with over 20 years of experience working in the NGO field. She joined One to One Children’s fund Africa, in May 2021 bringing a wealth of experience along in the fields of Finance, Procurement, HR, marketing and HIV operations/research. Before that, Rochelle worked at The Trauma Centre, Workers World, NACOSA , Desmond Tutu HIV Foundation and MES (Mould Empower and Serve).
Rochelle is a member of the South African Institute of Health Care Managers. Her qualifications include Management Certificate through the institute Damellin a further Higher Management Certificate through FPD where she boast cum laude pass mark and various studies of Grant and Cooperative Agreement course. She also has obtained certificates in Grants Policy and Management Training, Budgeting and costing for NPO’s, Fundraising Proposals and Financial aspects. She served on the Board/council of the Church of the Province of South Africa.
Rene Diane is the Impact Manager at One to One Africa. Rene is responsible for all monitoring and evaluation (M&E)-related activities currently focusing on the Enable programme’s transition to digitization.
Rene has over 16 years’ experience in social development and clinical health, working for organisations such Kheth’Impilo, NACOSA, Health & Development Africa and Hope Worldwide South Africa. She has led programme and M&E teams, and provided technical support and research oversight. Capacity development, Health System Strengthening and innovation is at the core of what Rene is passionate about.
Rene has a clinical health background and has worked as a nurse mainly in Botswana and South Africa before starting her career in M&E, capacity building and Health System strengthening. She is a qualified M&E Specialist, Assessor and experienced in digital health for monitoring and research purposes. Rene enjoys getting involved in projects which make a difference in communities and contributes towards social upliftment and social capital.
Dr Lillian Cingo is a South-African British professional nurse, counselling psychologist and honorary doctor.
For the last 8 years, she has been mentoring and fundraising for various HIV charities and NGO’s in South Africa. Prior to this, Dr Lillian was the Manager of the Transet Phelophepha Health-Care Train – a train that takes primary health-care and counselling services to rural South African communities – for over a decade.
Dr Lillian holds Honorary Doctorates from the Nelson Mandela Metropolitan University (South Africa), the Tavistock Centre (United Kingdom), the University of East London (United Kingdom), the University of Willemett (USA) and Rhodes University (South Africa). Dr Lilian also holds a Public Service Award from Liberal Caucus Queens Park (Canada) and a Doctorate of Social Science from the University of Cape Town (South Africa).
Over her career, Dr Lillian Cingo has won over 30 professional awards, including The Golden Key from the International Honour Society and being presented to the Queen as Best Neurological Nurse Specialist in 1975. Most recently, Dr Lillian was chosen as one of South Africa’s 21 icons alongside Nelson Mandela and Bishop Desmond Tutu.
Patience is a qualified Chartered Accountant with a passion of changing people’s livelihoods through implementation of various projects across the globe.
Over the past 15 years, Patience has been working in local and international organisations implementing education, agriculture, health and business linkages projects where she was responsible for building, leading and developing finance teams, implementing financial systems to optimize the financial performance of companies, risk management, grants management, compliance, pricing proposals and developing budgetary control models.
Patience worked in Zimbabwe for various profit and non-profit organisations. After moving to South Africa, she continued working in senior finance positions in local and global development organisations including DAI where she was responsible for financial management of projects across Africa.
A former Association of Chartered Certified Accountants (ACCA) South Africa, Network Panel member, Patience holds a BSc Honours from Oxford Brookes University and Masters in Business Leadership (MBL) from University of South Africa. She is a Chartered Accountant of England and Wales (ACA) and a Fellow Chartered Certified Accountant (FCCA).
Emma joined One to One Africa in August 2018 as our Head of Programmes. Emma has been working in the HIV/AIDS field for over 10 years; she has worked at the University of KwaZulu-Natal and at the School of Public Health at the University of the Western Cape where she also completed her doctoral studies in Public Health in 2017. Previously, Emma was Head of Operations at the Right2Know Campaign overseeing the Finance, Human Resources and fundraising departments as well as the day to day operations of the Campaign.
A former investment banker whose current work is a reflection of her personal passions, Gqibelo lives by the ethos that a life of service is a life well-lived, which is reflected in her work.
A graduate of the University of Cape Town and the Gordon Institute of Business Science (GIBS), she founded and ran a non-profit organisation for 15 years prior to joining One To One Africa in August 2021. As such, she is a seasoned leader and executive in the social development space, her previous organisation, Future of the African Daughter (FOTAD) having been publicly acknowledged by Mrs Michelle Obama.
Her work is characterized by her passionate but practical approach to her life and her work, informed by the unusual balance of her professional training in finance and economics, her passion and heart for the development and an almost quixotic enthusiasm and conviction in a better tomorrow for all. She is also a former member of the UN Women Civil Society Advisory Group (CSAG) Committee (RSA Multi-country office).
Jonathan Penkin is CEO of Goldman Sachs South Africa as well as the Head of Growth Markets ECM at Goldman Sachs International. Prior to this role, Jonathan was the Co-Head of the Financing Group in Asia Pacific (ex Japan) at Goldman Sachs Asia LLC.
Jonathan gained a BA in Political Science at the University of Cape Town before completing his MA in Political Science (Cum Laude) at the Hebrew University of Jerusalem. He also holds a BA in Jurisprudence from University College, Oxford.
Jonathan is a member of the Board of Governors of Tel Aviv University and a member of the International Council of the New Israel Fund.
Jenny Altschuler is a consultant clinical psychologist and family psychotherapist who has spent much of her professional life working in the public sector, most recently at the Tavistock Clinic, London.
Her work focused on families affected by life limiting illness, trauma and the training of health care professionals.
Jenny now works as an independent psychotherapist as well as supervisor and consultant to medical and mental health professionals working in a wide range of health care settings. She has also written extensively on ways of addressing the challenges that illness and trauma present.
Jenny has been instrumental in setting up our counselling centres in Kosovo, and the training and supervision of the counsellors who work in these centres is a matter of great importance to her.
Jenny also oversaw the clinical aspects of our Israeli-Palestinian trauma healing and Child Resilience projects. Her expertise is particularly relevant in advising on our HIV/AIDS initiatives, including our Expert Patient Programme and the work of PATA (Paediatric AIDS Treatment for Africa).
Executive Chairman
David is the co-founder of One to One Children’s Fund and the Chair of the Board of Trustees.
David qualified as a Chartered Account in South Africa, before transferring to the UK in 1977 to become Treasurer of Marks & Spencer plc.
Alongside his venture finance interests, David embarked on a career as a social entrepreneur some 25 years ago. He was Chairman of the Refusenik organisation and then co-founded the One to One Project with Rita Eker MBE, which led to the formation of One to One Children’s Fund in 2001, with a mission to relieve the suffering of vulnerable children, wherever there is no government or other support.
This led to the development of our HIV/AIDS support and treatment programmes in South Africa, trauma counselling programmes and day care centres in Kosovo and Israeli/Palestinian resilience building initiatives in the Middle East.
David is also the co-founder and Chairman of Paediatric AIDS Treatment for Africa (PATA), a network organisation of more than 400 HIV clinics across Africa, sharing best practice and treating more than 100,000 children born with HIV.
David received the Prime Minister’s Points of Light award in 2017 in recognition for his outstanding volunteer work benefitting thousands of vulnerable woman and children. He has also received the WIZO Commitment Award for Entrepreneurship in 2013 for his endeavours in the non-profit sector.