Entertainment Education Studies

Awareness, stigma and stereotypes: Adapting HIV/AIDS training materials for use with South African Indian school learners.

By Aarif Saib And Simone Samuels (2008)

A paper published on the KIT website.

(The Royal Tropical Institute (KIT) in Amsterdam is an independent centre of knowledge and expertise in the areas of international and intercultural cooperation, operating at the interface between theory and practice and between policy and implementation. The Institute contributes to sustainable development, poverty alleviation and cultural preservation and exchange.
KIT operates internationally through development projects, scientific research and training, and also provides consultancy and information services. These activities, along with those of its Tropenmuseum, Tropentheater and publishing house, are the Institute’s means of bringing together people and organizations within the Netherlands and all around the world.
The Institute is a not-for-profit organization that works for both the public and the private sector in collaboration with partners in the Netherlands and abroad. )

This paper is based on a research project that was conducted by the authors as postgraduate students in the School of Cultural Communication and Media Studies (CCMS) at the University of Kwa-Zulu Natal, South Africa in June 2008.

Acknowledgements:
Thanks to the United States Agency for International Development for funding to undertake this study received through Johns Hopkins Health and Education South Africa (JHHESA), and to the Graduate Programme in Culture, Communication and Media
Studies, University of KwaZulu-Natal, for directing the project.

Disclaimer: The opinions expressed herein are those of the authors and do not necessarily reflect the views of the United States Agency for International Development. Thanks to the project supervisor, Given Mutinta and paper editor, Emma Durden.

Abstract
This paper suggests that discriminatory beliefs and stereotypes reinforce the need for greater HIV/AIDS awareness which will result in positive attitudes and behaviour patterns. In South Africa, the taboo surrounding sex, sexuality and HIV/AIDS in Indian
communities suggests a need for implement participatory awareness campaigns in these areas which have been largely ignored by social development agencies. This research into the efficacy of materials developed by the DramAidE organisation is conducted with Indian senior secondary learners from a Church Youth group in Newlands West, outside of Durban. The research has two stages. The first stage measures the educational awareness and behaviour patterns of Indian senior secondary learners with regard to HIV/AIDS before the implementation of the DramAidE materials. The second stage is post-DramAidE material implementation, which measures the effectiveness of the DramAidE materials on the learners.

To access and download the paper, go to: http://portals.kit.nl/smartsite.shtml?ch=FAB&id=4617&Part=InDepth

Author: Mphinyane, Sethunya
Date: 2002
Unpublished Conference Paper, Southern African Communication Association, University of Potchefstroom, 2002
Abstract

Since it’s first appearance in Botswana in the mid eighties, HIV/AIDS has attracted a lot of attention, especially from the Government’s Ministry of Health. Countless workshops, broadcast media and academic messages have been floating around, in the government and other stake holders’ effort to ‘sensitise’, ‘educate’, ‘empower’, the people of Botswana to survive the pandemic. However, despite the commendable efforts, the infection rates have not been significantly arrested. Questions have been asked regarding this situation and resources have been allocated towards the task of understanding and remedying this development, to limited success. The relentlessness of the pandemic is a clear indication that the message that both private and government media is disbursing, of condom use, abstinence and anti-retroviral therapies is not the only one available to people.

By exploring existing narratives of and about HIV/AIDS among ordinary people of the city of Gaborone, Botswana’s capital city, this paper seeks to argue for an unrepressive media that promotes other stories. It argues that part of the problem of escalating HIV infection rates in Botswana lies with the fact that it is only official narratives of the pandemic that have been represented in Botswana’s private and public radio stations and newspapers, to the exclusion of local experiences and know ledges about the pandemic. I suggest that, this is because the paradigm from which the codes used in the messages are drawn from, is one that is alien to people at the level of day to day decision of health and illness. It is one they know better than to challenge, because of the massive campaign against their ‘ignorance’ that would result from such open challenge. This has resulted in what I would like to characterise as a superficial hegemony of the HIV/AIDS prevention message. By drawing from a scientific paradigm, one that has erected a wall around itself as ‘the undistorted truth’, media has closed avenues for open resistance, but as a result has failed to erase the alternative but muted narratives existing that inform people decisions on their sexual and health matters. I therefore make an argument that, unless people’s perceptions and stories are included in the myth making process, we run the risk of a ‘nationally’ celebrated but personally resisted myth, whose very hegemony is the ‘myth,’ only this time myth in the sense of false.

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Author: Jugbaran, Nazli
Date: 2003
Other Authors: Eliza Melissa Moodley
Type of product: Honours Research Essay
Abstract

This paper explores the efficacy of an intervention on HIV/AIDS and sexuality education with autistic children. A number of autistic children are sexually active, without realising the consequences of their actions, and this makes them vulnerable to HIV infection and pregnancy.

This intervention made use of entertainment education strategies, using puppet shows, theatre and music to educate autistic pupils at a school in Durban. The action media approach was used to involve pupils in the creation of the media product, in this case a music CD.

This paper details the origins and implementation of the project, as well as it’s efficacy.

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Author: Galaen, Leif
Date: 2003
Type of Product: Honours Research Project

Abstract

This paper involves a content analysis of feedback to the Entertainment Education (EE) programme SoulBuddyz, in the form of letters received by the Soul City Institute for Health and Development Communication (SCIHDC).

The researcher analysed 84 letters received by the SCIHDC in response to Soul City interventions 1 and 2 as of May 2003. Taking into account the letter writers age, gender and background, these letters were analysed in terms of their content with regard to language used, style of address, requests for materials and information, explicitly expressed positive sentiments and correct application of knowledge gleaned from the SoulBuddyz programmes.

There is little available literature regarding adolescent response letters to TV programmes, and this paper suggests a practical method for research, as well as the value of the exercise.

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Author: Delate, Richard
Date:
Programme: Graduate Programme in Cultural and Media Studies
Degree: BA Hons

Background

In 1994 South Africa emerged from the era of suppression and persecution not only of the majority population but also of minority populations. The suppression of the gay and lesbian community of South Africa was contained in three acts. The Immorality Act which banned sodomy outright. An Act prohibiting more than three single men gathering in the same room at the same time. The Age of Consent Act, which banned sexual, acts between men if one or the other was under the age of 19 years of age.

The South African Constitution adopted in 1996 for the first time extended equal rights to sexual minorities in South Africa. According to the Bill of Rights the new constitution recognises that everyone is equal before the law and has the right to equal protection and benefit of the law. Equality includes the full and equal enjoyment of all rights and freedoms. The state nor any person may not unfairly discriminate directly or indirectly against anyone on one or more grounds, including race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language and birth. The Constitutional Court moved quickly to repeal the three acts in questions thereby making South Africa one of the few countries, which acknowledges homosexuality as an equal right enshrined by law.

Prior to the advent of information and communication technologies gay South Africans were to meet in the bars and clubs, if these were not raided by the police detaining patrons. Found cruising in areas such as public parks and toilets, which was dangerous in itself as many were to be led into police traps, or beaten up by gay bashers who were known to stake out cruising areas.

The advent of information and communication technologies (ICTs) in South Africa coincided at the time when South Africa was finalising the new Constitution. The old laws were still applicable with ICTs providing gay South Africans with access to the net an alternative space in which to meet and explore their identity as gay South Africans. Fuzzie, an IRC User since 1993-4 explains

Keep in mind it was still very old-SA; so lots of people were still in the closet or just feeling their way out…like yours truly …more just a case of a useful coming out tool in general

The net in general helped me a whole bunch; newsgroups and eventually IRC

Though the arsehole/cruising factor is significantly higher, IMHO

At the same time South Africa was emerging from years of international isolation. ICTs provided an opportunity for South Africans to explore the world that they lived in previously denied to them, to link up and exchange information, experiences, ideas and to access information previously strictly controlled by the state. This in part explains the increase in Internet usage amongst South Africans post 1994, however limited to those who had access at work or who could afford access at home. This period also saw the rise of Internet cafes where members of the public could go and access the Internet at a reasonable rate of R15.00 per hour.

Since 1994 a number of efforts have been made to make the Internet more accessible. This includes declining call rates, the growth of large Internet service providers and more recently the introduction of a free Internet service provider through ABSA Bank. Despite these and other advances there is still a great digital divide between South Africans of different socio-economic status. The increase in the personal use of ICTs remain largely confined to middle and upper income South Africans. However, South Africans represent the largest amount of users of the internet in Africa. Of the estimated 4 million internet or email users in Africa only 1.5 million are found outside of South Africa. Readers interested in information on net accessibility in Africa and South Africa are referred to Mike Jensen’s website on African connectivity updated May 2001.

The poem introducing this paper was specifically chosen for it touches in brief the many issues confronting the IRC participant and to which I could relate having used IRC since 1993/4 and participating in Gaysa since 1998. The questions underlying this paper is to what extent has the Gay South Africa chatroom provided its users with an alternative to the bars, night clubs and cruising areas as an alternative safe space for gay South Africans to interact? Does IRC contribute towards developing a sense of community – does GAYSA represent a virtual community to its users? The issue of identity on-line to what extent do gay South Africans assume an on-line identity and when there is a cross over from the virtual to real life how does that relate to the persons online experience vs the real life experience? Does the internet reinforce the notion of identity and community amongst gay South Africans.

In exploring these issues this paper will aim to provide the following:

An overview of concept of identity, community

An overview of IRC as a medium

The Evolution of IRC in South Africa

The Evolution of Gaysa

An overview of the Gaysa chatline and the experiences of some users

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Author: Delate, Richard
Date: 2001

Introduction

LoveLife, created in 1997/8, is a joint initiative by a consortium of non-Governmental Organisations (NGOs) concerned with adolescent reproductive health in South Africa namely: Advocacy Initiatives, Health Systems Trust, Planned Parenthood Association of South Africa and the Reproductive Health Research Unit (RHRU). The annual budget for Love life is R150 million with core funding provided by the Henry J Kaiser Family Foundation (R100 million), the National Department of Health (R25 million) and R25 million coming from additional sources. Its core partners are the Department of Health, the National Youth Commission, the Bill and Melinda Gates Foundation and UNICEF (Love Life Brochure).

loveLife aims to reduce the rate of HIV infection among young South African adolescents by promoting sexual health and healthy lifestyles for young people aged 12-17. It expects to accomplish its goal through a brand driven, sustained multi-dimensional national programme focussing on making condom usage part of youth culture; establishing adolescent friendly reproductive health services; education; community outreach and institutional support (Love Life, 2001, p.8). Chief Executive Officer for loveLife, David Harrison explains that there are two sides to the loveLife model for influencing the sexual behaviour of young people.

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Author: Parker, Warren
Date: 2003
Presented at the South African AIDS Conference in Durban, August 2003
This paper reviews the conceptual framework of the loveLife campaign. It critically examines assertions made about the HIV/AIDS context at the outset of the campaign as well as references made to parallel initiatives and claims made via internal research.

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Author: Parker, Warren
Date: 2002
Other Authors: Salome Oyosi, Kevin Kelly and Susan Fox
Developed for Save the Children by the Centre for AIDS Development, Research and Evaluation (Cadre)

According to the All Media Products Survey (AMPS) there are 18,3 million commuters in South Africa, of whom 77% are taxi commuters and 33% commute on buses or trains. The highest proportion of commuters are located in KwaZulu- Natal, 22%, followed by 19% in Gauteng and 12% in the Northern Province. The ratio of males to females is 48:52.1

This large mobile audience has good potential for interactive HIV/AIDS activities, and over the past five years commuters have been targeted on an ad-hoc basis by various organisations. One example of an HIV/AIDS specific campaign was a sustained condom promotion activity conducted by the Department of Health in 1996/97 using minibus taxis. This involved the training of selected drivers in the provision of basic HIV/AIDS information and the location of free condoms on some 400 branded taxis. By the end of the project over 600 000 condoms were being distributed on a monthly basis. Other commuter site activities have been conducted by provincial health departments and non-governmental organisations and have included dissemination of materials on AIDS related days, condom dissemination, and short-duration promotion of HIV/AIDS issues.

The Commuter AIDS Information Project is a two year activity developed by the HIV/AIDS and STD Directorate of the Department of Health, South Africa. The project runs from October 2001 to September 2003 and is conducted by a partnership of four organisations – Comutanet; DramAidE; the Centre for AIDS Development, Research and Evaluation (Cadre) and the National Association of People Living with HIV/AIDS (NAPWA). The project targets the commuter population through providing basic HIV/AIDS information, referral information, condoms and leaflets via kiosks located at 20 urban commuter sites countrywide. The kiosks, which are managed by Comutanet, are situated prominently at each site and are regularly used for consumer product promotion. Two trained NAPWA members are located at each kiosk. Training and support is provided by DramAidE, and the project is promoted by Comutanet utilising exterior taxi signage, kiosk signage and advertising inserts on Star Music. The Star Music concept involves the free distribution of popular local and international music interspersed with short commercials to taxi drivers on a bimonthly basis.

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Author: Parker, Warren
Date: 2003
Introduction

Tsha Tsha Tsha is an educational drama focusing on the universe of young people engaging in explorations of love, sex and relationships in an HIV positive world. Set in a small town in the Eastern Cape, the drama explores young peoples’ relationships as they make their way through the passage to adulthood, developing self efficacy and humanity at an individual, group and community level. It reveals the complexity of the world of youth and explores their capacity to reflect on problems, to engage problems, to develop solutions, and to become important social actors in their own lives and in the lived world of their communities.

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Author: Parker, Warren
Date: 2003
Background

Over the past two decades, millions of dollars have been invested in behavioural interventions oriented towards education for behaviour change, and although many of these interventions have made impacts on knowledge and awareness, and have contributed to HIV risk reduction, they have been insufficient to the task of ensuring the rapid changes necessary for containing the HIV epidemic in many countries.

This brief review examines behaviour change concepts in relation to risk of HIV infection, and argues for a greater emphasis on public health approaches that focus on addressing contexts of risk with a view to supporting a more rigorous response to HIV prevention. In contexts where HIV infection is generalised, it is also argued that HIV prevention activities should be integrated into the continuum of HIV/AIDS treatment, care, support and rights.

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Author: Manyozo, Linje
Date: 2002
Other Authors: Lungile Dlamini
Place: Culture, Communication and Media Studies (CCMS), University of Natal, Durban.
Publication Satus:ct was done for the MA modul, Public Health promotion via Entertainment Education, coordinated by Prof Lynn Dalrymple.
Acknowledgements: Thanks to Arnold Shepperson and Elaine Binedell for supervision, editing and other Advice. Thanks to Johns Hopkins University for Research Funding.
Copyright: CCMS, University of Natal

Outline of Report

1. Background to the project
2. Introducing the area of study
3. The logistics of carrying out the study
4. A literature review on participatory playmaking
5. Methodological approaches
6. The challenges of work-shopping plays with communities in social education
7. Bibliography

1. The background to the project

I am a Malawian student who has previously worked on two Entertainment-Education projects in Malawi on issues concerning girls’ education, reproductive health and maternal and child health. This work involved researching, acting in plays in villages and writing radio plays. I grew up in rural Malawi where I used to see my mother wake up at around 4 a.m. everyday to draw water from the river. She would also wake up my sisters, younger than myself, to help her clean dishes. My father and I, the only son, would sleep until he reminded me to sweep the surroundings. The women would prepare breakfast and heat water for bathing. My father would bath first, followed by myself. The sisters would come later, which often resulted in them being late for school. Coming back from school, I would take my lunch and disappear to play soccer with friends. My sisters had to do the dishes, draw more water from the river, go to the maize mill or carry out whichever ‘women’s’ job there was. When mother fell sick, the girls had to stay at home to do all the ‘women’s’ chores. I also had an opportunity to tease my sisters at the end of school semesters as I usually performed much better than them.

The Entertainment-Education Course project provided a springboard from which to raise theoretical and methodological questions regarding the gender-based distribution of chores and aspects of participatory education and empowerment. On this project, I worked with an Honours student, Lungile Dlamini. She comes from Swaziland and I found her partnership beneficial as she comprehends Zulu, a language and culture very similar to her Swazi origins.

Project Objective

This was to enable young people to critically question how gender power relations affect the domestic economy in patriarchal communities.

Aims

· To establish what the community refers to as ‘men’s’ jobs and ‘women’s’ jobs.

· To establish community attitudes and perceptions regarding the relationship between gender and household chores.

· To produce a workshop play on the gendered nature of the domestic economy, spiced with songs and dances.

Expected Output of the Project

The anticipated result was the empowerment of community youth so that they would take the initiative in engaging in critical dialogue about the gendered distribution activities in the domestic economy and its consequences.

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Author: Maharaj, Arthi
Date: 2002
Place: Culture, Communication and Media Studies, University of Natal, Durban, South Africa
Acknowledgements: Thanks to Arnold Shepperson for su[pervision, and Elaine Binedell for editing. Thanks to Johns Hopkins University for research funding
Copyright: CCMS

Abstract

This paper serves as a follow-up study from research conducted among secondary school pupils from the Reservoir Hills, Durban district on the loveLife campaign and the necessity of interactive, peer-group education. This study is based on the responses received from the parents interviewed in the primary investigation. The high-school students who were initially the focus of the study appeared to be more receptive to the idea of sex education than were their parents. Many of the comments in the first study received from the parents and the students about their own parents, were rather negative and in need of further exploration. Using a qualitative analysis, this study aims to investigate the roots of parents’ reluctance to speak about sex to their children and demonstrates that parents need just as much tutoring in sexual communication as did their children. The possibilities of using a local soap/drama series to highlight these issues are explored by investigating the advantages of using drama as a communication strategy.

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Author: Leeway, Tsai; Morrison, Callen; Singh, Tyrell
Date: 2004
Place: Durban
Product: EE Project

Abstract

Eve Ensler’s play, The Vagina Monologues, addresses the issues of sexual violence and disempowerment in a provocative, entertaining manner. The script is based on Ensler’s interviews with over two hundred women about their personal experiences and includes topics such as genital mutilation, incest and rape. Although the play has been well received by audiences in many countries, it has also generated a considerable amount of controversy. The play has spawned a grassroots movement, The V-Day Campaign, which aims to put an end to violence against women and girls in the global context.

The body of this paper is based on our observations and analysis of two performances of The Vagina Monologues in March 2004; one amateur, one professional. Semi-structured interviews were also conducted with members of the professional and the amateur casts in order to gain further insight into, and understanding of, the topic. Entertainment-Education (EE) principles and theories have been used as a basis for our assessment of the present and potential roles of the play in addressing the social problems it highlights. Download the article

Author: Khumalo, Musi
Date: 2002
Place: Culture. Communication and Media Studies (CCMS), University of Natal, Durban, South Africa
Publication status: A student research project, conducted under the auspices of the Public Health Promotion via Entertainment Education MA module
Acknowledgements: Thanks to Arnold Shepperson and Elaine Binedell for supervision and editing. Thanks to Johns Hopkins University for research funding.
Copyright: CCMS

Abstract

In today’s highly commercialised environment, the raison d’etre of a public broadcaster should be the prioritisation of good programming rather than numbers and this responsibility is rooted in the need to enlighten the public and of the broadcast medium being a public space in which social and political life unfolds democratically (Raboy, 1996:6) The South African Broadcasting Corporation (SABC) is South Africa’s public broadcaster with a network of nineteen radio stations under its ambit. These stations have a collective listenership of 20,834 million (SABC website) within a national population of over 40.58 million (Statistics South Africa website). UKHOZI FM, as part of this network and with a similar social responsibility mandate, commands a listenership of around 4,6 million listeners making it the largest radio station in the southern hemisphere (UKHOZI FM website). The station’s main broadcast area, KwaZulu-Natal, is the most densely populated province in the country with 8,4 million people who are predominantly Zulu speakers and Zulu is the broadcast language of the station. Based on the above, a communication intervention targeting a mass audience, would reach a large part of the country’s populace, especially in KwaZulu-Natal. Although there has been no significant rise in the incidence of HIV since 1998 in South Africa, the point prevalence rates for HIV infection place KwaZulu-Natal at the top of the list with 36.2% compared to other provinces (HIV and Syphilis Survey, 2000). Further revelations indicate unexpected patterns of distribution of HIV by age which ultimately call for prevention efforts to be sustained beyond the youth category, which has constituted most of the target population of such actions so far (HIV and Syphilis Survey, 2000). The question then arises whether UKHOZI FM, as the major radio station in the province, has played its part in educating and conscientising KwaZulu-Natal’s population about HIV/AIDS prevention and management through its weekday entertainment-education social drama serial.

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Author: Finlay,
Date: 2004
Place: Durban
Product: EE Project

Abstract

This project aims at measuring the reception of the KwaZulu-Natal Department of Education and Culture Life Skills Division’s JAE (Just About Education) HIV/AIDS Information Tour, analysing the performance of the show at KwaSanti Secondary School (Marianhill). The project intends to assess the effectiveness of the Information Tour in conveying knowledge and attitude change. We elicited the response of the learners of KwaSanti Secondary School to the campaign’s use of

• Prominent figures
• Music
• Drama

The project discusses the employment of live mass information and or entertainment, based on a tradition of live mass political communication, in terms of broader principles of Entertainment Education (EE).

Our approach is based on a comparison between the JAE performance and the South African tradition of using mass meetings as a form of public communication during the anti-apartheid struggles of the 1980’s. Mass meetings became a preferred means to disseminate information to mobilize people against the common enemy, the National Party Government. Many post-apartheid institutions in South Africa today use similar tactics to inform and mobilise the public against health risks and disease (Tesfu, 2003). The project therefore endeavours to sharpen the definition of a broader question of: does the tradition of mass mobilisation, developed as a communicational form to oppose Apartheid, have comparable effectiveness as a health promotion strategy, specifically with regards to HIV/AIDS in modern South Africa? Download the article

Author: Dalrymple, Lynn
Date:
Director: DramAidE, University of Zululand and University of Natal
Adjunct Professor: Graduate Programme for Cultural and Media Studies, University of Natal.

Introduction: the legacy of apartheid

South Africa’s apartheid system repressed the social, economic and political lives of the majority of its citizens. It was a form of ‘racial capitalism’ that included both paternalism and a disregard for subaltern interests and aspirations. Most people lacked basic government services like housing, health care, water, sanitation and electricity. Black people were excluded from national and provincial government, and black municipalities had no power or democratic base: they were administrative agents of the white provincial governments. In the eyes of the apartheid government, there were no black urban poor. Anybody living on urban fringes without permission was there illegally and forcibly returned to the rural homelands. Whites benefited under job reservation laws, and once Nationalist party power was entrenched poor whites were almost unheard of.

The apartheid health system was one of the world’s most unequal, fragmented and wasteful. Fourteen racially differentiated health departments – ten for each Bantustan, three for the white, coloured and Indian populations, and one general affairs department -administered and duplicated services. Four provincial departments as well as 382 local authorities were also responsible for health issues. Even after desegregation in 1990, hospitals were still controlled by these segregated health departments. None of them catered for the black urban poor because, in theory, there were no black urban poor.

Apartheid ideology claimed to uphold western and Christian values, and encouraged a positivist view that conservative western knowledge systems were superior. This led to education and health systems that were imposed, top-down, authoritarian and disdainful of alternative ways of learning and healing. The present dispensation faces the problem of de-entrenching the knowledge and practices left behind after generations of this form of governance. The new policy discourse aims to empower previously disadvantaged people by addressing relations of power and knowledge, using a process of consultation through the devolution of power to local government.

This paper explores some of the contradictions inherent in both democratically changing social reality, and delivering practical changes in areas such as employment, housing, sanitation, health, and education. The focus is on building healthy cities that democratically accommodate the needs of the previously neglected urban poor. Foucault’s [1980] theoretical linking of knowledge production and the operation of power provides a useful framework for looking at a process of changing social reality. Relations of power are specific to different societies, being organised through relations of class, race, gender, religion, sexual preference and age, amongst others. However, alternative perceptions and forms of knowledge can challenge dominant knowledge systems [Weedon, 1987]. Within this actor-orientated paradigm the emphasis is on enabling poor individuals, households and communities to help themselves, with policies aimed at meeting basic needs and enhancing human development and empowerment.

What do we mean by the urban poor?

In mid-2000 South Africa’s estimated population was 43.68 million [South African Survey, 2000/2001:47], with 36.2% of economically active citizens unemployed -40.9% of the latter in urban areas [South African Survey, 2000/2001: 378-379]. This suggests that a significant population of South Africans could be categorised as the ‘urban poor’. However, there is a growing consensus – spearheaded by the work of Nobel prize winner Amaryta Sen – that aside from lack of income, poverty includes the inability to reach a minimum standard of living and well being as a result of deprivation of resources, opportunities and choices. Many South Africans’ continued poverty is intrinsically linked to the systematic entrenchment of discrimination during apartheid [Development Update, 2001:76].

Migrant labour was central to the political economy of South Africa for more than a century, and apartheid was in one important aspect the rationalised policy of labour migration. The policy restricted the movement of entire families to urban areas, and male circular migration was predominant. Although apartheid’s demise has changed the pressures and demands for labour, it remains unclear how these changes will affect future forms and patterns of labour migration. Current estimates are that more than 2.5 million legal, and many more illegal, migrants – from rural areas within South Africa and from neighbouring countries – work in South Africa’s mines, factories and farms. [Lurie, 2000: 343.].

Contemporary South Africa migration includes a significant shift of people from rural areas to informal settlements on the urban peripheries. Government’s response to this major problem has been to make forced removals a feature of life in South Africa once again. For example, in the Alexandra renewal project the euphemism for removal is the ‘de-densification of appropriate land.’ People who have built houses illegally in Alexandra are now being moved to outlying areas. Government argues that this is ‘not dumping people but assisting them. We are moving them from an area that is hazardous to their health and providing them with a piece of land. The previous government didn’t do that’. However, the people who are being moved to Diepsloot are angry because they have no access to electricity and running water as they had in Alexandra [The Sunday Independent, 24 June 2001].

The urban poor include growing numbers of street children and orphans. The Health Systems Trust estimates that AIDS would orphan more than 2 million children by 2005 [South African Survey 2000/2001]. Managing this development alone will require the joint efforts and resources of a number of government Departments such as Welfare, Education, Water Affairs and Housing.

The Transformation of Local Government: Defining `Urban.’

I. The Municipal System

Since South Africa’s first democratic elections were held, its system of governance changed radically. At the time of change, political parties and analysts agreed that strong provincial governance was critical for effective service delivery. The outcome was constitutionally guaranteed autonomous provincial governance, and municipalities becoming directly responsible for the provision of services to the urban poor. The wall-to-wall entities created by the Municipal Demarcation Act of 1998, with powers and responsibilities to deliver health services, replaced a mixed-up system of municipal, local, rural and homeland councils. There are three municipal categories: metropolitan [unicities]; district municipalities; and local municipalities. Several local municipalities make up one district municipality [Nicholson, 2001].

This system is expected to increase municipal powers, responsibilities and accountability. For example, local government now takes responsibility for providing health services. The transformed local governments have greater political status in the attempt to address the empowerment of previously disadvantaged people. However, there is still no solution to long-standing problems such as lack of adequate finance, capacity and skilled administrators.

II. Primary Health Care

The new national devolutionary approach to public health is based on principles of primary health care within a District Health system, replacing the apartheid’s emphasis on a curative bio-medical approach using hospital-based care, medicine, and advanced technology. The new approach attempts to employ principles of consultation and local empowerment by giving more power and responsibility to municipalities:

Resources must be distributed equitably, meaning that those areas with the least resources should be given the most assistance.

Communities should meet their different needs by being involved in the planning, provision and monitoring of health services.

A greater emphasis should be placed on services that help prevent disease and promote good quality health. This is a shift away from curative services.

Technology must be appropriate to the level of health care. For example, this would mean ensuring that all clinics have fridges for the storage of vaccines before equipping them with high-tech facilities.

There should be a multi-sectoral approach to health. In the Primary Health Care approach the provision of nutrition, education, clean water and shelter become central to health care delivery. So, for example, the department of Water Affairs and Education are important role players within the health system [Nicholson, 2000:26].

This offers communities a more developmental approach to health, in which they are not merely passive recipients; resources and finances shift away from high-tech tertiary hospitals to primary level services; and specialist doctors would play a more supportive role to nurses in clinics. The development of professional nurses who can manage clinics is key to this system.

III. Health Delivery: The District Health System

With the demarcation of municipal boundaries completed, the boundaries of the 180 health districts must be aligned with the new municipalities. For the district health system to work effectively it is important to get the size of the district right. It should be large enough to contain the full range of health services including a district hospital, but small enough to allow efficient service delivery and community involvement. The urban poor are often migrants, making planning and effective delivery a serious challenge. Many are ‘squatting’ illegally on non-residential land on which there is no proper provision for sanitation and water. The shifting nature of these communities also makes it difficult to implement the principle of giving them any real say over their own health care

Challenges in implementing the system

I. Financing local government

Introducing the new Health System is not without its problems, and its integration with the new local government system is by no means complete. Many South African municipalities are in a serious financial crisis. By mid-June 1999 an estimated 633 of the 843 local authorities had debts in excess of R9.3 billion which, together with serious capacity problems, impacted on their ability to deliver services [Reconstruct, 1999]. Part of the plan for financing local government was that wealthy communities within the new municipalities would finance the development of poorer communities. With a few exceptions, this has rarely worked because of the huge disparities in service provision inherited from apartheid. At the time of writing residents in the uThekwini [Durban] unicity are protesting over massive rates increases imposed without consultation. There are many rates and service-fee defaulters, and a number of municipalities have suffered from poor financial management. In some of the poorest areas, local government has little chance of raising revenue. It is still not clear how municipalities will be financed, but many may remain dependent on national revenues for some time [Nicholson, 2000].

II. Financing the Primary Health Care System

The re-allocation of resources to the primary health care system means that hospitals throughout South Africa have suffered. In July 1999, a provincial commission of enquiry in Gauteng investigated hospital care practices at several provincial hospitals [Chris Hani Baragwanath, Sebokeng Academic, Natalspruit, and Tembisa ] after complaints from both health workers and patients. Financial constraints were identified as the core problem. The commission noted that public hospitals lack capacity and infrastructure for coping with growing demand. Hospital managers cited the provision of free primary health care and treatment of children under five, as well as the demand for abortion, as causes of greater pressure on the system. The HIV/AIDS epidemic is also putting undue pressure on available resources for health delivery. [South Africa Survey, 2000/2001:237 -238]

However, as clinics become better staffed and better equipped they are beginning to take the pressure off the hospitals. A spokesman for the KZN Department of Health reported that the number of unbooked mothers delivering in hospitals dropped by 80% in 2000, and that while maternal mortality rates dropped significantly at clinics they increased in hospitals indicating that the referral system is starting to work. Unfortunately, the AIDS epidemic has significantly affected the new system, making it difficult to assess how well it is working [McGlew, 2001].

III. The Relationship between provincial and local government

The devolution of power to local government calls for a clearer distinction between provincial and municipal powers. The powers of provinces in relation to delivering health services are fairly deeply entrenched. The KwaZulu-Natal provincial Department of Health has direct control of 62 hospitals and 500 clinics, all funded and run separately from the unicity and district municipal clinics. The long-term aim is for municipalities to provide all delivery, and for the province to build capacity, monitor the delivery of health services and provide strategic and policy direction. However, there has been no decision on how to manage the staffing and financial implications of this change. For example, the transfer of health workers becomes complicated, because provinces and the municipalities offer different conditions of service.

IV. The National Government’s shift towards centralisation

One response to a lack of capacity and delivery at local level has been for the State to take more control over the provinces, a debate within both party and government that has intensified during Thabo Mbeki’s presidency. A recurring feature in the debate on the devolution of provincial powers has been whether national government had given the provinces enough powers to bolster their capacity and ability to deliver. Some argue that provinces act largely as implementing agencies for central government, which sets the direction in health, education, and welfare. This tends to stifle the development of talent and energy at the provincial and local levels, and central government is accused of undermining its own principles of grass roots capacity building and participation. [Development Update, 2001:12 -14].

V. The role of traditional leaders

A major issue during the negotiations preceding the 1994 elections was how to reconcile traditional institutions with the new democratic order. At the local and district level in rural areas the amakhosi [traditional leaders] were accorded ex-officio status. However, legislative inertia surrounding the precise roles and functions of traditional authorities has largely reduced constitutional bodies for traditional leaders to ceremonial entities. Traditional leaders have voiced serious concerns about the transformation of local government, mobilising against the changes expected to follow local government elections in 2000. Some compromises were reached, but the impasse between government and traditional leaders remains.

These difficulties are inherent when transforming to democracy from a hierarchical, authoritarian system of governance. Traditional leaders played a political and administrative role in the former homelands and self-governing territories. Colonial and apartheid legislation conferred on them the standing of local bureaucrats. However, pre-colonial institutions were themselves inherently patriarchal and hierarchical, with leaders claiming inherited rights to rule. It remains to be seen how much support will be given to traditional leaders who resist the new discourse of representative elective democratic governance.

VI. Traditional Healers

Traditional healers’ holistic and cosmological emphasis on health has played a significant role in resisting the bio-medical health model. Widely held and espoused in both rural and urban areas, traditional medicine is pivotal to indigenous social structure and religion. Practitioners are thus highly resistant to change, having maintained individual and social equilibrium for generations. Traditional healers are an example of Foucault’s thesis about the production of knowledge, its relation to power, and the ability to resist alternative forms of knowledge.

In South Africa, bio-medical practitioners still tend to scorn traditional medicine, advising people against healers’ advice and medicines. Others seem to have reconciled these two systems, however, and recently government has taken significant steps to recognise the contribution of alternative healers towards health delivery. First, they are often more accessible; second, they live and work in the community; and, thirdly, although they are not cheap, they are a source of comfort and care for many. On the other hand, some practices, such as sharing razor blades, are clearly dangerous in the context of the HIV/AIDS epidemic, and healers need to be persuaded to change in this regard.

VII. The HIV/AIDS Epidemic

Like most of sub-Saharan Africa, South Africa has been hard hit by HIV/AIDS. The government’s responses suggest that HIV/AIDS education programmes have paid insufficient attention to Foucault’s linkage between knowledge production, social practice, and ways of being. In spite of concerted education and communication campaigns the epidemic has not been contained. Sectors of the South African population, including the State President, have either consciously or unconsciously resisted valid bio-medical explanations of HIV/AIDS and ways of preventing infection.

Local government responses to the epidemic are unsatisfactory, suggesting some kind of resistance to the information about the disease. In his HIV/AIDS impact report to the Durban unicity council [Mercury, 27 June] Mr Bheki Nene noted that the council’s responses to the epidemic have been uncoordinated, fragmented, ad hoc, and sectorally focussed. Many sectors had only recently responded to the impact of the disease, while others were yet to respond. The report recommended that an AIDS co-ordinating committee should head the implementation of a council action plan.

Campaigns that overcome this resistance have to employ methodologies that accommodate the participants’ belief systems, and which also promote community participation in planning, providing and monitoring health services. However, Winifred Bikaako [2001] cautions against uncritical use of Western style participatory principles and practices. External objectives and organisational methodologies often dominate these methodologies, not necessarily increasing local autonomy and eliminating dependence. Although traditional ‘pre-western’ organisational forms, often hierarchical in structure, clearly conflict with group approaches, they remain part of the social reality to be changed.

Conclusion

South Africa’s new health system is decentralised, emphasising Primary Health Care delivered at district level. The approach is equity driven, to cater for both the urban and rural poor. However, there are challenges to implementing the approach, and provinces and local governments need to co-operate with commitment and integrity for the system to fall into place.

References

Bikaako, Winifrid. [2001] ‘Self-help Health initiatives of Urban Migrants: A Case of TASO Uganda’, Paper presented at the conference on ‘Building Healthy Cities: Improving the Health of Urban Migrants and the Urban Poor’, Kampala, Uganda.

Development Update: Annual Review. [2001] Quarterly Journal of the South African National NGO Coalition and Interfund funded by the European Union.

Foucault, M. [1980] Power/Knowledge: Selected Interviews and Other Writings. Pantheon, New York.

Lurie, M. [2000] ‘Migration and AIDS in Southern Africa: a review’. Journal of Science, Vol 96, No 5, pp 343 – 347.

McGlew, D. [2001] Director Communications, KwaZulu-Natal Department of Health, Telephonic Interview.

Nicholson, Jillian. [2001] Bringing health closer to people: Local Government and the District Health System. Health Systems Trust. Durban.

Reconstruct, [1999] 26 September.

South Africa Survey 2000/2001. South Africa Institute of Race Relations. Natal Witness, Pietermaritzburg.

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Author: Aziz, Liza
Date: 2002
Other Authors: Veslemøy Lothe Salvesen
Place: Culture, Communication and Media Studies (CCMS), University of Natal, Durban, South Africa
Publication Status: Students research project conducted under the auspices of the Public Health Promotion via Entertainment Education MA module.
Acknowledgements: Thanks to Arnold Shepperson for supervision and editing. Thanks to Johns Hopkins University for research funding.
Copyright: CCMS.

Introduction

I think that through these programmes, people’s views on the HIV/Aids virus will change. It tells people not to be sexually active until they are married. So I think that it will have a positive effect on many people and their lives. (Urban female pupil at Riverdene Secondary, Newlands, interview 27.05.02)

An Entertainment-Education (EE) approach has an established convention: it is theory based, utilises a comprehensive evaluation process with formative evaluation being paramount, it is a highly consultative process, its design makes purposive use of an entertaining medium to enhance and facilitate behaviour change, and it employs impact evaluation of the intervention.

In this study we have chosen to examine two out of five insert programmes called Voice Out, which was broadcast on the free-to-air channel, SABC 1, within the youth magazine programme, Take 5. We specifically chose Voice Out because the producers at the time were not aware of the strategies and methodologies that underpin EE. Voice Out dealt with the specific health communication issue of teenager sexuality within the highly charged environment of HIV/AIDS.

Mass health communication campaigns specifically use EE as an effective strategy to facilitate desired behaviour change. The insight offered by entertainment-education and supported by various academics in the field of health promotion, is that knowledge is not a sufficient condition for behaviour change (Parker, 1994; Piotrow et. al, 1997; Soul City, 2001; Tomaselli and Shepperson, 1997; Parker, Dalrymple and Durden, 2000). Voice Out was an attempt to fill the gap between knowledge and sexual behaviour among South African youth. The list of mass health communication campaigns that utilise the EE approach is lengthy: the Hum Log television series in India, which promoted family planning; the Philippine Multi Media Campaign for young people, which promoted sexual responsibility in youth; the Sesame Street television series was designed to stimulate the development of children in the United States; the radio programmes in Nepal, which promoted family planning; Soul City in South Africa which dealt with a number of health communication issues such as tuberculosis, HIV/AIDS and family planning (Singhal and Rogers, 1999; Meyer, 1994; Coleman, 2000; Storey and Boulay, 2001; Soul City, 2001). Because the production Voice Out addresses what is considered to be a pro-social health communication message, that of sexual responsibility in youth, we considered it an ideal example for analysing how producers, without the knowledge of the EE approach, would produce within this field.

The focus of this essay is to discuss to what extent EE methods and strategies were unconsciously applied in the process of making Voice Out. The essay consists of three major parts based on the following definition of EE:

Entertainment-education strategy is the process of purposely designing and implementing a mediated communication form [1] with the potential of entertaining and educating people [2] in order to enhance and facilitate different stages of prosocial (behaviour) change [3]. (Bouman, 1998:25)

Thus we will start by analysing the research, conceptualisation, production, and transmission of the insert programmes that constitute Voice Out, in the light of theories and methods that underpin EE [1]. Secondly we will discuss to what extent Voice Out was able to combine the two elements of education and entertainment, touching on the documentary genre within which the inserts are produced [2]. Because “the theory-based nature of entertainment-education increases the audience effects” (Singhal and Rogers 1999:211), we would also like to discuss to what degree the content of the programme relates to theories of behavioural change that are central to the field of EE. Here we will assess its impact using a controlled qualitative impact evaluation [3].

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