By: Mzikazi Masuku (Community Co-ordinator for the DO ART Project)
INTRODUCTION
Buxedene Clinic is situated in Ward 8 of Nongoma Sub-district in Zululand District. The total headcount of the facility is between 3 500 and 4 000, making it one of the sub-district's high-volume facilities. The clinic serves a catchment population from 18 villages in the ward. These areas are called Izigodi.
Management of the facility and the District's HIV and AIDS/STI/TB (HAST) officials have raised concerns about poor performance against targets for certain indicators. The facility team referred specifically to three indicators:
- Couple year protection rate (currently at 30%–36%)
- Pre-exposure prophylaxis (PrEP) initiation (currently at 3%–15%)
- Post-exposure prophylaxis (PEP) (currently at 0%)
It was against this background that the Buxedene community was mobilised to participate in a dialogue about the health problems and social ills experienced within the community.
Community engagement entails the active participation of local people in identifying priority issues and being part of the process to determine solutions. The health of the community is vital, and sustainability is threatened if health services and programmes are unavailable or inappropriately used. The National Development Plan states that South Africa's health challenges are more than medical, and identifies behaviour and lifestyle as contributory factors to ill health.
Community dialogues are conducted in order to enhance community involvement in health promotion and at a later stage, community development to identify problems in context and act on them effectively.
Why community dialogues?
Community mobilisation and development are increasingly seen as a prerequisite for successful uptake of health services. Participation remains an essential part of community mobilisation and community development, especially when community-based health services are to be integrated with pre-existing structures and aligned with community interests.
The approach seeks to maintain a continuous process of engagement between the Department of Health (DoH) and citizenry through active participation in discussions and jointly seeking solutions, as a result of which communities will be recognised as partners and accountability will be sustained.
The specific objectives of the community dialogues were thus to:
- determine community members’ level of knowledge of healthcare services through interactive sessions and meetings;
- educate communities about the available resources pertaining to outreach programmes; and
- encourage ongoing community involvement and participation.
METHODOLOGY
Consultative meetings were held with stakeholders of Ward 8 of Nongoma to orientate the DoH and other stakeholders on the concept of community dialogues for enhancing community participation and ownership. The previous three months' data from Buxedene Clinic were analysed to identify under-performing indicators.
Community leadership structures were identified during a plenary meeting with four high schools in the area. Each school was represented by five learners who were identified by the schools' administration. The learners were divided into commissions, and each commission had a facilitator.
Mzikazi Masuku facilitates the Commission process with a group of learners
For each indicator, questions were raised regarding reasons for available services meant for community not being accessed, especially by youth, and how the facility can be supported to provide access to services, especially for young people.
The commissions discussed issues related to the following indicators:
Couple year protection rate
- Youth are reluctant to use contraceptives, fearing that they might not be able to have children later in life.
- There is little to no communication within households about sexuality and reproductive health, so DoH support is required to involve and empower parents in this practice through health education.
- Peer pressure and sometimes fear of healthcare workers arises from being offered long-term contraception.
PrEP initiation
- Young people tend to associate PrEP with HIV, and question why the same medication given to patients with HIV is used as a prevention method (prophylaxis).
- If a young girl accessing health services is seen by her peers, people will tell everyone that she is HIV-positive, so she fears stigma and discrimination.
- Young people are not aware of how PrEP works, and hence do not access it from the facility. They are unsure as to whether or not they can become infected with HIV while on PrEP.
Learners presenting their Commission findings during the Buxedene Community Dialogue
PEP
- Much as they are aware of the availability of PEP, delayed reporting of rape cases in the community means that this service is not utilised.
- Youth are afraid of informing their parents about a rape as they fear not being trusted.
- Some young people are financially dependent on the rapist.
- The justice system is failing them, as some rapists are released back into the community, and the victims fear for safety of their families.
Commission members present their insights to the forum
Proposed interventions:
- Health education provided by the DoH at schools and in the community should be strengthened.
- Sufficient supply and distribution of information, education and communications (IEC) material should be ensured.
- A session for parents and guardians should be organised to equip them with sexual and reproductive education. If they are empowered in this way, they will be able to cascade the information to their sons and daughters.