During her visits she is armed with a backpack containing a scale, a measuring tape and growth charts on which she plots the weight and height of every child under six.
Melani is called a Mentor Mother – a name for a community healthworker whose main focus is the health of mothers and children. She works for a nonprofit organisation, Philani, funded by the Western Cape health department to provide “home- and community-based services”.
There are 120 Mentor Mothers in the province, serving 5 975 families.
Globally, research has shown that the work of community healthworkers can lead to significant drops in maternal and under-five mortality rates.
Melani does about seven to eight home visits a day. If a child is malnourished, she will visit the mother at least once a week. As the child improves, she will talk to the mom every two to four weeks.
The help she offers could be anything from advice on how and what to feed the child, guidance on hygiene and referrals to government clinics to assistance with applying for a child support grant.
Melani has also been trained to deal with other conditions when necessary, such as taking care of bedridden patients who might live in the same house as young children.
“Here in Khayelitsha we have many problems in the same house. There could be a malnourished child, tuberculosis, HIV and cancer in the same house,” says Nokwanele Mbewu, Philani’s senior programme manager.
“That means we have to train our workers comprehensively, otherwise we will end up with a different worker visiting the family for each issue.”
A 2013 study published in the medical journal Aids has shown that, in communities where Mentor Mothers work, HIV-infected mothers have babies with far healthier “height-for-age measurements” than those moms who don’t have access to Mentor Mothers.
Such moms are also more likely to use treatment that can prevent their babies from contracting HIV during birth or breastfeeding.
Both HIV-positive and -negative moms served by Mentor Mothers have been shown to be more likely to breastfeed exclusively for six months (research has shown that this practice has significant health benefits for babies) and they use condoms more consistently during sex.
Melani lives in the community that she serves and is responsible for about 500 households where she has to identify underweight children and make sure those requiring help get it.
The number of households she serves is double the suggested ratio of the national health department for its new “ward-based” community health worker programme, which would make each worker be responsible for 250 households.
Although health activists argue that 250 households a worker is far too many, Philani’s medical director Ingrid Le Roux says that it’s “unrealistic” in South Africa to expect anything less “as it will hugely impact on available budgets”.
Melani received six weeks of training before she was appointed as a Mentor Mother. She earns about R1 500 a month and receives a monthly cellphone allowance of R30.
She receives “hands-on” supervision. According to Le Roux, “every 36 Mentor Mothers are supervised by a co-ordinator in the form of a professional nurse”. The professional nurse oversees three assistant co-ordinators, who in turn supervise 10 to 12 Mentor Mothers.
“No one supervises from the office. Our nursing sisters are out in the community every day and would work with one assistant co-ordinator and four community health workers a week,” Le Roux says.
But, even though Mentor Mothers are supervised by professional nurses, which studies have shown is crucial to their success, a ratio of one nurse to 36 community health workers is six times that of the 1:6 as suggested by a 2011 “implementation toolkit” of the national health department.
“That is a lot of support, I cannot see that we can have that system in this country,” Le Roux says. “We simply don’t have enough nurses for this. We need to find our own system.”
by Mia Malan for Mail & Guardian