SOStainer

SOStainer Self-sustained Container Clinic

'Bringing Maternal and Child Health closer to the Community'

Concept

Since its inception, the work of the SABR has been focused narrowly on prematurity and the value that breastfeeding and donated breastmilk contribute towards reducing infant mortality and morbidity at the start of the Human Development Chain. Since 2015, we began to expand our mandate to embrace a life-cycle approach to infant health and survival, considering breastfeeding in the context of early childhood development and not only as a clinical solution to premature morbidity and mortality at hospital level. The social discourse that addresses maternal and child health has evolved dramatically towards upstreaming health care and addressing the determinants of health in communities to build a healthier society.  Therefore, after nearly two decades of breastfeeding advocacy, this development is a natural progression to promoting improved outcomes for all infants.

The health of an infant cannot be viewed in isolation. It is important to address maternal health and, therefore, the life cycle that will result in better health outcomes for both mother and child. This holistic approach drives us to consider breastfeeding as one component of the broader health services that need to be made available to pregnant women and children under five. Ante-natal health, HIV prevention and treatment, immunisation, family planning and breastfeeding support are some of the corner-stones that support better health outcomes for children once they leave hospital after birth and return to their communities. 

Project Detail

The SABR is about to launch the pilot project for SOStainer Clinics in Mankweng, a rural area in the Limpopo Province of South Africa. The SOStainer will bring holistic health programmes to mothers and their children under five years old, in under-served communities remote from clinics. The SOStainer clinic is a versatile facility designed for rural, low-resourced settings that aims to bring primary care services, and comprehensive Early Childhood Development programmes closer to the home and into the home with the intention of preventing the high rates of diarrhoeal disease affecting the Limpopo Province.

Currently, the SOStainer project has received funding from Discovery and we are in the specification and design phase of the prototype, having identified the location and established a partnership with the Limpopo DOH. In partnership with SACSoWACH (http://sacsowach.org/index.php/partners), the SOStainer project will promote grassroots health advocacy and drive health priorities at the community level.

Critical Needs Addressed

The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. Access to water and electricity, and the proximity of health facilities to the client’s home play a key role in accessing health services. The SOStainer will be installed in Makanye Ward in Capricorn District in Limpopo, 15km from the closest primary clinic. The district has a population of 1 296 247, with a population density of 59.7 people per km2 and falls in socio-economic Quintile 2, among the poorer districts. Only 19.5% of dwellings can access piped water, 30% are connected to flush toilets or sewerage and the unemployment rate is 37,2%. In the population under five, diarrhoeal disease and lower respiratory infections remain the top causes of mortality and affect the 5 to 14 age group as well. Furthermore, the district has one of the highest mortality rates in the maternal population.

An Innovative Solution

The SOStainer is solar powered, with a replenishable water supply. It is outfitted as a clinic for under-fives to support breastfeeding mothers and their children and to serve as an education and learning centre (See Appendix for concept drawings). The containers will provide the basis for a holistic, community-based care programme that will include: 

  • Breastfeeding support and nutrition; 
  • Immunisation; 
  • Collecting, pasteurising and distributing DBM; 
  • HIV testing and counseling;  
  • Nutrition support to prevent stunting; 
  • The five pillars of Child Development;  
  • Home visits for nearby community 

Beneficiaries and Impact

The SOStainer clinic will bring health care closer to the Ratambana ECD Centre that is 15Km from the closest clinic. The Mankweng informal settlement is amongst the poorest rural communities, lacking access to piped water and electricity and transportation to clinics. The only healthcare service available to this community is through mobile clinics that offer limited health services on an irregular basis and which are often out of stock

Travelling even 10 km to the nearest clinic is a far distance for a mother with a new baby. The SOStainer will cut out that distance and bring ongoing, basic health care to the Makanye District. The lack of proximity to health facilities often results in poor outcomes for children under five as a consequence of poor immunisation uptake and the overall lack of supporting health services. This results in higher mortality from diarrhoeal disease, respiratory problems and malnutrition. The SOStainer will leverage support through already established community based organisations and the Provincial Department of Health to grow the visibility of the SOStainer as well as through ongoing community dialogues and health assessments. 

The potential impact is a reduction of mortality and morbidity associated with diarrhoeal disease and pneumonia (the top two killers of infants under five) and a reduction in maternal mortality through a mixed strategy that supports grassroots advocacy and health communication whilst delivering key primary health services such as immunisation and nutrition support.

Critical Success Factors

The long-term target is to see a drop in fatalities caused by diarrhoea of at least 10% in the first 5 years and an increase in the uptake of immunisation from 57.7% to at least 80%. We also aim to see an increase in exclusive breastfeeding rates for all children.

Baseline indicators for diarrhoeal disease, respiratory disease, immunisation, breastfeeding and HIV, are derived from the Health Systems Trust information (links below). 

The Primary indicator will be defined by the number of mothers and children that visit the SOStainer and receive:

  1. support for exclusive breastfeeding;
  2. immunisation;
  3. anti-diarrhoeal packs & nutrition support;
  4. HIV/AIDS testing and support in year one.

It is estimated ha at least four, mother and infant pairs will visit the SOStainer per working day, giving an estimated total of  at least 1 100 visits in year one.

Through the community-based health workers, we aim to see 2 900 mothers and children in year one at house-hold level, offering holistic ECD support.  

Team Capacity and Partnerships  

With 15 years’ experience in altruistic human milk banking, the organisation works in close partnership with the National and Provincial Departments of Health. We work primarily to support infants exposed to HIV at birth, at high risk of mortality. We reach and support 3 000 premature babies annually. We operate 24 successful and prolific, in-hospital human milk banks in the largest, public, tertiary NICU facilities in South Africa, supporting the most compromised. 

The SABR has extensive experience in the delivery of health systems and works in collaboration with a number of organisations that, together, have the expertise required to design and implement the SOStainer health intervention. 

Having developed quality systems and technologies that are local and sustainable, we understand the needs of our beneficiaries and work in close partnership with a wide stakeholder base including technical experts, engineers, civil society organisations, government organisations and academic institutions. The engineering leads are in Sostieni, the technologies partner of the SABR, who have secured support from experts in the repurposing of containers to study the most cost-effective design for the container clinic. Beyond Wireless that currently supports the human milk-banking cold-chain and CleanRoom Technologies will support the design, access to solar technologies, and water harvesting systems. The University of Pretoria partner with SABR in research and development for public health.

The SABR is an advisory member of three technical working groups at the National Department of Health and the author of the Standard Operating Procedures informing the Proposed Regulatory Framework for Human Milk Banking in South Africa. 

Furthermore, The SABR is a known ‘voice’ in the South African advocacy arena, protecting, promoting and supporting breastfeeding in communities and the work place with media campaigns and regular communication through press releases.

Funding and Sustainability

SABR receives grants from five Provincial Departments of Health and from Discovery that has funded the renovation of human milk banks since 2015. Furthermore, we cost recover the processing of donated breastmilk for private patients in private hospital facilities, thus addressing the sustainability of the organisation directly as well as the demand for this emergency intervention. As Co-chair of the Coalition since 2016, the SABR is also one of the project leaders of the Dare2Care campaign funded by UNICEF.

The SABR won the Discovery Foundation Excellence Award 2018 for the SOStainer project. Funds were made available for the conceptualisation of the first container. The SABR will integrate the project with the Dare2Care campaign of SACSoWACH, addressing diarrhoeal disease especially in drought-stricken areas. 

The Limpopo Department of Health is a current partner of the SABR and, through the office of Daddy Matthews, will facilitate the correct processes to integrate the SOStainer programme with current DOH health programmes. A technical working group, representing all stakeholders, has been established that will inform the project design and implementation as well as offer synergistic opportunities with other CBOs.

Project to Scale

The SOStainer project and its impact have the potential for scale-up beyond the proposed pilot once it has been implemented successfully at the sub-district level and proof of the concept has been achieved. SABR receives grants from the Limpopo Province that support the running of the Mankweng Hospital human milk bank in the vicinity of the proposed site. The success of the SOStainer project will enable the SABR to leverage further support from the Province and other funders to scale up the intervention. A further scale-up to the remaining wards within Capricorn District and outward to the remaining Limpopo health districts will follow the success of the pilot.

The SOStainer is furthermore a modular health facility that can be adapted for different needs and different health landscapes, offering flexible solutions to address various determinants of health in low-resourced environments, thus making it attractive for health systems that suffer from budgetary constraints globally.  

SOStainer - front

SOStainer - rear

SOStainer - top

SOStainer - side

SOStainer - 40Ft - Simple idea for rough layout