The Siyayinqoba Outreach programme recruits, trains and deploys people to work in communities to improve health outcomes through social mobilisation and training. By providing scientific information in a way that is easily understandable, CMT’s social mobilisers and trainers empower individuals and communities to take an active part in managing & improving their health.
CMT is a strong advocate for the re-engineering of Primary Health Care and supports the role that community wealth workers, social mobilisation and community media can play in improving health outcomes in communities.
CMT’s Outreach team currently work in Kwa-Zulu Natal, and the Eastern and Western Cape implementing social mobilisation activities funded through the Centers for Disease Control and Prevention, and training and community engagement on exclusive breastfeeding and handwashing funded through the United Nations Children’s Fund.
CMT’s social mobilisation activities include door-to-door campaigns and initiating and hosting large awareness days in communities to take health information to individuals and to encourage and support them to take up health services. Community Mobilisers work with local partners and stakeholders to plan and host each event.
Edu-tainment as well as services such as HIV Counselling and Testing are available at all events; and those who test HIV positive are linked to treatment, care and support. Partnerships with SASSA, Home Affairs, the Department of Social Development, and the Department of Agriculture ensure a wide range of other services are also on site. IEC materials and condoms are distributed and referrals for medical male circumcision, PMTCT, STI screening and treatment and TB screening and treatment are made.
These community-based activities are supported by mass media activities at community level, including live radio talk shows, radio public service announcements and newspaper articles. All activities focus on providing health education and promotion and are intended to increase demand for and uptake of HIV prevention services and promoting behaviour change in order to reduce risk of HIV infection.
CMT provides one-day trainings on exclusive breastfeeding and handwashing with soap – 2 key initiatives that have proven to have a significant impact on improving child health outcomes. The training is targeted at frontline workers such as community health workers, community caregivers, home-based carers etc. The interactive training teaches proper techniques for handwashing with soap and how to make a tippy tap, while the component on exclusive breastfeeding provides detailed information on the health benefits of exclusive breastfeeding and discussion on the challenges that can be faced and how to overcome them.
CMT’s long history as grassroots activists for HIV has resulted in significant institutional knowledge and training expertise on all elements of HIV / AIDS. CMT has developed the Health Literacy Series, a set of DVDs, printed flipcharts and manual that deals with all aspects of HIV. While no longer funded to provide this training free of charge, CMT can provide health literacy training for a fee. See the Resources tab for more detail on the Health Literacy Series.
As part of CMT’s legacy of employing Community Health Workers, CMT, together with the University of Cape Town, conducted operational research to evaluate the impact of Community Health Workers on PMTCT programme coverage and health outcomes in HIV positive mothers and their children in the Motheo district in the Free State.
The study design was a randomised control trial. Community Health Workers were placed at 16 primary-level PMTCT services in the Motheo District of the Free State Province. In total, 32 health facilities were randomly identified as intervention or control sites where at least 100 women per month started antenatal care. Before and after data was analysed for the period between April 2011 and March 2013.
At the intervention sites, expectant mothers were offered a one-on-one meeting with a Community Health Worker, who encouraged HIV Counselling and Testing (HCT) and provided information on managing HIV during pregnancy and after birth. The Community Health Workers also took on task-sharing activities such as providing HCT and ARV preparedness. Individual follow up included telephonic and SMS reminders for HIV positive women to access every step of the PMTCT cascade and for HIV-negative women to re-test for HIV at 32-weeks of pregnancy.
The University of Cape Town team implemented a data strengthening intervention in all 32 sites and collected a range of PMTCT indicators for a before and after analysis between intervention and control sites in order to assess the impact of Community Health Workers in improving the coverage of PMTCT services.
While there were improvements in the intervention sites when compared with the control sites, there was an overall upward trend in coverage in all of the indicators of the PMTCT cascade and a decrease in vertical transmission across all sites. This can be attributed to the confounding effect of national campaigns and the significant national effort devoted to improving PMTCT programme coverage and other outside influences. Further, the unexpected effects of the data strengthening component could have played a significant role; in order to measure the impact of the study, data strengthening systems were put in place to ensure that indicators were collected accurately in all sites and training was provided on the use of indicators to identify missed opportunities and improve coverage. This improved the monitoring and quality of the data which in turn may have positively affected the quality of the work at facility-level across all sites.
The research findings indicated an increase in PMTCT coverage in sites where Community Health Workers were based, but this increase was not statistically significant in comparison to the control sites.
Results also showed that women accessing antenatal care in the intervention sites were more likely to return to re-test for HIV at 32 weeks of pregnancy; this was statistically significant. The increased rate of re-testing at 32 weeks is an important finding. As the rates of mother to child transmission reduce, ensuring there are no missed opportunities, particularly for women who become HIV positive late in pregnancy or while breastfeeding, is critical in order to eliminate vertical transmission.
A separate qualitative evaluation identified the crucial role of Community Health Workers in supporting, informing and ultimately enabling continuity of care during pregnancy, an indicator of which is the greater 32 week re-testing rate. It is believed that the Community Health Workers provided an interface between the community and the health system, assisting pregnant women to navigate through a complex treatment cascade and a complicated health system.
CMT has worked in close collaboration with the University of Cape Town and are very appreciative of the input, guidance and support from our board member Prof. David Coetzee. We value the hard work conducted by Kathryn Stinson and her team on the data monitoring aspect of the project and Chris Colvin and his team on the qualitative component. We would also like to thank and acknowledge Prof Helen Schneider from the University of the Western Cape for her insight and guidance throughout the process.
CMT would like to thank and acknowledge our team of field workers who worked passionately and tirelessly to implement the intervention. CMT also thanks our donors who supported this project over a 3 year period; the project was funded by The Monument Trust and USAID / PEPFAR through Johns Hopkins Health and Education in South Africa.
CMT and UCT presented the results at the Free State Department of Health and University of the Free State’s Research Day. At the awards ceremony, CMT was recognised for their presentation and received a trophy for the “Best Free State Research of 2013” award. CMT and UCT also displayed 2 posters at the PHASA Conference, one at the ICASA Conference in 2013 and at CROI in 2014.