Team PATA
Paediatric Aids Treatment for Africa
The Kidzpositive / Pepfar Du Noon Pediatric Community Outreach Project
Michael Levin
Email michael.levin@uct.ac.za
Site: Du Noon, Cape Town, South Africa
A community health worker spreads the message of hand washing.
Du Noon is a typical South African "township", a shanty town, where most buildings are shacks made from wood and corrugated iron. It is situated just North of Cape Town and borders a predominantly industrial area. About 60-80 000 people live in Du Noon and children under 12 years constitute 22 % of the total population with 56% of those children being under the age of 5 years. Water supply and sanitation is inadequate: 55% receive water via a pipe inside their house/yard. A large proportion of people 30+% use an outside/communal taps more or less 200m from where they live. Only 70% of the population has access to a flush toilet that is connected to a sewage system but 30% of people use bucket/pit latrines.
The health services in Du noon are overwhelmed by the need that exists in this poor community. One clinic serves both and children. It is a small prefabricated building with a general waiting area, 3 interconnected consulting rooms and a small pharmacy. A small separate prefabricated structure comprises another 3 small rooms where nursing staff deliver basic preventative child health services. About 80-100 children are seen every day and space and staffing limitations make follow up of concerning cases, nutritional assessment and regular growth monitoring or any health promotion impossible.
Dr Elbeth Hoffman, with one of her paediatric clients.
In May 2009, when the project first commenced a fragmented, disorganized and demotivated service was struggling along with this burden of disease. Children could not be followed up close to where they lived and very few children had been assessed for HIV and commenced on antiretrovirals.
The Kidzpositive / Pepfar Du Noon Pediatric Community Outreach Project has had a major impact on the health of the Du Noon community by providing an example of excellent service delivery and by working with local health partners to co-ordinate and improve child health in the area. Although staff comprises only one full time doctor, one community health worker and a researcher, we have had a wide-reaching (and sustainable) impact by upskilling staff from other organisations, notably both doctors and nurses from the 2 local clinics, HIV counselors and community health workers from other non-profit organisations and social workers.
Government partners
We continue work closely with and support the activities of 2 clinics in Du Noon and rely on access to their practical resources and infrastructure to improve child health in these areas. Rather than set up independent sites for service delivery, we integrate as much as possible with these sites and improve them in practical ways. We provide paediatric protocols and update management of HIV and TB as guidelines change and help with difficult cases. We ensure smooth referral pathways between these 2 clinics and their referral hospitals, subspecialist services and social services. Moreover we hold regular meetings between the facility managers and their upline supervisors to ensure that quality control is achieved. These meetings provided opportunity for transparent discussion and problem-solving and attempting goal directing actions with all stakeholders present.
A child waits for his appointment
In-service Training: Clinic Staff
Staff at the clinics are trained in assessment and management of paediatric HIV and paediatric TB. This is done by purchasing material and mentoring the staff through a self-study course, investing as much time is needed for each individual (usually weekly meetings) and through fostering structured study groups to facilitate co-operative learning and peer-tuition. So far 4 nurses, 2 counsellors and 4 community workers / ARV counsellors have successfully passed the course and received accreditation. In addition we have commenced training of 3 TB sisters, 5 ARV sisters, 3 child health sisters, 9 community health workers / home based carers and 2 ARV doctors.
Occupational therapy service
We have partnered with an occupational therapist (paid for by Kidzpositive from other funds). This allows us to assess and treat children with developmental delay and train parents in techniques to assist their children. In line with our ethos of co-ordination, our OT works with all other organisations working with children in the area and has build referral networks between them.
Community health workers and some of the children they "serve"
Community Health Workers (CHW)
We strongly believe that CHW play a crucial role in broadening access and coverage of health service within the community they work in and can undertake actions that lead to improved health outcomes. However many organisations work in this community and none of them have had training on paediatric assessment or care. Ongoing training, support and recognition is an important part to enable them to carry out their tasks successfully and this is an especially important part of our project. In 2009-2010 we trained 30 CHW from 4 organisations. Weekly workshops are held around child health topics are structured around South Africas’s Integrated Management of Childhood Illness protocols for community health workers. Topics include childhood immunizations, growth and nutrition, disability, child abuse, family planning, gastroenteritis, social grants, childhood development, HIV, TB and many others. The community health workers are encouraged to take part in health days organized by the project and spread the message to members of the community.
Community involvement outside the health sector
Our project has established links with family, child and social welfare organisations, offering training and facilitating mutual referrals. We are a member of the multi-sectorial task team to fight HIV/AIDS which networks between organisations with this common purpose. Most notably, our medical officer has been elected in her private capacity to serve as secretary of the Interim Health Committee for Dunoon in order to help the set up this valuable structure which allows community members to influence structures related to health service delivery in their areas.
Summary
In essence, although we have only 2 full time staff members and a tiny budget, we are the focal hub for co-ordination and quality control of all services related to paediatric care in the Du Noon community. We train and support government staff, other Non Governmental organisations and numerous community health workers. We ensure paediatric protocols are complete, accurate and up-to-date and we grease the wheels of paediatric referrals.
Ndebele cards
Our new product 'Ndebele cards' feature beautiful ethnic designs on beaded squares with a pin attached so you are buying more than just a card and your purchase is supporting a family affected by HIV/AIDS. The beadwork can be worn as a brooch or pinned to a bag. The cards are R20 each and can be ordered from beads@kidzpositive.org or inquiries to
+27 21 686 9710.