Project Director :
- A. Baumann
- J. Roberts
- M. Taylor
South Africa Site
- T. Gwele
- B. Bhengu
- G. Muchnu (University of Natal Site)
- R. Gcaba
- D. Memela
- G. Mathe
- L. Nkonzo-Mtembu (Province of KwaZulu-Natal, Department of Health Site)
- Canadian International Development Agency (CIDA)
The Primary Health Care (PHC) Program for Women of KwaZulu-Natal was a partnership between McMaster University, the University of Natal, and the Province of KwaZulu-Natal, Department of Health. This project was designed to develop, implement and evaluate a PHC program based on participatory methods and adult learning principles. The project focused on promoting PHC in Region D, KwaZulu-Natal by training rural community women, nurses, traditional birth attendants (TBAs) and sangomas (female traditional healers) to increase their knowledge of PHC.
The early phases of this project consisted of exploring the needs of the community; developing the curriculum of the PHC program; and establishing a reliable management structure and channels of communication between project partners.
The program for Women of Region D of KwaZulu-Natal commenced on January 1, 1999 with a two-month baseline data collection phase. Two McMaster School of Nursing graduates and one faculty member worked in partnership with one University of Natal faculty member and two KwaZulu-Natal Health Service nurses to conduct a field survey. This preliminary assessment was done to establish the needs of Region D and to evaluate possible interventions.
In an effort to mobilize community groups, community heads, stakeholders and health services, a consultative, participatory workshop was held in March 1999 following the data collection phase. This meeting between program developers and various community representatives identified resources in education, communication, law, and health, which could be accessed for the development of learning manuals to be used by PHC nurses of KwaZulu-Natal.
In 1999, 82 nurses were trained in Part I of the PHC curriculum (which included topics of power, gender sensitivity, political and justice systems, domestic violence, child development, and health promotion and illness prevention). These nurses in turn trained 565 community lay women. In 2000, the same nurses continued their training in Part II of the PHC curriculum (which included topics of economic empowerment and care of children and adults with health problems). In 2001, following a baseline survey of their practice and learning needs, TBAs were trained using the PHC curriculum. Training sangomas to increase their involvement in health promotion and illness prevention began in October 2001.
Project partners developed visual aids (flipchart and pamphlets) in Zulu and English to compliment the material in all training manuals. Some women who have been trained in PHC have gone on to establish income-generating community projects.
Three McMaster BScN graduates and one graduate student have gained field experience in rural areas on KwaZulu-Natal province as a result of this project. Two 4th year BScN students presented a poster on primary health care knowledge and attitudes among the nurses of KwaZulu-Natal at an international conference in India, based on the objectives of their clinical research course.
The project was completed in 2003.
Exploring the Barriers/Issues for Providing Home-Based Care for HIV/AIDS Patients in Eastern Cape, South Africa
- McMaster University, Canada
- Management Sciences for Health, South Africa
- Dr. Basanti Majumdar (Canada)
- Mrs. Nomathemba Mazaleni (South Africa)
- Carolyn Byrne
- Kevin Chan
- Stuart MacLeod
- Jacqueline Roberts
- Eli Tshibwabwa
- Tracey Chambers
South Africa Team:
- Mathabo Hendricks
- Felicia Manjiya
- Nonceba Mnyute
- Feziwe, Rasmeni
- Lulama Zonke
The International Development Research Centre (IDRC), Partnership for Global Health Equity
Conducted between March 2002 and March 2003, the goal of the study was to explore the day-to-day experience of people living with HIV/AIDS (PLWHA) in a rural South African community. While monitoring how these individuals cope with the infection, as well as the related stigma and discrimination, an attempt was made to incorporate this information into an integrated community-based health framework. The primary objectives were to explore the barriers to receiving care currently present in the community, as well as the barriers that family members and health care providers are facing, particularly the stigma and community pressure related to caring for patients with AIDS. Other goals were to identify local resources and assist in developing networks within the local community; to recognize the needs of, and assist various community stakeholders, in order to provide home-based care for those affected by HIV/AIDS; to assist community stakeholders in planning strategies aimed at prevention; and to perform a thorough literature review of community barriers, stigma, prevention strategies/local resources and issues related to caring for those infected with and affected by HIV/AIDS, particularly in the African continent and other developing countries.
Interviews with PLWHAs explored a number of themes surrounding physical, mental and emotional health. Some of these include activity level, poverty; support from loved ones, access to basic services, stigma and isolation surrounding HIV/AIDS, and the individual needs of the PLWHAs. In addition to providing their perspective on these topics, discussions with the Direct Care Givers (DCG) of PLWHAs further clarified the enormous financial burden they are faced with, an increased workload, and the overall effects on the physical health of the DCG. Emotionally and socially, there were common feelings about caring for PLWHA, fear of death, dealing with loss, and social activity levels. The DCG also shared personal feelings regarding the barriers to home-based care and prevention strategies.
Focus groups with community leaders and health care providers discussed a lack of prevention programs and the burden of stigma and isolation on society. They discussed poverty, the lack of basic services and assistance for PLWHAs, other barriers to care and support, and the need for community education and mobilization of resources. Health care providers discussed poverty, misuse of voluntary test sites, patient confidentiality for couples undergoing testing, and a need for improved community resources. Stigma related to HIV/AIDS was discussed by each group of participants.