by Candice Jansen

TB Healthcare in Western Cape

The Woman Behind the Scenes

Red Lungs

In 2009, the World Health Organization ranked South Africa fifth out of the 22 highest tuberculosis-burdened nations in the world. Every year, 500 000 new cases of TB occur in South Africa, largely as a result of the HIV/Aids pandemic, which places a significant burden on medical staff in the public health sector.

Impumelelo evaluator Professor Tony Morphet elaborates: “(Nurses) come under intense pressure to attend to waiting queues of patients. As a result, they tend to overlook both monitoring and recording, with the consequence that many patients fall away from the medication regime.” 

Since 2005, Judy Caldwell has played an integral role in helping clinics address this to combat the scourge of TB through the Administrative Support for TB Programme. 

This research focused Caldwell and her team on providing adequate training to lay healthcare workers in order to assist formal health services.

Results of research

To support nurses and doctors in clinics in the Cape Town metropole area, the programme recruits and trains unemployed laypersons with Matric as TB assistants and clerks to perform administrative tasks. They are responsible for: 

• creating and maintaining the records of TB patients;

• monitoring patients’ sputum tests;
• following up with those who test positive;
• tracking treatment defaulters (which includes house calls if patients cannot be located by phone); and
• assisting with the administrative tasks of home-based carers.
After six years with the programme, Caldwell is still astounded at “the empowerment (that the) Administrative Support for TB (Programme) has brought to these peoples’ lives.” 

Since its inception, the programme has trained and employed 87 TB assistants and 37 TB clerks to work at 27 clinics. This workforce has been integral to the 80% cure rate recorded in 2009 – a feat never before achieved in Cape Town. Currently under way are discussions to integrate the model into clinics providing antiretroviral treatment.

Wealth of experience

After almost three decades in the health sector, Caldwell came to the project with a wealth of experience. Born in East London, she studied nursing at Groote Schuur Hospital in Cape Town and went to Durban to complete her midwifery degree. 

She resumed work when her two children were still infants, at a time when women did not receive paid maternity leave. Modest about her ability to juggle a career with the demands of marriage and motherhood, she says there was simply no other choice. Caldwell worked in Bethlehem and Kimberley for a number of years before moving back to Cape Town.

Important relationships

Here, she joined the Western Cape Provincial Department of Health as the TB co-ordinator for the metropole area before joining the Cape Town City Health Department. 

Her familiarity with the government and her past involvement with the non-governmental organisation (NGO) sector enabled Caldwell to facilitate the relationship between Metro Health District Service, Cape Town City Health, and the TB & HIV Care Association (an NGO) to form Administrative Support for TB.

It seems fitting that this pragmatic woman has played a critical role in developing a programme concerned with the nuts and bolts of a system.

Yet, for the people involved, she has done something much bigger. 

Sister Lebo Nohiya brims with excitement as she tells of the support and encouragement Caldwell has offered her over the years. Nohiya is the facility manager of Site B Clinic in Khayelitsha, one of the busiest clinics in Cape Town, where 73% of HIV-infected people are co-infected
with TB. 

According to Sister Nohiya, Caldwell helped her in her current post after she joined the programme as a TB co-ordinator in Mitchells Plain on the Cape Flats. Nohiya joined the programme to help prevent others from experiencing the same tragedy she did when her father died of TB.

No ordinary employee

Despite her achievements, Caldwell is self-effacing and sees herself as an ordinary employee of the state. She is an employee with a particular talent for statistics, but brushes off any praise. 

How does one, at a glance, look at 96 clinics and determine whether they are doing the job they are suppose to be doing and getting the desired outcome? “You just have to train your eye to do this,” is Caldwell’s nonchalant reply. “This just happens to be part of my job. It’s just common sense.”

She is reluctant to admit her leadership plays a critical role in the programme’s success. “There are many people who do the work on the ground and I am terribly humbled by the role they play,” she says.

Caldwell is an Impumelelo Woman Social Innovator featured in its latest magazine, Women Making it Happen: Women and Social Innovation in South Africa
Visit for more information.
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