Healthy Start for a Brighter Future (HSBF)

by Sharon McCarty

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South Africa is a country of contrasts: first world shopping malls, private hospitals and fancy houses, and on the doorstep of these affluent areas reside millions living in third world urban poverty. Today, South Africa's rank on the Human Development Index is falling largely as a result of the HIV and AIDS pandemic, with its ranking now 125 out of 179 countries.

Informal settlements in South Africa lack sufficient basic services, including water, electricity, sanitation and food preparation and storage. It is well documented that such conditions are associated with a range of health risks, including diarrheal and respiratory diseases. With a high density of people living in overcrowded households, frequency of contact, and concentration and proximity of infective and susceptible people, the burden of disease is particularly high. A new “urban penalty” is developing where slum dwellers are suffering from infectious as well as chronic diseases, recession, persistent urban growth, deteriorating physical environments, and overstretched management capabilities of local government.

In addition, urban informal settlements have some of the highest HIV prevalence rates in South Africa. According to the DHS, of the country’s 19 million children, there are an estimated 3.4 million orphans. Half of these children have lost one or both parents to HIV and AIDS. With AIDS claiming almost 1,000 lives daily, the number of vulnerable children is set to increase. Children are more vulnerable to the effects of poverty than others. Five diseases – pneumonia, diarrhea, malaria, measles and HIV and AIDS account for more than 50% of all child deaths. In a slum environment the chances of contracting one or more of these diseases is compounded by poor living conditions and limited access to quality health services. Within vulnerable children programs, the under fives are some of the least represented, and at their age, the most vulnerable in terms of life-long impacts on their development. Poverty, malnutrition, poor health and non-stimulating home environments all detrimentally affect their cognitive, motor and social-emotional development.

Project HOPE is partnering with local organizations in the slum of Zanzele with an estimated population of about 10,000 people. Because of its “informal” status, there are few government services provided and little NGO interaction in the area. Many children do not attend school due to distance needed to travel into town. The dropout rate at secondary school level is extremely high. Studies have shown that improved parental education, particularly of mothers, is related to improved child survival, health, nutrition, cognition and education, as well as increased child spacing. They have also shown that when caregivers of vulnerable children become “partners” not “clients” and when vulnerable children are directly addressed, programs have a higher impact.

One of the keys to success in vulnerable children programming is integration. This is because the needs of a child usually span across multiple sectors and therefore coordination is essential. ECH requires stakeholders from various ministries to get together to provide coordinated efforts in targeting the multiple needs of the child. It is critical therefore for stakeholders to be provided a platform where they can easily work together. The "Healthy Start for a Brighter Future" program does this.

The HSBF program takes a two-pronged approach at addressing the needs of vulnerable children under 5 years. The first is to intervene at the child level through early childhood development activities. The second is to intervene at the caregiver level through multiple levels of services.

The goal is to improve the lives of vulnerable children under five in urban slums.
There are 3 primary objectives: 1) Increase access to early childhood development services for vulnerable children under 5; 2) Improve household living environment for families of vulnerable children; and 3) Improve lifestyles of all vulnerable children and family members caring for vulnerable children.

While many children face similar circumstances and challenges, each child and the family they reside with is unique. Each vulnerable child and household will undergo an in-depth health and wellbeing assessment which when analyzed will determine the specific interventions needed to bring them to a defined standard of living.

The HSBF program will be rolled out through a ‘phased’ approach allowing enough time for each activity area to get established, but in a logical order so that each of the activities will link together. The central mechanisms from which all other interventions will take place is through the establishment of an ECD site in which vulnerable children under 5 will be enrolled.

Phase 1 will focus on direct interventions at the child level through the establishment of the ECD site, including the selection and training of ECD teachers, site identification and building, and enrolment of 200 children. A family health and nutritional assessment will be carried out, a nurse will examine each child and a nutritionist will design a menu for the children’s cooked meal each day. A health education curriculum will be established and parents will begin health and parenting sessions on a bi-monthly basis.

Phase 2 will focus on increasing the security of the child through interventions directed at the caregiver level. Five interventions will take place: (1) Agriculture and animal husbandry training will take place on site with caregivers being empowered to implement low cost food gardens and animal raising in their homes thus increasing the nutritional security of the child and family. (2) Training on sanitation, water purification and hygiene will take place so that caregivers can learn to construct safe toilets thus contributing to the reduction in the incidence of diarrhoea which particularly affects young vulnerable children. (3) Education on constructing safer housing, and safety within in the house thus improving the living environment in which the child is raised up. (4) Economic strengthening activities will be put in place used to train caregivers in undeveloped skill areas, form linkages with local businesses, encourage savings and loans mobilisation all with the aim of increasing the disposable income of the household. (5) Government representatives from various departments will visit the site on a scheduled basis to inform and help caregivers register children, and apply for social security grants.

Phase 3 will focus on the health of caregivers through three interventions: (1) Family planning services will be provided to both male and female caregivers including the dispensing of contraception and education. (2) HIV/AIDS prevention activities including VCT and PMTCT services will be provided as well as HIV awareness raising activities. (3) Male engagement program will be established focusing on changing male stereotypical behaviour thus improving the lives of both female caregivers and the children in the household.

Phase 4 will focus on operations research to study and document the most effective approaches in this environment. Two potential OR frameworks might look at economic strengthening approaches most effective in a slum environment and performance rate of children having participated in ECD in comparison to those children who have not.

Through a phased approach, the ECD site will grow into a multi-purpose community resource center where Project HOPE and its identified partners will provide multiple services to both the vulnerable children and their families. The long-term goal of the program is to register the site as its own Non-For-Profit-Organization with the South African government, having built the capacity of the community to take ownership of the program, as well as encouraged government to participate allowing a successful transition into local ownership.

Target Budget - 2 Year Project $512,604

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