The University of Pretoria’s (UP) Community Oriented Primary Care (COPC) Research Unit has been contributing its expertise around the Mogalakwena mine in Limpopo by equipping community healthcare workers with skills and knowledge through work-integrated learning sessions.

Since October 2018, the unit, which is part of UP’s Department of Family Medicine, has been working with Impact Catalyst to empower community healthcare workers to deliver medical care and education to three communities in Limpopo – Mapela, Phafola and Mosesetjane – and to improve not only the health status of the people there through better management of chronic diseases but also to address other social concerns.

Impact Catalyst is an initiative founded by Anglo American, Exxaro, the Council for Scientific and Industrial Research, World Vision and Zutari, which all share a vision of creating enhanced social impact in the mining communities in Limpopo and expanding to other provinces. The aim is to establish inclusive, collaborative, cross-sectoral platforms and partnerships to achieve systemic socio-economic impact through public-private partnerships.

“The Impact Catalyst initiative is a perfect example of how the private sector can accelerate impact in communities when resources are combined with government sector efforts,” says Dr Suzi Malan of the COPC Research Unit. “Healthcare in rural areas constantly suffers from a lack of resources. The concerted effort by these Impact partners to support the Department of Health with resources such as training, IT, internet connectivity and establishing value chains, among others, go a long way towards creating positive spin-offs; these include improved relationships, connecting partners and better health literacy for individual community members.”

Due to the success of this project in Mogalakwena’s mining communities, Anglo American based its COVID-19 response on the COPC model across all its mining sites.

The WeCare programme includes a home-based response to employees and contract workers for screening, swabbing, contact tracing and follow-up during self-isolation. The second component of the programme is focused on supporting health facilities by offering a variety of COVID-related training sessions to health professionals, school governing bodies, principals and staff, traditional and faith-based leaders and anyone from the community requesting such training. Other services include setting up and manning screening stations, and supporting clinics where necessary.

Several studies have shown that community-based services delivered by professionally supported community health workers can deliver significant improvements in healthcare at a far lower cost, and can enhance health literacy at the household and community level. The group of 39 trained community workers adopted the premise that if the most vulnerable community members cannot get to a healthcare facility, they will take the facility to them.

“Due to these programmes, relationships of reciprocity and trust have been enhanced, and people are more open to us rendering our services,” says Julia Kgaase, a community healthcare worker for Rauwele Village in Phafola. “We’ve seen a shift in mindsets, showing that people have made health a priority, especially during the pandemic.”

Integration starts at a household level, with community healthcare workers driving health promotion and disease prevention, supporting patients on chronic medication, monitoring recovery progress, and providing support to patients that have defaulted on their medication. Their main objective is to prevent disease by empowering communities through education.

Health workers facilitate health literacy at a household level with the help of a multidisciplinary team that includes nurses, doctors, clinical associates, dieticians and other specialists, and by creating integration at facility level (clinics and hospitals) until more people are better able to manage their health.

UP furnished community healthcare workers with skills and knowledge through weekly work-integrated learning sessions and showed them how to use mobile devices to identify at-risk households. Those attached to the clinics in Mapela, Phafola and Mosesetjane have conducted 2 321 household surveys and 9 477 individual surveys to date.

Healthcare workers identify the households, register individuals, then conduct various screenings for diabetes, hypertension and other related illnesses. This is followed by an environmental screening to see if these homes have any issues with basic social services such as running water and electricity. The data gathered is used to inform future development projects and ensure that new projects address the actual needs of the community.

The upskilling of workers had a positive effect on the way they support their communities. Prior to training, some did not know how to use a smartphone. “The COPC has not only equipped me with primary healthcare education but has introduced me to the era of technology,” says Johanna Mosogo of the Mapela clinic. Healthcare workers can now easily engage with communities independently, and capture key information on mobile devices.

“The main reason this programme has been effective is due to the creation of social capital, as social networks have been established with various stakeholders to enable health issues to be tackled as well as other social problems that communities face,” says Sister Salome Mogashoa, master trainer at Phafola clinic.

Success stories have been pouring in. In one instance, a diabetic community member was using expired medication because he could not afford insulin. “Through the COPC, the matter was reported to my supervisor and the patient was channelled through the correct process to get help,” says Seanego Sebolaishi, a Mapela healthcare worker.

In another instance, Mary Shikoane of the Phafola clinic was treating a community member, Mr Moselana, who did not have an ID and was not receiving a SASSA grant. Through the COPC clinical associate’s involvement, he was referred to the relevant departments. “Thanks to the healthcare worker who treated me, I got my ID and will be receiving my SASSA pay-out soon,” says Mr Moselana.

The pandemic has focused attention on the importance of prevention of disease, as it has shown how easily a health system can be. That’s why Anglo American has approved rolling out COPC across all its mining host communities, to ensure better preparedness and health literacy among communities. A similar programme is being planned for the community of Lephalale local municipality in the Waterberg District.

In addition to the COPC project, Impact Catalyst is conducting several feasibility studies and pilot programmes to stimulate economic development in the region, and will make use of the data collected from these studies to inform future decisions. Some examples of proposed initiatives include the development of game farming, agri-processing and biofuels, laser-based refurbishment of mine equipment and the development of a fresh produce market.