Letlhabile Community Health Center, located in a tiny town called Brits, in the northwest corner of South Africa, provides many essential social services for the community. One of them is patient tracers. When HIV-positive children in the area do not pick up critical HIV medications, the patient tracers are informed, and in many cases, their actions can save lives.
One example is 12-year-old Sibu, who missed a clinic appointment. A patient tracer notified local social workers, trained by the Government Capacity Building and Support program, or GCBS, so they could conduct a home visit and figure out why Sibu had not shown up.
South Africa has one of the highest rates of HIV in the world, ranking third behind Lesotho and Eswatini, according to the most recent data from the IBRD/IBA World Bank. South Africa has been working for years to shrink this number but still has much work to do.
The GCBS program is a partnership between USAID’s PEPFAR program, the South African government’s Department of Social Development (DSD) and Pact. GCBS works specifically to improve services for orphans, vulnerable children, adolescents and youth to reduce the spread of HIV, to help them manage their health if they are HIV-positive, to know their status and to be educated about HIV.
Recognizing social workers’ crucial role in responding to the disease, Pact is going beyond health services, building the capacity of SA’s Department of Social Development.
Traditionally in South Africa, HIV has been viewed as a health responsibility. A key challenge has been shifting this perception so that social service practitioners understand the important role they have in reducing the impact of HIV; in addition to preventing new infections through education and awareness-raising efforts, social workers and other social service practitioners can help families access testing, treatment and support services to help HIV-positive children understand their diagnosis and adhere to antiretroviral therapy, or ART.
“When HIV is viewed only through a health lens, opportunities for referrals for very essential support services are overlooked,” says Ranahnah Afriye, Pact’s South Africa country director.
By building the capacity of DSD, GCBS is impacting service delivery on a large scale, across South Africa. Last year, the program reached more than 259,000 people with comprehensive services in seven focus areas: child protection, psychosocial support, HIV services, health services, nutritional support, economic strengthening and access to education. GCBS staff provide technical support at government health and social service sites and at DSD-funded non-profits, and have documented measurable progress including improved case management, increased frequency of contact with highly vulnerable children, and higher numbers of children being served at GCBS-supported sites.
“GCBS helps us to reflect on our operations, especially in HIV disclosure,” says DSD social worker Bongi Tlou. “It helps us to go back to our foster care places and use the disclosure tool and assess their health, especially in HIV care.”
The Tshwane North Outreach Drop-in Center is a great example. The center has been serving the Wolmer community in Pretoria for two decades and is supported by GCBS.
“For me, this is not work. I love doing what I do,” says Elizabeth Lombard, a center social worker. “This is a safe space for the children.”
The center supports more than 100 children between the ages of 4 and 18, and all of them currently know their HIV status—a huge accomplishment.
Tshililo Vurinosowa, a GCBS social worker who supports the center, says it has made huge gains in case file management, in training caregivers in HIV risk assessment and in making referrals to testing partners.
“All of this capacity development has allowed the social workers and caregivers to go out with confidence and get consent from parents to test their children, especially those at high risk,” Vurinosowa says.
Looking ahead, GCBS hopes to focus on sustainability and embedding core services within DSD at its district and service site levels. GCBS continues to strengthen the DSD’s monitoring and evaluation systems and capacity at all levels, including the use of data, to ensure improved management and programmatic decision-making, planning, implementation and measurement of the government’s HIV-related services for orphans, vulnerable children, adolescents and youth. And GCBS and DSD are continuing to produce new knowledge and best practices to improve services’ reach and quality.
Back in Brits, when social workers followed up with Sibu, they found her sick in bed. She had not gone to school for three months, and she was not taking her medication. They also found that her mother, Thandi, who is HIV-positive and pregnant, was suffering from feelings of shame and struggling to cope. Thandi wasn’t meeting her child’s basic needs, and because she had not told Sibu that she was HIV-positive, Sibu didn’t understand for herself the importance of taking her medication.
It took a few months, but with counseling and support from the social workers, both mother and daughter are now much healthier. Thandi disclosed both her HIV status and her daughter’s. Sibu is eating well, taking her ART every day and back in school. Sibu and Thandi’s relationship has improved, and they are feeling positive about their future.
Sibu and Thandi’s names were changed for this story to protect their privacy.