South Africa: Improving Health With Sustainable Solutions

Jay Liu, Staff Writer

July 6th, 2013
Path out of Poverty Center for Children
Reibeek Kasteel/Esterhof Facility (approximately 10km north of Goedgedacht)
Malmesbury, Western Cape South Africa

Plumes of dirt clouds were created each time one of the emaciated children slid gleefully across the floor. The air in this small crowded indoor play space was thick with dust, so much so that you could taste it and that it left a film of grime on your skin. These conditions were what I encountered while visiting a Goedgedacht facility, which serves the poverty-stricken youth living in a rural township some 65 kilometers north of Cape Town. While the facility provides a safe haven for these children, many of whom are orphans or whose parents suffer from the many common issues in this area (ranging from severe substance abuse and domestic violence, HIV/AIDS and Tuberculosis, poverty and food insecurity, etc.), it lacks the funding and capacity to provide everything these children need to survive. Even the play space, for instance, is a public health disaster. As it exposes these children to aerosolized dirt; in a country where respiratory infection is the fourth leading cause of death in the pediatric population, these conditions are simply disastrous.

The central idea behind Goedgedacht, which is name of both the name of the organization as well as the town it serves, is to create a sustainable poverty alleviation program; it aims to alter social norms by empowering youth in rural communities to prevent them from entering the cycles of domestic and gender based violence, substance abuse, unemployment and lack of education. When Goedgedacht Trust founded the organization over 15 years ago, 95% of the population in these communities dropped out of school prior to completing the 5th grade, and women were expected to bear a child in their early teens. Since its inception, Goedgedacht’s Path Out of Poverty program has formed 17 different initiatives that intervene over the 20 year span of a youth’s development. These interventions even now begin prior to the child’s birth, and involve a holistic approach, such as ensuring that expecting mothers receive proper antenatal care, and attempting to prevent fetal alcohol syndrome.

Some of the services that Goedgedacht offers include a free antenatal education course for expecting mothers, a baby unit, preschool, and a specialized “grade R” class. All of these services are free of cost to the local population, and are funded by a conglomerate of financers. The antenatal classes are intended to prepare expecting mothers to appropriately care for their newborn children, and provide a launch pad for their children to thrive. The baby unit targets four-month-olds to two-year-olds, and focuses on reducing malnutrition and fatalities due to preventable pathologies such as influenza, respiratory infections, and diarrheal disease. Preschool provides them with a hot meal each day and after school programs to increase the chances that they will progress to higher education. The Grade R program is intended to provide intensive care and attention to children of various ages whom are most at need. While plenty of other services are provided by Goedgedacht, these serve as the backbone of the NGO.

Goedgedacht’s intervention has transformed many communities by simply improving the general quality of life by addressing the complex public health issues plaguing these groups, and has been highly successful. The University of Ottawa monitors the program and consistently collects data to document the beneficial changes taking place. Recently, the Centers for Disease Control as well as the World Health Organization have requested to replicate the Goedgedacht model of community intervention elsewhere in the world.

While successful, the Path Out of Poverty program has inevitably run into some hurdles, which were highlighted during my visit. First and foremost, the budget with which the intervention is being conducted is insufficient, giving rise to a list of other issues. One such problem was that the facilities were dramatically under staffed, with a ratio of two or three caretakers to just under 100 children; this extremely dilutes the attention the staff are able to provide the children. Similarly, with such a small work force the facilities are unable to be open for more than business hours, meaning children cannot access its resources as often as they need. Also fueled by this chain reaction, the staff is incapable of providing more than a single meal for the youth during the day, yet many are undernourished and underweight.

Overall my experience at the facilities was touching, and it left a lasting impression on my perception of public health challenges that populations in undeveloped regions face. The problems and solutions are exceedingly complex and interconnected, and require the application of a multidisciplinary and multifaceted approach. Additionally, as was emphasized at Goedgedacht, sustainability is essential for successful intervention, as improving the health of a population is a marathon.

Jay Liu is a senior at Steinhardt studying Public Health. Contact him at


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