ENABLE
a model for transforming community healthcare in South Africa and beyond
The Enable solution is simple: integrated, door-to-door, health interventions by trained Mentor Mothers, providing access and referrals to clinics and hospitals.
OR Tambo, in the Eastern Cape, is among South Africa’s most remote, impoverished areas, housing numerous Last Mile communities. In these villages, distant from primary roads and corresponding resources, 66.5% of the population live in poverty.
Health outcomes are dire, with child and maternal health being particularly grim: 20% of under-5s suffer nutritional deficiencies; 16% of under-5 deaths are due to HIV/TB; 27% of expectant mothers are HIV+; and child inoculation rates are subpar.
Addressing these challenges, the Enable programme trains local women, known as Mentor Mothers, to deliver comprehensive healthcare in these hard-to-reach communities. This team of 40 now offers an array of health services, from antenatal and postnatal care to nutritional advice, immunisation referrals, HIV support, and assistance with birth registration and child support grants.
These Mentor Mothers, trusted figures within their communities, delivered health interventions to over 5,500 women and children last year, extending the breadth of healthcare beyond conventional clinics.
Major achievements to date
0%
Almost 0% mother-to-child HIV transmission rate after more than 1,700 births, when 27% of the mothers we work with are HIV+
91%
of children are fully immunised (2016: 34%)
75%
of pregnant women attend four antenatal appointments (2016: 27%)
5,777
Delivered health interventions to 5,777 women and under 5s
Holistic care
As our understanding has deepened, we’ve evolved our approach to focus on improving health outcomes and overall life chances for children by addressing the interplay between poverty, infrastructure, and health. The expanded Enable programme, launched in 2022, introduces three new components in addition to our existing Mentor Mother activities:
(i) Five Early Play Learning (EPL) Mentor Mothers now deliver structured play, book learning, and parenting sessions to 1,000 caregivers and their children within the community, utilising our Mentor Mother approach.
(ii) We’ve trained 10 Mentor Brothers to encourage men to challenge discrimination and inequality, fostering their active participation in partner’s health, addressing gender-based violence, and promoting responsible parenting. Already, we’ve identified over 500 men for project participation.
(iii) In response to the 31% adolescent pregnancy rate in our programme, we plan to recruit and train 10 Peer Mentors to provide appropriate HIV and sexual health information and referrals to these young mothers.
MEETING ADDITIONAL COMMUNITY NEEDS
Life-saving water and sanitation
Our work thrives on collaboration, helping us meet the genuine needs of the communities we serve. Our partnership with Ubuntu Pathways, an NGO committed to enhancing clean water accessibility in last-mile communities, has facilitated the installation of boreholes and pumps at 11 sites. This ensures clean water access, significantly improving life and health outcomes.
We've also teamed up with Breadline Africa to bring sanitary toilets to primary schools and Children's Centres, further upgrading the communities' living conditions.
The best medicine is food
In the face of widespread poverty and malnutrition, we've enabled 81% of children to receive child support grants. Through partnerships, we directly combat malnutrition, providing families with nutritional support, including multi- micronutrient supplements for young children, nutritional porridge for older children, weekly food parcels for the most food-insecure households, and food garden start-up kits.
“I only started taking my medication after [Mentor Mother] Funeka encouraged me to. I wouldn’t be here if it wasn’t for Funeka. I think I would be dead by now.
”
Inset map of Eastern Cape, showing the areas One to One Children’s Fund covers (in green). Click to enlarge map.
“Being a Mentor Mother, I make clients realise that this is not the end of the world for them. They can still get up and go on to achieve their dreams and not just sit around waiting for the day they will pass away.”
ENABLE STORIES
Meet Ayanda
Ayanda, a 26-year-old, pregnant and newly diagnosed with HIV. Mentor Mother Nokwanda met her during a household registration. Noticing Ayanda's denial about her HIV status, Nokwanda enrolled her into the Enable program and provided continuous counselling. Ayanda initiated Antiretroviral Therapy (ART) and remained compliant. When pregnancy complications arose in the 5th month, Nokwanda referred her to Canzibe Hospital. On October 28, 2022, Ayanda gave birth to healthy twin boys, both tested HIV negative at birth.
Meet Ivan
Ivan, a five-year-old malnourished boy weighing just 10kg, joined the Enable program in 2022. He immediately started receiving fortified nutritional porridge and Mentor Mother Zanele provided nutrition education to his caregiver and monitored his progress. His mother received seedlings to start a nutrition garden and is now growing various vegetables. Ivan, now weighing 13.5kg, is thriving thanks to improved nutrition, a child support grant, and up-to-date immunizations.
“The simplicity of the Enable model is its secret. This is no glamorous vanity project. It is a practical, low-cost solution to a problem. ”
THERE IS MUCH STILL TO ACHIEVE – AND WE ARE PERFECTLY PLACED TO ACHIEVE IT
South Africa's challenge is meeting the UN Sustainable Development Goals for child and maternal health, vaccination rates, and HIV infection. Our proven model is ideally suited to tackle these issues. Over the next three years, we plan to widen our Mentor Mother model across the province, training government health workers and aiding government clinics. This will extend proactive, accessible healthcare to tens of thousands more families. One year into phase three of our Enable Programme, we're aiming for a broader, lasting impact, with the potential to benefit 112,500 mothers and under-5s per year at a cost of £3 million.
Looking forward
We feel we are in a strong position to take this proven community health model to scale in neighbouring areas of the Eastern Cape, bringing in Community Health Workers as well as Mentor Mothers. We are also expanding our intervention to include sexual reproductive health and mental health, and using mobile technology to improve effectiveness. If we secure funding, we aim to reach 2,400 families directly and bring improved access to healthcare for thousands more.