Community immunisation programme

VISION

The mission of Hantam Community Education Trust is:

• To invest in human capital through education, training, skills acquisition, health and community care.
• To enhance the quality of life for people in this rural area and to break the cycle of poverty in a permanent and sustainable manner.
• Through examples of replicable models, improve the immediate and local environment.

OVERVIEW

Hantam Community Education Trust (Hantam Trust) works in rural communities within a 150km radius of Hantam in the Northern Cape, including 28 farms and the small towns of Bethulie, Venterstad, Steynsberg and Gariep Dam. Hantam Trust runs programmes in health, lifeskills, educare, and school and teacher development in response to needs identified by the community. With severely limited access to primary healthcare or a dispensing chemist, the people in these areas previously suffered from ill health and disease. Hantam Trust moved to fill this need in 2000 by establishing a clinic with a doctor, two nurses and three trained healthworkers, as well as a pharmacy with a qualified pharmacist in 2005, to which approximately 326 adults, 226 children and 17 babies currently have access. The clinic is open once a week and the pharmacy six days a week, while the healthworkers make visits to the farms. This project will expand the clinic’s reach and enable the healthworkers to run an immunisation programme for 44 babies over a year, in order to prevent the children from getting and spreading common childhood illnesses.

WHAT WE LIKE ABOUT THIS PROJECT

• Hantam Community Education Trust has branched out from education into healthcare, working with isolated rural communities in this part of the Karoo to provide services that are currently not available from the state.
• By running a clinic and pharmacy and making visits to farms, the Hantam Trust healthcare professionals are able to offer an affordable, accessible and comprehensive primary healthcare service, of which this project forms a logical part.

EXPECTED LIFE CHANGE

An investment of R22 050 will enable:

• 44 babies to be immunised by the Hantam Trust healthworkers over a year
• Approximately 176 family members of these children (with an average household size of five people) to benefit from their continued health
• Direct life change at R100 per person.

This project has breadth in being spread across the community. In itself, it is a simple intervention which does not have great depth, but it forms part of the overall healthcare strategy of Hantam Trust, which has depth in that it addresses problems holistically and follows a preventative approach. The project has intensity in that it will make a significant difference in a short time. It has permanence only if these children receive the necessary follow-up immunisations, but this is likely to occur since Hantam has thorough record-keeping systems, close relationships with the families and the buy-in of the community.

NEED

The nearest town to Hantam Trust’s health clinic and community pharmacy is Colesberg, which is 40km away, and the nearest city, Bloemfontein, is 250km away. As there is no public transport to the clinic in Colesburg, the Hantam Trust Clinic, which services 28 farms within a 50km radius, is the only accessible health service in the area. The government clinics in Colesberg are also inadequate and often run out of medicines.

Pharmacies in the towns of Venterstad, Steynsburg, Bethulie, Burgersdorp and the Gariep Dam have closed down and the only doctor is in Burgersdorp. Many of these chemists closed down as they were not able to cover their overheads after government changed the profit margin structures on medication. The government discontinued its mobile clinic eight years ago, due to financial constraints.

As a result of this situation, no adults or children in the Hantam farming district previously had access to regular oral and primary healthcare. This negatively affected the general health of the community and the children’s academic progress. There was no access to a dispensing chemist, and no intervention structure to assist the community with health and social problems. None of the children previously had access to immunisation services and childhood illnesses were common.

STRATEGY

Before the clinic was started in 2000, the community was consulted. On the strength of the needs that they identified, as well as the health-related problems the teachers picked up in the classrooms, Hantam Trust decided that a serious intervention was necessary. They established the pharmacy and clinic to address health problems and social problems such as alcohol, child and women abuse.

The Hantam Trust pharmacy services communities within a 150km radius. This includes all the families living on the 28 farms, as well as the towns of Bethulie, Venterstad, Steynsberg and the Gariep Dam. All the adults and children within a 50km radius also have access to the clinic and to the healthworkers’ visits. The clinic presently supports approximately 326 adults, 226 children (from 3 to 16 years old) and 17 babies (0 to 3 years old).

There are approximately 2 304 visits to the clinic annually by local patients. Each patient has a file indicating the number of times they have been seen, what medication is dispensed and what blood tests have been done. The farmworkers and nomads (karretjie people) pay R15 per visit. The members of the community and visitors pay for the consultation fee and their medicines either directly or through their medical aid. If the organisation knows that patients cannot pay, they are treated for free.

There are approximately 2 117 additional patients who access the pharmacy from the outlying towns, but this number is growing daily. Drugs are sold in keeping with the government regulatory mark-up and the pharmacy is registered with all South African medical aid schemes. All patients using the chemist pay for the service, but as there are no large overheads it is able to charge very affordable prices. It also supplies the farmers with veterinary medicines and has thus created an additional profit arm, thereby increasing its income generation and improving its sustainability.

ACTION PLAN

Preparation

The health clinic has been operational since 2000 and the pharmacy since 2005. The clinic presently supports approximately 569 people – adults, children and babies. Each individual has a clinic file with detailed records. The clinic is aware of how many babies have been born and their ages, and will plan the immunisations accordingly. New births will be fed into the plan.

Implementation

• Approximately 44 babies will be immunised by the Hantam healthworkers over the year, in order to prevent them from getting and spreading common childhood illnesses.
• Each baby will receive follow-up immunisations as needed (at particular ages), as well as an annual medical examination.
• A record of each child’s health status will be kept and updated.
• A training course will be conducted for the babies' parents. The trainers are able to guide the parents toward effective parenting by encouraging them to stimulate and talk to their babies.
• Follow-up will be provided by the clinic, which is open once a week from 8am to 1.30pm and sees an average of 48 patients each morning.
• The pharmacy operates six days a week and the pharmacist is able to provide the babies’ families with any necessary scheduled medication
• Healthworkers usually visit farms twice a week, where HIV/AIDS-related issues can be identified and reported back to the clinic.

Monitoring

• Quarterly reports will be written and filed by the clinic staff, including information on immunisations.
• Weekly reports will be made by the healthworkers to the clinic staff, including any upcoming immunisation needs.
• Parents will be required to attend the training course and their participation will be assessed.

ORGANISATIONAL EVALUATION

The Hantam Community Education Trust has proven the success of its educational model. By undertaking long-term monitoring of the scholars and including a healthcare component, they have made strides towards breaking the cycle of poverty. Hantam Trust has excellent support from the communities it serves and solid partnerships with non-governmental and community-based organisations, government agencies and farmers in the area. The clinic maintains thorough records and the pharmacy is managed by a trained professional. The staff are dedicated and passionate; some are highly qualified and others are being trained and developing their skills. All the staff come from the surrounding communities or now live there and have insiders' knowledge of the social issues facing residents of the area. The organisation has good fundraising skills, and an endowment fund has been created to ensure long-term sustainability. One weakness is that the organisation is not in a position to pay market-related salaries.

RISK PROFILE

Key Strengths

• Concept: The idea of including an immunisation programme within a holistic primary healthcare programme makes sense. The organisation is supplying an essential service, at a subsidised rate, to people in a rural area who would otherwise be unable to access it.
• Design: Most patients pay R15 per clinic consultation and pay for medicines, which covers some of the clinic's costs and ensures the patients' buy-in. There is a sliding scale so that those who can afford more, pay more. The pharmacy is registered as a Business Trust, with the Hantam Community Education Trust named as the sole beneficiary of any annual profit.
• Capability: The organisation is in its 18th year of successful operation. The staff are dedicated and passionate; some are highly qualified and others are being trained and developing their skills.
• Control: The clinic and pharmacy write weekly reports of all interactions with patients and keep patient records on file. There are good financial controls in place.
• Sustainability: Hantam Trust registered an endowment trust three years ago and fundraising is being done for both the running costs of the project and the trust. The organisation has already raised R6 000 000 of their target R20 000 000.

Key Risks

• Design: The success of this project depends on continued funding, since a once-off immunisation campaign is not useful without follow-up.
• Capability: A central staff member is leaving, but there is a succession plan in place.
• Sustainability: There is a risk that staff may leave to find better-paid work elsewhere, since salaries are not market-related. The organisation has not managed to secure substantial government funding or subsidies.
• External: The cost of medical supplies and pharmaceuticals is unpredictable.