MPILONHLE MPILONDE

Improving access to quality health care for hostel and
informal settlement residents

A research informed intervention to address health needs of hostel and informal settlement residents in inner city Johannesburg , South Africa

7th September 2004  

A research – informed intervention to address the health needs of hostel and informal settlements residents in Inner – City Johannesburg, with a focus on HIV/AIDS.

 

 

 

 

Objectives:

To work within a challenging cultural & social context and find ways to:

  • Address specific risk factors associated with HIV/STI acquisition.
  • Address specific STI/HIV knowledge and awareness needs.
  • Ensure access to improved primary health care services for STI/HIV
    prevention, testing, treatment, care and support.
  • Promote behaviour change related to primary & sexual health.
  • Decrease the prevalence of self reported STI symptoms.
  • Reduce reported rates of gender – based violence.

Research - Behavioral & prevalence survey & quality of care assessment.
Started in April 2004 & due to be complete by November 2004
Community Survey – a behavioural & prevalence survey

 

Target Population

  • 2 000 Men living in 6 hostels in the Benrose area of Johannes burg (Jeppe, Denver, George Goch, LTA, MBA and Murray & Roberts)
  • 1 000 Women living in the 6 surrounding informal settlements (Denver, George Goch, Platform 5, No. 9 Princess Street and Mangolongolo, shack farms i.e. Jeppe and Denver.


Fieldwork

 

 

  • 33 fieldworkers go to the research sites everyday between 13:00 and 20:00. Each fieldworker is accompanied by a block guide to ensure their safety. Block Guides (over 150 across all sites) have been trained to guide and introduce fieldworkers to residents. They are lead by 1 – 2 chief block guides in each site.

 Sampling and eligibility to participate

 

  • Fieldworkers identify a shack or a unit within a hostel according to the established sampling interval & arrange to interview all eligible women/men living there. The respondent must be 19 to 55 years old, have lived in community for 3 months or more & be willing to be interviewed & provide a urine and saliva sample.
  • If the person they are looking for is not there at the time of the first visit, the fieldworker returns to the shack or hostel unit at least 3 times to ensure that they reach the women/men.
  • Fieldworkers manage to complete up to 4 interviews per day. These are quality checked 3 times prior to data entry.

  • Fieldworkers are trained to detect the need for referral. If the individual is suffering from an STI, has suffered abuse or violent assault or would like to have VCT – they are given referrals to appropriate services.

Quality of Care Assessment

Target Health Facilities: Region 8 & 9 in Johannesburg: Esselen Clinic, Malvern, Jeppe, Urban Health, Mayfair, Yeoville, Rossetenville, and Joubert Park

  • Simulated Clients / Mystery clients are sent periodically over the course of the intervention to the 8 government health facilities. Mystery clients present with symptoms of STI’s, requests for condoms and for information on VCT, HIV and ARV’s.
  • Clinic Audits & Observations are carried out by Clinicians to assess facility capacity and staff skill to adequately provide STI – VCT – ARV & OI care.

Intervention

 Target Population – for intervention

  • 24 000 men living in the 6 hostels
  • 10 000 women living in the 6 informal settlements (including the abandoned buildings)

 The proposed Intervention consists of 3 sections:

  1. Community
  2. Health Sector
  3. Collaboration & Integration.

 
 Through these 3 components the intended outcome of the intervention is to observe:

  • Enhanced understanding of health and wellbeing.
  • Improved access to primary health care services for STI/HIV/AIDS &TB.
  • Increased utilization of primary health care services.
  • Improved living and sanitary conditions.
  • Increased levels of awareness of rights
  • Increased safer sexual practices among men and women.
  • A minimum of 10 000 active members to the community health clubs.

Intervention: Community Component

Building the Foundation: Mobilizing urban communities through Quality of Life Clubs. This is a systematic programme based on structured participation in a Club.

  • 24 modules held over 6 months, designed and facilitated with a range of expert groups – citizenship, participation, rights, environment, housing, income generation, access to water, gender, nutrition, health, STIs, HIV/AIDS,
  • After 6 months and committed attendance at meetings, members continue to design and run their own club meetings and they are supported in very simple ways to develop income generating health enhancing activities. What starts off as health education meetings becomes community led change.

Intervention: Health Sector Component

Attitude Adjustment Programme

Service providers are put through an intensive experimental & drama based training programme with the goal of shifting poor attitude and cultivating empathy.

  • Clinical competency Training in regions 8 & 9 of the City.
  • Syndromic Management directed at traditional healers (emphasis on referrals) & community health wardens/ workers
  •   VCT & ARV literacy directed at traditional healers, community health wardens/workers, staff in other government sectors who are in contact with community members but are not clinicians (housing, security, social services and environmental health)
  • Clinical training directed at clinicians, pharmacists in the private & public sector with more technical language directed at management of HIV/AIDS – linked with the ongoing RHRU training.

 

OI Management & Home care directed at Traditional healers, community health wardens/workers.

Mobile Services Unit

  • Eventually, as an output of the quality of life clubs and attitude adjustment programme, an effective health care provider supervised community health warden/ worker team will be established in order to reach men and women who do not yet access care at facilities.

Intervention: Collaboration & Integration

Facility based quality of care survey
 We anticipate that this component of the baseline survey will be completed by September 2004. This survey will involve an assessment of a range of primary health care providers including government clinics, pharmacies, private medical practitioners, private clinics and traditional medical practitioners. The quality of care survey is based on the DISCA tool1 and the National Baseline Assessment of Sexual Health and HIV services in South African Public Sector Health Facilities2. The survey will triangulate data collected using a range of methods, including: site assessments; record reviews; the tracking of referrals between health sectors; observations of clinical encounters; client satisfaction assessment (exit interviews), and simulated clients.

Technical Advisory Group (TAG) formed in January 2004

  • Composed of Gauteng Regional & Provincial Government: primary health, environmental Health, social services, security and housing.
  • Linking with current activities avoiding duplication affecting change through applied research and policy development and implementation.

Community Advisory Group (CAG) formed in June 2004

  • Composed of community members who have participated in survey and initial intervention mobilization and Community Based Organizations based in Benrose Inner City of Johannesburg who are focusing on Home Based Care, HIV/AIDS and Community development.
  • The purpose of this group is for both Mpilonhle-Mpilonde to link with current activities being led by grassroots organizations and for grass root organizations that rarely meet to discuss their activities. There is also the benefit of a forum to inform the community of our activities and allow for feedback and discussion, while creating the potential for a sustainable community structure.

Time frame

The survey is ongoing in the remaining 3 hostels.
The quality of care assessment continues throughout the course of the intervention. The community component of the intervention will be piloted in October-November 2004.

This website will be updated at that time.

Contact Details

Tel: 27 (011) 989 – 9296

Jillian Gardner: Senior Project Coordinator

Dr Monique Oliff: Senior Researcher

Jo Vearey: Researcher (Volunteer)

Thulani Mbatha : Community Liaison Officer

Vusi Cebekhulu : Junior Project Coordinator

This project has the full support of Metro Health.

The project is funded by the European Commission.

Additional funds are being sought for the expanded intervention.

 

 

19 th February 2004

For details about the first stages of the programme, please scroll down

 

What is the current status of the programme?

Fieldworker training!
 We are about to embark on our fieldworker training programme. A team of 27 fieldworkers will participate in a week long training programme that aims to equip them with the skills and knowledge required to work within this very challenging environment. Fieldworkers will be trained in appropriate interview methods, with a focus on how to deal with the sensitive nature of the health related questions, as well as in the collection of biological samples. We aim to bring together the need for consistent and quality data collection, with the importance of ensuring interviews are conducted in a sensitive and appropriate manner.

What are the fieldworkers preparing themselves for?
 The baseline survey will begin mid-March 2004 and will last between 10 and 12 weeks. Male fieldworkers will interview 2000 male hostel residents whilst female fieldworkers will interview 1000 female residents of the neighbouring informal settlements. The fieldworkers will interview participants and ask them to provide a urine sample for STI testing and an oral fluid sample to test for antibodies to HIV (OraSure method). The samples will be tested by Central Laboratory Services (CLS), part of the Wits Health Consortium, University of the Witwatersrand, Jo hannesburg .

We will be capturing the data as it is collected and running preliminary analysis on an ongoing basis, ensuring that the data is ready to use when the phase of designing the intervention begins. We plan to provide interim reports of the preliminary findings; these will be posted on the website.

Beyond the behaviour and prevalence study…

Facility based quality of care survey
 We anticipate that this component of the baseline survey will be completed by September 2004. This survey will involve an assessment of a range of primary health care providers including government clinics, pharmacies, private medical practitioners, private clinics and traditional medical practitioners. The quality of care survey is based on the DISCA tool1 and the National Baseline Assessment of Sexual Health and HIV services in South African Public Sector Health Facilities2. The survey will triangulate data collected using a range of methods, including: site assessments; record reviews; the tracking of referrals between health sectors; observations of clinical encounters; client satisfaction assessment (exit interviews), and simulated clients .

The Technical Advisory Group (TAG)
 The TAG has now officially met twice and has been involved in the design of the research tools. Members from various government departments have been contributing their ideas and suggestions to the development of the final questionnaires. The TAG forum has facilitated interesting and informative discussions about the Mpilonhle – Mpilonde project itself, as well as a wider range of topics such as the role of research in informing policy.

Do you want to get involved?
The next TAG meeting is scheduled for the 6 th of May 2004 , at 3pm . The aim of this meeting will be to provide feedba ck and preliminary findings as we reach the halfway point of the community based baseline survey.

If you would like any further information about becoming involved in the TAG or getting involved in another capacity, please feel welcome to contact Jo Vearey on (011) 989 9277 or e-mail [email protected] , or the Project coordinator Jillian Gardner on (011) 989 9283 or e-mail [email protected] .

1 Coetzee N. and Magwaza, S. 1998 DISCA: Guidelines for district supervisors in using the ‘DISCA' evaluation instrument Health Systems Trust , South Africa 2

2 Ramkissoon, A., Kleinschmidt, I. , Beksinka, M., Smit, J., Hlazo, J. and Mabude, Z. 2004 National Baseline Assessment of Sexual Helath and HIV services in South African Public Sector Health Facilities RHRU and the National Department of Health, South Africa

 

 

 22nd January 2004

What have we done so far?

FIRST STEPS …

Mpilonhle – Mpilonde is a three-year programme that started in May 2003 with formative work. This included ethnographic research (participant observation, interviews with key informants and informal conversations with residents), mapping of the study areas, preliminary interviews with traditional medical practitioners and pharmacists, as well as consultation with a range of community members and community based organisations (CBOs).

Avoiding duplication, promoting collaboration…
 Another major output of the first phase of the programme as been the formation of a Technical Advisory Group (TAG). The aim of this TAG is to bring together representatives from a range of local and provincial government departments including, but not limited to, Health, Environmental Health, Social Services, Housing, and Public Works.

It is anticipated that the TAG will provide an advisory forum for the programme. More importantly it will provide the opportunity for all those departments involved in the health of the target community to coordinate their efforts through Mpilonhle-Mpilonde. The TAG will regularly address issues around preventing duplication, promoting coordination of efforts and delivering a comprehensive service and clear message to the community by linking with current interventions, ensuring effective referrals, extending current efforts, developing new interventions and responding to the needs voiced by the community in the survey.

Talking to the community….
 A fundamental foundation for the programme is the community and quality of care survey. These two baseline surveys will gather information from the community and from the health providers (public, private and traditional) that will guide the intervention. The surveys are scheduled to begin in March 2004 and will run for approximately 12 weeks. The community survey will interview 2000 male hostel residents and 1000 female informal settlement residents. While the quality of care survey will target about 80% to 100% of all private and traditional health care providers and all public health clinics in the Region 8 and Region 9 of the City of Johannesburg. The results generated will be combined with the formative research, and experience of community members in the Community Advisory Group (CAG) and the technical expertise of the TAG. This will inform the design of an appropriate and effective intervention for this unique population. Please see the Project Information page for further details

Do you want to get involved?
 The next TAG meeting is scheduled for the 3rd February 2004 . If you would like any further information about becoming involved in the TAG or get further information about getting involved in another capacity, please feel welcome to contact
Jo Vearey on (011) 989 9277 or
e-mail [email protected]