The Impact Of Collaboration, Compassion, And Connection - Lefika La Ka And Pata

In a corner of South Africa’s North West Province one woman is driving powerful change from within her community. With the support of partners like PATA, deep compassion and fierce determination, Mathabeng Rose Mokoto - affectionately known as ‘Ma Rose’ - is ensuring children and adolescents living with HIV can stick to life-saving treatment regimens. This is the story of how collaboration, compassion and connection can change futures for good.  

When eleven-year-old Peter* met Ma Rose for the first time, his world was already shaped by survival. Peter wasn’t in school - his days were spent picking through the local rubbish dump in search of food to keep himself, his baby sister, and their mother alive.

“For me,” says Ma Rose “it was an emergency requiring immediate intervention.”

Ma Rose arrived that day with calm determination, listening ears, and a plan of action in mind. She took the family to the local clinic, insisted each member receive medical attention and purchased emergency food supplies to ensure adherence to treatment. However, her involvement didn’t end there, as she coordinated with multiple role players to change the course of these three lives forever in a matter of days.

Ma Rose’s journey began as a little girl growing up in a community near the town of Lichtenburg in South Africa’s North West Province. Known for its agricultural production, producing maize, wheat and citrus fruits amongst others.

The North West Province has one of the highest unemployment rates in the country, with the expanded unemployment figure at over 51%. Informal settlements have multiplied on the outskirts of town and most families survive hand-to-mouth on social grants or intermittent income from informal work.

Growing up, Ma Rose witnessed the effects of poverty on her community and dreamed of better outcomes. Although she had hoped to study social work, financial challenges redirected her into nursing—a field she came to love. Over the years, she progressed into management and leadership roles, eventually overseeing multi-district work in the private health sector. Still, she felt a persistent tug toward deeper, community-level impact.

Ma Rose registered her non-profit organisation, Lefika La Ka (“Our Strength, Your Refuge” in Setswana) in November 2020 during the height of the COVID-19 pandemic, though Lefika only became active in 2024 when funding for her private-sector role came to an end. This was the sign she needed, it was time for Lefika!

With Ma Rose at the helm, Lefika joined IMPACT4HIV (I4HIV), a multi-partner consortium aimed at preventing deaths by simplifying Advanced HIV Disease (AHD) management.

Through its consortium technical partner, PATA (Paediatric-Adolescent Treatment Africa), Lefika would become the conduit between the clinic and the community in the PATA C3 Model, serving as the catalyst for change. Through regular meetings, ongoing engagement, training and capacity-building, Ma Rose and her team were equipped with the skills and resources to drive change on the ground.

“PATA not only developed our skills-base, but by utilising PATA’s Linking & Learning Hub, we accessed curriculum, toolkits, and guides, as well as a network of over 6000 other healthcare providers, all doing similar work and sharing experiences, lessons learned and promising practices,” says Ma Rose.

The Lefika team conducted performance reviews of the clinics within their catchment area and discovered that nearly 30% of children, aged 0–15, registered as being on treatment, were not suppressing the virus.

Says Ma Rose: “These cases aren’t just numbers – they’re children, so urgent action on our part is a humanitarian imperative.”

Ma Rose found Peter, his mother and baby sister in their tiny, one-room shack which Ma Rose recalls was extremely cold and completely flooded on the day from seasonal rains. Both mother and son were visibly unwell. Neither wore adequate clothing for the cold. Peter had no shoes. After a gentle discussion, Ma Rose promptly took the three to the clinic.

While their arrival was met a level of irritation, Ma Rose’s calm, collaborative leadership changed the tone. After some negotiation, Peter saw a doctor and his viral load was tested. A physical examination (seldom initiated in clinical pathways) revealed another medical issue, requiring a surgical procedure. The mother was treated by the doctor and her viral load tested, while Ma Rose engaged with Peter to gather more information.

As Ma Rose suspected, Peter stopped taking his treatment long ago, as taking it on an empty stomach had made him sick; a reality Ma Rose knew was commonplace in a community crippled by poverty and a family so deep in despair. Clinic visits, a luxury, not a priority for a family on the brink of malnutrition.

Once the mother had been treated and viral load tested, the baby girl was then tested for HIV.

“When I explained that the child is still being breast-fed, and requested an HIV test, the healthcare worker seemed surprised,” explains Ma Rose. “This indicated to me how assumptions can lead to missed opportunities for care. Clinics are overburdened, focused on numbers, not quality of care.”

Remarkably, the baby tested negative for HIV. Ma Rose explained to the mother that breastfeeding needed to stop to prevent transmission, and assured her that she would provide emergency food supplies and help put a plan in place for both nutrition and treatment.

Next, Ma Rose turned to collaboration, first with the Department of Social Development, initiating an exploration into alternative living arrangements for Peter and the baby girl, deemed critical for the survival of all three. Peter’s father was in a position to take him and had desired this outcome for some time. The baby girl would be placed with extended family and the mother would be supported with necessary treatment for depression.  

Lastly, Ma Rose initiated discussions with the Department of Education, ensuring Peter would re-enter the school system in the catchment of his father’s home.

In just one week, Ma Rose and her team changed the course of life for three in critical need of a lifeline. Every day, they do the same for many other children and adolescents who had slipped through the cracks of care.

What’s Missing?

“Clinics are completely overburdened, families are overwhelmed, the situation, dire. What has been missing before now is a powerful conduit to strengthen clinic-community collaboration to ensure children and adolescents living with HIV are followed-up and supported holistically,” says Ma Rose.

PATA’s C3 (Clinic Community Collaboration) Model has been endorsed and integrated into many processes and programmes as a central methodology since inception in 2014.  The C3 methodology invests in building effective and structured clinic and community relationships, provides the necessary capacity-building and tools, works to strength local ownership, joint monitoring and district co-ordination. This builds and strengthens effective pathways for HIV case finding and management, improving service delivery, care and support across clinic and community platforms to improve prevention of mother to child transmission and paediatric service delivery.

“With the right partners, support, and training, extraordinary individuals like Ma Rose - and community-led organisations like Lefika - can be the difference between life and death, despair and hope, for children, adolescents, and their families,” says Abigail Dreyer, PATA’s Head of Learning, Influence, Networking, and Knowledge.

*Not child’s real name.

More Information

IMPAACT4HIV(I4HIV) is a multi-partner consortium led by Aurum Institute and partners, including Market Access Africa (MAA), Drugs for Neglected Diseases (DNDI), Paediatric-Adolescent Treatment Africa (PATA), and Solidarité Thérapeutique et Initiatives pour la Santé (Solthis) and will be implemented in Côte d’Ivoire, Sierra Leone, DRC, Nigeria, Mozambique and South Africa.

The objective of I4HIV is to prevent deaths among adults and children by simplifying Advanced HIV Disease management tools, expand the use of optimised AHD packages of care and provide robust operational evidence on innovative delivery models to manage AHD for people living with HIV, particularly children living with HIV, enabling further simplification and decentralisation of AHD management.

PATA’s role within the consortium is to engage communities through civil society representatives and Community-Led Organisations (CLOs), such as Lefika in Klerksdorp, South Africa, to optimise the delivery design and methods by engaging key stakeholders and raising awareness and generating demand for optimised AHD packages of care.

References

Statistics South Africa. (2025). Quarterly Labour Force Survey – Q1 2025.

Government of South Africa. (2025). Unemployment Rate Remains High in North West Province.

World Bank. (2023). Poverty and Inequality Platform.

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