A child’s circumstances at birth, where they are born, their family income, and whether their mother can afford nutritious food during pregnancy, should not determine that child’s chance at a healthy future.
Over the past five years, food and nutrition insecurity have risen sharply. Escalating living costs, food prices and limited access to affordable nutritious food have deepened hardship for millions of households. Most concerning is what this means for children.
The most recent Food Forward SA Household Food Insecurity Report paints a worrying picture. Millions of South Africans are experiencing hunger or severe food insecurity, with children disproportionately affected.
In the Western Cape, 17.5% of children under five are stunted, while among children under two this rises to nearly one in five. Stunting, which permanently affects cognitive development, educational outcomes and long-term health, remains one of South Africa’s most urgent but often invisible crises. The lasting impact it has on future opportunities threatens to create a vicious cycle of poverty.
If we believe that every child deserves a fair opportunity to live a healthy life and to reach their full potential, then we cannot ignore the conditions shaping health long before a child enters a classroom or a clinic. Equality in healthcare is not only about access to treatment when someone is sick. It is also about whether mothers and children have the support needed to prevent poor health outcomes in the first place.
Khulisa Care
Against this backdrop, the Western Cape Government and the DG Murray Trust, with the support of Shoprite and Grow Great, made a deliberate decision to work together to test a different model through the Khulisa Care initiative to prevent stunting.
The idea behind the Khulisa Care pilot was: could a “cash + care” model embedded within the existing public health system help support nutritionally vulnerable mothers and babies during one of the most at-risk periods in a child’s life?
Khulisa Care 1.0 was designed as a proof-of-concept pilot to test whether this type of intervention could function in real-world conditions, inside busy clinics and within the realities of South Africa’s public health system.
The programme combines monthly food vouchers with intensive community health worker support for vulnerable pregnant women identified as being at risk of delivering low birth weight babies, as well as mothers whose babies are born with a low birth weight.
The Western Cape Stunting Baseline Survey found that children between six months and two years old who were born with a low birth weight were nearly three times more likely to be stunted. The support continues until the baby reaches six months old, the age at which evidence suggests most mothers are accessing the Child Support Grant.
At its core, Khulisa Care reflects an important policy choice: addressing stunting requires us to intervene earlier, more holistically and more practically in the lives of vulnerable mothers and infants.
Protein-rich foods
The food vouchers, worth R525 per month, are restricted to nutritious protein-rich foods like eggs, milk, beans, lentils, pilchards and peanut butter. But the intervention is not only about food, and, importantly, adds a care component with home visits, breastfeeding support, maternal nutrition counselling, mental health support, encouragement around clinic attendance and practical guidance for new mothers.
Maternal nutrition, mental health, and access to care all shape pregnancy outcomes and infant development. Khulisa Care was therefore designed as a more holistic maternal and child health support model.
We started the pilot in July 2025 and have more than 1,000 mothers enrolled in the programme at the moment, in two urban settings and one rural. As we are now roughly halfway through our pilot, the Western Cape government conducted a structured review of the pilot model.
The review shows that the programme is reaching the intended population. The pilot successfully enrolled nutritionally vulnerable mothers and low birth weight infants across Breede Valley, Khayelitsha and Mitchells Plain. Importantly, many participants were not already receiving nutritional support through existing programmes. This suggests that the programme is helping identify and support vulnerable mothers and infants who may otherwise not have received support through current systems.
That matters because fairness in healthcare requires recognising where vulnerability exists and ensuring that additional support reaches those who need it most.
Meaningful support
The review also highlights the value being created for beneficiaries. Mothers consistently described the vouchers as meaningful support that reduced food insecurity and made it easier to feed themselves and their children. Many spoke about feeling less stressed about food, more able to follow nutritional advice from clinics and more supported during a difficult period in their lives.
One mother interviewed through the programme described how the support helped improve breastfeeding and infant weight gain after the birth of her premature baby. Others spoke about the reassurance of knowing that somebody was checking on them during a vulnerable period in their lives.
Perhaps one of the clearest lessons emerging so far is the importance of community health workers. They became the bridge between clinics and households, providing continuity of care that short clinical consultations alone cannot achieve.
At the same time, Khulisa Care 1.0 is highlighting the realities of implementation.
The review is clear-eyed about the operational pressures experienced during roll-out. Enrolment processes were often time-intensive. Data systems were fragmented. Frontline staff worked across multiple partially connected systems. In some cases, clinicians reported spending significant additional time enrolling a single patient.
The voucher system itself also went through several iterations. Early redemption models created frustration for beneficiaries because vouchers could initially only be redeemed in a single transaction. But importantly, the programme adapted as learning emerged.
By December 2025, a multi-swipe system had been introduced, allowing beneficiaries to redeem vouchers multiple times throughout the month. Redemption rates improved significantly thereafter, with the majority of beneficiaries using more than 80% of the voucher value.
Too often, governments become hesitant to test new approaches because of the fear that if every aspect is not perfect from the outset, the entire idea will be dismissed before meaningful learning can take place. But complex social challenges like food insecurity and stunting require innovation, adaptation and the willingness to learn in real time.
The next phase
Importantly, the learning from Khulisa Care 1.0 has already informed the next phase of the programme. Khulisa Care 2.0 will focus on improving early enrolment during pregnancy, strengthening workflow integration, clarifying staff roles, stabilising data systems and strengthening the visibility of the care component alongside the food benefit.
There is also a deeper understanding now of how to ensure dignity in social support. When vouchers fail at tills or mothers are left uncertain about whether support is available, the emotional cost can be significant. The review correctly identifies dignity and agency as central considerations, not peripheral ones.
The learning emerging suggests that integrated models that combine nutritional support, healthcare and community-based care may help strengthen support for vulnerable mothers and infants, reduce stunting and ultimately, provide our littlest residents with the best early opportunity to thrive and to break cycles of poverty. DM
Mireille Wenger
www.dailymaverick.co.za
