Alexander Health Centre and University Clinic Johannesburg Profile of the clinic

The Alexander Health Centre and University Clinic occupies a unique position not only in the community of Alexander, but in the social history of South Africa itself. Since its humble beginnings as a missionary mother-and-child clinic for the 20,000 strong Alexander community some 70 years ago, the clinic has grown from the original two-roomed corrugated iron building to a model community-based primary health care facility. Today it serves an impoverished community of around 400,000 people which is crammed into an area of just one square mile in extent on the edge of Sandton, the wealthy centre of South Africa's financial life. Few places illustrate as glaringly as these neighbouring suburbs the country's social dichotomy, born out of a long history of segregationist development. It is against this history that the ongoing evolution of Alex Clinic, as it is affectionately known, must be understood.

When the founding charity, the American Board Mission, decided to withdraw from Alexander to focus on other needy areas in 1939, the newly independent clinic was registered as a welfare organisation, and private benefactors permitted the construction 4 years later of new premises on 4-acres of land on the edge of the township. At this time the University of the Witwatersrand forged a symbolic link with the clinic, which became a training facility for medical students under a full-time medical director.

Over the following decades the clinic became a centre not only of health care, but of passive resistance in an increasingly adverse political climate. Increasing pressure from the government to see the residents of Alexander forcibly relocated under apartheid legislation, led from protest and boycott actions of the 1950s to ever worsening social despair and political tension. Major unrest in Alexander accompanied the 1976 Soweto riots, and kept escalating until, in 1986, it peaked with a mini-war in the streets. Alexander Clinic was specifically targeted by government for its unfaltering spirit through these years, first by imposition of a full financial

Figure 11.77 Alexandra Health Centre and University Clinic, South Africa: external view. Architect: Meyer Pienaar. Photograph by Christopher Malan

Figure 11.78 Alexandra Health Centre and University Clinic, South Africa: additional external view. Photograph by Christopher Malan (also in colour section)

Figure 11.79 Alexandra Health Centre and University Clinic, South Africa: another external view. Photograph by Christopher Malan

Figure 11.77 Alexandra Health Centre and University Clinic, South Africa: external view. Architect: Meyer Pienaar. Photograph by Christopher Malan

Figure 11.79 Alexandra Health Centre and University Clinic, South Africa: another external view. Photograph by Christopher Malan stranglehold and, in 1986 a series of firebomb attacks which were later found to have been perpetrated by the police's secret special branch under government orders.

At the height of this turmoil the clinic again emerged as a pioneering establishment, in using the climate of adversity as a driving force to explore community-based alternatives to health care delivery, and implementing its vision to the effect that it is today regularly held up as a model for community-based primary health care in South Africa. Its strong ties with the community were forged not only through the role it played in times of political hardship, but by implementation of a variety of new concepts. Literally each adult resident in Alexander was given voting rights at the AGM, to ensure the board of directors was truly representative of the community. In some respects, the clinic premises became a broader community centre, and the clinic itself launched satellite facilities, outreach programmes, educational drives and homecare initiatives in the township.

This very close integration of the clinic into the community it serves keeps guiding its ongoing forward planning. Following political transformation in South Africa the clinic has had to respond to ever new challenges - political faction fighting in the years of transformation, a wave of violent crime as the new democracy takes hold, ongoing social despair with severe problems of criminal violence, domestic and sexual abuse, regular scares for epidemic diseases, such as cholera, and an AIDS problem is disastrous proportions, with 70% of people volunteering for AIDS tests at the clinic in the year 2000 having test HIV positive. Today the clinic is re-assessing its role within the community in a strategic forward planning exercise, to address this new wave of challenges by exploring options for increased counselling services, pre-ventative health care and focusing on the medical as well as social aspects of the HIV/AIDS pandemic.

At the same time the clinic is engaged in talks with the new government, to work out a mutually acceptable model for public/private sector co-operation. Currently the government, which follows a policy for free primary health care delivery, subsidises the clinic's operational expenses to an amount of 80%. With appeals for private donations increasingly difficult to motivate in a free democratic environment, the challenge lies in trying to secure full operational subsidies from government, without sacrificing the independence which has afforded the clinic its adventurous spirit in the past, and has permitted it to be a pioneer in exploring sustainable, community-based alternatives to health care delivery.

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