Issuu

Issue 31: September 2025

The legacy of Douglas and Eleanor Murray Invest in South Africa’s potential

DGMT is a South African public innovator through strategic investment. Our goal for South Africa is a flourishing people, economy and society. Towards this end, DGMT currently distributes about R200 million per year and leverages and manages a similar amount of funding through joint ventures with other investors.

Through the newly rebranded edition of our Hands-on Learning publication, we hope to play a helpful role in synthesising information from innovators and implementers in civil society, supporting them to share what they have learnt so that others are able to draw from and build on their experiences.

IN THIS ISSUE WE FEATURE

LEARNING BRIEF 1

How our unsung heroes can reduce stunting

South Africa’s community health workers (CHWs) share the same lived experience as the people they serve. They are part of their communities, key figures of influence and mobilisation. They bring primary healthcare to those who struggle to access it and enable the formal health service to be more responsive to community needs. They are not only the eyes and ears of communities; they are connectors – linking people to the formal health system through home visits. CHWs are also well-placed to address the drivers of stunting, but they are often under-resourced and unrecognised.

LEARNING BRIEF 2

Building buzzing brains

By age five, a child’s brain reaches 90% of its adult size, and in the first few years of life, children form about 50% more neural connections than adults will have. This explosive networking lays the foundation for cognitive development that continues into early adulthood, constantly being pruned and remoulded, and shaping how someone learns about, makes sense of and behaves in their world.

LEARNING BRIEF 3

DGMT’s approach to scaling and lessons along the way

Scaling, the process of expanding impact to reach more people, influence systems, or shift social norms, is not simply about making projects bigger. In complex environments like South Africa, it requires new ways of thinking, strategic partnerships, and a readiness to adapt to changing political and economic conditions. For DGMT, scaling is embedded in its mission: to unlock the “10 opportunities to escape the inequality trap” and to shift national outcomes in early learning, youth employment and social inclusion. 26

HOW OUR UNSUNG HEROES CAN REDUCE STUNTING

This learning brief looks at how Grow Great, Philani and One To One Africa (OTOA) are supporting CHWs with the training and equipment they need to prioritise maternal and child health and reduce malnutrition.

The care and nutrition that mothers and children receive during the first 1 000 days of a child's life play a crucial role in shaping their growth and learning trajectory. But South Africa is facing a malnutrition crisis, with recent figures revealing one in four has limited access to food.1 Malnutrition is one of the major drivers of stunting – a (largely preventable) condition where young children are too short for their age and do not reach their full growth potential due to chronic nutritional deprivation, often made worse by repeated infections. The country has a persistently high stunting rate, with more than a quarter of children under five years of age affected.2

Countries such as Peru and Brazil, which struggle with similar resource constraints to South Africa, have successfully reduced stunting. In just eight years, from 2008 to 2016, Peru cut its stunting rate from 28% to 13%; between 1974 and 2007, Brazil reduced stunting in children under five years of age from 37.1% to 7.1%.3 There was no single recipe to reduce stunting; each country used its own contextappropriate strategy; however, community health workers (CHWs) played a central role in both of these success stories.

SUPPORTING ACCESS TO PRIMARY HEALTHCARE

In South Africa’s primary healthcare system, the current ratio is 0.31% of doctors per 1 000 patients, far below the World Health Organisation's recommendation of one doctor for every 1 000 patients.4 The South African ratio translates to one doctor often being responsible for more than 3 000 patients, with a severe shortage of doctors in rural areas and the public sector.

CHWs form part of a powerful network that enables the formal health service to make sense of, and respond to, community health issues despite these shortages. They are also connectors – linking communities to primary health services through home visits, so patients can avoid joining long queues at clinics or paying expensive transport costs.

“We’ve seen that in countries where stunting rates have dropped, CHWs were empowered, trained and upskilled to spot children showing early signs of growth faltering. These countries credit much of their success to the impact CHWs have had on maternal and child health outcomes.”

- Nicola Stofberg, Grow Great deputy executive director

1 Statistics South Africa. 2025. General Household Survey 2024. Pretoria: Stats SA. Available at: https://www.statssa.gov.za/publications/P0318/P03182024.pdf

2 Mbali, N. 2023. Childhood stunting and malnutrition are critical health challenges for SA. Daily Maverick, 26 July. Available at: https://tinyurl.com/4vwhkk7j

3 Kathuria, A.K., Arur, A. and Kariko, E. n.d. Success stories with reducing stunting: Lessons for PNG. Washington, D.C.: World Bank. Available at: https://tinyurl.com/2ses8b9a

In South Africa there are about 45 000 CHWs.5 They are mostly female, and each supports roughly 250 households. They offer health education, conduct screenings for early detection of diseases or complications, provide support for adherence and make referrals for health, nutrition and complex social issues including substance abuse, gender-based violence (GBV) and chronic poverty.6 CHWs work in teams led by an outreach team leader (an enrolled or professional nurse) and are linked to primary healthcare clinics. They are well-positioned to identify when children are not growing as they should because

5 Jooste, S., Ramlagan, S., Magobo, R., Shean, Y., Sewpaul, R., Dukhi, N., Cloete, A., Petersen, Z., Mabaso, M., Davids, A., Maseko, G., Ginyana, T., Molopa, L., Vondo, N., Parker, S., Zuma, K. and Moyo, S. 2023. A national skills audit of community health workers and outreach team leaders employed by the National Department of Health 2023. Pretoria: Human Sciences Research Council.

6 Thomas, L.S., Buch, E., Pillay, Y. et al. 2021. Effectiveness of a large-scale, sustained and comprehensive community health worker program in improving population health: The experience of an urban health district in South Africa. Human Resources for Health, 19:153. Available at: https://doi.org/10.1186/s12960-021-00696-8

PREVENTATIVE SCREENING AND HEALTH PROMOTION

UNDER DIFFICULT CONDITIONS

CHWs have walked a long and difficult road in South Africa, acting as conduits for the primary healthcare system and reaching people where the state presence is weak. They played a significant role in addressing the HIV and TB epidemics and remain a first point of contact for healthcare at community level. While CHWs are not clinical professionals, they are recognised healthcare providers whose scope of work is largely preventative. Trained to deliver screening and health promotion services, they also support chronic disease management, maternal and child health, palliative care and basic preventative care – but they do not diagnose illnesses. CHWs are typically contracted by provincial governments or employed through non-governmental organisations (NGOs).

CHWs face a variety of obstacles in their work, including that they often operate in high-crime areas, work with limited resources, and receive inadequate training, support and remuneration. Many CHWs are not provided with the basic equipment necessary to perform growth monitoring of children at home. For instance, they currently lack basic scales for measuring weight. Instead, they are given coloured measuring tapes to assess mid-upper arm circumference (MUAC), which can help identify children with acute malnutrition. While this method remains valuable, better early detection and intervention methods are needed.

In rural parts of the Eastern Cape, Limpopo and Mpumalanga, clinics and caregivers are often difficult to reach because of the long distances between them. Most CHWs rely on public transport or walk to carry out their work. CHWs also face mental health pressures, as they often serve in multiple caregiving roles within vulnerable and impoverished communities. They must balance this demanding work with their own responsibilities as daughters, wives, mothers and grandmothers. Despite these challenges, CHWs continue to serve their communities, but their impact could be far greater with stronger support, training and resources.

“If we truly value our CHWs and if they had the time to deliver quality education, adequate screening and prevention for maternal and childcare, we would see the system become less burdened over time. CHWs are leaders within their communities, and efforts to uplift them will enable preventative measures to be carried out at the community level by other trusted figures, such as religious and traditional leaders.”

– Dr Tevarus Naicker, DGMT innovation director

DGMT believes that to improve the future of South Africa’s children, it is crucial for CHWs to be properly trained in maternal and child health and nutrition, as well as the building blocks of early childhood development (ECD).

This learning brief features three NGO-run programmes that demonstrate how care can be delivered, with a key focus on maternal and child health and nutrition. The interventions focus on identifying and supporting pregnant women and infants during the first 1 000 days, a period that has the most profound long-term influence on both health outcomes and socio-economic development.

GROW GREAT: HALVING STUNTING BY 2030

Grow Great is a national campaign that began in 2018 with one goal: to halve childhood stunting by 2030. At the time, stunting (the result of chronic malnutrition in early life) was often considered a normal condition, and thus rarely spoken about, even as it held millions of children back. To promote understanding of the condition, Grow Great launched its national awareness campaign and mobilised South Africans to reduce stunting. “Too many children were falling behind before they even had a chance to begin,” says Grow Great’s deputy executive director Nicola Stofberg. “We set out to change that. Today, Grow Great works across clinics, households and communities to make stunting visible, urgent and solvable – and to build a future in which every child can grow to their full potential.”

Grow Great Champions (GGC) is an initiative of the campaign that equips CHWs to become champions for children, particularly in preventing stunting. The programme aims to build a national network of motivated CHWs who advocate for child well-being at the community level. It provides CHWs with resources, training, mentorship, and a community of practice, meaning they are better able to support families and improve maternal and child health and nutrition outcomes. Grow Great enters into formal partnerships with the Department of Health to train CHWs.

GROW GREAT RUNS FOUR CORE TRAINING SESSIONS:

Onboarding of team leaders, with a focus on the first 1 000 days, which is aligned with the pillars in the national Side By Side7 campaign, growth monitoring and supervision of CHWs.

As part of their core work, CHWs screen for vulnerable children and mothers, specifically identifying children at risk of stunting. They conduct growth monitoring using appropriate tools and provide tailored advice on proper nutrition and essential care practices to support healthy growth and development. Through regular home visits and health promotion, CHWs play a critical role in empowering caregivers to prevent stunting and ensuring timely referrals when needed.

As part of their broader training, GGCs are trained on the Road to Health Book, which includes important guidelines such as LovePlayTalk. These guidelines are demonstrated by GGCs in homes; parents and adults in the family are encouraged to interact with their baby by talking and reading to them, and through interactive play. By demonstrating these interactions, the GGC builds trust with the caregivers, which opens the door to providing additional support and information about the child’s health, growth and development.

GGC was launched in mid-2018 and to date over 3 800 GGCs across Limpopo, Gauteng, the Free State, Mpumalanga, the Western Cape and the Northern Cape have collectively growth monitored over 270 000 children under the age of two. They have also supported over 48 277 pregnant women to care for themselves and their baby, attend antenatal clinic visits and identify and refer at-risk behaviour (such as drinking). Among the mothers reached, Grow Great is seeing a higher uptake in exclusive breastfeeding compared to the national average.8 7 Side-by-Side is a campaign of

Onboarding of CHWs, focusing on the first 1 000 days and growth monitoring.

One-day growth monitoring training for CHWs, with the focus again on growth monitoring skills (particularly weight, length and MUAC measurements).

Refresher training, an annual one-day training for both team leaders and CHWs.

“CHWs are an incredibly powerful way to deliver complex health information at different points in a child’s journey. When a mom is pregnant and not attending her antenatal clinic visits, a CHW can encourage her and connect her to the healthcare she needs. This helps ensure her baby is growing well in utero and that she’s taking her antenatal vitamins, reducing the risk of low birth weight, which is a strong predictor of stunting.”

- Amanda Edwards, Grow Great M&E specialist

PHILANI MENTOR MOTHERS: BRINGING HEALTHCARE HOME

The Philani Maternal, Child Health and Nutrition Trust is an initiative established by Dr Ingrid Le Roux, a Swedish doctor whose vision has transformed the lives of numerous mothers and children. In 2002, an extension to the project, the mentor mother programme, began operating in informal settlements surrounding Cape Town, where the clinic-based nutrition rehabilitation programme had struggled to reach children facing severe malnutrition.

Philani only engages with a community when invited to do so, and with the support of local structures in the recruitment process. The initiative begins by identifying women who, despite living in poverty, have raised healthy children – these women are known as 'positive deviants'.9 The programme aims to build on the existing skills of these women, encouraging them to share their coping strategies and knowledge with others in their community.

Philani's training unit provides a thorough six-week introductory course (four weeks in class, two in the field) in maternal and child health and nutrition for newly recruited mentor mother candidates. The training also includes basic ECD training (practical and easy ways to stimulate your child in the home, education about development milestones, etc.). Once employed, mentor mothers receive the necessary equipment and ongoing practical training in the field from coordinators who collaborate closely with them.

9 Griehsel, M. and Stanford, M. 2013. Philani Mentor Mother Programme. Giant Film Production. Available at: https://www.philani.org.za/wp-content/uploads/2014/08/Mentor-Mother_D9-2.pdf

The programme focuses on bringing a supportive and informative primary healthcare intervention into the homes of families. Mentor mothers guide moms through the rehabilitation of their underweight children, support pregnant mothers to improve birth outcomes, help decrease the number of children born with a low birth weight, assist in the prevention of mother-to-child HIV transmission, and improve the quality of life of people with chronic illnesses.

Philani focuses on two main strategies to deal with malnutrition from a preventative standpoint: antenatal support and home-based growth monitoring. It also includes a brief alcohol harm reduction intervention offered to any community member who screens as being at high risk for alcohol misuse, including but not limited to pregnant women. In recent evaluations conducted in the Eastern Cape, the rate of low birth weight among babies born to women supported by Philani was approximately 9%, compared to the national rate of approximately 13%.

In addition:

Women visited by mentor mothers are more likely to attend antenatal care, breastfeed exclusively and avoid harmful practices, improving health outcomes and demonstrating the importance of companionship.10

Mentor-supported mothers show significantly lower depression scores. 11, 12

The model strengthens primary healthcare by linking households to clinics and services – identifying risks, treating malnutrition, supporting treatment adherence, and improving access to grants.13

In the Western Cape, there is a formalised partnership whereby the mentor mothers programme is funded through the Western Cape DoH as part of their community-based service. In the Eastern Cape, although Philani has occasions to work with the provincial DoH, mentor mothers are employed directly by Philani.

In 2025, Philani has 290 mentor mothers:

245 operating in the Western Cape in Khayelitsha, Crossroads and Mfuleni.

45 operating in the Eastern Cape across the Zithulele and Coffee Bay regions of the OR Tambo District.

10 Stansert Katzen, L., Tomlinson, M. et al. 2020. Home visits by community health workers in rural South Africa have a limited, but important impact on maternal and child health in the first two years of life. BMC Health Services Research, 20:594.

11 Stansert Katzen, L., le Roux, K.W. et al. 2021. Community health worker home visiting in deeply rural South Africa: 12-month outcomes. Global Public Health, 16(11):1757–1770.

12 Tomlinson, M., Rotheram-Borus, M.J. et al. 2016. Thirty-six-month outcomes of a generalist paraprofessional perinatal home visiting intervention in South Africa on maternal health and child health and development. Prevention Science, 17(8):937–948.

13 le Roux, K., le Roux, I. et al. 2014. The role of community health workers in the re-engineering of primary health care in rural Eastern Cape. South African Family Practice.

“The primary healthcare system is not quite in touch with what's happening on the ground in communities. Our model is really trying to address that through door-to-door, visits, bringing knowledge to where the person is, and figuring out what they need. Maternal and child health, in our opinion, is just not a priority at the grassroots level; the way interventions are structured from our health system doesn't really have a strong implementation plan for that.”

– Dr Ingrid Froneman, Philani deputy director

ONE TO ONE AFRICA: FIGHTING MATERNAL AND

NEONATAL MORTALITY

In 2016 One to One Africa (OTOA) started work in the rural Eastern Cape aimed at addressing the unacceptably high rate of maternal and neonatal mortality. OTOA follows a similar model to Philani, recruiting women from local villages to become mentor mothers in the OR Tambo District, specifically in the Nyandeni sub-district.

OTOA runs an eight-week training programme (six weeks in class, two in the field) for the mentor mothers. The training includes peer mentoring, learning the ins and outs of home visits, screening for TB and HIV, reproductive health education, antenatal care, postnatal care, infant feeding and nutrition. OTOA provides qualified mentor mothers, affectionately known as Nomakhaya (isiXhosa for “home-carers”), with the necessary equipment and resources. In 2019, the programme was expanded to support 27 government CHWs across 10 facilities in Libode, Lusikisiki, and Port St Johns, providing them with training, equipment, uniforms and ongoing supportive supervision.

To promote access to healthy, nutritious food for children, OTOA implements a comprehensive nutrition intervention that includes prenatal vitamins for pregnant women, the distribution of seedlings to support household food gardens, multiple micronutrient supplementation (MMS), and fortified porridge for young children.

In 2022, OTOA launched the expanded Enable programme, which introduced new components in addition to existing mentor mother activities:

Five ECD mentor mothers are now providing structured play, educational activities, and parenting sessions to 600 caregivers and their children in the community.

OTOA trained 10 mentor brothers or Abakhuluwa (isiXhosa for “elder brothers”), who engage men to help challenge harmful masculinities, discrimination and inequality. These mentor brothers encourage men to become more actively involved in their partners' health, address gender-based violence and promote responsible parenting.

In light of the 31% adolescent pregnancy rate within the programme, OTOA also recruited and trained six youth champions to empower girls, build resilience, and offer essential HIV and sexual health information and referrals to adolescents and young mothers.

A dedicated social worker employed by OTOA collaborates with the Departments of Home Affairs and Social Development, as well as the South African Social Security Agency (SASSA), to facilitate timely birth registrations, identity document applications, and access to social grants, while also addressing child protection cases.

In 2024 there were 30 OTOA-trained mentor mothers supporting 3 697 pregnant women and new mothers. In addition:

of malnourished children were fully rehabilitated within six months. of children had up-to-date immunisations. of babies with a low birth weight were rehabilitated.

“When you consider that their presence alone has helped virtually eliminate maternal and neonatal mortality, and significantly reduce malnutrition, it’s clear that Nomakhayas are making a profound impact. While they aren’t highly trained, the outcomes of their work suggest they have the knowledge needed to drive meaningful change.”

- Gqibelo Dandala, OTOA executive director

There is no doubt that CHWs are a critical workforce able to address the drivers of stunting in homes, and that they bring tangible benefits to their communities.

PRIMARY BENEFITS OF SUPPORTED CHW INTERVENTIONS

PATIENTS RELATE TO MENTOR MOTHERS

Mentor mothers are neighbours, relatives and friends of the people they serve, and they are already familiar with their daily struggles, community dynamics, language and culture. They have a deep understanding of the health challenges that communities face, and are able to build up relationships of trust and support. Philani’s Dr Froneman explains: “Quite unique to the model of being a mentor mother is this idea of connection. Our health systems are large, with patients just being numbers in a big system, and poverty really breeds this feeling of isolation and disconnect. Mentor mothers provide connection, they provide care, they say: ‘I know you; I care about what happens to you.’”

Dr Emma Chademana, OTOA programme director, points out that many of the Nomakhaya team members themselves live with a chronic illness. They are comfortable talking about their own health with caregivers, and provide examples of how someone who lives with a chronic condition can still be healthy.

EARLY INTERVENTIONS

CHWs connect vulnerable people to the support and care that they need, providing blood and glucose screening as well as specific maternal support in situ related to:

Antenatal care: CHWs provide information on preventing stunting, exclusive breastfeeding, nutrition guidelines, hypertension, HIV status, mental health and antenatal supplements, and encourage antenatal clinic visits.

Postnatal care: They rehabilitate low birth weight babies, offer lactation support, encourage postnatal clinic visits, and provide information on child nutrition, the introduction of solids, immunisations, and accessing the Child Support Grant (CSG).

“I think the gold dust about mentor mothers is the ‘why’. They provide information in a digestible manner to our clients, helping them understand why it's important to do what is being advised. Why is it important to focus on nutrition? Because it affects the health of your child. When you know better, you do better. Mentor mothers are the carriers of that knowledge, and they answer the big ‘why’. Once people click onto the ‘why’, they start taking action for themselves.”

- Gqibelo Dandala, OTOA executive director

PROVIDE CONTEXT-SPECIFIC SUPPORT

CHWs play a significant role in educating women about the benefits of exclusive breastfeeding, and they play an equally important role in supporting those moms who do not. “The CHW will know the individual context and if the mom is not breastfeeding, there is no judgement. She can help to educate the mom about the correct use of formula, that diluting formula foods is not ideal and that mixed feeding is not ideal,” says Dr Tevarus Naicker, DGMT innovation director.

A VALUABLE RESOURCE

CHWs are a valuable resource for their communities – helping caregivers prioritise their health by providing accessible healthcare knowledge. They also share their insight into the community with the primary healthcare system. For example, when accompanying someone to the clinic, a CHW might say: “This client has a two-year-old and a six-year-old at home, so their immunisation schedules should be checked.” A CHW’s knowledge of the whole family can improve the health of that family and, over time, benefit the wider community.

“As a mentor mother, I'm passionate about empowering fellow mothers with practical knowledge to care for their children. We visit homes, sharing tips on nutritious feeding, breastfeeding, and utilising local resources like home gardens. Our goal is to make healthy practices accessible and affordable, showing that good nutrition doesn't have to be expensive. We're making a tangible difference in our community, even if it's not always immediately recognised.”

- Andisiwe, OTOA mentor mother

THEY CAN INFLUENCE MOMS TO REACH MILESTONES

CHWs sit both inside and outside the system and, by addressing maternal and child health and nutrition through the first 1 000 days, can influence mothers' decision-making at critical stages. They can also help mothers navigate the unfamiliar primary health care system, which can be far from where they live. A CHW can oversee all the key milestones that need to be reached in order to ensure that, by the age of two, a child is well nourished and ready to thrive.

As these three programmes have shown, public understanding of the importance of the first 1 000 days, and the link between maternal and neonatal health and stunting, has expanded in recent years. There are several key lessons to share about how to achieve maximum impact.

KEY LESSONS

1 PUT MATERNAL AND CHILD HEALTH ON THE MAP

“Since

Grow Great trained us, communities accept and understand us in a way they didn’t before. We now have equipment like scales and MUAC tapes, and we help mothers access nearby services at minimal cost. The support we provide, especially to pregnant women, allows us to identify those facing challenges, record their cases and refer them to the clinic in time. This reduces the maternal mortality rate.”

– Kholofelo Mmola, GGC from Mopani, Limpopo.

Historically, a significant portion of funding from the National Department of Health (NDoH) has been earmarked for HIV and TB interventions. NGOs that have the support of provincial governments in maternal care have learned to demonstrate why the first 1 000 days is so important and how this can be incorporated into existing HIV/TB-focused policy, while ensuring that CHWs have the necessary support to navigate the multiple aspects of their service delivery.

2 CHWS MUST BE PROPERLY EQUIPPED

In impoverished communities, CHWs are often the first to respond to a crisis, but the last to receive any equipment. If the government wishes to address the malnutrition crisis and reduce mortality, it must empower CHWs with the tools to growth monitor children early. Providing CHWs with a basic mechanical scale, along with training to recognise at-risk children, could easily offset the investment needed for the equipment. Successful programmes like those mentioned here have demonstrated the effectiveness of using scales to monitor children's growth in their homes.

As Grow Great’s Stofberg points out, “If we can get one thing right in our country it should be that every CHW has a scale and is able to growth monitor a child.”

WHAT’S IN THE BACKPACK OF GROW

GREAT CHAMPIONS?

Digital scale

Mid-Upper Arm Circumference (MUAC) tape

Measuring tape

Pregnancy tests

Client folders and growth charts

First 1 000 Days guide (their training manual)

Basic stationery (pen, pencil, ruler, eraser and sharpener)

Guide to the Road to Health Book

A branded scarf

“The scale is truly a special item for us. It helps the CHWs negotiate their way into homes and provide an immediate service (weight measurement), which paves the way to building trust and relationships between service provider and client.”

– Dr Thato Mosidi, GGC strategic lead

The mother might explain that it was her husband’s way of caring for the child. In other cases, Nomakhayas might find a pregnant, HIV-positive woman on treatment – while her partner is not.

“Culturally, Nomakhayas cannot engage with husbands or partners directly about these issues,” explains OTOA’s Dr Chademana. “We realised we needed to support them as caregivers, and we actually needed another man to speak to them about this.” The mentor brother programme was launched as a way of engaging male partners in the maternal and child health programme. It also aims to address the rise of GBV and tackle harmful norms and cultural practices.

DATA CAN HELP DEMONSTRATE IMPACT

MENTOR BROTHERS SUPPORT MEN AND TACKLE HARMFUL NORMS

Initially OTOA Nomakhayas supported the infant and mom during home visits, but a gap was identified in support for male partners. For example, a mom might agree to exclusively breastfeed, but when the Nomakhaya returned, she would find a two-month-old baby drinking formula.

The District Health Information System (DHIS) collects data at the clinic level, but the work done by CHWs is often not captured in the system. Thus, all the work, effort, time and impact of CHWs goes unseen by the health system. In Gauteng, however, GGCs have been able to share information from the Grow Great database, and it is recognised by the health department.

All three NGOs in this brief are using a digital app that helps CHWs track clients and also provides real-time data. The app is designed to work offline when CHWs are out of range, and sync back to the main server when connected. The hope is that the data collected via this app will be integrated into the health system so that CHW impact can be seen. This can help make the case for why CHWs should be better funded by the NDoH. 4

CHIME: MUSIC FOR MOMS’ MENTAL HEALTH

OTOA uses an app to screen for depression and other mental health concerns, revealing a rise in such issues. In partnership with the Perinatal Mental Health Project at the University of Cape Town, they introduced CHIME (Community Health Improvement through Musical Engagement), a musical intervention that empowers Nomakhayas to support their clients through song. Research shows this approach is therapeutic and can help reduce certain mental health challenges. Nomakhayas have produced albums of songs, each carrying a health message on topics such as depression, diabetes, high blood pressure and accepting an HIV diagnosis.

early antenatal care, keeping immunisations up to date, and the importance of Vitamin A and deworming. As Amanda Edwards, Grow Great’s M&E specialist, stresses, these interventions are all evidence-based approaches to tackling stunting, but there’s no single solution. “All of these things are linked. One cannot say: ‘We’ll make sure all our moms are exclusively breastfeeding and, bam, we’ve cured stunting.’ It’s about providing a comprehensive intervention to the women who need it most, at the most critical phase, to address as many of the underlying causes as possible,” she explains.

Public understanding of what stunting is, why it's an important issue, and what can be done about it has improved, but it is still not widely recognised as a crucial factor in child well-being. More education is needed. CHWs can help by highlighting the wide-ranging impacts of stunting. Its effects are long-term: children who are stunted are more likely to face chronic illness, become overweight, struggle to find work, and add to the burden on the health system.

AGENTS OF CHANGE

Many CHWs have little education – some passed matric, others did not – and their employment opportunities are limited. By being part of the supported programmes examined above, they are empowered in two significant ways. Firstly, they are given an income; many feel this “gives them a voice” in their own household. Secondly, their personal status in the community is elevated when they become a Nomakhaya. Many are active in community structures, such as child health or water and sanitation committees, because they’re recognised as credible voices. At community events, people expect to see a Nomakhaya present, as they’re regarded as local leaders.

By attending local meetings, mentor mothers deepen their understanding of the local context and become aware of the priorities of the communities they serve. At the same time, they are trying to advocate for better health outcomes and empower the communities from within. “In those committees, in those meetings, we are trying to infuse the sense of agency for people’s health as well,” explains OTOA’s Dr Chademana.

5 6

NO SILVER BULLET FOR STUNTING

CHWs promote exclusive breastfeeding for the first six months and encourage dietary diversity thereafter to ensure children are well nourished. They also share information on

CONNECT MOMS TO THE CHILD SUPPORT GRANT (CSG)

A criticism sometimes levelled at Grow Great is that the campaign addresses malnutrition, but doesn't hand out food. Grow Great believes that simply handing out food parcels is not going to solve the malnutrition crisis. But a CHW can connect women with local resources that will give them access to food. Grow Great’s Edwards explains: “A really great success for us is connecting our most vulnerable women to the CSG. This involves getting them to the Department of Social Development (DSD), helping them fill out the paperwork and getting birth registration documents so that they're able to access the social support they need to buy necessary resources, such as food for the house.”

DGMT is advocating for the proposed Maternal Support Grant (MSG) as another way for moms to access affordable nutritious food.14

RECOGNITION IS IMPORTANT

CHWs often feel disconnected from the primary health system, but are still expected to make referrals to clinics. When the health system is unresponsive, CHWs can feel vulnerable and lose motivation to continue making referrals. For example, a nurse might say: “Who are you to tell me this child has symptoms of TB? You are not a clinician.” According to Grow Great’s Stofberg, this kind of response can undermine a CHW’s confidence in her ability to make a difference.

Equipping CHWs to do their jobs properly is a motivating factor. However, providing them with recognition within a formalised programme also helps them feel like valued members of a community that contributes to important work. It is equally important to recognise the impact that team leaders and operational managers have on the success of a group of CHWs; they can influence different layers of the health system and help them see the impact of their work. That’s why Grow Great celebrates CHW Day annually.

MENTOR MOTHERS ARE THE EYES AND EARS OF THE COMMUNITY

When entering a new community, mentor mothers are essential for understanding the lay of the land. For example, Philani has recently begun supporting Mfuleni, opposite Khayelitsha on the N2 highway, where the programme began. It’s a completely different environment. Philani has been deliberate in training new CHWs to ask: “Does this apply in your community?” Mentor mothers are the eyes and ears of the community, and Philani relies on their feedback. “Philani is there to serve the community. It's not about what we think is right. It's about what they need,” says Dr Froneman.

WHAT'S NEXT?

Government adoption and recognition are essential for CHWs to do their jobs well. To be effective, their training and resourcing must be integrated into the health system – but this won’t happen without departmental buy-in. Sensitising the health system to CHWs’ capabilities, the roles they can play, and the funding required to support them is critical.

The Western Cape government has acknowledged that CHWs are an important resource and is helping to fund Philani mentor mothers. Grow Great has been making headway in Gauteng; instead of the organisation delivering interventions and training, it helps the province roll out the model with Grow Great as its technical support partner. In the Eastern Cape, OTOA occasionally partners with government. However, neither NGO is in a position to scale its programme to the rest of the country. This risks creating fragmented systems that run in parallel. One solution is to build on the existing CHW network, offering a more comprehensive healthcare package in which baseline training in maternal and child health and nutrition is compulsory.

One powerful force missing in the CHW space is a collaborative coalition of NGOs doing similar work. Competition for funding, geographic reach or partnerships with the health department may stand in the way. There’s an opportunity to create a formal structure that brings these organisations together, allowing them to share experience, amplify influence and strengthen support for CHWs. “I think our voices will be more strongly heard by the department if we're calling for the same thing, to improve government’s approach to CHWs,” concludes Grow Great’s Stofberg.

This is the learning experience of:

Learning Brief written by Daniella Horwitz and edited by Rahima Essop, with contributions from Grow Great, Philani, One to One Africa and DGMT.

BUILDING BUZZING BRAINS

This is why early childhood development is vitally important for building thriving minds. Yet data shows that only about two-thirds (68%) of 3–5-year-olds in South Africa attend a group learning programme of some kind – which means about one in three children may be missing out on the cognitive stimulation they need during these early years. Data shows that about 40% of South Africa’s early learning programmes (ELPs) are in rural areas, often run by women who make do with few resources and little support. Moreover, the majority of ELP providers in the country have to charge parents and caregivers monthly fees to run their centres; of the roughly R14 billion families spent on ELP fees in 2020, more than a quarter – R3.7 billion – was paid by the poorest 60% of households.

DGMT believes a digital work management tool called the ECD Connect app can help ELP providers to thrive, so they can give children the best possible start. Just as neural connections – built through constant ‘serve-and-return’ interactions –amplify the brain’s power, the potential of ECD practitioners could be unlocked through a dynamic network that connects them to one another and to rich learning resources.

MAKING CONNECTIONS THAT SHAPE BRIGHT MINDS

A newborn baby’s brain has about 100 billion nerve cells – the result of having grown, on average, by around 250 000 cells per minute during the course of a pregnancy.1 This staggering number becomes even more mind-boggling when the connections between cells are considered: scientists estimate that there are a thousand times more neural connections in the brain at birth than neurons themselves.2 When you consider the information-processing power of these trillions of neural connections, it’s hard not to marvel at each child’s potential to develop a bright and capable mind.

Sensory pathways – specifically for vision and hearing –develop rapidly in the first year of life, peaking at around six months of age.3 At the same time, the circuits underlying language skills also develop, but only reach their highest rate of development between seven and 10 months of age, shortly after the peak of sensory connections development. Between years one and five, the pace at which connections form to support functions like decision-making, problem solving, memory and planning – essential for learning and thinking tasks – is at its highest.

Yet it’s not only the bewildering proliferation of nerve cells and neural connections in the young brain that determines a child’s cognitive ability, but also the way these circuits are shaped and refined. A process of pruning – strengthening some neural branches and letting unnecessary or inefficient ones wither, much like shaping a shrub – is a natural part of building smart minds.

Serve-and-return relationships are a big part of this developmental process.4 Young children naturally seek interaction through babbling and making facial expressions and gestures, and when caregivers or other adults respond to those actions – in other words, “returning” what the child “served” – it creates stimulating feedback that strengthens brain architecture and elicits further interaction.

This is why ECD is so important for building thriving minds. Yet data shows that only about two-thirds (68%) of 3–5-yearolds in South Africa attended a group learning programme of some kind in 2022.5 This total was made up of 45% of children attending ECD centres, crèches or playgroups and 23% enrolled in primary school (typically Grade R).

The numbers suggest that one out of every three children may miss out on optimal opportunities for cognitive development that could otherwise set them up for a bright future. Moreover, the 2021 ECD census6 showed that three-quarters of ELPs in South Africa were in low-income settings. They typically have to make do with few resources, and only about one in three were registered with the social development department and thus able to get state subsidies.7

1 Ackerman, S. The development and shaping of the brain. In: Ackerman, S., Discovering the Brain. Washington, DC: National Academies Press; 1992. Available at: https://www.ncbi.nlm.nih.gov/books/NBK234146/

2 Ibid.

3 Center on the Developing Child. In brief: The science of early childhood development. Cambridge, MA: Harvard University; 2007. Available at: https://developingchild.harvard.edu/resources/inbriefs/inbrief-science-of-ecd/

4 National Scientific Council on the Developing Child. Young children develop in an environment of relationships. Working Paper No. 1. 2004. Available at: http://www.developingchild.net

5 Hall, K., et al. South African Early Childhood Review 2024. Cape Town: Children’s Institute, University of Cape Town and Ilifa Labantwana; 2024. Available at: https://ilifalabantwana.co.za/wp-content/uploads/2024/07/SA-early-childhoodreview-2024-FINAL.pdf

6 Department of Basic Education. ECD Census 2021: Report. Pretoria: Department of Basic Education; 2022. Available at: https://datadrive2030.co.za/wp-content/uploads/2022/09/ecdc-2021-report.pdf

7 At the time of the 2021 survey, support for ECD was a function of the Department of Social Development. The Department of Basic Education took over the portfolio in 2022.

NUMBERS TO KNOW

A newborn baby has about 100 billion brain cells.

During the course of a mom’s pregnancy, her child’s brain grows, on average, by 250 000 nerve cells per minute.9

A two-year-old’s brain has 50% more neural connections than an adult brain.10

By age five, a child’s brain has reached 90% of its adult size.11

USING TECH TO HELP CLOSE THE GAP

This is where ECD Connect,12 a project partly funded by DGMT,13 fits in. The ECD Connect team developed a suite of online tools to help improve access to quality early learning, by making it easy for ECD practitioners and principals to:

keep track of their lesson plans, and children’s attendance and development record their crèche’s income and expenses access training and resources connect with other ECD practitioners.

By helping practitioners keep records and making admin easy, ECD Connect can facilitate data-driven decisions about and for their classes and businesses. For example, a user can track attendance at their centre, build a record of how children progress, log income and expenses, and store receipts or payment notifications for their records. It’s a stepwise way to move towards professionalising small, independent crèches in low-income settings. In turn, it can encourage more parents to enrol their children in ELPs, and so help more children build a solid foundation that will prepare them for formal schooling.

“Keeping track of things at a crèche can be a game changer in the early learning landscape, because it can help practitioners to make better decisions later,” explains Peter Schütte, the project’s team lead. “But for most of the centres in our target market, it’s really difficult.”

- Peter Schütte, project lead of ECD Connect

8 Ackerman, S. The development and shaping of the brain. In: Ackerman, S., Discovering the Brain. Washington, DC: National Academies Press; 1992. Available at: https://www.ncbi.nlm.nih.gov/books/NBK234146/

9 Ibid.

10 Society for Neuroscience. n.d. Brain facts: A primer on the brain and nervous system. Washington, DC: Society for Neuroscience. Available at: https://www.brainfacts.org/the-brain-facts-book

11 Ibid.

12 ECD Connect. Available at: https://ecdconnect.org.za/

13 DGMT. ECD Connect. Available at: https://dgmt.co.za/project/ecd-connect/

It’s a small step that can help to bring about big change. “I think of it as a ladder,” says Peter Schütte, the project’s team lead. “To get to the top, you have to start on the first rung. ECD Connect is there to help practitioners take that first step.”

To create a digital tool that would be truly useful, the team settled on building an app that would be able to work both on- and offline, require little data, be easy to navigate and be able to work in a browser, independent of the type of device being used.

All an independent ECD practitioner needs to get going is the link to the app and a device that can connect to the internet, whether it’s a smartphone, tablet, laptop or even a desktop computer. “The app was designed with the least-resourced ECD practitioners in mind, which is uncommon given the incentives at play in a typical market economy. It’s not just another app you download from the app store,” explains Schütte.

He adds: “The choice of this design was intentional: to do a few simple things well.”

ECD CONNECT IS A SUITE OF APPS SUPPORTED BY A

SINGLE CODE BASE

ECD practitioners and principals are primarily using the free, open-access version of the ECD Connect app, which went live in April 2025.14 It has a standardised set of functions, distilled into modules for classroom management, business management, provider connection, and access to training materials.

But this wasn’t the first version of the app to be developed; in fact, it was the culmination of related developments that all use the same core code base.

Two of these are custom-made versions for other DGMTsupported projects working in the ECD space,15 namely Funda App16 for SmartStart and CHW Connect17 for Grow Great.

In addition, a white-label platform, called ECD Connect Partner, was developed for other research and training organisations, which they could rebrand with their own logos and colouring. This is currently used by Khululeka,18 Ntataise19 and True North,20 all non-profit organisations working in marginalised communities, to advance access to quality ECD.

Teaming up with SmartStart and Grow Great at an earlier stage allowed the team to leverage complementary relationships within the DGMT network to gather valuable user data and insight – and provided an opportune training ground. For example, when SmartStart sought a streamlined, time-efficient way for its large network of early learning providers to manage classroom and business admin, the Funda App offered an opportunity to trial the concept with an established user base.

14 To download the app, go to: app.ecdconnect.co.za

The tool was designed specifically for ECD practitioners in low-income settings. Based on what typical users in this demographic told field workers during extensive predesign interviews, the team realised that the key pain points that would have to be solved included:

practitioners experiencing a high administrative load, often because of double reporting

practitioners feeling isolated from peers and undervalued in their communities

a lack of feedback and support

difficulty in accessing teaching resources in languages other than English

complicated requirements for getting access to funding (where applicable).

15 For more about SmartStart and Grow Great, see: https://smartstart.org.za/ and https://www.growgreat.co.za/

16 See: https://learn.smartstart.org.za/courses/funda/

17 Grow Great. 2023. Annual report. Available at: https://www.growgreat.co.za/wpcontent/uploads/2024/05/GROW-GREAT-ANNUAL-REPORT-2023-final-DIGITAL.pdf

18 See: https://khululeka.org.za/

19 See: https://www.ntataise.org/

20 See: https://www.true-north.co.za/

“Ingikhiphe

i stress [it has removed my stress], no more paperwork, ngiyithandela ukuthi it works everywhere [I like that it works everywhere]. I can track my spending, and my income.”

–

SmartStarter from Gauteng

CHW Connect for Grow Great followed. Grow Great focuses on child and maternal health in the first 1 000 days of a child’s life. Similar to SmartStart, Grow Great supports a large network of users – community health workers, in this case –who needed an efficient and simple way to monitor their clients and provide feedback, connect with others in their communities and access learning content. This custom build helped the ECD Connect team to refine their product further.

A SIMPLE START TO THE ECD CONNECT APP

Here are five quick things to know about the app:

It’s a digital tool to help ECD practitioners manage their workload.

It runs in a browser and so can work on any internet-connected device – from a smartphone to a desktop computer.

“Files

go missing all the time –you’ll misplace them. But you can’t misplace them on the app.”

– Grow Great Champion, Nkomazi

It’s simple to use and offers four modules of functionality: one for classroom management, one for business management, one for accessing training materials and one for connecting with other practitioners.

It takes up little storage space and requires little data.

The open-access version is free to any ECD practitioner in South Africa.

THE FIRST FIVE YEARS

Just like the first five years of a child’s life are an important window to set them up for a bright future, so too were the first five years of the development of ECD Connect.

Project conceived and application for initial funding

Field

and

lockdown because of COVID-19 pandemic

Focusing on understanding the target market’s needs upfront, and allowing them to inform the design process, was invaluable, notes Kim Tichmann, ECD Connect’s data and product strategy lead. “We met with 148 potential users during our design phase and held 18 usability testing sessions to refine flows and layouts,” she explains. Each session helped to pinpoint another tweak that would make navigation and use easier, until the final layout was settled and could be locked down for development.

Just as the design was an iterative process, so too were the early trials and pilot phases, with data from each step being used for quality control and to shape the tool’s functionality on the back end. As a result, formally launching the app was a fairly painless process, despite some “inevitable glitches in the beginning”, notes Schütte.

FIVE YEARS AND BEYOND

With the white-label and open-access platforms live, “this year is very much about learning”, says Schütte. “Next year is for scaling.” The aim, says the team, is to get 1 000 people signed up by the end of 2025, and 12 500 by the end of 2026.

It’s an ambitious goal, but one they think can be achieved –especially considering the user base the white-label partners have access to.

A big part of getting more users on board will be expanding training sessions. So far, the team has run roadshows in the North West, the Northern Cape and also in urban settlements such as Langa, Manenberg and Masiphumelele in the Western Cape.

“As a committee member or a board member of an ECD [centre], you’ll be able to trace the progress of a school … and you can actually advance our kids. It’s easy, it’s accessible and it will take you step by step.”

– Robert Gunda, Ezibeleni Creche, Upington

In her role, Tichmann can see how the app is being used in real time – and the data gives her valuable insight into what works and where small tweaks or fixes are needed: “I can see from the patterns in user data when something isn’t working as intended. Of course, it’s disappointing in the moment, but at this stage it’s all about learning. I get excited by what the data reveals: how people are using the tool, where they’re getting stuck, and what that means for how we improve ECD Connect.”

These workshops typically last around two hours, explains Justin Shanks, who’s in charge of stakeholder engagement for ECD Connect. No one session is the same, though: sometimes there are more than 100 people at an event, sometimes fewer than 10.

“We learn as we go,” he says. “Something we realised early on from these workshops is that digital literacy levels vary markedly in each group and this can be a big hurdle if you haven’t planned accordingly. In our first few sessions, we covered far less than we set out to.”

Now the team focuses on three things, in line with the project’s philosophy of doing simple things well. These are: to get attendees signed up on the app; helping them to add the app on their device’s home screen; and walking them through using the app’s basic functions.

But in-person training is expensive and so the project team is also experimenting with using other channels, such as YouTube videos,21 WhatsApp messages and SMS campaigns, to get the word out and drive up numbers.

Part of the team’s exploration of usage patterns this year is to look at ways to use reverse billing to cover users’ data costs. “We can see from the user statistics that not being able to buy data is a barrier to people actually using the app – it doesn’t matter how simple the functionality or lightweight the application is,” says Tichmann. It’s something the team has also learnt from their collaboration with Grow Great and SmartStart, both of which have experienced similar challenges and needed to find ways to fund their users’ data costs.

21 See: https://www.youtube.com/@ECDConnect

TURNING NUMBERS INTO KNOWLEDGE

One of the strengths of ECD Connect is that because the backend architecture of the app allows for data to be collected on usage patterns, it can offer a real-world window into what’s happening in ECD classrooms in South Africa.

“The data gives us an early look into things like how much income people are making [from their centres], what they’re spending money on, how many children are in a class, what activities they’re accessing, and so on. It’s not something you can get anywhere else, and with information like this, it’s something an organisation or a donor or a government can respond to, to drive real change,” says Tichmann.

“Of course, it depends on us actually being able to roll out to a lot of people. It depends on them using it. It depends on us making updates and doing research,” she adds, which is why sustained funding for the next phase of the project is crucial.

THE WHITE-LABEL PLATFORM, AFTER BEING LIVE FOR EIGHT MONTHS22

189 practitioners signed up across three organisations

417 children registered

508 attendance registers saved

19 child progress assessments completed

4 child progress reports for caregivers generated

THE OPEN-ACCESS APP, AFTER BEING LIVE FOR JUST OVER TWO MONTHS23

708 practitioners signed up

232 children registered

124 attendance registers saved

102 themes planned (a theme is a set of lesson plans covering 20 school days)

60 child progress assessments completed

57 child progress reports for caregivers generated

85 practitioners joined the ECD Heroes community on the app

ECD CONNECT: CUMULATIVE USER GROWTH

LESSONS LEARNT

Introducing a tech tool into the market is no easy feat, and definitely a steep learning curve. Here are five take-home lessons:

START SMALL

When it comes to developing an app, design something small that works end to end – even if it’s just one function. “Whatever you have in mind, make it smaller,” advises Tichmann. “We thought we scoped something really basic – what the industry calls a minimum viable product – but actually we had thought up a dream product,” she laughs.

GOING FROM SPEC TO TECH IS HARD

Something that sounds easy to do in words can be hard in code, says Tichmann. That’s because in digital language every instruction is based on calculations and logical relationships. “You have to be very exact in defining the rules for how a

calculation should run – and then test, retest and test again to make sure a function does exactly what you planned it to do.”

DO SIMPLE THINGS REALLY WELL

Digital literacy is not the same for everyone. Having an app that’s informed by user needs and a simple interface that’s easy to navigate can go a long way to getting sign-ups to scale.

BE WELL CONNECTED

Signing up users for an online app can live or die by the strength of your Wi-Fi connection, says Schütte. “Having insufficient connectivity at a training session can really kill a vibe.”

BE PREPARED TO WEAR MANY HATS

At a tech start-up, everyone has to do a little of everything. “Sometimes you wear one hat, sometimes you share a hat with someone else, sometimes we pass the hat around,” says Shanks. “Being all-in is the only way to stay afloat.”

WHAT’S NEXT?

With both the white-label and open-access versions having gone live in the past year, the focus from here on in is to greatly increase usage and so help support all ECD practitioners to give children the early-learning start they need to build buzzing brains.

A big part of increasing the number of active users will be finding a way to reverse bill data costs and to roll out training at scale, which will require some innovative approaches. Building on the large user base established through SmartStart and Grow Great, expanding ECD Connect’s reach will generate robust data on usage patterns and highlight any technical improvements needed.

More importantly, insights into how ECD practitioners run their centres day to day can inform how the government plans, monitors and – crucially – invests in ECD in South Africa. Growing the user base on a platform like ECD Connect can help build a data ecosystem that equips policymakers to make impactful decisions, giving every child the chance to build a bright future.

Just like the pruning and moulding of a child’s neural network, ECD Connect will also adapt and change as it grows. One of its risks is that it becomes too distant from its site of application, from the hands of ECD practitioners themselves. Discussions are already underway to integrate its work more fully into the ongoing development of service delivery platforms that are committed to open networks.

This is the learning experience of:

This brief was written by Linda Pretorius and edited by Rahima Essop, with contributions from the ECD Connect team.

DGMT’S APPROACH

TO SCALING AND LESSONS ALONG THE WAY

Over the past 15 years, DGMT has evolved from a philanthropic grant-maker to a “public innovator through strategic investment”, reconfiguring its structure, funding approaches, and partnerships to pursue change at scale. This has meant moving beyond isolated projects towards systemic interventions: from shaping national early childhood development (ECD) platforms to securing policy wins like zero-rating the digital content of public benefit organisations (PBOs) and influencing government strategies for children and teenagers.

This learning brief examines DGMT’s journey of mainstreaming scaling within its organisational strategy. It outlines the mindsets, mechanisms and partnerships that have enabled scale, and unpacks three practical examples that illustrate different pathways: a focused policy device, an ecosystems approach, and a political approach to national mobilisation for children and teens. The aim is to share lessons that other civil society actors and funders can adapt when moving from promising pilots to population-level impact.

Cultivate and connect imaginative leaders

THE EVOLUTION OF DGMT

FROM CHARITY TO NATIONAL MISSION

DGMT’s endowment comes from the “old white money” of construction engineer Douglas Murray and his wife Eleanor. Although their company’s leadership reflected the era’s demographics, the couple insisted profits benefit all South Africans. Their personal trusts (established in 1944 and 1950) merged in 1979 to form the DG Murray Trust, which initially supported projects in “welfare” and “education”, with a small grants team assessing applications that arrived by post on a case-by-case basis.

The first real challenge to this project-based way of working happened in 2008, when DGMT, the ELMA Foundation and UBS Optimus agreed to create a pooled fund under DGMT’s management to test new models of service delivery for early childhood development (ECD). Once the impact of these models was demonstrated, the funders then agreed to incubate a systems-change initiative within DGMT, called Ilifa Labantwana – the "legacy of our children" – to work towards universal access to early learning in South Africa.

This experiment was the prototype for a new approach, no longer working in isolation but in partnership with other funders who were willing to pool their funding, within a jointly governed initiative operating under the day-to-day management of DGMT until a new legal entity was established or that joint venture had run its course. In this way, institutional arrangements that began to leverage sufficient funding for scale were put in place.

The establishment of Ilifa Labantwana coincided with a change in composition of the DGMT Board, with the inclusion of more women and black leaders who had been antiapartheid activists. Their experience of inequality and public systems shaped the trust’s shift from short-term projects to long-term national development outcomes. Together, they acknowledged that achieving development outcomes at a national level would require fundamental changes in key components of the system – how relevant sectors of government worked and what they funded, how civil society and business worked together and even what the general public thought and did. Inevitably, this required a quantum leap in DGMT’s thinking about the scale of its intervention. It had to think big.

NATIONAL DEVELOPMENT OUTCOMES

The mainstreaming of scale in the organisation was, therefore, more a consequence of DGMT’s ambitious objectives than a separate statement of intent.

By 2016, the chosen national development outcomes had been honed as “10 opportunities for South Africa to fly”. This wording was later revised to make the goal more practical, becoming “10 opportunities to escape the inequality trap” in 2023.

Strategies and targets are tuned every five years, with each opportunity treated as a long-term objective and supported by high-level strategies and specific outcomes, but these objectives anchor DGMT’s funding decisions and define the organisation’s current scope of funding while leaving space for new ideas and for “new and unusual” proposals when they surface.

For each opportunity, DGMT starts by assessing the related national status of children or young people to identify critical points of intervention that can act as levers for change. Its edge-thinking seeks out new options, by identifying programme gaps, missed opportunities for synergy and collaboration, and interesting but untested ideas. Typically, this involves primary or secondary research and engagement with many of the relevant national, sub-national and local stakeholders. This analysis serves as the basis for designing strategy that is both within DGMT’s remit and capability.

1 Cultivate and connect imaginative leaders 2 Release the systemic chokes that trap us in inequality

3 Build productive synergies between communities and the environment 4 Give every child the benefit of early childhood development 5 Stop nutritional stunting among young children 6 Make sure every child is ready to read and do maths by the time they go to school 8 Accelerate learning for children failed by the system

7 Build simple, loving connections for every child

9 Create new connections to opportunity for young people

10 Support young people to keep their grip on opportunity

FROM GRANT-MAKER TO STRATEGIC INVESTOR

Rather than acting as a conventional grant-maker, DGMT sees itself as a public innovator, with one foot in community programmes and the other in testing pathways through national and provincial policy spaces.

With an endowment of about R4.4 billion – modest by global standards but among the three largest private foundations in South Africa – DGMT disburses around R200 million each year. Private foundations contribute just 15% of non-profit revenue nationally. The corporate sector provides more, largely driven by black economic empowerment requirements, and some

corporate foundations are twice the size of DGMT. Individual giving, from both high-net-worth donors and thousands of smaller contributors, is the second-largest source of income for civil society organisations.1

What sets DGMT apart is its blend of grant-making, inhouse incubation and assertive policy advocacy. Financial independence allows us to back evidence-based but sometimes unpopular policy reforms.

DGMT funds about 200 NGOs a year and incubates 10-15 initiatives internally. Some stay in a research and development portfolio; others gain managers and revenue streams and spin off. Five have become standalone entities in eight years.

The shift to “strategic investor” necessitated a change in the way grants were managed. DGMT has always been sensitive to the power dynamics between funder and grant recipients and sees itself as an investor-partner in projects led by

implementing partners. However, DGMT had kept itself at arm’s length from governance and management. As DGMT moved towards larger, long-term projects with multiple funders and sometimes multiple implementing partners, the trust started to play a stronger leadership role in the design and development of new initiatives, their governance and the convening of co-funders. Typically, these joint ventures were initiated after consultation with role-players in the sector to determine which of them were willing and interested to work together towards a goal that was much larger than that of their individual organisations. In some instances, an existing organisation was commissioned to drive the new initiative, but in others, DGMT took responsibility for recruiting a new team and incubating it within its management structure. In these instances, the founder funders served on the first boards, gradually expanding those boards to include other nonexecutive directors.

A MINDSET FOR SCALE: FOUR THINGS THAT INFORM DGMT’S THINKING

THINK DYNAMICS, NOT STATICS

Political science academic John Kingdon’s theory on Policy Windows is a simple and useful way of understanding how change happens. Kingdon argues that change is likeliest when empirical evidence, political interest and public influence reinforce one another. The job of the change-maker is therefore to increase the power of each of these three systemic forces in highly fluid operating environments.

THINK EXPONENTIALLY, NOT LINEARLY

By 2011, DGMT had already identified its interest in initiatives likely to have a “strong multiplier effect”. It positioned itself as a catalyst for change in South Africa, explaining that a catalytic effect can be achieved by demonstrating successful models that can be taken to scale, or by overcoming systemic bottlenecks, or by investing in initiatives with an innate replicator effect.

DGMT developed a keen interest in knowledge-based networks as vehicles for accelerating change and focused on social franchising as a route to both quality improvement and economies of scale.

DGMT also increased its involvement in public advocacy and litigation, understanding the large-scale and enduring impact of legal precedent.

AIM FOR TIPPING POINTS

Network analysis has shown that, for many social conventions, the tipping point for large-scale adoption requires a committed minority (typically about a quarter to a third of the population), rather than an absolute majority. This insight is a source of encouragement for DGMT, which does not have the resources for its programmes to sustain

engagement with most people but can intensify their efforts within a critical mass of the population. Its rule of thumb for media engagement is to reach about two-thirds of its target population by above-the-line (mass) media, while attempting to achieve sustained engagement with 20-25% of that population, either through social media or face-to-face interaction.

Shaping this engagement is formative research, typically conducted by DGMT’s academic partners, which plays a critical part in trying to understand what drives specific behaviours. Identifying and focusing on the sector of the population that is amenable to change may precipitate a positive tipping point in social norms, ultimately effecting large-scale change well beyond the intervention group.

DON’T RUN FROM RISK, FACTOR IT IN

EXAMPLES OF SCALING IN PRACTICE

The following three examples illustrate different strategies DGMT has used in pursuit of the 10 opportunities to escape the inequality trap:

Focused policy device: Zero-rating mobile data

An ecosystems approach: Achieving universal ECD

National agenda-setting strategy: Mobilising for children and teens

1FOCUSED POLICY DEVICE: ZERO-RATING MOBILE DATA

DGMT has identified three key determinants of expected impact, namely: the potential benefit of its investment portfolio under ideal conditions; the degree of control it could exercise over each outcome with that portfolio; and the time horizon in which change could likely be brought about. It categorised different levels of intervention as projects, programmes, systems, policy, societal culture and blue-skies exploration – recognising that the further along the spectrum from projects to exploration, the greater the potential benefit, but the less control DGMT could exercise over that outcome and the longer it would take to achieve it.

Thinking probabilistically also helps to move away from the magical thinking that can underpin grant-making, where funders overestimate their ability to influence systems, policies or even cultures. Based on this calculation of expected benefit, DGMT has defined its "sweet spot" as support for the design of large-scale programmes and systems change in South Africa, with moderate potential to effect policy and normative change over 10 years. 4

DGMT’s Opportunity 2 is to “release the systemic chokes that trap us in inequality.” A major choke is the digital divide. Although internet access has climbed to 78%, only 14% of South Africans have fixed lines and 1 GB of data costs 2.17% of the average monthly income – above the UN affordability threshold.2 High unemployment (32%) makes data even less attainable.3

DGMT made numerous policy submissions to the Information and Communications Technology (ICT) Policy development process to embed the zero-rating option in foundational policy documents. Zero-rating means that the network operator provides the data to the content provider for free, allowing any user to access this content at no cost. In 2018, the idea attracted the interest of the Competition Commission’s Data Services Market Inquiry established to review data costs. At the inquiry, DGMT argued for zero-rating as a partial solution within a broader set of cost-reduction strategies. The recommendation was included in the commission’s final report but was not implemented amid the horse-trading over its other recommendations. By February 2020, the proposal was dead in the water.

A month later came the complete lockdown of Covid-19 and suddenly the value of digital communication became apparent to all. The Department of Communications and Digital Technologies issued a directive requiring network operators to zero-rate the local educational and Covid-related health content of websites. In the meantime, DGMT had been working with over 60 public benefit organisations (PBOs), funding many of them, to strengthen their digital offerings and prime their technology for zero-rating.

2 Alliance for Affordable Internet Access. 2021. South African data. Available at: https:// adi.a4ai.org/affordability-report/data/?_year=2021&indicator=INDEX&country=ZAF 3 Statistics South Africa. 2024. Quarterly labour market survey Q3:2024. Available at: https://www.statssa.gov.za/publications/P0211/Presentation%20QLFS%20Q3%20 2024.pdf

On 5 May 2020, 39 of the PBOs were included on the official list of websites approved for implementation. When wealthier schools got bumped up the waiting list ahead of PBOs, DGMT contracted a legal firm to serve papers on the most recalcitrant network operator, with government as second respondent. They backed down within a week and all the other network operators followed suit, registering the PBO domains for zero-rating. User traffic to the digital content of most PBOs increased by between 25% and 50% in the next month and continued to grow over the next few months.

The case had been made, but the question remained how to sustain it once the disaster regulations were lifted. Fortunately, this experience coincided with the auction of additional spectrum by the national communications regulator, which all five network operators required to meet their 5G roll out plans. In a meeting with the national regulator, DGMT successfully argued that zero-rating of PBOs (and of government services) should be included as a condition of licence.

In April 2022, the five network operators all successfully bid for the spectrum licence obliging them to zero-rate the digital content of PBOs. When the communications regulator was slow to implement the policy instrument, DGMT mobilised over 200 PBOs in a petition published as a full-page spread in a national newspaper. The process of registration of PBOs for zero-rating is now underway, facilitated by a registration and vetting app commissioned by DGMT.

DGMT played a pivotal role in identifying both the problem and the solution. It built the capacity of PBOs to implement that solution, actively advocated for it, and participated in national policy review processes to enable it. DGMT also mounted a legal challenge when necessary, seized the openness to change created by the Covid-19 crisis, and linked the solution to something network operators all wanted: access to more radio spectrum. Once the policy was promulgated, DGMT’s active mobilisation of PBOs helped keep the pressure on the regulator to ensure its implementation, while its development of a registration and vetting app facilitated it.

In this case, the scaling strategy was to identify a single policy device that could be implemented and sustained without the need for additional public funding. The use of this instrument, namely licensing requirements which priced in the obligation of zero-rating, had achieved the national scale to begin to bridge the digital divide.

TIMELINE OF DEVELOPMENTS:

2013-18: DGMT inserted zero-rating proposals into ICT policy drafts and testified at the Competition Commission’s Data Services Market Inquiry.

March 2020: Regulators ordered to zero-rate educational and health sites.

2021-22: DGMT pressed the regulator to link zero-rating to the 5G spectrum auction. All five operators won licences with zero-rating attached. This condition was formalised in the licensing framework.

2023-24: A DGMT-commissioned app helped PBOs register to be zero-rated.

AN ECOSYSTEMS APPROACH: ACHIEVING UNIVERSAL ECD

DGMT’s largest national contribution to scaling has been towards the objective to give every child the benefit of early childhood development.

The World Health Organisation’s Nurturing Care Framework identifies five inter-related domains for young children’s healthy growth and development. They include responsive caregiving, good health, adequate nutrition, safety and security, and opportunities for early learning.

Yet, in South Africa, more than two thirds of children under the age of 6 live in households that cannot provide for their basic needs.4 Stunting affects over 1.5 million children or more than a quarter of children under five, and about twothirds of 3-5-year-olds attend an early learning programme. 2

4 Hall, K., Almeleh, C., Giese, S., Mphaphuli, E., Slemming, W., Mathys, R., Droomer, L., Proudlock, P., Kotzé, J. and Sadan, M. 2024. South African Early Childhood Review 2024. Cape Town: Children’s Institute, University of Cape Town and Ilifa Labantwana.

The poorest children have the lowest attendance rates and experience poor quality programmes.

For a decade, Ilifa Labantwana operated as an incubated project within DGMT before spinning off as an independent legal entity. Its role was to help drive systems change in ECD by working with government. Key focus areas include facilitating policy change and regulation, unlocking government financing, building information and data systems, strengthening delivery platforms and public communications about ECD.

DGMT’s role has been as mission keeper, working with government, co-funders and implementing partners to design the emerging ecosystem and construct its building blocks. It should be acknowledged that the development of this ecosystem did not follow a preconceived grand design. Rather it emerged as the natural consequence of the findings and experiences of the systems innovators, Ilifa Labantwana and Innovation Edge, as well as the insights of the dozens of community-based organisations funded directly by DGMT and others. This ability to embrace emergence and keep adapting was a critical success factor for scaling.

Since 2008, the ecosystem has evolved to include the following organisations:

Ilifa Labantwana

Works with government on policy, financing, and quality assurance.

Innovation Edge

Supported the emergence and development of new ideas for early learning practice. Incubated within DGMT for six years.

SmartStart

Social franchise platform for ECD practitioners. Offers standardised training, assessment, licensing and coaching support.

Grow Great

National anti-stunting campaign with a community healthworker arm and Flourish antenatal franchise. The campaign combines public communication with interpersonal support to shift nutrition behaviour.

A bespoke entity (Ilifa Labantwana) working with government and dedicated to policy and systems development towards the goal of universal access to early learning.

A bottom-up process of experimentation, research and development through Innovation Edge.

New service delivery platforms that are designed for scale, to address nutrition, early learning and literacy development.

Mechanisms for evaluation of the impact of programmes.

Partnerships with the private sector (albeit still limited) that are able to harness their commercial platforms for public communication and distribution of learning and training resource materials.

A constituency of ECD practitioners who are able to advocate on their own behalf.

NATIONAL AGENDASETTING STRATEGY: MOBILISING FOR CHILDREN

AND TEENS

Despite gains since 1994, many South African children remain at risk: a quarter face violence;5 6 60% live in the poorest 40% of households;7 25% are stunted;8 and half of school-leavers may never work.9 Covid-19 reversed food security gains10 and stalled health progress.

THE KEY FEATURES OF THE ECOSYSTEM INCLUDE:

A long-existing network of individual ECD programmes and resource and training organisations that is slowly being organised to create better interfaces with government systems of quality improvement and funding.

5 UBS Optimus Foundation. 2016. Optimus study South Africa: Technical report. Sexual victimisation of children in South Africa. Final report of the Optimus Foundation Study: South Africa. Available at: https://www.saferspaces.org.za/uploads/files/08_cjcp_ report_2016_d.pdf (accessed December 2023).

6 Delany, A. and Hall, K. 2017. Analysis of South African Police Service crime data, 2013/14–2016/17. Available at: http://www.childrencount.uct.ac.za/indicator. php?domain=11&indicator=84#5/-28.672/24.698

7 Department of Social Development. 2023. Reducing child poverty: A review of child poverty and the value of the Child Support Grant. Cape Town: Children’s Institute, University of Cape Town. Available at: https://www.researchgate.net/ publication/374618161_Reducing_Child_Poverty_A_review_of_child_poverty_ and_the_value_of_the_Child_Support_Grant

8 Statistics South Africa. 2017. South Africa demographic and health survey 2016: Key indicator report. Report No. 03-00-09. Pretoria: Statistics South Africa. Available at: https://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00092016.pdf

9 Statistics South Africa. 2024. Quarterly labour force survey (QLFS), Q1:2024. Available at: https://www.statssa.gov.za/publications/P0211/Presentation%20 QLFS%20Q1%202024.pdf

10 Hall, K., Proudlock, P. and Budlender, D. 2023. Reducing child poverty: A review of child poverty and the value of the Child Support Grant. Pretoria: Children’s Institute, University of Cape Town for the Department of Social Development. Available at: https://www.researchgate.net/publication/374618161_Reducing_Child_Poverty_A_ review_of_child_poverty_and_the_value_of_the_Child_Support_Grant

In 2023, a DGMT representative seconded to the presidency supported the development of a National Strategy to Accelerate Action for Children (NSAAC). The secondment was agreed with the Office of the President to lead the development of the strategy. The Technical Task Team, led by the Chief Operating Officer in the Presidency, synthesised inputs from every government department and the wider children’s sector, with consultations including learner representative councils; a national summit of stakeholders then recommended the strategy to Cabinet. As of September 2025, the NSAAC is pending Cabinet approval.

What is new and potentially innovative is an agreement between the Presidency and DGMT to formalise their collaboration through the creation of an ‘Accelerator’ to identify and focus on priorities and strategies which are neglected or fall between the cracks of government departments. These include issues of food security, language development and cognitive stimulation of very young children, screening for hearing and visual disabilities, agency and identity of teenagers, and alcohol harm reduction.

Unlocking value through greater synergy across government and non-government sectors in South Africa could boost the national response for child and adolescent well-being. DGMT has appointed a team to drive the work of the Accelerator, working with relevant government departments, civil society and the private sector. Its key functions include public communications, information synthesis, programme design and development, networking and resource mobilisation. The Hold My Hand Accelerator commenced its work in 2024, focused first on mobilising the public and leaders across society in support of children. The work is still largely in a formative phase but provides the framework for national public-private collaboration which will hopefully become more substantive and formalised over time.

THE FUTURE OF SCALING AT DGMT: WORKING WITH INFLUENCE, NOT MORE MONEY

As a relatively small endowed funder, DGMT has nearly reached the upper limit of what it can commit to new large co-funded initiatives. Adding more would either divert resources from the broad civil society network it supports or require exiting some of the very scaling platforms it helped establish. In practical terms, the capacity to spark ideas, gather multiple funders into joint ventures, and de-risk new

initiatives through incubation within DGMT will be more constrained.

Consequently, the organisation’s potential as a catalyst for large-scale change will rely even more on its position of influence in policy discussions and systems-change processes. That position is partly tenuous as relationships with individuals in executive and legislative branches are never guaranteed, but it is also grounded in DGMT’s consistent consultation with dozens of civil society organisations and in its independent, evidence-based public voice across multiple media channels. This legitimacy does not rise and fall with political turnover; rather, it reflects DGMT’s role in channelling perspectives “from the ground” into policy spaces.

Reaching the bounds of co-funding capacity can be read as a missed opportunity to keep launching promising ventures, and to some extent it is. Yet as DGMT has become more embedded in policy and systems change, the relative importance of its own money has declined. The organisation’s value increasingly lies not in how much it can fund, but in its ability to mobilise coalitions around ambitious goals to escape the inequality trap. Constrained funding also invites consolidation: trimming initiatives that did not take off as expected while ensuring those now entering the exponential part of their growth curves do not lose direction or momentum. That involves securing substantial new foundation support to reach a “mezzanine” level of scale, and continued engagement with government to find and increase revenue streams for programmes that have already reached the first floor.

LESSONS FOR OTHER FOUNDATIONS

This learning brief shows that scale is not the preserve of global giants. Well-positioned local foundations can punch well above their financial weight when they work with partners who know the terrain, speak plainly in public, and pool resources under shared governance. Collective funding reduces the load on implementers and concentrates the expertise needed to move from promising pilots to population-level impact.

1 Collectively governed pooled funding is a useful mechanism to concentrate the necessary financial and technical resources to initiate the journey to scale. Competing funder demands can be a considerable distraction for social entrepreneurs who should be applying most of their effort to negotiating the political, systemic and cultural pathways to scale. Pooled funding enables the implementer to focus more on strategy and less on funder management.

2 Clarity on which strategies for scale are being deployed. This will keep all role players focused even as contextual dynamics are negotiated.

3 Systems change needs a driver. Keep a dedicated “driver” in place to hold the ecosystem pieces together. In DGMT’s ECD work that role was played by a bespoke systems facilitator (Ilifa Labantwana).

4 The demand side is as important as the supply side. Spend time understanding what motivates parents, caregivers and practitioners. Understanding and responding to human motivation can incentivise the uptake of new technologies or enhanced participation in programmes. These psychological incentives often determine the success or failure of scaling initiatives, especially when they rely on substantial shifts in social convention.

5 Achieving scale does not always require substantial new resources from government. Look for a single, enforceable policy lever that can carry public benefit at minimal fiscal cost. In this case, making zero-rating a condition of spectrum licences created a self-funded pathway to national reach. The practical steps were simple but sequenced: embed the obligation in the licensing framework; prepare public benefit organisations so they are “implementation-ready” when the window opens; follow through with targeted legal action only if compliance stalls; and keep visible, collective pressure on the regulator while providing a straightforward way for organisations to register.

WHAT’S NEXT?

Over the coming decades, global philanthropy will continue to shift, sometimes along ideological lines, sometimes through consolidation. For DGMT, the constant is our view of scale: it is a means, not an end, a way to grow public benefit and, in particular, to reduce social and economic inequality within environmental limits.

In a period of disruption that risks eroding the gains of recent years, momentum will come from working together. Stronger coalitions between foundations in the North and South can keep attention on what matters, translate evidence into action, and carry progress from one planning cycle to the next. That is how we will keep scaling in service of people, not power, and help more children and young people realise their potential.

This is the learning experience of:

This brief is an adaptation of a longer brief written by David Harrison and Larry Cooley for the Scaling Community of Practice. The brief was edited by

THE LEGACY OF DOUGLAS AND ELEANOR MURRAY

DGMT is a South African foundation built on endowments from Douglas and Eleanor Murray to promote charitable, educational, philanthropic and artistic purposes within South Africa. Douglas Murray was the son of, and successor to, John Murray, the founder of the Cape-based construction company, Murray and Stewart, which was established in 1902. This company merged in 1967 with Roberts Construction to become Murray & Roberts, with the parent Trusts as the main shareholders. In 1979, the Trusts combined to form the DG Murray Trust as the main shareholder before the company was publicly listed. Subsequently, the Trust relinquished its ownership to a major finance house. Eleanor Murray remained actively engaged in the work of the Trust until her death in 1993.

The Foundation is now the holder of a portfolio of widely diversified assets, which reduces the risks in funding the achievement of its strategic objectives. DGMT currently distributes about R200 million per year and leverages and manages a similar amount of funding through joint ventures with other investors. DGMT’s ultimate goal is to create an ethical and enabling environment where human needs and aspirations are met; where every person is given the opportunity to fulfil their potential, for both personal benefit and for that of the wider community.

By investing in South Africa’s potential we aim to:

› Create opportunity for personal growth and development that will encourage people to achieve their potential.

› Help reduce the gradients that people face in trying to seize those opportunities.

› Affirm the value and dignity of those who feel most marginalised and devalued by society.

The DGMT Board

TRUSTEES Mvuyo Tom (Chairperson) - Ameen Amod - Shirley Mabusela Murphy Morobe - Hugo Nelson - Diane Radley - Edgar Pieterse

CHIEF EXECUTIVE OFFICER David Harrison