"they were a pioneer in demonstrating how such services can, and should be provided to learners without disrupting teaching and learning, as well as maintaining privacy and confindentiality; all critical non-negotiable considerations for successful Sexual Reproductive Health service provision in school".
Dr. F Kumalo, Chief Director: Care and Support in Schools
Department of Education
Stated in 2019 about the Integrated School Health Programme
The 45 to 60 minute individual session done by a Health Counselor include Health Screening for Infectious Diseases such as Sexual Transmitted Diseases (STIs), Tuberculosis (TB and DR TB), and Non Communicable Diseases such as Diabetes, Obesity, and High Blood Pressure. An average of 90% of the learners opt to test for HIV. Further learners are screened for a range of behaviour and psychosocial problems. These include substance abuse, risk-taking behaviour, depression and other mental health problem issues of family dysfunction and food security, risk for gender-based violence and sexual abuse.
Learners receive health education sessions prior to individual screening. Sessions preferably are provided outside their regular classrooms in a space created between two mobile units with a canvas roof erected over the unit to protect from sun, wind and rain. This to create a sanctuary where learners can feel free to express themselves in a safe environment away from their daily routines.
Topics include Sexual Reproductive Health, Living a Healthy Life, Healthy Relationships, Gender Based Violence, and Substance Abuse.
The electronic medical record will trigger not only discussion points based on the answers of the client, but also provide decision support for referral if required. The mobile unit has a psychosocial counsellor and a nurse as part of the team who follow-up on those with specialized needs or who are HIV-infected. For services not provide by the unit, the learner is lined to care to the closest appropriate clinic or other services sites. Once the mobile unit leaves the school, a Linkage to Care Coordinator follows the learners in need for additional services until all the needs are met.
Mpilonhle uses an opt-out approach strategy which has worked effectively in the schools. This means that all learners are receiving an individual screening session, unless they opt-out. It ensures high-enrollment and destigmatizes persons who utilize services.
The mobile units provide auditory and visual privacy, and are attractive for youth and staff . The units have been custom designed, are very ruggedized and require modest maintenance. They have been used for over 14 years by Mpilonhle and are still going strong.
School generally lack individual consultation rooms and privacy screens provide no auditory privacy and minimal visual privacy. This inhibits any meaningful discussion of most health issues, but especially issues pertaining to sexual and reproductive health.
The programme makes extensive use of non-professional staff such as Health Counselors who have at a minimum a matric degree (High School) and certified training in HIV Testing Services (HTS). The Health Counselors report to a Professional Nurse who provides weekly training sessions and updates on current practices. A Social Worker and Psycho-Social Counselors provide support for learners in need for psychosocial services as identified by the Health Counselors during the screening process.
Policy documents include the 2012 "ISHP Guidelines"; the 2017 DBE "National Policy on HIV, STIs and TB"; the 2019 DBE "Report on the Consultation of Learners, Educators, and Parents / Guardians / Caregivers, on the Provision of SRH Services to Learners in High Schools" (Mpilonhle was part of this consultation); and the "Childrens' Act 38 of 2005". Mpilonhle in its school services incorporate virtually all components of government guidelines.
Memorandum of Understanding (MOU) are obtained from the relevant Provincial Departments (DOE, DOH, DSD). Schools in need of services are identified by DOE and DOH District ISHP staff. Information sessions are held to all school community members which include parents and caregivers, School Governing Boards (SGB), school personnel and learners explaining the services that will be provided in detail. Contracts are signed with the schools and regular reports are provided summarizing services provided and problems identified.
The consent process is crucial and involves consent of the schools (the contract), the parents and guardians (parent consent forms), and assent from the learners.
The units are towed - thus freeing up the vehicle for other service activities such as transporting blood samples, sputum tests to clinics, or transporting patients for further care and staff to other service activities. Each unit contains of two consultation rooms. They are based at the schools, community centers or colleges for the duration of the programme and then moved to the next location.
Mpilonhle pioneered the development of an Electronic Data Collection application in 2007 to be then used by the Mobile Health team who provided services in deep rural areas of the uMkhanyakude District. Mpilonhle believes that real-time electronic data collection maximizes data accuracy and efficiency. The design and application – initially funded by PEPFAR - was modified and improved through funding from the European Union in 2015. The electronic data system operates on mobile devices (smartphone or tablet) and works on a store and send principal. Information collected is transmitted over GPRS, Edge or 3or 4G when a cell phone signal is available, or via the web. The SIM card is restricted in accessing the IP address of the cloud server where the data is stored.
The electronic record assures the quality of data collected and the quality of services provided. It allows monitoring performance of individual staff members including length of visit of average client. It has embedded checks that automatically reject data that is out-of-range, invalid or internally inconsistent. It follows preassigned question "trees" depending on the answer to certain questions and provides decision support including when to test and when to refer. It ensures that the screening is consistent by not allowing for appropriate questions or screening examinations to be skipped (unless the client refuses to answer). It automatically calculates computed values such as BMI and it eliminates transcription error.
Mpilonhle worked with the DOH ISHP programme of the uMkhanyakude Local Municipality and introduced the electronic device which was well received.