Module 4

Module 4 Framing Document

Please read this Framing Document together with the Tekano in Spain 2021 document that forms the last section of this Fellows Guide. 

Different conceptualisations and approaches to social change

There is no one way to effect or advance social change. Different social actors have different conceptualisations and approaches which also lead to very different outcomes. In the examples below, we highlight the differences between collective versus individual efforts to achieve social justice, and the results they tend to offer. Yet in the end, approaches to social change are best presented on a continuum, rather than as one end of the spectrum or the other.

The Fees Must Fall movement thought about and undertook its programme of social change in a very different way from individualised and atomised students, who limited their action to applications and correspondence with universities, the NSFAS or bursary funds. Another example is the Treatment Action Campaign (TAC) as a movement and social power building formation compared to localized HIV/AIDS support groups, that tackle and try to solve immediate problems for individuals. As it evolved, TAC developed a mix of approaches that include public interest litigation through to small organising and support groups for activists to campaign locally and combine nationally and to even act internationally. Similarly, Medicines Sans Frontier’s (MSF’s) strategy combines service delivery, building state institutions, working with organised communities and social movements, undertaking lobbying and advocacy work, and public education. 

Similarly, what the Gift of the Givers (GoG) does to provide immediate service delivery is different from how the Abahlali baseMijondolo social movement undertakes social action. By comparing the GoG to AbM’s approach, it is striking that the two organisations have also collaborated where the service delivery focus of the GoG became possible through the powerful self-organisation of the AbM whose under-developed and under-served constituency desperately needed the GoG’s services.

Another example concerns organised and unorganised workers. Generally, those who are organised in trade unions or worker committees, have collective consciousness, self-organisation, collective bargaining and exercising of their organisational rights. In contrast, individuals who use Legal Wise to advance their workplace rights may have good legal advice, but they do not have the collective attributes of a trade union or worker committees. So, while individuals may not be subject to the whims, bureaucracy, sexism and even corruption of some of the trade unions; these individuals lack the broader vision or systemic impact on wider socio- economic issues that trade unions and other worker formations can have. Even with the advantages that trade unions bring, radical critiques point out that trade union struggles for better wages, better working conditions and other benefits are essentially ‘reformist’ and do not go far enough. They are said to fall within the notion of the possibility of helping to ‘reform the state’ so that it is more worker friendly. This argument holds that trade unions are therefore too limiting because they do not address the fundamental and systemic reasons for poor wages, poor working conditions and general exploitation of workers by the ruling class (capital and the state).

To help distinguish, identify and understand the different approaches to social change here are critical components to think through:

  • Analysis – What tools of analysis have been used to define and understand the problem each social actor is responding to? What, if any, ideological and /or political underpinnings inform this analysis? Who does the analysis – those affected or is it mostly on behalf of those affected?
  • Roots of the problem – How does each social actor understand and explain what the roots, causes and drivers of the problem it seeks to respond to are?
  • Demands, solutions and the vision – What solutions do the social actors propose? How do these solutions resolve the problems of the affected people? How far do these solutions go? Do they ameliorate the immediate issues and concerns? How do the solutions affect and challenge the roots, causes and drivers of the problem? How do the solutions integrate people into the given systems or go beyond the given systems? Are the solutions about mere reforms within the dominant system? In other words, is the approach that of saying there is no alternative to the given system? Or are they about a systemic transformation that changes the prevailing conditions and even challenge the given social order? Or are they about an even deeper systemic change such as that implied by radical notions such as revolution or decolonisation? What is the vision that informs the demands and solutions? How transformative is the vision?
  • Forms of action to achieve change – What are the forms of action proposed or undertaken to address the problems? Who decides on the action/s versus who does the action/s? There are different forms of action – service delivery, charity, donations, petitions, marches, occupations, other forms of direct action, violence, etc. What forms of action are likely to effectively address the problems? To what extent do the actions integrate the affected people in the given system or enable people to go beyond the given system? What implications does each form of action have for building collective social agency or reinforcing individual effort and identity, or for building collective social power in contrast to individual power? To what extent are the actors’ forms of action used for challenging or maintaining the given balance of power between different social interests and forces? How do actors measure successful change and is the prize big numbers of people taking action (tending to be a push for mass united broad platform approaches); or is the prize that critical principles are underpinning action and being fought over, towards lasting transformation (tending to be smaller and possibly isolated struggle)? 
  • Critical intersectional considerations in taking action – Who are social actors choosing to work with and what lenses are being utilised? How aware are they of positions of authority and privilege? How are systemic issues of race, patriarchy, class, ableism and heteronormativity (among others) being addressed within their formation and in their strategies and engagement? Is there a critical consciousness around race, around women, around class, around the disabled, around the LGBTIQA+ community, and others in language, platforms, actions, etc.? Does this matter? And if yes, how are these being demonstrated? And if not, why not?
  • Strategy and approaches in relation to the courts and the legal system (public interest litigation) – What is the role of courts and the legal system in the strategy of the social actors? Are courts and lawyers the be-all and end-all of the strategy for change? The famous Irene Grootboom case matters – through constitutional litigation, she won the right to have a house provided by the state for free, but she died without such a house and without organised social pressure on the state to deliver.
    In contrast, the TAC and the LGBTQIA+ communities have combined court action with sustained social mobilisation which has resulted in real court victories with real life impacts for affected people.
  • Relationship with the state – how does the analysis referred to above help social actors to critically understand the state (the political economy that shapes the bias and actions of the state)? How do the proposed demands, solutions, visions and forms of action affect the relationship with the state? In the case of HIV/AIDS, many organisations opt to partner with the state, including through providing home-based care, sitting on hospital boards, sitting on the board of SANAC and receiving funds from the state. Many have achieved impressive outcomes following this partnership approach. The TAC has opted for a mixed methods approach to manage its analysis that the state as an institution can attach strings and tie civil society down to limited actions. After TAC won its series of key victories, it shifted its approach to engage and even partner with government to support it to tackle its problems. It did this while at the same time using social mobilisation to put pressure on the state. More radical movements, such as the Anti-Privatisation Forum (APF) took a very clear political economy position on the state as being part of the ruling class, and therefore ‘the enemy’ and would not under any circumstances collaborate or partner to solve problems of water, electricity, housing, etcetera. Trade unions and radical ecological movements have a history of combining different strategies when it comes to the state. This will be a mix of collaboration with, challenging of and rejection of the state (the “with, beyond and against the state” approach).
  • Understanding capitalism – economic inequalities, economic elites and socio-economic struggles – and to what extent does the analysis critically understand capitalism? What is the approach of the social actors to economic inequalities? How do the chosen demands, solutions, visions and strategies weigh up and measure in the “with/beyond/against” spectrum?
  • Conceptualisation of rights and public goods – how do the social actors define rights? Are the demands seen as a basic right or a favour from the state or other elites? How do they define their demands and solutions in relation to public goods? For example, is it about mere access to private health care or is it a broader vision of universal access to health as a public good? Or is it a hybrid, a combination of different approaches? What is the approach of the social actor to an issue such as affordable medical treatment being regarded as a right and a public good; or as a commodity that depends on one’s financial circumstances? How do the social actors approach the realisation of rights in relation to the given system? For example, can access to affordable medical treatment be effectively achieved within the given system? Or does it imply systemic transformation? How is the very notion of human rights and its ‘supply and demand’ (duty bearers versus rights holders) philosophy and practice viewed by the social actor? 
  • Relationships and interactions with communities purporting to be served – in determining what actions will work and for whom, how are communities/constituencies being engaged? Where is the power of constituencies or communities really sitting for this social actor in reality not as espoused?  Is it a case of we know best or nothing about us without us? How do these social actors consider approaches that take us away from the effects of colonisation, apartheid and patriarchy? Do social actors choose to work in partnerships or alone and why? Is there in a need for inclusion, joint solutions, integration and shared approaches? Is there tolerance for difference? How do they receive and work with critique in the interest of advancing social change?

From the above, it is best to conceptualise and regard the different theories of, approaches to, and outcomes of social change as representing a fluid spectrum or continuum without strict and fixed boundaries. It is a spectrum with overlapping zones that represent hybrids. For example, some theorists have argued about anti-systemic reforms which are not limited reforms for the here and now, but are reforms with a radical, transformative logic and even a revolutionary potential. Put graphically, this fluid spectrum of social change approaches can be represented as follows:

 > Ameliorative > Reforms > Transformative > Revolution/Decolonisation >

Focus of the module

As you can see above, health equity and social justice are not possible without transformative social action. This approach is informed by the foundation laid in the earlier modules. Module 4 will deepen how we think about social change and our roles and positions within it. We will learn about different approaches to and visions of social change. We will work out the main ways and strategies of it being achieved. We will learn about the primacy and role of collective and organised working class self-emancipatory social power that drives meaningful and lasting social change. We will learn with activists and movements that have important lessons and victories from their long-term work for social change. We will connect this overall learning to our lifelong journeys as agents for social change.

In sum, the module will focus on the following strategic questions: What is social change? What does it mean from a health equity perspective? What are the different approaches, visions and outcomes of social change? What are the most effective ways and strategies to achieve social change? What is the place of the organised collective social power of ordinary people in winning social change? What can Tekano Fellows learn from Spain and other international contexts about the importance, role and dynamics of social agency, collective activism and collective movements in driving social change? What do all these lessons mean for how Fellows approach the implementation of SCIs and for the lifelong journey as agents for social change?

Applied learning from different countries

Each year, the final module of the Tekano Year Long Fellowship (YLF) learning process takes place in a chosen country. Within the context of severe travel constraints imposed by the global COVID-19 pandemic, the country of Spain was chosen for 2021 as the destination and host for Module 4. 

International experiences are invaluable for helping us to triangulate and see our inequity, injustices and other challenges from a different perspective. They also help us realise new ideas and approaches to achieving health equity and social justice. This Module is not about a frivolous social jaunt into another country without a connection to the learning process in the YLF!

Spain has been chosen for this year’s visit, because of its incredible history of popular movement-driven struggles for social change in health equity and social justice. Like us in South Africa, the country of Spain is beset with its own ongoing inequities, injustices and challenges, but these are directly and consistently challenged by organised and collective social power that different social movements represent. They have inspiring angles of success in fighting neoliberalism and its assault on social justice and equity. We will visit the Basque region’s area of Barcelona, where self-emancipatory organisation is resilient, despite all the odds. 

You will find a consolidated overview of Spain as the last section of this Fellows’ Guide. Please read that section in conjunction with this Framing Document, ahead of the module. It will offer you a concise historical, socio- political and logistical overview of what to expect from this week in Spain. 

Exercise and food for thought

Different conceptualisations and approaches to social change

Task: Use the above questions to characterise and critically think through the forms, theories and approaches to social change exhibited by one of the clusters of organisations listed below. When writing up your answers, consider presenting them in the form of a diagram or table or other such graphic representation to show similarities and differences. Remember, you only need to do this exercise for one of the clusters:  

  1. Use at least five of the critical components of social change posed above to characterise the form of social change followed by each of the organisations in the cluster you have chosen.
  2. Where would you locate the strategy of each organisation along the continuum or fluid spectrum of social change?
  3. Consider whether any of the organisations that you are reviewing combine different strategies that spread out across the continuum or fluid spectrum (hybrid)
  4. Critically reflect on your SCI concept note in relation to the cluster of organisations whose social change approaches you have just analysed. What is similar? What is different? What can you learn from the analysis for the implementation stage of your SCI? 

Clusters of organisations 

Choose only one cluster and consider which one in the light of your Social Change Initiative (SCI), to test the usefulness of this form of social change analysis. Do a web search for the formation’s website unless specific links are offered below: 

Cluster 1:

Cluster 2:

Cluster 3:

Cluster 4:

Building tomorrow today: Social change is collective action and collective power 

No matter what approach one has to social change, it is universally accepted that in the absence of organised and collective social movements we often find the entrenchment of inequalities, injustices and the hollowing out of the promise of freedom and democracy. It is not a surprise therefore that South Africa’s democratic crisis today includes the emaciated web of life of movements that represent organised and collective social action for social justice. Whether it was the successive waves from the 1950s to the 1980s in the struggle against apartheid, or the mass activism period of the Treatment Action Campaign (TAC) in the early 2000s, or the COSATU-led massive workers strikes from 2000 to 2002, or the more recent ‘Fallist’ rebellion from 2015 and the TotalShutDown Movements of 2018; or the continuing mass struggles in urban and rural areas by different social movements. It was always mass movements made up of ordinary people across the length and breadth of the country who directly challenged the entrenched political and social power of the apartheid regime, of powerful drug companies, of the university ivory towers and of ever present patriarchal norms.

These sustained mass struggles enabled collectives of activists and communities to imagine and experiment with what a future South Africa could look like. These mass upsurges enabled workers, students, feminists, the unemployed and other popular forces to dare with building significant social power in the workplace, at universities, in the townships, informal settlements and rural areas. As a result, alternative visions of the future got expressed in popular notions such as people’s power, people before profits, the right to say no, and decolonisation – these alternative visions had real presence in the consciousness and practices of activists and organised popular forces.

Mass upsurges also include attempts to concretely experiment with building alternative institutions, spaces and logics. This includes the horizontal leadership of the Fallists, the occupation of the Bremner building at UCT by the mass of student activists, the people’s speak-out forums on HIV/AIDS, the independent worker committees that existed outside formal trade unions during the 2012 platinum and farm worker strikes, the diffuse community-wide activist cells in current rural and urban resistance as well as the street committees, civics, SRCs, parent-teacher-student associations, people’s education camps, cooperatives and other local initiatives of the 1980s. As a result of such self-organisation, the police could not enter the township of Alexandra. With no police presence, the township did not have any cases of crime for 3 months in 1987. This was achieved through effectively organised street committees that involved every household in every street and block of the township. This self-organisation was broken when the police forcefully re-entered Alex and arrested the key leaders of the Alexandra Civic Organisation which was at the heart of the township’s self- organisation. This example demonstrates and underlines the importance of organised and collective social power and action in challenging oppression and inequality, and in advancing the struggle for social justice and broader social change.

In contrast to today’s South Africa, several important case studies in Spain and elsewhere in the world demonstrate how various movements are actively and consciously winning reforms that achieve social justice in the here and now. They are doing this while at the very same time building the logic of what the future of social justice could look like. This is prefigurative politics whereby ordinary people, activists and organised social forces are consciously organising to build tomorrow today. 

We saw a few examples of this in the innovation labs we visited in the Eastern Cape province during Module 3. Even with such innovation labs, today’s post-apartheid South Africa is very far from a situation where the mass of ordinary people, activists and organised communities are involved in a collective search for emancipatory pathways. Many are still looking for the arrival of trucks from the Gift of the Givers and other such humanitarian aid, to ameliorate immediate pain without asking critical questions such as: What systemic and structural drivers necessitated the intervention by the Gift of Givers? What social power does the intervention build? What happens once the Gift of the Givers have packed their last tent and left?

Social change is collective

Collective social power is the key driver of social change and is diametrically different from individualised, atomised social entrepreneurship or celebrity “activism”. The latter forms of actions may help poor children to benefit from donated school shoes or sanitary pads, etcetera, but remains charity. Such actions often elevate the public profiles of the donors whilst leaving the roots of inequality and injustice unchallenged. These actions can tend to reduce the beneficiaries to passive recipients. 

Yet even if social change is collective, it can still fall along a wide continuum or fluid spectrum. For Tekano, key to lasting social change is the extent to which it is informed by a political economy approach, that is positionality in relation to ruling class power. This form of social justice activism requires a critical analysis of the systemic and structural foundations of inequality, an analysis of power relations (the balance of power), the ability to envision a different future, and working out effective strategies and tactics to use collective social power to win immediate change whilst also opening the pathway to deeper, transformative, structural change.

Most community and civil society organisations in South Africa have not engaged in challenging the systemic and structural foundations of inequality. Radical critiques of civil society argue that it often NGOises systemic and structural problems. It often ends up acting primarily on behalf of, instead of supporting the self-organising social power of those affected.  It lacks an organic social base. This critique normally applies to mainstream NGOs who work from the outside in. Their strategies are often informed by the priorities of funders or defer to the state in ways that limit the social agency and self-emancipatory impulses of working class and poor communities. 

Then there are organisations like the TAC and the Equal Education Campaign, that demonstrate hybrid features which combine NGO-like elements whilst also having a mass movement and activist character. There have also been examples where NGOs have complementary relations with mass movements – often including a service and support role determined by the interests and strategy of the mass movement, but also including uneasy relations and struggles over resources, strategy and political control and direction.

Only a few examples in South Africa demonstrate how collective social action can win social change. The Treatment Action Campaign, for example, did not campaign for donations of ARVs or other such charity donations to HIV positive people. It undertook sustained organising by HIV positive people which turned the TAC into a real social force with social power, weight and voice. It directly challenged a failing government and greedy drug companies. This kind of organising enabled HIV positive people to move out of stigmatised closets to claim public space and legitimacy. The same dynamics are present in the struggles for dignity, land and housing of the Abahlali baseMjondolo social movement, in the Amadiba Crisis Committee’s struggles against mining imposed from outside on the people of Xolobeni, and in some of the cases we studied in Module 3. 

Social mobilisation, movements and movement-building

At the heart of collective and sustained social action, are organised movements made up of different social forces. Movements are about the collective aspiration of groups in society made up of critical, co-accountable, informed, confident, able, knowledgeable and dynamic activists involved in sustained social mobilisation, organising and building of social power, to drive social change.

The notion of movement-building is consistent with the idea that for poor and working class people to bring social change in their lives, it has to be done collectively. The working and unemployed poor do not have the social, economic or political capital of the ruling and middle classes to solve problems as individuals. Without such mass participation or deep democracy from below, political and economic elites rule society solely for the advancement of the interests of a few. 

The place of feminist politics in collective social action for social change

Also present in the logic of transformative action is the notion of a radical feminist perspective and politics. The healthy equity and broader social change that Tekano desires requires a radical, progressive and emancipatory transformation of gender relations. This would start with a conscious and sustained effort to strengthen and deepen the autonomy of women.

Tekano’s feminist approach also challenges heteropatriarchy. Heteropatriarchy refers to the domination of power over and control of cultural, social, economic and political systems and structures by cisgender and heterosexual males. This reality means the multi-dimensional oppression of cisgender females and people with other sexual orientations and gender identities. Also critical in Tekano’s approach to radical feminist politics is to conceptualise feminism as indigenous instead of the popular misconception that it is foreign to Africa. Histories of Africa demonstrate how women and other oppressed sexual and gender identities have consistently resisted and challenged heteropatriarchy and sought to expand the realms of freedom and expression for these oppressed identities. It was the dictums of colonial administration and Calvinist doctrines of Christianity that imposed and entrenched heteropatriarchy in ways that buttressed indigenous patriarchy and uprooted the emancipatory impulses from organic contestations from within. However, the nationalist and liberation movements that challenged colonialism did not go far enough to deconstruct the colonial legacy. These movements often perpetuated and reproduced heteropatriarchy.  

Since the 1994 democratic dispensation, women’s autonomy and the rights of LGBTQIA+ people have been boosted by political democratisation, protection of constitutional rights to equality and non-discrimination, gender equality, legislative and policy initiatives.  This includes the provision of social security grants, various rural development programmes, and locally driven processes of change that have enabled women’s access to local land, and opportunities for women’s local entrepreneurship. 

Previous modules have explored how neoliberal macroeconomic policy has meant that these interventions could not be realized, to successfully change the systemic and structural foundations and daily manifestations of gender oppression and heteropatriarchy. We see its day-to-day manifestation in conservative social attitudes, continued domination of political and other leadership roles by cisgender men, discourses and practices that roll back the rights and equal status of women, violence against women, homophobia, the reassertion of hetero sexism, limited binary approaches to sexuality, hate crimes against LGBTQIA+ people and many other examples. A feminist perspective and strategy needs to be integral to any movement building for social change, for it to be holistic and potentially truly transformative.

Key concepts and learning areas

The key concepts and learning areas for Module 4 are:

  • Social change and social justice – including how these relate to health equity
  • Social agency, social power and collective social action
  • Social movements, movement-building, organising and social mobilisation
  • Strategy and tactics for social change including the notion of social change as innovation
  • Hegemony, power analysis and the balance of power
  • The place of catalytic communities in collective social action for social change
  • The place of radical feminist politics in collective social action for social change
  • The country we are visiting and its health system
  • Connecting learnings from the module to the SCI
  • Celebrating the YLF & the transition to Life-Long Fellowship.

With this module building on the foundation laid in earlier modules, it is critical that Fellows revisit key concepts covered therein. These concepts include critical pedagogy, catalytic communities, collaboration with others, relational leadership, political economy, structural and social determinants of health, and activist collective innovation. 

The learning approach and process

As has been the case with previous modules, the learning approach and process will combine the following:

  • Experiential and participatory learning which resonates with the approach of critical pedagogy
  • Learning as an individual and collective journey
  • Learning as a story – our stories, the stories of others, the stories of communities, the stories of activists and movements in a different country, curating new stories, the stories of alternatives, shaping a story for the future of Fellows as critical, committed and engaged agents for social change, the stories of political economy 
  • Concretely applying key concepts from earlier modules
  • Building a learning community – rooted in patience, collaboration, respect and in valuing our difference.

Key aspects of the learning process

We also restate important other attributes and aspects of the learning process. We are conscious of:

  1. Vulnerability, discomfort and conflict – enabling safety for Fellows to express their vulnerability and discomfort, and also any conflict that may arise in the learning process: this aspect will even be more present given that we will be in a different country with its own histories, cultures, languages, concepts of time, and other things that we often take for granted
  2. Embracing diversity – including a keen eye to what is silenced, hidden and unsaid
  3. Disruption – effective and inclusive ways in which the learning process will positively disrupt received and dominant knowledge based on the core belief that education for social change is not neutral: this is about the decoloniality of being: this includes finding ways to hold uncertainty in the learning process
  4. Transformative change and its personal impact (personal transformation) – the political is personal, the personal is political; shaping and holding a learning pathway that enables Fellows to realise that real, genuine, thorough-going transformative change necessarily goes through pain, disturbance, disruption, vulnerability, discomfort and dis-ease
  5. Creating spaces for dialogue and reflection – engaging in critical self-reflection as well as helping Fellows to unpack narratives – dominant narratives/hegemony: the story (how this hegemony developed) and ways to disrupt the comfort in the hegemonic story (interactive exercises on deconstructing the dominant narrative)
  6. Space – for each Fellow to consciously reflect on the learning process and to bring that reflection into the common learning space (including the possibility of publishing the reflections where appropriate)
  7. Consolidating the learning journey – into tangible learning outcomes and impacts
  8. Listening – to each other, listening to others, and harnessing these into the learning process and noting issues that may require follow-up after the Module
  9. Optimising comparative critical learning – in ways that enables Fellows to draw appropriate lessons and implications from the experiences of activists and movements in the destination country for their SCIs, for the broader South African context, and for their collective life-long role as agents for social change: in this regard, actively engaging in dialogue with our Spanish interlocutors – the centrality of activism and movements in their experience, engaging as solidarity, Fellows being challenged to also reflect on and share their journey

To restate that the above is not mere ritual but an important reminder in particular as Fellows prepare to transition to the Life Long Fellowship where these attributes will be required and are likely to serve as the vital ingredients for Fellows flourishing further as critical, committed and engaged agents for emancipatory social change on the basis of organised, collective social action. This is about enabling Fellows to work out about what forms, theories and approaches of social change are best suited to address the structural and social determinants of health in South Africa.

Preparations and reflections by Fellows (before and during the module)

  • Preparatory activities
  • Reading and giving feedback on this Framing Document
  • Pre-contact work
  • Learning about Spain
  • Logistics
  • Preparing for site visits including respectful ways of how to engage during visits

The programme for the Module also includes space for critical individual and collective reflection. This is a key part of the learning process.

South African context

This reading was prescribed for Module 3, so this should just be a refresh reading to deepen your engagement in Module 4: 

Scott V, Schaay N, Schneider H, Sanders D ‘Addressing social determinants of health in South Africa: the journey continues’ in South African Health Review 2017, Health Systems Trust, Chapter 8, 77-87


Once again, we hope that this Framing Document gives you a clear idea of the core learning shaping Module 4. It will serve as a reference point throughout the module, with express elements being integrated into the module content. 

We are confident that this last module is well-conceived to support an exciting and dynamic transition from this Year Long Fellowship into your Life Long Fellowship!

Phambile maqabane!