The Mopani district is a vast and mostly rural area where the population is scattered across numerous smaller villages and communities. The population of Mopani District is 1,2 million with an HIV prevalence rate of 24.6% among pregnant women and an estimated 19% in overall population. The low population density means that any one healthcare facility will cater to very few people in its immediate area, or otherwise will serve a number of communities scattered across a large geographic area. In the first instance, clinic staffs are under-utilised; in the second, the already limited resources of the community are further burdened by having to travel long distances to access healthcare.
The Government has allocated Mopani District the status of ‘priority district’ based on the low quality of healthcare and education services, high rates of poverty and unemployment and poor infrastructure.

Anova’s support in the Mopani district in Limpopo has evolved from service delivery to a more enduring model of offering technical support to existing staff, imparting knowledge and skill that is likely to outlive shorter-term intervention.

Through its Khutšo Kurhula project, Anova’s team in Limpopo engages in a series of system strengthening and capacity building efforts to improve access to services as well as the overall quality of service in HIV prevention and care programmes. This is supported in the communities by  the Family Free Project, another Anova initiative funded by Orange Babies in the Netherlands.

At present the Anova team supports all 100 primary healthcare facilities and 7 hospitals in Mopani.

Building capacity

The Khutso Kurhula project was founded in 2004 and initially focussed on support group empowerment, the pre-ART program and ART service delivery. Anova has operated technical support teams in the region since September 2010, to provide support in CCMT. This includes mentoring of healthcare workers, in-service trainings, enabling more effective drug supply-chain management and improving accuracy in data collection through the District Health Information System (DHIS).

In addition, resources are provided to improve healthcare delivery and infrastructure improvements include the provision of air conditioners for improved drug storage and cabinets and shelving for efficient filing.
Anova also provides support for provincial and district strategic plans and the findings of research projects further feed into the process of strengthening health systems.

Within the comprehensive support provided by Anova, Programme Manager, Remco Peters says one of their strongest investments has been in strengthening monitoring and evaluation. This has centred on training, skills-development and data mentors. This is essential to guide the allocation of support services in order to provide ‘evidence-directed’ support.  Anova is a front-runner in implementation of the new Tier.net system monitoring and evaluation system in rural South Africa.

Khutšo Kurhula provides mentoring and in-service training in CCMT, data management, pharmacy and nutrition support. It has been instrumental in providing “post-NIMART” training, from initiation to clinical management and has incorporated a paediatric focus.

Bringing the message home: Community support for PMTCT

Anova’s Khutšo Kurhula project is supported and reinforced by another Anova project called Family Free, which is funded by Orange Babies in the Netherlands. Anova’s Family Free project is committed to the prevention of mother to child transmission of HIV in the community. As its name suggests, the project takes a very personal approach and much of its campaigning and messaging is aimed at making HIV prevention a family and community affair.

The programme uses role play to reach children grouped by age on the day they come to the clinic for treatment. Involving grandmothers, who as the family matriarchs are often assigned the responsibility to care for infants, is a key consideration for Family Free’s work. By encouraging grandmothers to spread the PMTCT message to their daughters and daughters in-law, Family Free is helping to ensure the message truly gets home.

The target groups are women of reproductive age (‘keep the negatives negative’), pregnant women (promotion of early testing and antenatal care), HIV-positive pregnant women (information on PMTCT issues), and HIV-infected children on ART (treatment literacy and disclosure).

In 2012 the Family Free project will launch a mobile HCT to reach the most rural villages. This van will include a point-of-care CD4 count machine to offer the best possible service.

Road shows: Taking it to the Street

Anova’s Khutšo Kurhula team also has a good relationship with government which Programme Manager,,Remco Peters ascribes to Siyani Marima’s tireless communication of their work through road shows, stakeholder meetings and advocacy.

The road shows reached 442 key role players, who act as sources of assistance and information in the communities in the district. The key role players include traditional healers, department of health staff and municipal councillors.

Rural Research

The Anova team in the Mopani district is developing a unit with specific expertise on clinical and operational research in rural settings. This aims to optimise the distinctly rural aspects of the area providing trusted and valid rural information that can be used in planning as well as improving health care.

Several studies are under way and in different stages of the approvals process, covering subjects including adherence to and side-effects of ART in HIV-infected children, STI screening in women of reproductive age, accuracy of implementation of blood monitoring protocols, and evaluation of clinical impact and operational set-up of molecular methods for diagnosis of TB.

The unique mix of clinical skills, research expertise and the relationship with the Department of Health provide fertile ground for research in rural South Africa. This is crucial because most available research and knowledge focuses on urban areas or high-resource settings rather than remote rural resource-poor settings. And as observed in the paediatric and STI studies, findings and implications may be very different in rural settings. Various research projects are conducted in collaboration with other Anova teams and national and international partners and academic institutions.

Efficiency through Roving teams

In partnership with the health department, Anova staff in the Mopani district have also devised a means to overcome the obstacles posed by rural health care. By creating roving teams that can move from one clinic to another as needed, skills and expertise are optimally utilised. These teams are based at sub-district level and are composed of nurses, pharmacist assistants, data staff, a lay counsellor and a driver; some of the teams have a (part-time) doctor for additional support. Technical supervision is done by the technical manager based at the main office This model that has yielded good results for the Limpopo teams. Its success has made it a popular approach in Anova’s Mpumalanga work with Anova’s Soweto projects as well as other NGOs showing interest in replicating the model in their work.

The  application of the roving team had enabled Khutso Kuthula project to offer technical support all the primary health care facilities in the District.