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How Zenzele Itereleng’s co-resourcing of an initiative in the rural Eastern Cape is showing the way to achieving transformative development
When I went blind, I couldn’t cook, I couldn’t even bath and wash my things and my husband and grandchildren had to help. Now I can cook for myself and my grandchildren. I can look after myself.
Visual impairment and blindness are major public health challenges facing many communities in South Africa. Those living in the rural and remote areas are usually socio-economically challenged, and therefore do not have access to adequate eye care services. This may result in visual impairment and blindness. The provision of eye care services by Grace Vision in partnership with ZI NPC has significantly contributed to the reduction of the burden of visual impairment in the OR Tambo District Municipality, Eastern Cape. It is therefore essential that these challenges are addressed through the ZI NPC and Grace Vision partnership for the benefit of the rural communities in the OR Tambo District.
OPERATIONAL INSIGHTS
- While rural communities often face many of the same challenges as their urban counterparts, their context presents a unique set of barriers to addressing the impact of poverty, unemployment, and inequality.
- Framing an initiative within a community lifespan helps promote more meaningful and transformative development outcomes.
- Facilitating community-level change requires a capable strategy backed by a beneficial mix of resources.
BUILDING SUSTAINABLE AND THRIVING RURAL COMMUNITIES
Zenzele Itereleng (ZI) is a non-profit company founded in 2011 as part of an Anglo American Platinum (AAP) community empowerment initiative. Called Alchemy, this initiative provided a mechanism for a R 3,5 billion equity ownership scheme benefitting specific communities near AAPs operations and within its labour sending areas. At the heart of Alchemy is a bold vision to facilitate development at a community level to ensure sustainable and thriving benefit communities through and beyond mining.
Within the Alchemy family, ZI has been charged with sustainable, long-term development in AAPs labour sending areas (LSAs) within South Africa, Mozambique, and Lesotho. In South Africa, these areas are in the Eastern Cape’s OR Tambo District and the Greater Taung Municipality in the North West Province.
WHY RURAL COMMUNITIES MATTER
One in three South Africans lives outside an urban area. Nearly half of all children under the age of 18 live in a rural community. Not only do rural communities make up a significant proportion of the general as well as youth population, but they are also more likely to be negatively impacted by poverty, unemployment, and inequality. Addressing the root causes driving this negative situation often differs greatly in nature when compared to urban and peri-urban settings. Therefore, while a problem may share a label, such as unemployment, the fundamental nature and impact of a problem differ significantly.
For example, service delivery in rural communities poses a great challenge not just due to their geographic spread out but also in how vulnerable such services are to the smallest of changes. Consider the impact of one of two doctors leaving a rural hospital and how this would impact its service delivery capacity. Compared to an urban hospital with several doctors, one doctor leaving would be far less problematic. Similarly, if a service is not offered close to one’s home in a city it is likely you could travel to a nearby service. For a resident of a rural community, such a scenario could mean travelling a far distance at a considerable cost.
As LSAs, many rural communities also have a long-distance relationship with mining operations. With this in mind, mining operators in South Africa are required through their Social and Labour Plans to support the development of communities both near their operations as well as in far-off areas from which they recruit. Alchemy through ZI takes this commitment to LSAs one step further through a dedicated focus and operating model to serve these rural communities in a manner that responds to the unique nature of their context.
THE CHALLENGE WITH VISION LOSS
The South African health system has chronically underperformed in managing avoidable blindness by offering access to affordable eye care services. The scale of the problem is significant with over 11 million South Africans affected by vision loss. Women are disproportionally affected, making up nearly two-thirds of those affected. Without meaningful access to eyecare services, those affected by vision loss will experience significant barriers in their education, employment, health, and activities of daily living.
In a rural community accessing an eyecare service is often impractical both in terms of travelling to an eyecare professional and in the cost of treatment. This makes rural communities particularly vulnerable to the impact of avoidable blindness and vision loss.
Image credits: Grace Vision
HOW GRACE VISION HELPS ADDRESS AVOIDABLE BLINDNESS
Grace Vision addresses vision loss by improving access to eye care services, including cataract surgery, in the rural communities of King Sabata Dalindyebo and Nyandeni municipalities in the Eastern Cape.
Operationally their primary outreach service is offered through a mobile eye clinic that travels to remote sites. The mobile clinic provides access for community members to undergo an eye examination, have spectacles prescribed, schedule cataract surgery at a partner public hospital and in emergencies connect to an on-call ophthalmologist. The per capita cost for the services offered is roughly a tenth of the cost of private service providers.
The scale of Grace Visions intervention is impressive with annual reach targets of 26 000 screenings, treatment for 8 000 primary eye complaints, dispensing 4 000 pairs of glasses and providing access to cataract surgery within three months of diagnosis.
LOOKING BEYOND GRANTS MANAGEMENT TO CREATE CHANGE
As Alchemy’s Community Development Trusts (CDTs) and ZI became more established they started to reflect on how they could fully realise their vision for sustainable and thriving communities through and beyond mining. In a nutshell, it was concluded that ultimately this audacious vision calls for transformative outcomes at a community level.
Considering how this could be achieved it became clear that a highly capable strategy was needed that enables the Alchemy family to be an effective facilitator of transformative development rather than grants management. While grant-funded projects did present with positive short-term outputs, in general, they suffered from a significant drop-off in value post-funding and did not compound to create the community-level changes that would predicate sustainable and thriving communities.
BETTER RESULTS THROUGH IMPACT BY DESIGN
As part of Alchemy, Lefa La Rona Trust has been supporting the CDTs and ZI to develop a highly capable strategy to facilitate transformative change. Called Impact by Design, this strategy helps the Alchemy family meet their situational analysis obligation to better understand the communities they serve, define what transformative change looks like and the means to facilitate that change. The principal product of this work is a systemic community profile that is structured around a specific community’s life course. This profile includes a means plan, which uses Human Centred Design to better understand how to create specific changes from the perspective of those directly affected. Paired with the means plan is a resource plan to enable the progressive resourcing of interventions along a well-defined change trajectory. In due course, these profiles will inform ZIs governance oversight and operational planning.
A LIFE COURSE APPROACH
Zenzele Itereleng’s community profile for OR Tambo District points to its large under-25 population. It also highlighted data supporting the role older adults play in taking care of this large under-25 population. A critical problem faced by youth in this district is the transition into employment either after school or after studying further. The expanded unemployment rate in OR Tambo is double that of the national rate, indicating not only a shortage of suitable employment opportunities but also pull factors that keep women and children at home to care for others.
If you overlay the Grace Vision initiative on their host community’s life course the value of their work goes beyond individual numbers and services. Firstly, school health services are at best poor in rural communities. Ensuring school children are screened regularly and have access to corrective eye ware is a significant service gain. Similarly, helping adults with access to eyecare services helps realise educational and employment goals. For older adults, like Mrs Ncothovu, access to timely cataract surgery to restore their vision is fundamental to their ability to take care of themselves and others.
As such co-resourcing Grace Vision helps ZI facilitate other critical outcomes along a positive life course trajectory from conception to death. These include facilitating better outcomes from educational assets in the community, promoting employment and boosting the resilience of households to address the needs of children and older adults to increase their capacity to direct their lives more freely.
Looking towards the future, ZI is aiming to engage in more initiatives with co-resourcing partners who are interested in contributing towards meaningful and transformative change.
Zenzele Itereleng Contact: Mr Peter Lentswane
Case Study Author: Dr Andrew Crichton
