Why Pathfinder Works in South Africa
With a population of over 50 million people, South Africa has the fourth-largest population in sub-Saharan African. It is also a country suffering from a devastating HIV and AIDS epidemic, in which heterosexual sex is the predominant mode of HIV transmission, followed by mother-to-child transmission. Today, HIV prevalence is 17.8 percent, with young people and women bearing the burden of infection across South Africa's nine provinces. And while people are generally knowledgeable about HIV prevention, the high incidence and prevalence rate indicate a significant need for more effective evidence-based strategies-particularly those that target young people.
Since 1996, Pathfinder has worked in South Africa, implementing a broad range of programs and building relationships with community groups and district and provincial departments of the government. Today, Pathfinder focuses on contributing to the reduction of HIV infection rates of South African youth aged 15-24 years and reducing mother-to-child transmission among young HIV-positive mothers. Our interventions promote the adoption of safer sex practices and guarantee accessibility to quality, integrated services delivered in a social environment that is free of stigma and discrimination against people living with HIV. Pathfinder's approach to youth-friendly services stresses the importance of privacy, respect for youth and their decisions, and establishing an accepting environment for young people. This includes promoting consistent condom use and prompt treatment for STIs and limiting the number of sexual partners, while also addressing the contextual factors that make it difficult for young people to implement behavior change, such as gender relations and cultural norms.
A key aspect of Pathfinder's approach to systems' strengthening is collecting evidence that enables public, private, and community partners to make informed health-related decisions. In South Africa, examples of the kinds of evidence we collect to range from "the number of antenatal care clients aged 10-24 receiving their first test to determine CD4 levels" and "the number of advocacy activities conducted for comprehensive, safe abortion services" to "the number of HIV-exposed infants born to clients aged 10-24 who were given Nevirapine within 72 hours after birth." Some illustrative data from Pathfinder's work in South Africa suggests that in the first two years of a five-year program to strengthen and expand comprehensive HIV and AIDS prevention program funded by the Centers for Disease Control and Prevention (CDC):
- 100 percent of abortion clients accepted a family planning method after receiving services
- 1,492 women and girls aged 10-24 were counseled and tested for HIV at their first antenatal care visit
- 6,380 HIV-positive individuals between the ages of 10-24 years were reached and supported through evidence-based individual or small group-level interventions
Building Capacity, Strengthening Systems
Pathfinder aims to leave behind systems, and structures that are institutionally, programmatically, and financially sustainable. For example, in South Africa, Pathfinder:
- Builds the capacity of public sector service providers, facility managers, peer educators, and organizations working at the community level around health facilities for better service delivery in our project intervention areas.
- Provides training to service providers and peer educators on technical subject matters such as HIV and AIDS management, provision of quality services, monitoring and evaluation workshops, mentoring, and facilitation skills.
- Implements skills transfer initiatives that ensure more effective service delivery and staff competencies among services providers and community health workers.
- Mobilizes a broad base of young people, youth groups, youth centers, HIV and AIDS support groups, local youth-focused NGOs, and traditional and community leaders, to promote youth-friendly health services.
Watch to see Pathfinder's work in action in the Dukuza Clinic of South Africa:
In South Africa, Pathfinder promotes the adoption of safe sex practices while increasing access to quality, integrated, and youth-friendly sexual and reproductive health services.
In a year of remarkable achievement, including Pathfinder’s landmark victory at the US Supreme Court and our return to Bangladesh with a $53.8 million project, what was most exciting? The answer—integration—is the theme of Pathfinder’s 2013 Annual Report.
This technical update discusses Pathfinder South Africa’s experience supporting youth-friendly comprehensive abortion care service delivery in public sector facilities, providing recommendations for future such efforts.
Strengthening Community and Health Systems for Quality PMTCT: Applications in Kenya, Nigeria, South Africa, and Ethiopia
This technical brief discusses PMTCT implementation experience in four African countries, providing recommendations for future efforts to more holistically advance improved PMTCT outcomes in resource-limited settings.
This paper presents Pathfinder's comprehensive approach to safe abortion programming including provider training, client friendly counseling, addressing the needs of vulnerable populations including youth, community mobilization, and advocacy.
Here, a staff of only three nurses deliver babies, provide AIDS testing and counseling, educate patients about family planning, and care for TB, diabetic, epileptic, and trauma patients, among a long list of other tasks. Dukuza serves between 100 and 200 patients each day, and with the current AIDS epidemic, pressure on the clinic to serve more patients grows.