A case study of community-level intervention for non-communicable diseases in Khayelitsha, Cape Town

While NCDs affect both women and men in a setting like Khayelitsha (an urban township of Cape Town), there are particular factors that need to be considered with respect to the way in which this burden of disease impacts on the health of women and girls in such contexts.

This document presents a case study of an intervention, implemented in 2001 by the School of Public Health at University of the Western Cape (UWC), which aimed to address the burden of NCDs in a low-resource area of Khayelitsha. The intervention involved working with community health workers and engaging them as change agents to reach out in this community to address NCDs.

Findings from the case study include:

• the intervention was viewed as bringing health services to the community instead of people/clients being attended at the health facility
• community health workers are easily accessible to community members: since CHWs reside in the community, people find it easier to ask them questions and have a discussion about their conditions
• having CHWs talking to people either in their homes or at support groups, and also having awareness campaigns where people could have their blood pressure and blood sugar measured, increased their understanding about these conditions
• this intervention further empowered CHWs with knowledge relating to the environmental issues that have an influence on NCDs and thus they became more aware about the dangers of these conditions
• CHWs who participated in this intervention felt that their training was more practical and gave them skills to deal with problems in real situations. However, coordinators felt that on-going training is essential to ensure that newly recruited CHWs are also knowledgeable.
• the training received has made the CHWs visible to the Department of Health as they are often called upon to assist in campaigns and activities relating to NCDs
• challenges to the intervention included: lack of finance to conduct activities; poor referral to health facilities; poor working relationships between the CHWs and the health facilities; lack of resources; lack of equipment required to conduct intervention activities; and high turnover of CHWs due to the lack of security in terms of funding.

One of the components of the intervention was a visioning exercise with respondents, where they identified their ideal programme. The document provides a table with their ideas.

Recommendations include:

• women were at the forefront of this intervention and their actions and behaviour as role models should influence their family members. However, it is imperative to begin to raise the interest of men in health, particularly in such a patriarchal community.
• there is a need to extend similar programmes to schools to influence learners (girls and boys) as this may have an influence on their future health behaviours as well as reduce the burden of obesity and NCDs
• there is a need to implement prevention programmes that focus on early life and throughout adulthood at all Government levels
• women’s health programmes where an integrated management approach to HIV and NCDs is implemented are needed, as these conditions tend to co-exist in the same communities
• risk factors for NCDs are multi-factorial, so it is essential to take a multi—sectoral approach, and there is a need to involve community leaders to ensure buy-in
• future policy needs to include interventions that address the conditions of life that make it hard for people to make lifestyle choices in a food environment that does not always enable that choice. A focus only on interventions targeting individual behavioural change is inadequate in settings like Khayelitsha.