On a recent morning in Sefikile, in North West Province South Africa, something unusual appeared at the edge of town. As the sun rose, a small cluster of white tents popped up, one canopy at a time. Health care workers and volunteers strode between the temporary structures, unstacking bright blue chairs, setting up banners, and preparing medical supplies.
It was the first day of I-TECH’s Re Mmogo Pholong (Setswana for “Together in Wellness”) community health event, and soon, local residents gathered in the waiting areas, talking easily together. After each visitor was privately registered, many took the opportunity to have a wellness exam and screening, talk with a community health care worker, and be tested for HIV and other sexually transmitted infections (STIs). At the conclusion of their visit, most also met with an onsite nurse.
Re Mmogo Pholong is one part of a wider, community-based I-TECH prevention program, funded through the US Centers for Disease Control and Prevention. The overall goal is to mobilize communities in order to reduce the incidence of HIV, particularly in two priority districts of South Africa. In these areas, which face high HIV burdens, the program will also support health services at local clinics, wellness clubs for people living with HIV, community activities, and additional services. The event in Sefikile, along with another in the town of Ledig, marked a successful launch for the program, which will continue throughout the year. In the first five weeks, Wellness Days are on track to screen over 500 people for HIV, STIs, and other health concerns.
Wires, but No Power
At first view, it’s difficult to pick out much about Sefikile. Tall industrial power lines run parallel to the town. In the morning, the roads are quiet; sunlight reaches across the low houses. In long pens, goats poke through strands of yellow grass, raising their heads to survey the dry terrain.
In fact, Sefikile’s residents face a host of challenges. Although it’s just a few miles from a large mine, Sefikile is an informal settlement, isolated from transportation, employment, and medical services. Despite the power lines, the settlement doesn’t have electricity. And when residents need medical care, they often walk or hitchhike miles to the nearest clinic.
“People have so many challenges that they have to prioritize issues, and health sometimes falls behind,” explains Lebogang Ntswane, Re Mmogo Pholong project coordinator, “–especially when it’s difficult to access services.” She adds that the Re Mmogo Pholong event, together with the other events and services in the program, are designed to help alleviate some of these barriers. For a few days each month, residents can take advantage of free family planning and provision of contraception, hypertension and diabetes management, personalized risk reduction counselling, pregnancy testing, screening for tuberculosis, HIV testing, sexually transmitted infection screening, and onsite treatment. For many visitors, the event is the only access to health services they can manage.
At the launch, one young woman passed her daughter gently to a neighbor when her name was called. “My friend heard about this,” she said, “so I came. Some people went home and decided to come back tomorrow, but I wanted to do this today.”
“The first day, everyone comes,” says Ntswane, smiling. “Communities are close, so people say, ‘oh, my neighbor was here,’ or, ‘I saw a flyer for this’–and sometimes a lot of people have seen that single flyer in just a day!”
“Some come thinking, ‘oh, I’ll just have my blood pressure checked,’” she adds, “but in the end, most take advantage of all of the services we offer.”
A Combined Approach
Wellness Days are only one part of the larger I-TECH initiative. “We designed the overarching prevention program based on an analysis of, and discussions with, local communities,”* says Jay Gilvydis, I-TECH South Africa Director of Training and Program Implementation. “We’re working to meet the needs of these communities and lower the incidence of HIV through what we call ‘biomedical, structural, and behavioral interventions’–that is, by combining a few key approaches.”
Ntswane elaborates: “We have eight days of wellness events each month,” she laughs, “so what happens the rest of the month?” She explains that I-TECH will also be providing hands-on support and mentoring to nurses, counselors, and monitoring and evaluation staff at a local clinic linked with each site. Wellness clubs for people living with HIV will provide emotional and psychosocial support and training on a wide range of topics, from household budgeting to dealing with substance abuse and gender-based violence. Other activities bring all residents together on projects, such as community gardens, to improve their joint quality of life. In addition, the program includes onsite events that provide residents access to other government services, such as obtaining identification cards for themselves or birth certificates for their children. Finally, Re Mmogo Pholong uses volunteers and community working groups to keep in touch with residents. “Our community working groups will be our eyes and ears on the ground,” explains Ntswane. “They can help us get the word out about upcoming events, bring us ideas and concerns from the communities, and help us target our strengths and challenges.”
During the first year of the project, I-TECH activities will eventually reach nine sites in the two target districts; in the second year, it is expected to expand into two additional sub-districts.
“I Was Waiting for This”
Back in Sefikile, a woman in her seventies sat on the edge of a blue chair, gesturing with a slender hand as she chatted with her neighbors. “I’m here to check my blood pressure, and to talk to a nurse,” she explained. “I couldn’t travel [to a clinic], but I can walk here. –I was waiting for this!”
Read more about I-TECH’s work in South Africa
* I-TECH and the University of California San Francisco’s Center for AIDS Prevention Studies (UCSF-CAPS) conducted a situational analysis in the two priority areas. The analysis included about 300 interviews with key informants, focus groups, and in-depth interviews. Through this process, nine community-based venues were identified to target HIV prevention activities.