In early 2022, the Mikhulu Child Development Trust, supported by the Seven Passes Initiative, trained hundreds of community health workers all over the Western Cape — from the Klein Karoo to the Garden Route. 

Community health workers are an important part of our health system. Community health workers are lay community workers who are trained to bring basic, but essential, support on health and well-being to families in their own homes. Community health workers are part of the Department of Health and they work closely with the clinics and hospitals in their area.

The Western Cape Department of Health’s (WCDOH) “First 1000 Days” programme provides interventions and support to parents, helping them have a healthy and happy start to their children’s lives. Since book-sharing has such a beneficial impact on children’s language and attention skills, child-caregiver relationships and even the likelihood of violent behaviour later in life, it has been included in the WCDOH’s First 1000 Days programme.

Community health workers play a key role in the First 1000 Days programme. They conduct regular home visits with pregnant women and mothers who have young babies under the age of two. The role of the community health worker is to support mothers and babies on many different interventions related to health, development and well-being. This includes breastfeeding, immunisations and support on early stimulation and parent-child relationships.

“The critical period of brain development happens by the age of two,” explains Karen Ross, Programme Manager at Mikhulu Trust, “and the community health workers are visiting women that are pregnant, and follow up visits after the birth, too.” Training these community health workers in book-sharing therefore provides a perfect opportunity to directly impact mothers of young children, in their own homes.

Mikhulu Trust, supported by Seven Passes Initiative, has run book-sharing training with community health workers at different community based organisations all across the Western Cape province.

“In the Garden Route, we have done training in locations from Still Bay and Albertinia in the West, to Plettenberg Bay in the East and then Oudtshoorn and Ladismith in the Karoo,” explains Karen. “In the West Coast, we have done training at organisations from Vredendal to Malmesbury and, in Central Karoo, we have covered Beaufort West and Murraysburg.”

Roslynn Damons, the Parenting Facilitator Manager at Seven Passes Initiative, trained the majority of community health workers in the Garden Route. “It has been an amazing journey for me,” she says. “I have been saying for a long time that all parents across South Africa should do parenting programmes, especially book-sharing programmes because it all starts there, in our own homes.” Because community health workers are typically from the communities that they serve, this also makes the programme more effective – because the mothers are being shown how to share books by someone who understands their realities and their communities.

As part of the programme, community health workers are trained on how to deliver four sessions about book-sharing with mothers of twenty minutes each. The book-sharing aspects are woven into the other existing “check-list” of items to cover with the mothers.

So far, Mikhulu Trust has conducted 32 two-day training sessions across the Western Cape and we have trained and mentored approximately 700 community health workers. Mikhulu Trust is also providing wordless books for each mother being visited by the community health workers.

Both Karen and Rosylnn reflect on how the community health worker project has resulted in wider social consequences. “The Community Health Workers are being introduced not only to book-sharing techniques,” explains Karen, “but also to things like collaborative problem-solving and active listening. These basic facilitation skills help them to be able to support mothers more widely.”

This project is part of a “whole of society approach” – in that Community Health Workers can also refer mothers to libraries and local organisations, and hopefully set in motion a realisation that caregivers can access different kinds of support as their children grow up.

Rosylnn, too, notices other impacts. She has conducted follow-up visits with community health workers three months after the training. She finds that older people in the communities – grandparents, for example, who are more likely not to be able to read – have also started book-sharing as an accessible way to interact with children in their households.

“This project is also about responsibility. If we look at what is going on with youth and young children in our country, we need to step up and take back the responsibility of parenting,” explains Rosylnn. “It is also about learning about responsibility. For example, the child senses ownership over the book [that is provided as part of the community health worker visit]. This teaches the child about responsibility as the child can take care of the book.”

As Karen points out, supporting parents is vital to the development of communities. “A lot of community health workers reflected that this kind of work is vital in their communities, where there are problems of parents feeling disconnected, extreme poverty and lack of resources”, she says. Karen hopes that the “whole of society” approach might help mothers and caregivers to know what support exists out there, and access more resources like books and libraries. Such access is difficult for many mothers, especially in rural areas, and this requires wider development and improved access for more low-income households.

Nevertheless, this project has set something in motion: hundreds of community health workers, every day, are showing mothers and caregivers how to share books with their young children and affirming the positive role that they play in their children’s development. For Rosylnn, this work is part of a wider effort to develop South Africa. “I have seen the impact of this project, and I feel so happy to have been part of that,” she says. “You have to be the change that you want to see. I was part of the growth in community health workers, and therefore I am part of the growth of the country. That makes me happy.”