Deep in rural South Africa, there’s a small clinic that’s way ahead of the rest of the country when it comes to sustainable healthcare and – importantly – HIV/AIDS statistics. 

Dr Peter Schrooders, Dr Hugo Tempelman and Dr D R Moraba run the Ndlovu Care System in the Elandshoorn municipality of Mpumalanga (previously Limpopo), catering to a population of 150 000.
Their story is of how dedicated people can make healthcare work, in a sustainable fashion, in even the most remote of rural communities.
The project has four arms: a private practice; a laboratory; a community care trust; and a development trust.
Resources in the area are typical of many communities in South Africa. Electricity is supplied by Eskom, but a self-starter generator has been installed as the supply is by no means guaranteed.
According to Dr Schrooders, water is also piped in – but from about 200km away, and so the Ndlovu administrators have installed a borehole as well for when the water supply is irregular.
Waste removal is divided into two sections: household and medical. Household waste is incinerated and then used to fertilise the garden; needles are incinerated as they are used while other medical waste goes to the medical incinerator.
In terms of IT, a network links all the various sections and a single version of patient data can be accessed according to users’ access levels for different services. The project also boasts a broadband satellite connection so it is always in touch with the outside world.
By making the maternity hospital private – women pay R300.00 to deliver a baby – and leveraging state-sponsored programmes as well as private-public enterprises, the centre is able to provide the following: a maternity hospital, which includes treatment against mother-to-child HIV transmission; an HIV/AIDS centre where anti-retroviral medication is rolled out and managed; four nutritional units which operate up to 10km away from the clinic; a tuberculosis (TB) programme; an AIDS awareness programme; and a dental care programme.
The success of the project has been staggering: with about 400 babies born in the maternity hospital each year, and an AIDS infection rate of about 25%, an aggressive campaign to prevent mother-to-child transmission means that just one child has been infected.
The nutritional units grow vegetables and help to care for malnourished children and their caregivers. They also teach people how to grow their own food and care for their children, while helping them start their own vegetable gardens.
The TB programme treats well over 1 000 people a year – in fact, but August this year, it had registered over 1 000 people already – and is important as TB frequently goes hand-in-hand with HIV infection.
Dr Tempelman – who was recently knighted by the Queen of Holland for his work in Elandshoorn – explains that two-thirds of the world’s HIV/AIDS burden is on sub-Saharan Africa.
In South Africa alone, between 5,5-million and 7-million people are HIV-positive. Every day, about 1 000 people die as a direct result of the virus, while a further 1 900 are infected.
He urges the country to make a concerted effort to roll out anti-retroviral drugs, which will help people infected with HIV keep their viral load below the critical levels at which they would otherwise become full-blown AIDS sufferers.
As part of the Ndlovu project, people living with HIV – but managing the disease through anti-retroviral drugs – are employed in steady jobs and thus contribute to the sustainability of the project and the community as a whole.
In addition, the implementation of a laboratory on-site means that skilled workers have been attracted back from the cities to the rural community and helped to uplift the quality of jobs available.
The laboratory is critical in speeding the analysis of blood samples and thus keeping patients in the programme and aware of their status.
Dr Tempelman stresses that these factors, as well as issues like education, good nutrition and a healthy environment that includes sport, all contribute to the success of a project like Ndlovu.
He adds that the project is sustainable and would be easy to replicate in various communities around South Africa.