Module 1

Module 1 Framing Document


This framing document sets out the core ideas shaping Module 1 and is designed to spark critical reflection, analysis, questions, points for debate, and is for use as a reference point for the whole of Module 1.

What is Module 1 about? What does Tekano want to achieve with Module 1? What is planned for it? What will we learn? How will it be done? What is our role as Fellows? Following the two and a half days you spent undergoing Orientation, and as we start with Module 1, you are probably preoccupied with these and many other questions.

This concept document helps Fellows to understand the objectives of Module 1, what the learning journey and approach planned for this module look like, and what the expected roles and responsibilities are in the learning process.

Module 1 is a foundational module where the Tekano leadership development journey for Fellows starts in earnest. What and how we learn in this Module will lay the foundation for the three (3) other planned modules as well as your overall journey as a Fellow who is expected to be a relational, collective, and problem-solving leader as well as being a critical, committed and engaged agent for health equity and social change.

This module comes after two and a half days of orientation where Fellows have learnt about Tekano, what the Fellowship is about, the Yearlong Fellowship, Lifelong Fellowship, the Atlantic Fellowship Community, the Tekano learning theory and approach, Tekano learning tools and other induction information. Through the orientation, all Fellows should now feel at home, ready and set to begin an exciting and challenging learning journey.

The theme for this Module is The Health Equity Landscape and Leadership for Social Change. The three triad of core concepts informing this theme are health equity, relational leadership and social change. Building from the theme and the specific objectives for the module, Fellows will be challenged to deepen their critical thinking and reflection on this triad of core concepts.

The prevailing context matters for health equity. As Fellows start the learning process in this module, it is important to recognise that the immediate issues prevailing in wider society will not be outside the learning room. Therefore, this module is sensitive to this and will find ways to connect the learning process with the current context.

Based on the Module’s theme and objectives and conceptualised as a continuous learning journey and narrative, the Module’s daily programme will cover the following pillars:

  • DAY 1 – The broad context: what is the current moment telling us from a health equity, leadership and social change perspective?
  • DAY 2 – The neoliberalisation of health
  • DAY 3 – Understanding South Africa’s health system
  • DAY 4 – Relational leadership, social change and social agency
  • DAY 5 – Introduction to Social Change Initiatives and possible host organisations

What the module objectives imply for each Fellow’s learning journey

The core logic and pillars underlying the Module’s objectives are the following:

  • The broader context – the need to critically understand the broader context – its core features, dynamics, roots and impacts on health equity; the implications of this broader context for health equity, relational leadership and social change; and the need to locate health equity, leadership and social change within the broader context.
  • Neoliberalism and its impacts – getting Fellows to grapple with the complex concept, history and impacts of neoliberalism as a key underlying and driving feature of the current context – the focus will be on its impacts on health and economic policy which have seen dire outcomes for human development, public health, and economic fortunes of all countries in the world.
  • The underlying systemic and structural causes of health inequity – which include power relations in society, our country’s history, the dominant economic system characterised by inequality, apartheid geography, skewed and unequal food systems, the state of the health system, and the lack of universal access to decent basic necessities and public goods (such as decent work, decent housing, water, electricity, education, public transport, etc.).
  • Agency for social change – pathways towards the development and rebirth of Fellows as critical, committed and engaged agents for social change.
  • Relational leadership – the meaning, theory and practice of Fellows as relational leaders consciously cultivating collaboration, leadership in community and in context, and working collectively with other Fellows and others in wider networks of catalytic communities.
  • Critical skills for critical, committed and engaged agency for social change – as a crucial part of the learning process, Fellows are challenged to engage as critical, involved, active and dynamic participants, which is different from passive learning. This will also involve developing new critical skills required for the envisaged learning – skills such as self-care for learning and social agency, listening to hear and understand as different from defensive listening normally aimed at responding, critical reading, critical analysis, critical reflection, journaling, etc.

This underlying logic means that each Fellow must be fully present, active and engaged in the learning process throughout the module. Here are some useful tips to achieve this:


Please consistently bring and involve your full body, mind and heart throughout the Module, be aware of where we are and what we are doing, wake up to the inner workings of our mental, emotional, and physical processes, work out ways to control our reactions to what is going on around us, work out with manage and respond affirmatively what is going on around us and how not to be overwhelmed by what is going on around us. Whenever you bring awareness to what you’re directly experiencing via your senses, or to your state of mind via your thoughts and emotions, you’re being mindful.

The head, the heart and the hands

Health equity, social change and human transformation are not just about what we think or do practically or what happens in the real world. They are also about how we feel and understand how we feel. In other words, as emerging leaders for health equity and social change, we need to consciously find a way to ensure that we continuously connect the head (thought and logic), the heart (feelings, emotions) and the hands (doing, action, praxis). The Tekano Fellowship programme works at strengthening the capacities and competency at three levels (though not exclusively):

  • Conceptual and leadership capacity (HEAD): Understanding the social context, the political-economy of health, the structural and socioeconomic determinants of health and what it means to be a strategic and competent leader for health equity from an African, decolonial, class conscious and feminist lens.
  • Relational leadership (HEART): Creating awareness of your leadership positionality as part of strengthening emotional intelligence, confidence and collective leadership skills in relation to self, to others and to societal systems that affect health equity, and as part of continued leadership reflective praxis in learning and unlearning.
  • Leadership skills for social change (HANDS): Building core, practical and basic organisational skills to support advocacy, research and social media work, including strengthening innovative strategic planning and advocacy inside and outside of government, building research skills, dealing with the media and strengthening communication skills, writing skills, project planning and management skills, finances and fundraising skills and other skills identified through the Fellowship programme.

This approach consciously relates the cognitive domain (the head) to critical reflection, the affective domain (the heart) to relational knowing and the psychomotor domain (the hands) to engagement, action and practice. Over time, this conscious and continuous linking of the head, the heart and the hands can result in a rich synthesis of experience and reflection along with awareness and caring. Experience, reflection, awareness and caring are an essential ingredient in shifting and transforming ourselves into being the new, more empowered leaders and agents needed for health equity and social change.

Expectations vs. objectives

Work out what each of the set objectives of the module means to you. Go beyond the given text or words, use your own words or other creative ways to give your own meaning and interpretation of the set objectives. Also work out your own expectations from this module (what you expect to learn and contribute) and weigh them up against the set objectives, work out the similarities, the connections, the differences and the disconnections between the set objectives and your expectations – use these to assess your own learning journey throughout the Module.

Your existing knowledge

Whilst you will definitely learn new things in the fellowship, the learning approach seeks to recognise, affirm and build from your existing knowledge, experiences and contexts. Creatively tap into your experience and existing knowledge that you enter the module with. Connect it with the fellowship learning experience. Work out what to unlearn, what to relearn, what to learn anew, and keep a door open to ongoing uncertainty about knowledge and the future as we cannot ever determine our life’s pathways in advance, even more so our journeys as agents for social change.

Questions you have

Work out the questions you have and also the areas of curiosity and learning you have an interest in, share these with others, and bring them in an organic way into the learning process.

Listening to others (putting our ear to the ground) and engaging in genuine dialogue

Much of the learning in the Fellowship happens through conversation and collaboration among Fellows and the envisaged broader catalytic community. Listening happens in our brains. People often hear what they are ‘listening for’; then, they change what they hear depending on what they know and how they feel about the information shared. They even subconsciously change it to fit their own interpretations and interests, which is why it is so widely said that we misunderstand, misinterpret or change most of what we hear. Thus the importance of listening to learn and understand. When you truly listen, what you hear can change you. You might change your perspective, your position or your mind, because the information you receive is not altered by your filters or biases — both of which can be deterrents in our listening and our learning. In the section dealing with the learning approach, we extend this discussion on listening by suggesting four elements of the required action listening – connective listening, reflective listening, analytical listening and conceptual listening. These are crucial to enhance and optimise learning effectiveness and to lay the foundation for healthier cultures for collaborative, relational leadership. As author Mary Mayesky so aptly stated, “learning to listen” is a prerequisite of “listening to learn” – i.e. best to listen to learn and understand, which is different from listening in order to reply as is often the case in our excitable and heated social and political contests.

Your voice

Speak!!!! Express how you feel, what you think and what you would like to do. Speak respectfully and not for long. As you express your voice, hear other voices too.


Central to how we analyze our socio-political context is the notion of power. We will think through two intersecting forms of power – oppressive and transformative – and how they impact social justice for those who are oppressed, exploited and marginalised. When it comes to power, the core questions we will address are:

  • What forces and dynamics of power are operating in our context to keep blacks, women, working class communities and other social groups oppressed, exploited and marginalised?
  • Which forms of power can transform these dynamics and build more equal and just relationships and societies?

These questions allow us to look at how some forms of power silence and subjugate while other forms can work to transform oppressive systems and create equality and justice. This information and analysis makes it possible to study the challenges and opportunities that our specific context offers. Power matters. We need to think about how it affects the agenda for health equity and social change, and what our leadership journey as Fellows means for how we think about and understand power, and how our lifelong social agency may challenge and transform power.

Applying a critical thinking approach

Use the critical thinking approach that we worked through in the Orientation. Critical thinking seeks to go deep, beyond the obvious surface of dynamics and phenomena in society. The critical thinking approach does not take things as they appear on the surface. It deliberately digs deep way beneath the superficial understanding of society. It enables a dynamic and deep understanding of power configurations, root causes, systemic and structural issues, meanings, social contexts, ideologies and other such foundational processes that shape societies.

Consistently ask yourself the following critical thinking questions – What? Who? Why? Where? When? How? Give answers to these questions as you undertake the critical reflection.

Challenge yourself to think beyond what is reported in the news. Even challenge yourself to disagree or debate with yourself – but why are you stating things the way you do? What about other understandings and answers that are different from yours?

Centering women in our analysis

Whenever we grapple with issues and questions of power, we will consistently try to analyse through the eyes or standpoint of the majority of women in our country (black working class / poor women), whilst also referring in this framing, to other oppressed, exploited and marginalised social groups. In line with the Tekano learning theory and approach, this approach is a deliberate exercise to consciously centre women in our analysis thereby deepening our feminist politics.

Grappling with the South African context

As we go through Module 1, the broader reality of what is happening in our country and the world will loom large. It will come through in what we receive on WhatsApp, pictures in Instagram, posts and discussions on Facebook, news reports in the media, reports from our home locations, and so on. Therefore, the learning process in Module 1 cannot be not delinked from this broader reality out there. What then are some of the key features defining the current context in our country and world today?

Understanding the context in which we are located and its power dynamics is vital for us as Fellows starting a lifelong journey of leadership and social agency for health equity and social justice. The context analysis activities we will undertake today will enable us to develop an overview of power dynamics that shapes politics, the economy, social life and the responses of ordinary people to the situation.

Through this we are answering two fundamental questions:

  • What are the features and dynamics of the current moment in South Africa?
  • What implications does this context have for health equity and social change?

The most unequal country in the world

South Africa remains the most unequal country in the world in spite of having a wide-scale portfolio of welfare grants that include cash transfers, free water and electricity, a National Health Insurance under construction, free AIDS medicines and subsidised tertiary education. Aside from the latter two victories from mass movements – the Treatment Action Campaign in 1999-2004 and #Fees Must Fall in 2015-17 – and some other common-ing of state services (such as electricity and water informally reconnected in so many poor areas), the life of ordinary people is so miserable – with around two thirds of our compatriots below a realistic poverty line (that R350/month is simply not good enough as a response).

According to the UCT-based South African Labour and Development Research Unit (SALDRU), the real minimum cost of living in this country is close to R50 per person per day for a proper Upper Bound Poverty Line. And it is even higher if you consider the food baskets that incorporate all basic nutritional needs and other essentials. This is well framed by the ongoing monthly Pietermaritzburg Economic Justice and Dignity group research, that analyses and presents cost of living information. More than 3 million children go to bed hungry while a handful of CEOs have incomes of more than R1.7 million a year on average.

Covid19 has made this situation worse with poor and working people the most vulnerable part of the population to infection and death from many diseases, not least Covid19. This vulnerability of poor and working people is not because of unhygienic ways and locations in which they live. It primarily stems from the evolution of the country’s political economy during apartheid and the post-apartheid period. Central to this political economy has been a neoliberal policy framework which has resulted in poverty for millions, an immuno-compromised population among both young and old, in townships with no social services essential to the fight against Covid19 (housing, water and so on), in violence against women and children, in unsafe townships, and in a collapsing health system – the list goes on. The lack of urgency, the lack of decisiveness, the lack of a pro-poor bias, the pro-business orientation and the corruption that characterised the state’s response to the Covid19 pandemic are mere manifestations of the logic of neoliberalism.

South Africa has a stagnating economy where mass unemployment is now way above 12,48 million people, this being a record high at 46.6% with the youth hardest hit at 66.5% (Statistics South Africa, 2021). The Covid19 years from March 2020 have seen massive retrenchments and the employment of younger, newer labour at lower wages, limited or no benefits and worse working conditions. In other words, we are likely to have evidence of increased super-exploitation of employed workers in contrast to sustained profits by the very top of business owners, and precarity for a large number of vulnerable and informal workers adding to the dire conditions of the permanently unemployed mass.

This dire economic situation means a deepening crisis of social reproduction as we see in the collapsing social fabric in the zones of rot and decay instead of sustainable and decent human development (poor and working class communities in the townships, informal settlements, peri-urban areas, inner cities, rural villages, and other locations where poor and working people eke out a life of poverty, misery and squalor). What happens to the 600 000 matriculants from the 2021 academic year? To the hundreds of thousands leaving the education system every year since 1990? What do they do? The overwhelming majority of them cannot be absorbed into the formal economy or post-school education. They have no possibility of further development and decent livelihoods.

The above means that the zones of existence of poor and working people are fertile breeding ground for violence against women, criminality, drug abuse, gangster violence, the kind of social unrest we saw in July 2021, as well as reactionary discourses, ideologies and mobilisation as we see with the xenophobic Operation. This militates against emancipatory social change. A 10th February 2022 press statement from the Abahlali baseMjondolo social movement states that “The Report of the Expert Panel into the July 2021 Civil Unrest acknowledges the complete lack of political leadership in the KwaZulu-Natal province during the riots, the deep popular anger at corruption and the withdrawal of the Covid grant, the extent of social desperation and hunger, and that for a few days the riots took the form of a massive food riot by poor people, people who were mostly very far from being Zuma supporters.”

As if the economic crisis was not enough, the collapsing state we have enables accelerated commodification and dispossession of poor and working people. Sustained corruption and cronyism are hollowing out the capacity of the state (in government departments, parastatals, municipalities and other public institutions) as mandated by the country’s Constitution. Not a single public institution has not been affected by the rot. The outcome of this decay and collapse of the state is the deepening marginalisation and sustained underdevelopment of those who were most oppressed and exploited under apartheid, who were supposed to be the main beneficiaries of a democratic, post-apartheid dispensation.

The collapse of public services also worsens the burden of unpaid social reproduction labour carried by women. The majority of women are now pauperised and dispossessed and end up yet again having to bear the costs, burden and weight of reproducing society and thereby subsidising the profitability and wealth of the elite.

The overall impact of this on health systems inequity should be obvious – collapsing hospitals and clinics, limited human resources for health, medicine stock-outs, etc.


  • Are there seeds of alternative progressive politics from these zones? What are these? What is the potential of these
  • What are examples of other angles of analysis that should be considered, for example, what is happening within different communities, in the informal economy, in religious or faith-based institutions, and what is the impact of climate change?
  • Take time to think deeply and critically about the many other aspects of the political context that we have not considered. What sense do you make of them? What do they mean for health equity and social change? What do they say about the quality and capacity of the leadership we have as a society (from community level all the way to the top)? What message and implications do they give about the role of Fellows as critical, committed and engaged agents and relational leaders for health equity and social change?
  • How do we respond to the fact that there is not a single quarter anywhere in our society that is building and advancing an agenda to rebuild the state in line with the country’s Constitution; and that there is not a single force organised enough to effectively reclaim and rebuild the state for progressive redistribution as mandated by the Constitution?
  • Another example of leadership is the taxi industry which was celebrated when it defended some of the malls against looting during the July 2021 social unrest. But taxi violence is well recorded. What explains the emergence and power of izinkabi and other taxi warlords? What about those who use violence to control the trucking economy on the N3 between Jozi and iTheku?
  • From this crisis-ridden context, some have predicted that the powder keg will grow yet more explosive beyond the food riots and social unrest we witnessed in July 2021. What are the lessons on leadership from this Abahlali baseMjondolo social movement statement on the July 2021 uprisings? What does this dire powder keg possibility mean for the leadership role of Fellows, activists, civil society, and others?


The implications of our current context for health equity

Section 27 of the Constitution deals with health care, food, water and social security. It provides as follows:

  1. Everyone has the right to have access to —
    1. health care services, including reproductive health care;
    2. sufficient food and water; and
    3. social security, including, if they are unable to support themselves and their dependants, appropriate social assistance.
  2. The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.
  3. No one may be refused emergency medical treatment.

This section of the Constitution guarantees everyone the right of access to health care services and imposes on the state a duty to take reasonable measures within its available resources to achieve the progressive realisation of this right. The country’s Constitution defines health as a right and is biased towards health as a public good that should be available to everyone instead of a commodity to be bought and sold for profit on the market.

The 1997 White Paper for the Transformation of the Health System in South Africa says that one of the aims of health policy in the new South Africa is “promoting equity by developing a single, unified health system”.

Section 9 of the Constitution (the Equality clause) states that everyone is equal before the law and that “equality includes the full and equal enjoyment of all rights and freedoms”.

The constitutional provisions and the White Paper cited above demonstrate that protecting and fulfilling the right of access to health care services requires the government to take steps to tackle inequality. This view has been reinforced by several decisions of the Constitutional Court. For example, in its 2004 judgment in Minister of Finance v van Heerde the Constitutional Court put it succinctly as such: “When our Constitution took root a decade ago our society was deeply divided, vastly unequal and uncaring of human worth. Many of these stark social and economic disparities will persist for long to come. In effect the commitment of the Preamble is to restore and protect the equal worth of everyone; to heal the divisions of the past and to establish a caring and socially just society. In explicit terms the Constitution commits our society to ‘improve the quality of life of all citizens and free the potential of each person’”.


Consider the current dominant logic of health as a commodity worsened by the commodifying impact of collapsing health servicesWhat then is the meaning of health as a right?

What is the meaning of health as a public good?

What is the relevance and utility of alternative health narratives in light of the given context? For example, health activists are increasingly referring to constructing alternative health narratives – from colonialism and land dispossession to decolonial, indigenous, feminist constructions. 

Why then health equity and social change?

Why does Tekano emphasise social change initiatives?

The implications for transformative leadership and the Tekano Fellowship journey

It is important to consider the state of leadership in society today and the meaning and relevance of relational leadership – leadership as activism and as being a catalyst. The purpose of this fellowship is to strengthen layers of leaders who are critical, committed and engaged agents for social change. This may be an extension and expansion of your prior leadership roles and style. It may need unlearning and new learning, or it may simply be a new, challenging and hopefully exciting contribute journey. 

The leadership role of facilitators and guests on this Yearlong Fellowship Programme is to enrich spaces for critical and active learning by Fellows, and not to dominate or capture the space. It belongs to Fellows. If this happens, use your leadership to offer us supportive critical feedback, so that it can be addressed promptly and healthily. 

Additional videos and reading recommendations for Module 1


View these two videos and use the questions below to guide your critical analysis of them:

Moeletsi Mbeki identifies what’s behind South Africa’s economic struggle (Youtube, 14 minutes)

What triggered the recent violence in South Africa? | Inside Story (Al Jazeera) (Youtube, 26 minutes)

What is happening and why? What are the major things happening in this country that concern you, the communities you are part of or care about and the movements/organisations you are part of? Why are these things happening? What produces and drives them?

Impact: How do these things that are happening affect the communities of most concern to you, the movements you know/care about or are your movements/organisations you are part of and the struggles you are involved in? What do these things you have described mean for the change and demands that your movements/organisations stands for and desires? Do they enable the achievement of these? How? And why? Or do they block progress? How? And why?

Who benefits? Who are the key players in the things you have described? Which kind of people or groups benefit the most from what you have described? How do they benefit? Why do they benefit? Who has power and exercises it in what is happening? How do they use it? How are those with power positioned in the whole set-up?

Who loses out? Who is disempowered by what is happening? Who is losing out? What explains how they get disempowered or lose out? How are the disempowered located or positioned in the whole set-up?

Implications for social change and social agency: What do these things you have described mean for the change and demands that your movements/organisations stands for and desires? And for health equity? Do they enable the achievement of these? How? And why? Or do they block progress? How? And why? What does this mean for my role as a Fellow on a journey for social change and health equity? What does it mean for my role as an agent for social change and health equity?

Additional videos worth critically reviewing…

South Africa Pushed to the Limit: The Political Economy of Change|Interview with Hein Marais (Youtube, 12 minutes)

The power and role of the financial sector in the economy (financialisation of the economy) told through Pretty Woman Case study of South Africa’s Economy | video by Oxfam South Africa (Youtube, 13 minutes)

Sampie Terreblanche: White South Africans Will Have to Make Some Sacrifices | An interview with the late economist, Sampie Terreblanche (Youtube, 29 minutes)

A Tale of Two Slums: Tacking Poverty in South Africa (Youtube, 17 minutes)

The Dark Side of South Africa’s Vineyards (Youtube, 18 minutes)

Additional readings

Abahlali baseMijondolo. 2021. KwaZulu-Natal and Gauteng are burning, we need to build a just peace. 13 July 2021

Cottle, Eddie. Potent brew that led to South Africa’s urban uprising: Pandemic, recession and a crisis of social reproduction. 2 August 2021

Covid-19 Working Class Campaign. 2021. CWCC Statement on the Rioting. Statement by the Covid-19 Working Class Campaign Released: 25 July 2021 – OR

Covid-19 Working Class Campaign. 2020. Movement building in the shadow of COVID19

Sikwebu, Dinga. 2021. Umthandazo weJazz (Jazz Prayer for Peace)


This framing document is designed as a background provocation document for the whole of Module 1. It may or may not represent the views of Tekano and is to be viewed as a critical education tool, and not as a Tekano position paper.