Tackling the Trojan Horse

As AIDS becomes more visible, so does the need for the workplace to take on a new more proactive function, and thereby turn the tide.

Asked about their company’s response to South Africa’s exploding AIDS epidemic, many employees would scratch their heads and reply, ‘What response?’ A few, on the other hand, might grasp your arm like the Ancient Mariner, and enthuse about the new meaning AIDs work has given their workaday world.Wanted - for not stopping AIDS

For while many CEOs haven’t yet grasped that this silent, stealthy enemy has crept, like a Trojan horse, right into their camp, ever-more visible sickness has galvanized numerous businesses, big and small, into dynamic action. The results are sometimes surprising, bringing not only an antidote to despair but also a more compassionate awareness of the workforce as vulnerable human beings.

While this may seem difficult to relate to rands and sense, in the long run it may well serve both. For, as Lee Kingma, Human Resources Manager at Securicor, and Chamber of Commerce representative on the Western Cape AIDS Council, told businessmen at a recent breakfast, `Managing the pandemic needs combined effort from government, business and the NGO sector. As business has a ‘captive community’ – a large part of the nation’s workforce – their impact could be dramatic if they committed themselves to an AIDS strategy and implemented it effectively.’

‘Corporates in South Africa have notoriously tried to ignore the impact of HIV/AIDS’ says Dr Bridget Farham, editor of AIDS magazine, Perspective. Numerous surveys seem to bear this out. Change is slow and painful. Only one in four companies in the Western Cape, for instance, has developed an AIDS strategy, according to the Bureau for Economic Research.

Clem Sunter, South Africa’s favourite scenario planner, as well as being chairman of Anglo American Chairman’s Fund, puts the situation bluntly: `”Ready, aim, fire” is what scenario planning should be about,’ he says. ‘In America it tends to be “ready, fire, aim”. But in South Africa, it’s “ready, aim, attend a conference!” Talk is not progress! There has not been nearly enough fiery action, fuelled by passion.’

In cold business terms, which tend to suppress any emotion as dangerous as passion, three things bring a company to the point of firing at HIV/AIDS: 1. What it finds profitable to do, in terms of its business interests. 2. What it must do, because of legislation, regulation, public expectations etc; and 3, What it should do, from personal conviction.

There are signs, amid the gloom, that the pump behind all these pressures is being primed. `With the escalating loss of loved ones, colleagues and respected members of society, comes the realisation that denial will no longer do,’ says Veni Naidu, a chartered marketer doing his PhD on this topic. `A concerted multi-dimensional response from all decision makers is evolving.’

Among advances has been the establishment of SABCOHA, the South African Business Coalition Against HIV/AIDS. This supports the many businesses which lack the money, time and resources to give the disease the attention it demands. SABCOHA’s most recent contribution has been developing an HIV/AIDS toolkit for businesses, itemising the most effective and efficient way forward.

Another great national weapon is Metropolitan’s Red Ribbon website. Here businesses can download free material, get contacts, information, examples of best practice and so on. It gives (and is one itself) superb examples of partnerships that work – big business twinning with small business, industrial organisations taking the initiative etc. The message is, `You can manage HIV/AIDS. It is not a catastrophe nor an automatic death sentence. But it is tough, and you can’t go it alone.’

Many mistakes have been made and lessons learnt. Key is that a company’s AIDS strategy should come from the top down and from the heart, not just the rule-book. The most exemplary (and costly) plans can go wrong. An example is the copy-book Voluntary Counselling and Treatment Programme provided by one manufacturing company, to which hundreds of employees responded. But less than half of those tested ever returned to hear their results, making the exercise largely pointless. The sensitive psychology of the matter had somehow been botched. More expert counselling was needed – more about this later.

External pressure on business to raise its head from the sand came from the Second King Report on Corporate Governance. Henceforth, said King, company reports should specify whether a company had developed an appropriate HIV/AIDS strategy, and whether there were policies in place to address and manage the disease. `King 11 has for first time ensured that good governance cannot be present if HIV/AIDS is ignored,’ says Bridget Farham.

However, surveys show that the majority of companies still see HIV/AIDS as a soft issue, to be handled by human resources. `Best practice suggests that either the managing director or the board take responsibility. This will ensure that the full business risk is assessed and managed, not only the employee risk,’ says the Deloitte survey.

Some respondents to this survey argued that their company was ‘low risk’ because of a predominantly high-skilled and white workforce. This, in a country where six times more white people than anywhere else are infected, may be dangerous thinking. It bears out a finding by the World Economic Forum Global Health Initiative that ‘Businesses appear to be making decisions based on a patchy assessment of the risks they face’. Those companies who do prevalence testing are on much firmer ground.

Antiretroviral Therapies

Treatment and care is another big issue. Less than five percent of companies are providing antiretroviral therapies, and although they are being urged to, many CEOs ask `Now that the government is rolling out ARTs, why should we provide them?’ `Twenty per cent of AIDs victims are economically active,’ Dr Jack van Niftrik, CEO of Life Works, responds. `This will result in an economic loss of at least R154 billion over the next seven years.’ Dr Fareed Abdullah of the Western Cape Department of Health adds: ‘Without any medical intervention five million people will die over the next 10 years. This is a camel’s hump of mortality. With treatment this ‘hump’ could be spread over 30 to 40 years. The difference will be between an economy that struggles to develop, and a good future.’ He warns that even in the Western Cape, which is way ahead of other provinces, the ART roll-out is extremely slow.

Kingma’s support for AIDS strategies was born out of personal experience at Securicor. `We have a responsibility towards our labour force- most of them young men – and helping them manage their disease, first out of compassion, and second because it makes good business sense. Without it medical aid costs increase, absenteeism rises (by as much as 37 percent in some companies) and productivity drops.’

Clem Sunter is proud that Anglo was the first company to offer free HIV treatment to its staff. Today 1 200 miners are on anti-retrovirals at a cost to the company of R12 million.

‘But this is better,’ he says, ‘than not putting employees on the pills. Don’t even waste your time trying to work out if this is more expensive than doing nothing. You can’t. For a mining company coping with sick labourers underground could be disastrous.’

Other Solutions

Business leaders whom Sunter dubs `foxes’ are those who use their wits to survive by considering two factors: First, the things they have control over, and those they don’t; and second, the facts that are certain and those that are not. Foxes on `the HIV high road’ first accept that HIV/AIDS will impact hugely on their business. `Disease management’ is then a necessary option, starting with a survey of that impact.

Surveillance

Accurate prevalence rates are a crucial first step for any company. A manufacturing business in KZN, for instance, conducted voluntary anonymous blood screening tests and found a prevalence of 4,3 percent among top management, 18,2 percent among supervisors, 9 percent among technical staff and 20,4 percent among shop floor employees. So much for the myth that only the unskilled are at risk.

On the other hand, a construction industry group faced with growing absenteeism, found good news when anonymous saliva testing proved that only eight percent of the workforce was positive instead of the 25 percent they’d feared. This made viable proactive strategies such as providing ARTs.

A further advantage of surveillance is that when external agencies are brought in, measurable targets can be introduced. Indeed this is the yardstick of a good intervention. At a sugar mill in Northern KZN, for instance, condom distribution increased by 400 percent, treatment of STDs decreased by 88 percent and an estimated 11 new infections were averted, in the 12 months following their survey. Another company identified its primary target group for reducing the further spread of HIV and other STDs.

Woolworths commissioned an actuarial analysis, despite believing their staff were low-risk. To their surprise, this showed that by 2010, 16 per cent would be HIV positive, slashing productivity by up to three percent – equal to closing down one big store. This led to a long-term strategy focussing mainly on awareness, condom distribution, and education about sexually-transmitted infection. `The aim is to reduce prevalence by 20 per cent by 2010,’ says medical officer Dr Tony Davidson. `For every rand spent on peer education, the organisation could save R10′.

Actuarial models don’t have be highly sophisticated – they can be simple snap-shots. They highlight cost increases which may not have been factored in, such as absenteeism, recruitment and training costs, and the impact on employee benefit and medical aid costs. It is estimated that the costs of ignoring HIV/AIDS in the workplace are between 3.5 and 7.5 times higher than the cost of managing it. For example, very restrictive employee benefits can reduce morale and discourage early disclosure, making responses such as succession planning more difficult.

One company used actuaries to assess the current and future impact of HIV/AIDS on 40 individual product items, using demographic data relating to customer segments.

New jargon has been inevitable – `KAP studies’, for example. KAP stands for `knowledge, attitude and practice’, and such studies help companies to focus their education efforts more effectively. The sometimes surprising results inform everyone. For instance, half the respondents in one company believed they were at risk of contracting HIV/AIDS; many expressed fear of discrimination, stigmatisation and safety. Significant myths in various surveys included that: HIV/AIDS is a punishment; sleeping with a virgin may cure it; that African traditional medicine may have a cure; that TB causes AIDs; and that mosquitoes are carriers.

Prevention

Of the many ways businesses can change the way AIDS unfolds, prevention is obviously the gold standard. Five key components have emerged, and many lessons have been learnt.

Education and awareness

The most basic component is an awareness and education programme, although three out of four small companies don’t even have these. The second is voluntary counselling and testing (VCT) – crucial since the data informs other policies. Third is communication of the company’s HIV/AIDS policy to the workforce; fourth, training leadership and management in how to deal with the disease, and fifth, engaging with communities by, for instance, extending education efforts to spouses and dependents. A good example is the Bata shoe factory in Estcourt, KZN. There, 98 percent of the staff are women, and many of their husbands are unemployed. They begged the company to approach the chiefs for permission to educate the men about AIDS too, since a common attitude among them was that since lobola had been paid, they could do what they liked with their wives!

Leadership makes all the difference. A picture speaks a thousand words, and one of the CEO with his sleeve rolled up having a blood test goes a long way to removing stigma, as Tony Trahar, Chief Executive of Anglo American, demonstrated.

`Edutainment’ by means of videos, plays, music and so on has flourished, being an effective way of reaching (sometimes illiterate) blue collar workers. Eskom staff, for instance developed their own play. `We worked on the script, the sets and the music,’ says Renier Venter, who eventually became mentor for many peer educators. `We took the play to communities all over, including schools and prisons. Later it won an award.’

Training staff as peer educators has also proved effective, not least because they speak the same language, both literally and figuratively, as their colleagues. Often, this has brought forth individuals with such passion for the work that they have been made `champions’. A publishing company uses a focus group to identify and encourage such people. An excellent example is Harold Bokaba of Unilever. A warehouseman for 25 years, his idealism led him into union work. Seeing AIDS spread, he developed a burning desire to help, and started a shop floor awareness programme. When Unilever made training for peer educators available, Harold was first in line. `Once equipped with counselling and education skills I started doing voluntary work in the AIDs clinic at Boksburg,’ he says. `Many patients needed pre- and post-test counselling. Sometimes I would see 15 in a morning.’ Soon he was giving talks at churches and schools too. But after several years, he suffered burn out and was unable to sleep. A compassionate Unilever nurse arranged for psychotherapy. `After only three sessions I was a changed person!’ Harold says. `I rediscovered my passion for the work.’ Subsequently he was offered a post as `AIDs champion’, and now advises on AIDs programmes in Unilever’s seven South African sites, plus other companies.

Treatment and Care

Many agencies offer complete HIV/AIDS management packages and avoid the pitfalls of inadequate counselling. Sixty-three percent of companies encourage counselling, pre-test, post-test and on-going. Of these, nearly 40 per cent contribute to the costs – the larger the company, the more likely this is. One in four outsource their employee assistance and wellness counselling programmes (EAP) to a national provider, whose counselling often includes not only HIV/AIDS but also family, social, violence and drug abuse counselling. Advantages are that the counsellors are more effective; and confidentiality is more obvious (and perhaps more real!) Also, separation of work and HIV/AIDS issues ease the objective evaluation of those issues.

Seventy per cent of large companies provide on-site treatment. Occasionally they go even further and treat the broader community. A well-known example is the Lesedi project run by the Harmony gold mining company in partnership with the South African Institute for Medical Research, Family Health International and the Institute of Tropical Medicine in Antwerp. The mining industry, relying as it does on migrant labour, is reaping the whirlwind, since the use of sex workers by men deprived of their families is high. Miners are a significant source of STIs and HIV infection. The Lesedi project targeted not only them, but also women in the surrounding communities. In the first nine months, the incidence of gonorrhoea and chlamydia was reduced by 42 per cent and there was a 77 percent reduction in genital ulcers. These dramatic declines were mirrored in the women, and the project spread. A computer model estimated that this treatment averted 39 percent of HIV infection among the women, and 48 per cent among the miners, saving the mining companies at least R6,8million.

Union support was crucial in garnering such co-operation. Small businesses, which struggle to implement HIV/AIDs programmes, find such help invaluable. The SA Clothing and Textile Workers Union (SACTWU) is an excellent example – it runs its own VTC programme which has trained 2000 shop stewards and more than 80,000 workers countrywide. Dr Feroza Mansoor, director of the programme, also sees SACTWA Union providing antiretroviral therapies to its members soon, and has plans for an orphanage and a hospice.

There’s no doubt that small and medium businesses need any help they can get. For although 90 per cent of them believe they have a responsibility to decrease the impact of HIV/AIDS on their business, only 34.5 percent are doing anything about it. Why? The main reasons are lack of time, and financial constraints, although 13 percent don’t feel HIV/AIDS will have enough impact to justify action. They should be aware of what happened in Uganda, when supply of cheap replacement labour ran out. Faced with a rotting coffee crop and no-one to harvest it, land concessions had to be given to Korean nationals in return for labour to pick the coffee beans.

One solution that has often proved fruitful is to develop local partnerships. In cape Town, for example, Securicor offered free security services to the local Trauma Centre who, in return, offered free counselling to all Securicor staff.

On a more sophisticated level, the Chris Hani Baragwanath Hospital, Soweto, obtained invaluable help from two small companies in providing internet solutions for its HIV vaccine trial. The hospital, with around 146,000 patients a year, is doing much research into HIV/AIDS, in conjunction with the University of the Witwatersrand, the World Health Organisation and UNAIDS. It has 25 PCs and 90 users, all internet enabled. A coalition of two small businesses, InfoStat and CubiICE, offered a satellite business solution on a private network, which halved the costs. They got excellent coverage out of their sponsorship, in return for which they received the latest information on the virus.

`Businesses of any size can contribute to battling AIDS. They only need to do what they do well, where it matters.’ Says Peter Piot, director of UNAIDS. `The fight against AIDS needs to be part of every aspect of business life: In providing for workforces, in participating in community life and in dealings with other businesses.’

Business Associations

Business associations and coalitions to tackle HIV/AIDS have also joined in the fight, sometimes with great success, as firms have a greater incentive to participate in and sponsor prevention activities if they can focus on the problems facing an industry sector or geographical area. The haulage industry has been particularly well organised, offering posters and training courses.

Benefit plans

Aid benefit plans with higher premiums provide a level of funding for HIV/AIDS treatment and care. But small print should be checked to see whether the HIV/AIDS funding limits override the `unlimited’ hospital benefits, warns the Red Ribbon site. In the current environment where dedicated HIV/AIDS benefits have not been widely introduced, there is serious risk that existing benefit structures may be inappropriately applied. Low cost medical aid schemes limit their HIV/AIDS benefits to wellness programmes and drug management programmes only, without funding the cost of care or medication. These schemes do however normally fund medication to HIV positive mothers, prevention drugs to prevent mother to child transmission and medication to rape victims. A number of insurers are now in the market with HIV/AIDS cover to enable employers to cover their workers. Capital Alliance Life, for instance, has made its mark in providing a comprehensive range of products specially targeted at the C and D income groups.

Conclusion

Clearly the challenge HIV/AIDS presents for businesses both great and small is enormous. But as all these examples prove, there is no need to feel powerless. Every initiative counts, and South Africa’s proud, gutsy heritage of tackling ‘impossible’ problems will, in the end, enable us to triumph.

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Using the power of collective imagination – a story from Hout Bay

It’s not often that I meet a champion – someone with a great big vision and a great big heart – a bright spark that lights other sparks and makes big fires. Such a person is Bronwen Lankers Byrne, coordinator of the “Imagine Hout Bay” initiative. “Imagine Hout Bay,” as I discovered, is all about getting diverse community groups talking together, dreaming together and creating together. Read on to find out more.

Bronwen Lankers Byrne

Originally a fishing village, Hout Bay, about 15 kilometres from Cape Town City centre, is the place where I grew up in the seventies. Then it was a pristine valley. Now it is ravaged by rampant development. A microcosm perhaps of what has happened in the last 30 years across the globe. Hout Bay is also the place I first had to grapple with that bizarre apartheid logic – whites lived anywhere they pleased in sprawling houses with large gardens. The “coloured” township was crowded up above the Hout Bay Harbour – 3 story blocks of flats, or tiny dwellings, swirling in the dust of the prevailing winds. In the 12 years post 1994 this has not changed, but now clinging to the hillside as you come into Hout Bay is the rapidly expanding “black” township area known as Imizamo Yethu. The result is that in this little piece of paradise ringed by sandstone mountains and the flashing blue ocean, live three separate divided communities. Divided by colour, divided by class, divided by geography, divided by the differences in the services delivered and the opportunities afforded to the children who are born.

For Bronwen Lankers Byrne, living as a Buddhist nun close to Imizamo Yethu, her introduction to the “Imagine!” approach, through a workshop, suddenly offered a way to start bridging all these divisions. Bronwen describes a trauma experienced by many who were children growing up under apartheid, who in the natural unprejudiced state of children made friends “across the colour bar” and who felt the pain of separation as they were forced to follow different dramatically inequitable lifestyles according to the grand scheme of “separate development.” For Bronwen, the back yard room where the family domestic worker lived with small son Thabo was her safe space, and Thabo her child hood friend. She was heartbroken when they had to attend different schools. So has followed her life marked by a wide range of work and places but all with same common denominator – to unite people. Now in a small monastery Bronwen was so inspired by the possibilities of the “Imagine!” approach that she disrobed as a nun and began work as the coordinator on a small stipend, living in a single room and riding a bicycle for transport.

“Imagine!” came from a method used by Bliss Brown in Chicago in 1992 when she was distraught by her own divided city. It is rooted in what is called an “appreciative inquiry approach” – this is an organisational development approach where change begins with valuing and appreciating what is working and wonderful amongst a particular group or community. This gives people energy for change in a way that talking about problems and everything that is wrong does not!

Hout Bay Community After valuing what is, the next step is where the dreaming and imagining comes in. It asks different stakeholder groups to imagine what can be in their community. Bronwen told me just how they went about this. In 2004, the “Imagine Hout Bay” initiative trained 70 community volunteers from the three divided Hout Bay communities in interviewing skills and how to administer an interview questionnaire.

Sometimes for the very first time, coloured interviewers went into the shacks of black interviewees, or black interviewers went through the remote controlled gates into the houses of white interviewees. But more than this, youths interviewed the old, the unemployed woman interviewed the corporate director and the Rastafarian interviewed the Christian. In short, people who did not usually talk to each other started having conversations. And that conversation began with valuing each other: One of the interview questions is “what do you value most about yourself as a human being? A member of your family? A member of your community?” Just out of these conversations people started making connections and linking the dots between each other and things started to happen.

  • Themba Makau partnered up with the bicycle empowerment network (BEN) and local mentors and now has a bicycle repair and maintenance shop in Imizama Yethu.
  • A holiday programme was started involving adult volunteers and children from all the communities.

These were opportunities that arose simply from the discovering of what is happening in and around in the area and making the obvious links.

But the interviews were more than about the healing that goes with people from different groups valuing and talking to each other and the possibilities arising from networking. They asked people to go a step further into imagining a future together. The highlight of the interview schedule is the ‘dream’ question where the interviewer invites the interviewee to:

“Please close your eyes and imagine Hout bay 10 years from now. The year is 2014 and extraordinary and wonderful things have happened. Hout Bay is a community of which you are extremely proud. Describe this community that you are living in.”

Following 300 interviews, Research Surveys, a local research company, helped with the capturing, analysing and synthesising of data. The results were presented at a huge gathering and celebration of people from all the communities with joyful displays of dance and music and including the mayor and other local government stakeholders. What “Imagine Hout Bay” had found was that all its inhabitants appreciated the same things about where they were living – its beauty, its diversity. They all wanted the same things too – equality, justice, and to nurture the incredible fragile interdependence between themselves and the Hout Bay environment. Bronwen’s eyes are bright as she describes this celebration, “the mayor,” she says, “was moved to tears and put aside her prepared speech.” I think I can understand why, there is something especially moving about the energy of ordinary people coming together — with and for each other — with no designs on office or power or money.

What followed this celebration, undoubtedly the high point of the “Imagine Hout Bay” initiative so far, was the establishment of an inter-sectoral development forum with 8 flourishing sectors which involved over 1000 people in 80 different meetings. Some of the dreams realised by these sectors were:

  • The youth rehabilitating a park in Imizama Yethu — they renamed it Ukujika Park which means “turn around park.”
  • The establishment by a “Back to your Roots” walk by the Rastafarians who take people on mountain walks and identify medicinal herbs and the like.
  • A “From Street-to-Stage” concert where local young dancers and musicians from the different communities took to the stage and brought the house down with their enthusiasm and passion.
  • A recycle caravan which exchanges recycled goods for donated stationary and second hand clothes and goods for the children in Imizamo Yethu and Hangberg.
  • A “Heritage Day” street parade and soccer match involving the different communities.

In reflecting what had helped her as a leader in the “Imagine Hout Bay” initiative, Bronwen doesn’t hesitate, she says it is “recognition of the value of inclusivity.” She explains that part of her training as a nun was to “recognise and let go of judgements. As soon as you get into judgements you start to separate from people,” she says, “instead I keep asking, “how can I bring them in, what can they offer?” In the “Imagine!” approach, difference amongst individuals and groups is seen as a strength rather than as a barrier to working together. Inclusivity is not only the method or the way to do things, however, it is also the goal and the vision – a united society where is everyone is valued for their unique contribution.

Another big part of being a leader is sustaining belief and enthusiasm, in holding this vision. When I ask Bronwen about the challenges they are facing, I realise just how tough this can be. There are the usual blockages to the “Imagine Hout Bay” initiative: Greed. Power. Corruption. In all the communities, the powerful and the rich hold the reigns and it is often in their interests to block development. The greedy continue to manipulate themselves into leadership and use their connections to get government tenders. It’s also in their interests to keep an ignorant community. There is propaganda about the “Imagine Hout Bay” initiative in the Hangberg community and Imizama Yethu. People are claiming it is a “white thing”. The old pain from years of division and inequality resurfaces. “The blocks happen,” says Bronwen, “when people go back to the hurt.”

Bronwen does not seem daunted by these challenges, for her the vision is as it has always been through her life, clear and bright. She says that the way forward is to go back to the healing and back to the story telling. She is excited about the possibilities that a little extra money will bring which will allow for three field workers from the different communities to work for a year with her and “Imagine!”

She explains that the trick to sustaining the energy of “Imagine Hout Bay” is to “keep creating the results and letting people seeing them.” Certainly for me, who was a child in this place, hearing about the celebration and some of the outcomes of the “Imagine!” initiative has lightened my heart, inspired and excited me. I must feel like all the Hout Bay residents who have participated in the “Imagine!” initiative — that if these small things are possible amongst these different divided groups, then so is much much more.

As we part, I take a photograph of Bronwen and her bicycle in front of the Sentinel Mountain which has stood marking the entrance of the bay for millennia. There is something of that stillness in Bronwen too. Driving again out of Hout Bay, I am left with her words ringing in my head: “hold the vision and keep inviting people in.”

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After the fall: ex-prisoners and voluntarism

What type of person do you imagine when you think of a volunteer working for the benefit of others in South Africa? Do you imagine a township Mama whose long life has been spent caring for her children, grandchildren and her community? Or do you imagine a privileged young idealist who takes time out between studying to try to make a difference? And when you consider those in need, who do you imagine?

One kind of person that one doesn’t usually imagine being a volunteer – or as the ideal beneficiary of volunteer activity – is a robust young ex-prisoner.

Yet recent research involving young men in conflict with the law has brought to light some poignant personal stories from such young men, providing a fresh look on the motivations of those who become volunteers – and those who have been helped by volunteers.

While many of us are tempted to write off “criminals” as a lost cause, some of these young men, with the help of some innovation intervention programmes which often make use of committed volunteers, are turning their lives around and some are themselves becoming committed to volunteer activity.

This number of young ex-prisoners in South Africa is large and growing. In the financial year 1995/6 for example, two in every 100 young men aged 18 to 20 were convicted of committing a crime. According to the Office of the Inspecting Judge, 56% of the national prison population comprised persons aged 18-30, as at January 31, 2005. Some 30 000 prisoners are released from prison every month in South Africa. By weight of numbers alone, the fate of ex-prisoners in South Africa is of great importance.

The following stories have been extracted from focus group interviews held in 2005 with young men who have been involved with Khulisa, NICRO, Hearts of Men, and the Together Action Group, all organisations which provide interventions which seek to assist young people in conflict with the law with developing the skills required to adapt to a life without crime. Many of the young men participating in these programmes have chosen to engage in volunteer or community-serving activity on leaving prison.

Some now have dreams of serving the community:

“A straight face and a positive mind”I had negative mind towards prison warders, so at first I was actually stubborn and I looked at life in a negative way, but later something happened to me. It was one day when I was lying on my (prison) bed and then I had to respond to nature, so when I walked down to passage into the bathroom there was a mirror on the wall, so when I walked passed that mirror I saw something, then I went back to that mirror and looked at that mirror and I saw the (self) reflection. The reflection that I saw on that mirror was not the reflection that I expected, it was a very different person that I was seeing on the mirror, and I had a cigarette too, by that time I was also smoking mandrax and weed (i.e. dagga) and then I looked at the reflection, I took the puff of the cigarette, and I saw the reflection getting worse after that puff and I took the cigarette out of the mouth, I saw a different reflection thinking of myself as a young man, you know, intelligent so that day I had to make a decision as to which image in the mirror do I actually want to be, and fortunately I needed to make a right decision, I decided to make a image, with a straight face and with a positive mind, so from that day, I had a mission.  I involved myself with church as a Christian. Three weeks down the line I was an MC and later I quit smoking after that I went to the authorities to ask them to provide a smoking free zone, like a cell, and then they ask me to go back to draw a petition and find out other guys who have the same problem, so I did that petition and I found other guys who had the same interest in arts, I brought the petition and it was approved so they gave us a cell, and I was responsible for that cell. Later it was discovered that the cell was the most cleanest and healthier in the whole prison because every Sunday there was an inspections for the cleanest cell and cleanest people in the cell. Later on Khulisa came in.  I was trained as drug peer counsellor, then I had to go back into prison as a counsellor and changed person so I touched a few lives of other prisoners.

And others have simply taken a person journey to becoming responsible citizens.

“As a person you fall but you also need to stand up”I am 27 yrs and currently busy with my IT studies and I am running Internet Cafe. I am a teacher by training. After getting almost ten years, I stayed eight years in prison for alleged arm robbery. My experience in prison was quite a shock to be in such a place knowing you have nothing to do with the crime, though you were with the actual people who committed the crime. it was quite saddening, but in another way was a learning curve, not to mingle with people that you know what they are doing for living as well and for me it sort of brought me up to realization where I was and where I wanted to be – after that I just went to completing my schooling.  I did my teaching Diploma whilst in prison through UNISA, and I taught there (in prison) for a couple of years, basically giving lot of counseling and teaching as educator until my appeal came through last year, so it was that, almost eight years. My interaction with the correctional officers was more or less difficult. Anger was one thing I fostered for quite sometime until I realized that I am fostering anger and is not going to do me much. I had this thing that when I leave prison I am going to start with these warders, you desperately need to avenge because of ill-treatment, I had that thing in my mind also thinking with the anger that I was here for someone’s wrong.  one way or the other the officers or someone outside has to pay for this, but as time went on, no, I think it healed, that I realized that I might go away with it or get into trouble with the law again. I was introduced to Khulisa in Boksburg by a social worker – basically Khulisa introduced me to a one part of me that I did not know. I firstly went through their manuals, which was sort of some therapy healing my anger and my wounds, and realized that as a person you fall but you also need to stand up.

And others see themselves as part of a larger community of men who will be different from their forebears:

“We can be different from our fathers”The programme (Hearts of Men) is the best thing that has ever happened to us, we were able to open up for the first time, talk about our fears, our concerns and what we would like to achieve in life. We want to be different from the rest of our peers, we want to be different from our fathers, we want to be different from the rest of the community, we want to prove to the world that we can be educated, we can be responsible members of the community, we can work instead of relying on proceeds of crime.

Yet the challenges faced by these young men on leaving prison are perhaps harsher than the circumstances which may have contributed to their being imprisoned in the first place. Rejection by their home communities and parents is a painful reality which many ex-prisoners face.

“The community hated us”The community of Westbury hated us so much. Some of us felt that our parents also hated us. Actually I had to move out. No, I am no longer staying in the same community where I used to live before going into prison. One day I had to move. I had to come back one day I heard people coming up with stereotypes thinking, saying that “once a criminal always a criminal”, so it was not easy for me, some of them because I cannot move around telling everyone that I have changed, but they could see that I have changed but some were sceptical about that, so I just have to tell myself that I needed to move on with my life. A typical community in township – especially those who hate crime in a neighbourhood would say, Oh, the criminal is back!

And the prison experience makes them an easy targets for those on the lookout for accomplices.

“People know what you are capable of”I don’t see myself doing crime because I know how to deal with situations although sometimes you are from the township and in the township life is not always the way you want it to be especially with us people who once were involved in criminal activities in the past, you will get someone who would want you to get involved in criminal activities in a different way, you see, people who would provoke you knowing that you are capable of doing this such as gangsterism or shooting at people, they might think that they can just sent you to hijack a car as you are capable of doing that, just taking a car and come back.

Yet many are convinced they have changed for good, and for the greater good.

“Taking responsibility”Khulisa has given me basic skills of how to cope with certain situations such as anger management, conflict resolution etc and those are the skills I got from Khulisa. I don’t see myself doing crime because I know how to deal with situations. We don’t see ourselves coming in conflict with the law because we have been taken through a journey of understanding our actions, the effect of whatever we do on our families, our community and the country as the whole. We can now take responsibility for our actions, we can differentiate between right and wrong, we respect ourselves and other people.

While these stories provide hope and inspiration, the number of young men benefiting from intervention programmes offered by organisations such as Khulisa and NICRO remains small, compared to the numbers leaving prisons each month.

Yet there may well be an exponential effect, with beneficiaries of the programmes in turn seemingly passing on what they have learnt to their peers and to their communities.

For more information on programmes for prisoners and ex-prisoners, visit:
www.khulisa.org.za
www.nicro.org.za

The material used in this article draws on research conducted by Jabu Dhlamini for the Umsobomvu Youth Fund.

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March of the Barefoot Doctors

The Maoist cultural revolution introduced the concept of a barefoot doctor – a rural paramedic permanently deployed in far-flung villages. These embedded health-workers would live within and under the same conditions as their client communities – copying the Chinese peasant farmers’ Spartan aversion to footwear (which, apart from being an urban luxury had a ruinous effect on the paddy).

In South Africa, increased pressure on the public health system, coupled with the urgency of the HIV phenomenon has led to renewed interest in this model. Two recent studies, by Nina Hunter of the University of Kwazulu/Natal and Irwin Friedman of the Seed Trust, have highlighted experiences in the South African experience of barefoot medicine.

South Africa’s first brush with barefoot medicine came in the 1980′s. Friedman’s study implicates the change of regime in 1994 with the collapse of this network. Citing a reluctance of the new government to fund a national lay caregiver network, Irwing notes that the networks “were replaced mainly by numerous small [community based organisation] projects fielding a disconcerting array of ‘volunteers’ and single-purpose workers that have less coherence and insecure funding.”

Since then, there has been a formalisation of funding, training and other support for better resourced programmes. The expanded public works programme presents a further fillip, with the health department having indicated an intention to include caregiver networks as part of it’s sector-contribution to the public works programme.

A second phase followed a decade later with the Cuban deployment of the mid-nineties, in terms of which a team of Cuban doctors was spread across state facilities in under-resourced (largely rural) clinics and hospitals across the country. This project was marked by some successes, but as it happened entirely in terms of a government-to-government agreement, lacked a critical component of private initiative. The South African government has been aware of this limitation, and on the back of it’s volunteerist project of 2002/3 sought to encourage and help initiate the establishment of broader community-based networks.

The government regards the rise of community caregivers as an important component in the broader deployment of community development workers. At an address in the Northwest three years ago, president Mbeki described how these cadres “should be able to assist the people to tackle a whole variety of questions, including those relating to health, welfare, agricultural development, economic activity, education and training and safety and security”. This raises the prospect of improved cooperation between the state-sponsored health infrastructure (both the national and provincial departments) and private caregiver initiatives. The trick is to optimise the dovetail.

Much of the content of community caregiving is driven by the requirements of HIV-related care. This is not surprising, given the scale and character of the pandemic In Friedman’s estimation, currently there are close to 9000 groups, involving more than 19000 volunteers, receiving state funding. The provincial health department in Kwazulu province has allocated R15.7m for community care in the 2004/5 financial year. This allocation is expected to grow, given the scale of HIV infection in that province. A successful programme may see replication in other provinces, where similarly robust attempt at reducing the reliance on state-care are still lacking. These networks face formidable challenges including uncertainty in the training qualification framework and integration with related organsiations in and out of the government’s social services architecture.

Nina Hunter’s study found evidence of a switch away from public reliance on state health infrastructure. Over the five-year period from 1999 to 2004 the client satisfaction figures for public health services declined. At the start of the period, 41% of respondents indicated unhappiness with the levels of service at hospital and clinics. This rose to 68% by the end of the period. The corresponding figures for clients satisfied with the service were 50% and 24% respectively. In contrast, the dissatisfaction figures for community caregiver service were 82% and and 29%. The respective satisfaction figures were 11% and 40%.

The attitudinal shift indicated in these figures is explained by an increased understanding about the role of community-based care. As Hunter indicates “Some family caregivers describe the condition of ill people as not improving when they are in hospital. Medical managers believe that nursing care is what is needed for terminally ill patients, whose condition will ultimately not improve. However, a shortage of nurses is a key problem in providing this care, as are hospital resources. Family caregivers express a need for professional care, but medical managers express a need for support at the community-level in caring for terminally ill people.”. This, a coordinated effort in which state resources are focused on short-term (including emergency) treatment, and away from hospice-like functions is likely to lead to an optimal arrangement for the public/private distribution of healthcare. And as the shift in perceptions persists, communities are likelier to reduce their reliance on the state for end-to-end provision of health care. At the same time, the state should follow through by honouring its commitment to support independent caregiver networks.

Hunter cites cost and stigma as significant barriers to the integration of state and caregiver efforts. Cost arises because community caregivers are provided with treatment prescriptions which they cannot afford to execute. This leads to ineffective improvisation or – worse yet – a breakdown in collaborative effort. Stigma is a problem as it prevents patients from presenting at clinics, on account of the publicity garnered from spending hours waiting in a public, earmarked queue. This leads to an over-reliance on homecare, which not only pressures limited caregiver resources, but puts those resources to uses to which they’re not optimally suited.

The prescriptions in both the Friedman and Hunter studies provide budgetary and logistical constraints for entities establishing independent caregiver organs. Firstly, an allocation must be made for paying a stipend to the caregivers. This could range from R1000 to R1800 per month, depending on where the caregivers are located. In Hunter’s analysis, this compares favourably with minimum wages in other sectors. A maximum of 250 households has been suggested to facilitate effective monitoring and limit the erosion of quality. Empirical evidence uncovered by Hunter is that rural caregivers earn 40% less than their urban counterparts. As the caregiver network assumes responsibility for a broader range of interventions, training becomes important. Friedman emphasises issues to be addressed in the development of uniform training standards for community caregivers. This includes mentoring and stakeholder engagement, in order to assure quality control and smoothed cooperation. In addition, training should be based on registered standards, with a preference for training in the regions where the workers are to be deployed.

A comprehensive guide to possible community intervention is provided by Friedman. The range includes:

* Generic community health workers.
* Home-based caregivers.
* Treatment supervisors.
* Farm and village health workers.
* Family planning advisors.
* Traditional birth attendants.
* Home nurses.
* Nutrition advisors.
* Water and sanitation workers.
* Community disability workers.
* HIV/AIDS communicators/counsellors.
* Paramedics.

Hunter mentions the gender-related aspects of community care. These are not explicitly addressed in policy directives, with possibly ruinous effects on the implementation of programmes. She quotes studies that indicate “that there has been a continued and dramatic feminisation of the labour market that has occurred in South Africa over the second half of the 1990s. The increase in employment among women has been largely due to the increase in self-employment in the informal economy, which is associated with lower earnings and insecure working conditions (ibid). While government has encouraged women to participate in the labour market, this economic approach is not in line with government’s policy of welfare retrenchment. No guidance is given on how women are meant to provide both unpaid care and work at the same time.” This increases the need for caregivers to exchange their experiences.

If the prescriptions for increased caregiver support are to be implemented, then several private sector initiatives should be implemented. On the issue of training, a pre-emptive curriculum and resource development will speed the unification of training standards, and introduce efficiencies in training. Technologies to facilitate the transfer of skills and experience should be put in place. Higher up the cost and complexity chain, Friedman calls for GIS networks to track the deployment of personnel. These may be developed and sponsored privately. At the same time, specific attention should be paid to the programme in Kwazulu province, which will continue to provide lessons for the cooperative implementation of these programmes. Friedman points to structural issues, such as the need for specialisation within the caregiver networks. The idea is that an overarching layer of generalist structures will coordinate and monitor the specialists. Since there will always be a requirement for integration with skilled professionals, the ranks of the medical community (palliative nurses, professional counsellors and the like) should be canvassed for volunteers to assist in defining the collaborative scope. And finally, government should be lobbied coherently and continuously, to maximise the chance of benefiting from it’s stated commitment to the programme.

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SANZAF – a faith-based initiative

The South African National Zakah Fund (SANZAF), is a faith based socio welfare and educational organisation established during the Apartheid Era as a means to alleviate the suffering of those destitute, needy and oppressed. Since its inception and formalisation in 1974, the organisation has moved rapidly from a ‘charity’ organisation, to an agency of empowerment, with a solid infrastructure, and a strong support base both regionally and nationally.

SANZAF is an agency that administers Zakah, an obligatory tax which Muslims pay annually with specific intent to alleviate poverty. As one of the religious pillars of Islam, Zakah as a concept also extends to Sadaqat, a voluntary tax used to assist communities outside of the ambit of formal Islam. A key component of the cycle of Zakah, is the involvement of volunteer workers who view their input as a spiritual act thus completing the fluid axis of money, resources and volunteer services that allow SANZAF to carry out its mission of empowering people in need within the community. As an institution, SANZAF’s base of volunteer workers, is not formally recruited as such, but is drawn from a pool of people, who constantly offer themselves up, and are registered on their database for future reference.

The organogram of SANZAF reflects how it has grown over a period of thirty years into an institution that has 22 offices throughout Gauteng, KwaZulu-Natal, Northern, Eastern and Western Cape and employs over 40 full-time staff members who adhere to a strict code of conduct and implements a standardised service. SANZAF consist of a National Assembly, a Board of Trustees, and a Management Board with a National Director, a Regional Executive, a Regional Co-ordinator, staff and volunteers.

In the Western Cape, SANZAF have offices based in Bridgetown, Mitchell’s Plain, Delft, Elsies River, Paarl, Wellington, Malmesbury and Worcester. Trained caseworkers and fieldworkers attend to referrals, interviews, assessments of cases and updating of records. Information is documented before decisions are taken by the evaluation committee of SANZAF. Daily information of requests and assistance rendered are filed for future reference, accountability and statistical analysis.

On a daily basis, the Western Cape SANZAF caseworkers counsel 150 needy and destitute persons, on an appointment basis, from Monday through to Thursday. On average they attend 600 requests per week. These individual counselling sessions comprise of a trained SANZAF staff member who assesses the requirements of the individuals. A destitute person may need immediate relief, such as food, which is allocated on the same day basis, whilst those who need money, for debt relief, rent etc, will have their request processed within three days, and need to provide SANZAF with sufficient documentation to prove the validity of their requests. This aspect of Zakah deals with the short-term solutions. The biggest challenge facing caseworkers in this arena is dealing with the amount of people who need assistance, and debriefing of staff is built into the administrative process of the organisation.

Abduragmaan George, an administrator at SANZAF in Bridgetown explains that one of the key areas of focus for SANZAF is development programs which explore training in basic economics and priorities in order to help communities becomes self reliant. At least 50% of SANZAF’s annual income is spent on educational funding, skills training; home industry and self help projects. Skills training and motivation allow people to become self supporting in order to promote the rehabilitation and self respect of individuals. Their HAIRDRESSING program is just one of their many success stories. To date they have facilitated the training of 36 individuals who are not only qualified hairdressers, but have complemented this process with business and life skills. A program like HAIRDRESSING is accessible to people, as they do not need huge capital layout to start a business, they can work from home, or make home visits, and all they need is scissors, hair brushes and hair dryers etc. This therefore becomes a manageable and affordable home industry for a previously unemployed person.

SANZAF runs a series of varied projects under the development umbrella. In the Western Cape, these include 65 students in COMPUTOR LITERACY, 15 students in HANDICRAFT project, 45 students SEWING classes and 30 students in the MECHANICS program which includes training in spray painting. This means that 191 previously unemployed persons will have the opportunity to begin small businesses from home equipped with attendant life and business skills to help sustain their families.

SANZAF’s National Bursary Fund remains one of its most impressive achievements to date. Launched in 1985 the South African National Muslim Bursary Fund (SANBF) has spend more than R 15 million and invested in over 8000 students nationally in a range of courses from Hifz and religious modules, to degree courses at universities and technicons. The program is intended for needy, A Aggregate Muslim students in South Africa for studying studies at a South African university. The bursary is afforded on merit with more attention and focus being placed on the children of Zakah recipients.

In addition the Western Cape SANZAF provided 400 bursaries to students this year alone, a figure which has grown incrementally through the years. SANZAF also administers the IDB SCHOLARSHIPS TRUST, a loan bursary scheme through the Islamic Development Bank (Jeddah) and have disbursed R 4.8 million rand in this project.

Outside of development and bursary projects, SANZAF organises a range of programs to support communities such as the POVERTY RELIEF PROGRAM which provides financial and material assistance to those who do not have the basic necessities of life, such as food, shelter, clothing, education, medicine and resources to pay household accounts and debts. Their OPERATION WINTER WARMTH provides material relief in the form of food, blankets and clothing to the homeless and destitute families in informal settlements, during the icy cold wet winter months. THE MAKTAB PROJECT organises and develops local and regional committees to take over the full running of a Masjid, Jamaat Khana or Madrassa, whilst the MADRASSA SUBSIDIZATION ensures that students and teachers in impoverished areas are financially assisted to ensure that educational programs are sustained. The South African National AWQAF FUND concentrates on raising funds for the maintenances and buildings of clinics, schools, training facilities and places of worship. SANZAF’s FEEDING SCHEME programmes are conducted mainly at unemployment queues, old age homes, orphanages, and refugee shelters. Further subsidies are also afforded to schools to supplement their feeding schemes. A specific SOUP KITCHEN subsidy exists to supply Community Based Organisations (CBO’s) in poverty stricken areas with equipment, pots, stoves, gas cylinders and raw foodstuff to prepare meals for destitute families.

SANZAF has also played a leading role in the formation of the Islamic Relief Agency (IRA), an organisation established to help people afflicted by disasters locally as well as internationally. In this respect more than 300 organisations of various leanings and affiliations worked together under one banner and have aided relief in countries such as Iraq, Bosnia and Rwanda (War Victims), Somalia (Famine Relief), Marconi Beam (Fire Disaster Relief), Kwacele (Peace Rally), Inanda (Riots Relief) and many other flood, fire and tornado Operations in South Africa.

The success of SANZAF lies in the concept of Zakah, a process whereby Muslims are encouraged to purify their wealth through circulating a portion of their income to address material imbalances within society. This philosophical base allows SANZAF to ensure that the social welfare of Muslims is addressed. The challenges faced in this context rely of the effective collection and distribution of Zakah, and is dependant on the integrity of Muslims who pay their Zakah. Theoretically, the wealthier Muslims become, the more Zakah they can pay and the more they can further empower their communities.

As an organisation tasked with, a religious responsibility to ensure the welfare of Muslims, who politically have occupied a space of historical disadvantage, the challenge of redressing those imbalances still occupy centre stage. Whilst SANZAF recognises that government is not in a position to address issues on the ground, and that the intervention of caseworkers within SANZAF remains the first port of call for help, the notion of neutrality in the face of rife social inequality across South Africa is increasingly challenged. SANZAF is realising more and more that the task of building up of South Africa as a whole to secure the benefit of all humanity is a social and economic issue that needs to be addressed.

A developmental challenge facing an organisation such as SANZAF lies in translating the notion of welfare to the broader South African community to facilitate social solidarity and the spirit of reconciliation. It needs to be acknowledged that Sadaqat, the system of voluntary tax, which is set aside to deal with these issues may need to be increased? Could the model of Zakah be considered and adopted in other communities? Could the concept of Zakah exist in other communities without a religious component? The success of SANZAF and the concept of Zakah seem so embedded in its spiritual motivation that it appears to be the driving force for the success of this model.

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