Resourceful Young Children

Resourceful Young Children
Learning Brief


Philani Maternal Child Health and Nutrition Project

lessons on successful programme implementation from the Philani Maternal, Child Health and Nutrition Project

Category: Resourceful Young Children | Formalisation of human resource development | 8 November, 2013 - 18:00

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Project Background

In 2013 Philani expanded its Eastern Cape Mentor Mother Programme, which is a home-based intervention developed to address South Africa’s high maternal and child health morbidity and mortality, and its underlying causes. This initiative is designed to work with the South African government in helping to reach the fourth and fifth Millennium Development Goals.

The Philani Programme aims to move health, nutrition protection and care beyond clinics and institutions into the community in order to improve access to basic health care for many isolated rural communities.

The programme works as follows: A trained mentor mother identifies pregnant women and underweight children in her geographic working area and invites them to participate in a health and child development intervention programme. She helps the family to rehabilitate an under weight child and supports pregnant women through their pregnancies - encouraging antenatal clinic attendance, HIV and TB testing, treatment participation and adherence, delivery at health facilities and appropriate feeding choices. This is an initiative designed to make pregnancy and delivery safer, and to improve child health and development. Health, wellbeing and early childhood development are closely linked and the mentor mothers discuss ways for mothers/caregivers to bond with and stimulate their children from an early age.

Where We Work

We work in the Eastern Cape villages of Zithulele and Coffee Bay. Zithulele is the site of a district hospital, and Coffee Bay is a seaside community some 350 km from East London, in the Mqanduli sub district, acknowledged to be one of the poorest areas of South Africa. The Coffee Bay and Zithulele communities face significant challenges - water must be carried from nearby rivers and dams and is seldom purified, electricity is not readily available, roads are poor, and transport to hospitals, clinics and other basic services are unaffordable for many. Social problems in these areas are rife. A high proportion of the male population are migrant workers. This along with the impact of HIV has decreased the number of adult family members able to do manual work in the homesteads. It is not uncommon to find young children heading households, not attending school and looking after younger siblings.

Our Programme Implementation

Our Philani Mentor Mother programme was started in these communities in 2010. It currently employs:

  • A project manager,
  • A project administrator,
  • 37 Health mentor mothers and 20 ECD mentor mothers
  • 2 Health coordinators and 1 ECD coordinator
  • 2 assistant coordinators who support the mentor mothers.

These individuals make up care teams and the Philani Eastern Cape teams currently look after 162 families with underweight children, and 1089 pregnant mothers. Together they conduct an average of 4000 home visits a month.

All of our so-called “Mentor Mothers” are fully trained by the Philani training team from Cape Town. The success of the Mentor Mother Programme is dependent on the quality of the mentor mothers’ intervention - their ability to transfer coping mechanisms and training content to the individual household level.

We carefully recruitment Mentor Mothers and give them practical and relevant classroom and service training, field support and supervision, monitoring and evaluation, and performance feed back.  We also cooperate with government health structures and community leaders to ensure the successful implementation of our care programme. We do not believe that any community health worker programme can be successful without paying close attention to these factors.

Critical Lessons Learned During Our Programme Implementation

Recruitment
In Zithulele and Coffee Bay, we ask the headmen and chiefs to propose potential mentor mother candidates. They are asked to make their suggestions according to various criteria of the person’s maturity, respectability, commitment to the community, status as a ‘positive deviant’, basic literacy, and understanding of health and social issues.

Senior staff members interview these candidates and afterwards they go through initial training. They are only finally accepted as staff members after completing the training and passing a competency test. During this time the trainers have a chance to observe the candidates, assess their attitude to the training and their fellow trainees, their punctuality, engagement with the training material, and their level of commitment.

The lesson learned is that it is worth investing time and effort in the recruitment and selection process of mother mentors. It will ensure quality intervention, limit the turnover of mentor mothers, and maintain continuity for families in their care.

Training
Experienced field and supervisory staff from our Cape Town offices conduct all the training and final recruitment. They provide instruction, based on years of experience, and they can accurately convey the vision of the model, the values of the project, its working routines and core activities.

During training we stress the importance of a respectful attitude and willingness to listen to mothers/caretakers. We encourage the creation of good relationships where positive change of behaviour is possible. We also highlight the importance of not attempting to solve the family’s many social problems but rather to focus on supporting them find their own solutions.

We believe that our programme is only as good as the quality of the individual mentor mother’s intervention in the home, which in turn is only as good as her commitment and knowledge. We have observed the importance of providing mother tongue instruction, varying classroom-based training, presentations and role-plays with field exposure.

The lesson learned is that it is worth investing in high quality trainers and training methods. These need to be inclusive and participatory, regularly reviewed and repeated as needed. Supervisors and coordinators must conduct follow-up field-based training to consolidate the learning process.

Support and Supervision

Our current staff ratio is roughly 12 mentor mothers reporting to 1 assistant co-coordinator. The assistant co-coordinator is usually a more experienced mentor mother who has come through the ranks, and shown leadership potential. The assistant co-coordinator runs difficult debriefing sessions and must create opportunities for relaxation and sharing for the mentor mothers – who regularly meet deep poverty, illness and desperation in their work.

At the managerial level, the Eastern Cape staff relies heavily upon close contact and support of the senior staff in Cape Town. We have learned that senior Cape Town staff must allocate more time for visits to the Eastern Cape office, and be available for frequent telephone and email support and advice.

The lesson learned is that the availability of daily, in the filed supervision and support is a key ingredient to quality intervention, and it is essential to maintaining motivation and commitment to the programme. We have also learned that supervision is a skill that does not come naturally to all, but needs to be taught. Many of our senior mentor mothers need training in how to supervise in a wise and effective way.

Monitoring, Evaluation and Performance Feedback
We monitor programme outputs such as number of visits, caseloads, hospital and social case referrals; and programme outcomes such as rehabilitation rates, grant application approvals, and HIV treatment adherence. The collected results are discussed with mentor mothers during their performance appraisals.

The lesson learned is that sharing this information focuses mentor mothers’ attention not only on increasing their visits and caseloads but also on improving the quality of their intervention. It makes their work more interesting and challenging when results can be measured and they can see the outcomes of their work in numbers and percentages.

Cooperation with Government
Our aim is for the Mentor Mother Programme to be integrated into the Primary Health Care system in the OR Tambo district and we have hoped to engage the Department of Health in the Province in discussions about this process. We have had success on the sub-district level but it has proven difficult to get meetings set up at district and provincial levels. Emails and telephone calls are not responded to and agreements about meetings are not honoured.

The lesson learned is that we need to be proactive and report our progress to the Department of Health but that getting their attention about our programme’s success is an on-going relationship building process, which requires patience and persistence.

Cooperation in the field with Zithulele hospital and most clinics is working very well and expression of appreciation of the mentor mothers’ work from the staff at the hospital and clinics is an important motivating factor. The mentor mothers follow up on patients who have been discharged from the hospital or who are not returning to clinics for their HIV or TB treatments. They refer these patients to the clinics and hospital where that are promptly treated. Six government Community Health Workers are participating in the present Philani training of newly recruited mentor mother candidates to further strengthen this cooperation.

The lesson learned is that building good relationships with the hospital and clinics is essential to be able to access efficient services for mothers and children and that good communication is a great help when mentor mothers need to follow up vulnerable patients recently discharged from hospital.

Cooperation with Community Structures
We are pleasantly surprised by the keen interest in the Mentor Mother’s Programme from the communities surrounding Zithulele and Coffee Bay. Chiefs, headmen, grandmothers, and fathers have asked us to host meetings and training workshops. These training sessions have been very well received. This has also boosted the mentor mothers’ self esteem, confidence and motivation, and has helped to develop a natural process of accountability in the community. Chiefs and headmen have helped us recruit suitable mentor mothers, and they have been open to our suggestions about approaching government to demand better services for their communities.

The lesson learned is that it is vital to engage chiefs in the programme objectives. This means informing them of health and social issues affecting their communities and guiding them on how to respond to these issues.

Remaining programmatically flexible in the face of contextual challenges
Our intervention in the communities we serve has highlighted a number of other issues that our mother mentors can help families overcome.

  • The families we serve often carry a heavy debt burden, which impacts on their health and wellbeing. They frequently go into debt with loan sharks who illegally hold onto the client’s bankcards. This has led our coordinators having to make contact with loan sharks in the community and challenging them to release the bank cards of desperate families, negotiating reasonable loan conditions, and establishing payback plans.
  • We have learnt not to target only households with pregnant women but instead to canvas every homestead in a community. Mentor mothers suggested that they visit every homestead in their area to attend to social-economic and health related issues. We subsequently designed a home visiting form to register these issues and record interventions and outcomes in both Coffee Bay and Zithulele.
  • The Philani coordinators also help family members to get their ID books, birth certificates, and welfare grant applications completed. They act as social advocates, challenging unhelpful, home affairs and social services employees to provide essential services. They have created good relationships with some of these government officials and can now get clients’ documents and grants processed in reasonable time. They have canvassed and received support from politicians in the area to back up demands for proper services from government departments in Mqanduli.
  • Our mentor mothers are deeply concerned over the high numbers of teenage pregnancies in their areas and we realise the need for a strategy to decrease teenage pregnancies. This is an issue that has been discussed at community workshops and is still on the agenda so that our mentor mothers, together with leaders and elders, can find a way forward.

Conclusion

This learning brief outlines the lessons learnt by the Philani team regarding recruitment, training, continued support, and monitoring of Mother Mentors who provide home-based care and support in rural Eastern Cape. This brief also discusses the difficulties of working with government, the benefits of cooperating with community structures and chiefs, and the importance of remaining programmatically flexible in the face of contextual challenges.
 

Philani Maternal Child Health and Nutrition Project


P O Box 40188ElonwabeniCape TownSouth Africa


 021 3875124


In Short

This learning brief outlines the lessons learned by the Philani team regarding recruitment, training, continued support, and monitoring of Mother Mentors who provide home-based care and support in rural Eastern Cape. The brief also discusses the difficulties of working with government, the benefits of cooperating with community structures and chiefs, and the importance of remaining programmatically flexible in the face of contextual challenges.


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