Category: Resourceful Young Children | Test population-based models of provision | 23 January, 2013 - 10:08← BACK
The Philani Mentor Mother Programme is addressing South Africa’s high maternal and child morbidity and mortality and its underlying causes. Child malnutrition and the high HIV and TB prevalence in OR Tambo, Eastern Cape - one of South Africa’s poorest district - contribute to South Africa’s failure to reach the millennium development goals 4 and 5. Through its home-based approach the programme improves access to basic health care for many isolated rural communities. The programme also addresses the lack of access to preschools for children in this district by including early childhood development and stimulation in its intervention. We believe that the programme can help decrease maternal and child mortality and morbidity and contribute to improved child development.
The Philani mentor mothers identify every pregnant woman and underweight child less than 6 years of age in their geographical areas and invite them to participate in the Philani intervention programme. This programme moves maternal, child health nutrition, protection and care beyond health facilities making it home based. It works holistically by including child development, stimulation and play in its intervention programme. The strategy of the mentor mother programme is to intervene at household level, rehabilitating underweight children and supporting women through their pregnancies, encouraging HIV and TB testing, PMTCT participation, delivery at a health facility and appropriate feeding practices to make pregnancy safer, birth outcomes and child health and development better. With a listening and respectful approach behaviour can change to benefit both mother and child. Health, well-being and early childhood development are closely linked and mentor mothers discuss ways for mothers to bond with and stimulate their children from an early age.
A total of 41 mentor mothers have been recruited in Zithulele and Coffee Bay and trained in maternal child health, nutrition and early childhood stimulation and development and they are covering as many communities with their full home based intervention programme. In the Zithulele area with twenty four mentor mothers a total of 766 pregnant mothers and 128 underweight children were actively part of the progamme at the end of July 2012. Between 2 250 and 2 600 visits are done every month and between 1 600 and 2 000 children are weighed every month. Seventeen mentor mothers have been working in the Coffee Bay area since April 2012 and a total of 209 pregnant women and 51 underweight children had been admitted to the programme by the end of July 2012. We also do a little less than 2 000 visits and weigh almost 2 000 children per month in this area.
The success of the programme is dependent on the quality of the mentor mothers intervention at household level and critical factors to achieve this are a careful selection process, relevant and thorough in classroom and continuous in service training, building a respectful relationship with families, strong support and supervision structures, self-assessment and an ongoing evaluation process. The Philani intervention model has proven to be successful in an urban setting and the Philani mentor mother programme in the Eastern Cape was initiated to test it in a rural setting. We do not believe that any community health worker programme can be successful without paying close attention to these factors.
More of our lessons learned:
We have been surprised over the keen interest in the mentor mother’s programmme from the rural communities around Zithulele and Coffee Bay. Chiefs, headmen grandmothers and fathers have requested meetings and training workshops and these training sessions have been very well received. The fact that the programme and individual mentor mothers are seen and appreciated by leaders in the community has increased mentor mothers’ self-esteem, confidence and motivation. A natural accountability process is developed through this. This is different from contact with counselors in the peri-urban Cape Town where political posturing and conflict between factions often in the same party make contact with leaders rather something to avoid.
When work started in the Coffee Bay area mentor mothers soon came back with the suggestion that they visit every household in their areas. They felt that even if there was no pregnant woman or underweight child in the homestead there were issues - often social-economical but also health related - which needed attention and where they could intervene. A home visiting form was designed to register these issues and record interventions and outcomes in both Coffee Bay and Zithulele. This asccounts for our high number of social referrals for ID books, birth certificates, grants, pensions etc. Our coordinator responsible for referrals has created good relationships with home affairs and social services employees and can now get clients’ documents and grants processed in reasonable time. She has canvassed and received support from politicians in the area to back up her demands for proper services from government departments.
Our mentor mothers are deeply concerned over the high numbers of teenage pregnancies in their areas and this is an issue that has been discussed at the community workshops in an attempt to together with leaders and elders find a way forward.
The aim is for the mentor mother programme to be integrated into the Primary Health Care system in the area and we have hoped to engage the Department of Health in the Province in discussions about this process. It has proven difficult as emails and telephone calls are not responded to and agreements about meetings are not honored. The cooperation in the field is on the contrary working very well and expression of appreciation of the mentor mothers’ work from the clinical staff at the hospital and clinics is an important motivating factor. The idea is not to increase but to lighten the load on hospitals and clinics by preventative measures and home based health interventions.
We know that the programme is only as good as the quality of the individual mentor mother’s intervention in the home. We have again observed the importance of varying classroom-based training, presentations and role-plays with field exposure. Review and repetition of training as well as in-service training consolidate the learning process. The importance of a respectful attitude and willingness to listen to mothers/caretakers is stressed in the training, creating good relationships where a positive change of behaviour is possible. The importance of not attempting to solve the family’s many social problems but supporting them in finding their own solution is continuously stressed.
In both the rural and urban context the availability of supervision and support is a key ingredient to quality intervention, essential to maintain motivation and commitment. The current staff ratio in the programme is 10-12 mentor mothers to one assistant co-coordinator, who is usually a more experienced mentor mother who has come through the ranks, and shown leadership. We have learnt the importance of debriefing sessions and performance appraisals. The work is hard, the mentor mothers meet deep poverty, illness and desperation and we accept that not every trained mentor mother will be able to continue delivering a good intervention over many years. Some discover after a short time that the work is just too hard. The Eastern Cape staff stresses the importance of close contact and support from the Cape Town outreach team including regular visits.
The positive factors are strong community interest and support, good cooperation with and support from clinics and hospital, committed, enthusiastic and hard working mentor mothers and support staff. Challenging meaningful work, which gives the staff a feeling of making a difference in individual and communities’ life.
The difficulties are poverty, the feeling of isolation and powerlessness in this part of South Africa, distances, poor roads, poor services, the lack of education for children and youth as a way to escape poverty, teenage pregnancies in high numbers, the great difficulty to set up meetings with government staff at any level, sub-district, or district, the often very poorly organized meetings the staff is called to where no one from the health department arrives, corrupt and unhelpful social services, home affairs, etc.
The way forward
Philani wants to consolidate the established programmes and expand to new areas according to needs expressed by communities. We want to strengthen the ECD component by recruiting and training assistant mentor mothers and employ an ECD coordinator. We will continue our effort to make contact with the Department of Health and get the memorandum of understanding signed, which we have drawn-up and sent to the Department as a first step in cooperation. We will continue to collect baseline information on health and social needs from all households visited to guide our interventions. We will participate in a “birth study” run by Zithulele hospital and Stellenbosch University following up for 12-18 months all children born in the areas over a 2 months period.
Phaphani Street, Khayelitsha
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In this learning brief the Philani Maternal Child Health and Nutrition Project shares their best practice in terms of implementing their community-based programme where mothers who did well in parenting, despite difficult circumstances, are paired as mentors to pregnant or new mothers. Despite different outcomes for interventions, all community-based projects share common challenges and thus many organisations can learn from their experience.