phonela-planPholela Community Health Centre (CHC), 45 minutes from Underberg, was the source of community oriented primary health care (COPC) in the world. Two doctors, Sidney and Emily Kark from Israel, created the concept and practice in the 1940s at Pholela, and COPC has flourished around the world since that time.  But Apartheid in South Africa crushed that practice and the Pholela CHC beginning in the 1950s.  Sidney and Emily returned to Israel and continued to spread COPC, partially through their writings, and particularly their book From Pholela to Jerusalem.

We at Ndawana, knowing nothing of this early history of Pholela, created a similar concept that governed the creation and operation of the Ndawana Clinic.

The re-emergence of Pholela CHC as the focus of re-engineering of primary health care in KwaZulu-Natal in 2010 engaged Edzimkulu in a number of ways. The relationship between Pholela and Edzimkulu was already long-standing and strong.  The first roving doctors at Pholela and its clinics were Edzimkulu volunteers.  Until 2011, Ndawana’s supervising facility was Pholela.  Chris sat on the task team for the re-engineering of Pholela.  CCGs from Pholela are trained by Edzimkulu in skills that vary from conducting the Stepping Stones program to how to hang a scale and weigh a child at the household level.

Pholela and Edzimkulu bring different strengths to the table.  Edzimkulu arose not from a clinical context but rather a community context.   Low-cost, community-based solutions to health issues were developed out of necessity. Edzimkulu continues to strengthen existing programs and develop new approaches for COPC.  Both sites have been selected as good practice sites at the provincial level and Edzimkulu also at the national level. The clear opportunity for the future is to bring the sites together with an overall vision and sharing of resources that will allow for more than islands of excellence; the goal is to build toward a critical mass that will lead to more effective and efficient primary health care in the province and the country.

Integration of experience developed in Ndawana with Pholela will significantly strengthen both initiatives and will not only ensure sustainability of the work that Edzimkulu has done in the last twelve years but provide a strong structural mechanism for widespread dissemination and replication of our work.