A South African People’s Health University (SAPHU) programme is offered by the People’s Health Movement South Africa (PHM-SA) in the Northern Cape province of South Africa. Although the Northern Cape is not one of the poorest provinces, unemployment is close to 30% and there are extremely high levels of TB, including multiple drug resistant TB.
The participants attending the Northern Cape SAPHU programme in 2017 all came from the Francis Baard District, from the small towns of Hartswater, Jan Kempdorp and Pampierstad, bordering on the John Taolo Gaetsewe district with shocking TB statistics. The last group was from Kimberley, which is the capital of the province, where the SAPHU was held. There were 18 participants in total, of which six came from Kimberley, four from Hartswater, three from Jan Kempdorp, and five from Pampierstad.
In the case studies of their community assets and needs assessment prior to the four-day SAPHU course (10-13 October 2017), all groups stated that in their communities there was a mixture of formal and informal housing structures, with the formal housing having running water and flush toilets, and most people in their communities making an effort to grow flowers, trees and grass and keep their yards clean. At present in Pampierstad, the street drainage system is blocked due to sand and litter that enter the drains, making this an unhealthy environmental issue. The smaller towns, situated about 140 kilometres from Kimberley, all border on farming areas of the North West Province. Only Hartswater and Kimberley have private health services; Pampierstad and Jan Kempdorp have public clinics and traditional healers are present in all areas.
In relation to their working conditions, the greatest challenges are not having any protective clothing for heat or rain, or when dealing with clients where they should have masks and gloves to protect themselves from highly contagious infections. In rainy weather it is difficult to visit their clients. The Department of Health (DoH) often pays their stipends late and when they have challenges, they are caught between the NGO that is the conduit for their payment and management, and the DoH, both shirking responsibility for conditions of service and for supporting the Community Health Workers (CHWs) in their work.
The groups from different towns in the Northern Cape each identified a project for their area.
The Kimberley group identified TB as one of their biggest problems and will be targeting primary schools as they believe that young children are open to learning through games and songs and will take the messages home with them for the rest of the family.
The Pampierstad group will also tackle TB, but will target the general population at taverns, taxi and bus ranks, restaurants, schools and creches and will have monthly campaigns for all in the town at the local stadium.
The Jan Kempdorp group is tackling a littering dumping site in the community as they have observed that this health hazard is increasing and is particularly dangerous for children.
The Hartswater group has identified that a lot of children in an area called Nkandla have not been fully immunised. They would like to reach 100% immunisation coverage. They will do home visits in their area and have campaigns encouraging immunisation.
All groups have set objectives to reach by the time the follow-up workshop takes place in February or March 2018 to evaluate how they have managed and where they need further assistance.
Participants’ Experience of the SAPHU
Discussions were animated and participatory, and participants appreciated the opportunity to come together and share their challenges, as well as learn from and get support from each other. They felt that the SAPHU was a valuable experience as it offered a chance to deepen their understanding of the role of social determinants of health in illness and disease, find out how to look for ‘the causes of the causes’ when coming upon a problem and not only for the cure, discuss the importance of CHWs and the roles they play in other countries, learn more about the background of health systems, the comprehensive primary health care (PHC) approach and its elements, and making them feel empowered to make a difference in the world and in other people’s lives.