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Johannesburg - The toddler bolts towards the hut the moment he spots Funeka Xhalisa. Walking at a steady pace down the hill towards the toddler’s homestead, Xhalisa cracks a broad smile when she spots the little one.
The toddler’s chubby legs almost struggle to keep up with his enthusiasm to reach the hut, and he screams past the dogs lazing by the door, bellies turned to the afternoon sun.
His high-pitched, excited yelling alerts the women in the hut to Xhalisa’s approach, and they turn to greet her as she enters the door, offering her the only semblance of a seat, a wonky wooden bench against the wall.
Xhalisa rummages through her rucksack and produces a scale, gingerly placing it on the mud floor.
In the time it takes Xhalisa to prepare, the toddler has flung off his tattered clothing and waits naked and impatiently for the women to stop chattering.
He hops on to the scale and proudly looks up at Xhalisa, who bends over to read the weight, earnestly recording it on a chart. When she is finished, she smiles and pats him on the head. The women clap enthusiastically and help him to get dressed while another toddler is weighed.
With policymakers and researchers trying to find ways to transform South Africa’s ailing primary health-care system, the Philani Maternal, Child Heath & Nutrition Project, of which Xhalisa and other women are a vital cog, is slowly but surely revolutionising the health outcomes of mothers and infants in a small corner of the the OR Tambo district, in rural Eastern Cape, and in Cape Town, including Khayelitsha.
Philani is having a major impact on health outcomes for both the women and their children.
In essence, Philani hits at the heart of some of South Africa’s biggest and most challenging health problems, which affect the health of mothers and children: HIV, TB, unsafe delivery and poor birth outcomes, foetal alcohol syndrome, and high rates of infant malnutrition and stunting.
Philani’s core intervention is to recruit mothers from their communities like Xhalisa, who have managed to raise healthy children despite their circumstances, as mentor mothers.
The mentor mothers visit mothers-to-be in their homes and continue to visit them years after the child has been born, firstly ensuring that the pregnant mother has a healthy and safe birth and then ensuring that the baby grows and thrives.
These visits continue until the child is six years old. The mentor mothers are also continually trained on how to handle the various challenges they are confronted with.
The mentor mothers literally walk from house to house, and in the Eastern Cape this translates into hiking up demanding hills and navigating poor transport links to identify and support pregnant women and malnourished children.
The task list is long, but critical. Among others, all children under six years old in the household are weighed, their growth monitored on charts, clinic cards are checked to see if they have received their immunisations, exclusive breast-feeding is supported, nutrition is discussed with tips on how to make healthy, affordable meals, and clinic referrals are completed.
A novel approach has been to incorporate early childhood development into home-based support from the mentor mothers.
The pregnant women receive HIV counselling, discussions take place on accessing grants, and so on.
“If they identify a severely malnourished infant, the mentor mothers will continue to visit that household on a daily or weekly basis, depending on the severity of the situation,” explains Sarah Gouws, who manages the Eastern Cape project.
Philani started in Zithulele, near Mqanduli in the Eastern Cape, more than two years ago and has now expanded to nearby Coffee Bay.
In total, 44 mentor mothers are working in the OR Tambo District, and they average well over 3 000 visits every month to some 1 200 households.
In a relatively short time, anecdotal evidence is showing that the impact is significant, with reports from Zithulele Hospital doctors indicating that they have seen a decrease in malnourished children.
Senior Philani staff have regular meeting with the chiefs and headmen.
Hundreds of kilometres away from Zithulele, the Cape Town leg has been running since 2000, and 120 mentor mothers reach up to 4 000 families annually.
Nokwanele Mbewu, senior programme manager for the outreach programme, believes the strength of Philani lies in the fact that it reaches people in their homes as opposed to health institutions.
“We acknowledge the mentor mothers’ coping skills, and we strengthen these mechanisms and encourage them to go back to their communities and share what they have learned,” she says.
Mbewu adds that the programme is not only about nutrition, but also about ensuring that the children grow cognitively. This means the mothers are encouraged to engage with their babies while still in the womb and once they are born. She believes that mentor mothers set themselves apart from community health workers because they focus on the entire household as opposed to a single health problem.
“We deal with all problems, and while we may not be able to solve them all, we can offer the family support in its attempt to find solutions. We’re not educators, but listeners,” she says.
Philani was founded more than 30 years ago by Dr Ingrid le Roux and community members who believed that nutrition and health were the starting points if every child in this country was to develop to their full potential.
“A child that is malnourished and sick is not going to be educated. So we felt nutrition should be the basis,” says Le Roux.
“We aim to help mothers to help themselves. By working with mothers, educating them in the basics of nutrition and health, providing them with skills training and giving them an opportunity to earn a living, they ensure not only the health and well-being of their children and themselves, but of their community,” she says. – Health-e News Service