Regional health threats

Case studies - South Africa

5.8 Into the community – home- and community-based care

Home- and community-based care (HCBC) is one leg of AngloGold Ashanti’s HIV/AIDS support programmes, along with prevention and treatment.

HCBC is generally run by community-based organisations (CBOs) and non-governmental organisations (NGOs), which rely on funding from both government and the private sector to provide technical and financial assistance to operate effectively, often in remote areas, to provide care for sick and dying community members and to care for orphaned children.

Five HCBC organisations have been identified for inclusion in the company’s wider HIV/AIDS outreach programme. They include Carletonville HCBC and the Rudo Project, both based near its operations at West Wits in Gauteng; North West Hospice in Klerksdorp located near its Vaal River operations; Bambasinani Project in the Eastern Cape, a major labour-sending area; and TEBA (The Employment Bureau of Africa), which provides HCBC in the four major labour sending areas comprising the Eastern Cape, Northern KwaZulu Natal, Lesotho and Mozambique.

Depending on the focus of community care, these organisations offer some or all of the following components of integrated care:

  • palliative care for bed-ridden sufferers, daily or three times a week, as well as educating family members on caring techniques;
  • visits to child-, granny- and relative-headed households, about three times a week;
  • support groups for people who, although infected with HIV/AIDS, live positive lives; and
  • income-generation and poverty alleviation through, for example, vegetable gardening and bread baking. Support group members are also involved in other projects like beadwork and sewing.

Most of the NGOs have teams of professional nurses, social workers and counsellors, all volunteers recruited from within the community. Recognising that NGOs and community volunteers provide a range of communitybased health services, most provincial health departments offer community health worker training on patient care. Heartbeat (a community development organisation) has developed a care programme for orphaned children and TEBA training is provided under the auspices of Goldfields Nursing College.

AngloGold Ashanti’s involvement is to finance certain aspects of their support programmes, either from the AngloGold Ashanti Fund or from the AngloGold Health Service (AHS) budget.

Carletonville CHBC, formed in 1999, provides assistance to the Khutsong, East Driefontein, Welverdiend and Carletonville communities, with a focus on palliative care for orphans. The AngloGold Ashanti Fund donated R200 000 in 2005 and AHS also provides a limited financial management service to assist with book-keeping and administration. Buti Kulwane, AngloGold Ashanti’s HIV/AIDS workplace programme manager, who has been closely involved with the Carletonville HCBC for many years, also sits on its board. In this capacity he is able to offer technical advice, for example, on the importance of good governance in attracting resources from both the public and private sectors. The staff comprises some 30 volunteers, and by the end of October 2005, assistance had been extended to 102 bed-bound patients in all three areas under the project, 462 people living with AIDS and members of support groups, and 503 orphaned children.

Although the Rudo project in Fochville has not received direct funding from AngloGold Ashanti, it hopes to be a beneficiary of pooled skills and resources, in a move to incorporate all HCBC programmes in the area under one roof – namely, Carletonville HCBC, the strongest in terms of capital and capacity. In order to create one strong and effective organisation with combined expertise and resources, key stakeholders in the Carletonville area have come together to develop a municipal response to HCBC. They include AngloGold Ashanti, Goldfields, Heartbeat, Rudo, Carletonville HCBC and government. The amalgamated organisation is expected to be effective by June 2006.

For the past 12 years, North West Hospice has served the Klerksdorp, Orkney, Stilfontein and Hartebeesfontein (KOSH) communities, as well as the townships of Jouberton, Kanana, Khuma and Alabama. Primarily offering home-based care for all patients with life threatening illnesses, it has now extended its services with the provision of a day care centre for children up to the age of six. At the end of October 2005, 400 patients were on the CHBC programme, while 48 children were being looked after at the day care centre. Sixty-nine volunteers man the home-based care programme while the children’s centre employs a manager, a social worker, a teacher and four assistant teachers. The hospice is about to open its first eight-bed in-patient unit in Jouberton to care for patients in the last stage of life. The AngloGold Ashanti Fund has donated an annual grant of R300,000 for a three-year period commencing 2005.

The Bambasinani Project assists the communities of Umzimkulu, Bizana, Flagstaff, Ntabankulu and Lusikisiki in the Kokstad region of the Eastern Cape. AngloGold Ashanti provides for the employment of a professional nurse, at a cost of about R190,000 a year. A total of 3,258 visits for home-based care were made in the first half of 2005.

TEBA, formed in 1902 to recruit unskilled labour for the Witwatersrand gold mines in South Africa, commercialised its services in 1998. TEBA’s rural support arm includes community HIV/AIDS programmes. AngloGold Ashanti, along with other mining companies, entered into an agreement with TEBA in 2002 for the provision of HCBC care for terminally ill former employees. The bulk of AngloGold Ashanti’s HCBC funding – in 2005 this figure totalled R794,000 – is directed towards TEBA, which has offices in the Eastern Cape, Northern KwaZulu-Natal, Lesotho and Mozambique. Funding by TEBA is on a capitation fee of R3.75 per employee per month. Since its inception in 2002, 620 ex-AngloGold Ashanti employees were enrolled in TEBA HBC.

AngloGold Ashanti recognises that the high prevalence of HIV/AIDS in South Africa presents significant challenges to government, industry and civil society groups. In recognising that government alone cannot shoulder the burden of HIV/AIDS care, the company is committed to assisting CBOs and NGOs, which have been instrumental in the shift from hospital to home-based care, thereby easing the pressures on understaffed and under-resourced provincial health departments.

Report to Society 2005