Description: Poverty, unemployment, instability and violence are central features of township life. As a result there are large numbers of malnourished children and destitute mothers who constitute the most vulnerable groups within these communities.
Philani, a community-based health, nutrition, and development organisation, was established in 1980 to address this challenge. In 2000, Philani launched its child health and nutrition Outreach Programme. The programme is based on the "Hearth Model" which identifies children at risk, teaches mothers good caring practices based on coping mechanisms available in the community, and support women to believe in and rely on their own abilities and strengths to raise healthy children. Initial funding was provided by the Provincial Health Department (DoH), while the private sector and international donors provided funding for the extension of the project during the second and third years. In 2003, due to the success of the project, the DoH asked Philani to administer the DoH community Integrated Management of Childhood Illnesses (IMCI) project in Khayelitsha and in 2004 was asked to take over the full management of the programme. The IMCI and the Philani Outreach Programmes are now fully integrated and function as one.
During the past three years, the project--together with the participating communities--have selected and trained 65 outreach workers. These workers operate in nine informal settlements outside Cape Town. Training of the outreach workers includes: how to handle rejection and anger; how to build trust; what strategies are effective in families where children are neglected and abused; and how to approach substance abuse and deal with its affects on children. Once their training has been completed, they are able to do growth monitoring, and have basic health knowledge and knowledge of community resources and referral channels to be able to deal with obstacles in applying for child and disability grants.
Innovation: The Programme takes child health and nutrition beyond clinics into homes, identifies child health coping mechanisms already present in communities, and strengthens these coping mechanisms. Much of the programme is based on adult learning practices as it trains and motivates women to rehabilitate their own children at home.
Effectiveness: Since the programmes have been merged, 2000 malnourished children have been included in the outreach intervention programme. This means weekly visits, support, and progress assessment by the outreach worker, who assists the mother to understand the needs of the child and to develop good caring practices. They ensure that the child's immunizations are up to date, and that they are screened for tuberculoses. Children who qualify have access to social grants.
Poverty Impact: An evaluation of the last six months show that 62% of the children on the programme had improved as measured by weight gained. Hundreds of children have been fully rehabilitated and discharged from the programme. Mothers have been equipped to take charge of their lives and their children and have contributed to the improvement of their communities.
Sustainability: The annual cost of R750 000, makes it efficient. Partly as volunteers carry it out and there are no institutions or handouts involved. It is less costly than a clinic-based child health and nutrition rehabilitation programme. Seventy percent of the funding comes from the provincial DoH, with the balance been sourced from the World Childhood Foundation. Funding has been secured for the next three years and a long-term strategy is in place to continuously identify new avenues of funding.
Replication: As this programme addresses child malnutrition, HIV/AIDS, and child neglect and abuse in poor communities, it will be ongoing. The model used can be easily replicated nationally as a cosy effective child nutrition and health intervention programme.