Building Healthy Communities

REPORT: Mamelani Projects – Building healthier communities in the Western Cape

“I see all these conditions in my community, but I don’t know what to do about them. Now I understand what I can do. Lack of knowledge destroys people’s lives. The more you know, the more you can take action”

Mamelani sees its work as a response to a need that was identified in the communities where it operates to improve the state of basic health education. Beneficiaries are widely consulted in putting together training programmes to suit their particular needs and the programmes are designed to be experiential, with feedback seen as an integral part of all the programmes.

The Wellness Workshops aim to provide community-based health education in a format that empowers individuals and groups to make informed decisions about their health and to better care for themselves and their families. The workshops are tailored to the needs of very low-income families and are attended mostly by women. They are designed to provide accurate information regarding major illnesses, with an emphasis on low-cost ways of strengthening the body’s immune system; promoting the correct use of medication in conjunction with home-based remedies; and ensuring that participants are able to access clinic services and apply this knowledge at home.

Activities and Outcomes

This progress report covers activities from the 1^st of September 2010 – 13^th of January 2011.

• Mamelani conducted 8 Community Wellness workshops running over a period of 8 weeks with a total of 126 participants. The workshops targeted health workers, home-based carers, sufferers of chronic illnesses and family members.
• During November 2010, Mamelani revisited some of the organisations that it had trained previously, to offer refresher courses and share some of the new information that had been added to the training curriculum, in partnership with UCT's Dietetics Department.
• Focus groups were held with 112 group members, to identify the most pressing and common health challenges faced by participants.
• Facilitators have also been trained in how to make a hotbox, an insulation cooking device that allows the user to save electricity, and have been including this as a new component in the training. Groups have been very excited about this new component.
• In November, as part of National Nutrition Week, Mamelani facilitated three community-based awareness days (in Gugulethu, Danoon and Khayelitsha). 51 participants attended the events. The purpose of the awareness days was to share key messages regarding good nutrition, as well as essential information regarding the prevention of diarrhea, leading up to the season where preventable diarrhea cases are the highest in the year.
• During this reporting period facilitators saw 15 individual clients for one-on-one counselling sessions. Topics that were covered in these sessions included issues such as ARV adherence, relationship and marital problems and support of HIV positive pregnant mothers.

 Challenges

• Although groups have the knowledge to make changes in their lives, behaviour change is an on-going process. For example, some participants shared that they want to change the way they cook for their families, but that family members complain that the food is different. To try and address these challenges, Mamelani we will be meeting with groups on a monthly basis for at least 6 months after the training to motivate and support people in maintaining healthy lifestyle choices. For those whose families resist the dietary changes, they encourage making changes slowly, starting with one healthy meal per week at least and to discuss with their family the importance of eating a healthy diet.
• When the organisation being training undergoes changes, such as a cut in funding, it affects the morale of the group. One group lost its funding during the time of their training and were no longer able to give food parcels to group members. This created stress for trainees, and internal tensions between trainees and their coordinators. This had a negative impact on the learning space. Mamelani have started to build stronger relationships with coordinators of the groups they are working with, which has helped
• Particularly with support groups, the emotional challenges they face can disrupt the training. In some cases we have had dedicated sessions to sharing emotional issues that trainees are facing, and sharing tools and information about specialised services, which might be able to help them work through these issues. It was found that allowing them the space to share what is holding them back, has opened the space for them to seek appropriate support, and therefore be able to apply themselves to the learning process.
• The challenges faced by participants as a result of poverty and unemployment including poor housing, lack of access to health services, and lack of income has a huge impact on people realising their right to health. Mamelani has initiated a small income generating programme, where women from the programme are creating sustainable livelihoods for themselves through by making wallets from recycled materials. This does not begin to address the economic needs of all the members of the groups, and Mamelani are also developing partnerships with organisations that assist people in generating their own income. Mamelani has also developed strong partnerships with social movements, such as the Treatment Action Campaign and People’s Health Movement who fight for people’s rights to access treatment and care.
• Mamelani does not have a community based venue from where we can offer one-on-one counselling. This makes it difficult to find a suitable private space for these counselling sessions. They have arranged to meet with local partner organisations to try secure community-based spaces for this counselling.

Monitoring and Evaluation

• Attendance records were kept for all workshops and refresher courses. 75% of participants attend 6 or more of the 8 sessions of training. The attendance register is also used to update the database and monitor who has successfully completed training
• Pre- and post-workshop questionnaires as well as course evaluation forms were completed by participants. Results from questionnaires indicate that there significant knowledge gain as well as an 80% improvement in the implementation of key health areas. Evaluation questionnaires also showed that more than 90% of participant recorded that the information shared was relevant in their lives and that the information was clearly presented and the workshops enjoyable.
• Records are kept on all individual participants and any follow-up consultations are recorded. The records from individual consultations show that individual sessions are powerful and effective in aiding clients to implement the necessary ongoing changes in lifestyle. Progress reports show that most clients are supported for a period of 4 to 6 months after the training, but in the case of pregnant mothers this can be even over a period of 12 months. Clients most likely seek help for HIV related and relationship issues. Clients often present with multiple issues. Records also show that a large percentage of individual clients continue to call the facilitator even after resolution of the initial problem.
• Weekly feedback sessions were held with the facilitators. This ongoing evaluation and feedback allows facilitators to address issues and as they arise and adapt training to the needs of the group and incorporate new information as required.

Conclusion

This project has met all of the requirements for this reporting period. While it is always difficult to assess the success of programmes that have behaviour change as their ultimate goal, it is clear that this project has enjoyed overwhelming success in improving basic health knowledge among its beneficiaries.

Assuming that each direct beneficiary takes the knowledge gained and implements changes that affect the health of at least four family members, just over 1000 people will have benefited indirectly from the programme over this period.