Addressing the legacy of the Dop System: Tackling alcohol abuse among South African farm workers
Leslie London
Department of Community Health,
University of Cape Town
1999

Although the payment of alcohol to farm workers as part of their conditions of service, known as the DOP system, is no longer legal in South Africa, alcohol abuse remains one of the major challenges facing the health services in the Western Cape.^1,2 Evidence indicates that although the DOP system no longer operates as widely or with such intensity as originally introduced under colonial agriculture,³ a number of farms in the region continue to provide workers with alcohol as part of their conditions of service.^3-5 For example, the estimates of the current prevalence of the DOP system range from less than 2% based on industry estimates⁶ to 20%.⁵ Even in the absence of a DOP system, alcohol dependence among farm workers continues to play a major role in enmeshing farm workers in a cycle of poverty and dependence from which escape is extremely difficult.⁷

The adverse health and development impacts of the DOP system and alcohol abuse are substantial among rural farming communities, where alcohol-related trauma, exceptionally high rates of TB, child and adult malnutrition, and foetal alcohol syndrome are common in the Cape.¹ In addition, social problems associated with alcohol such as child abuse, violence against women and family disruption are major obstacles to access to health and social services for farm residents.⁴

In response to these kinds of difficulties in delivery of mobile clinic services in the Stellenbosch rural areas, nursing staff of the local authority initiated a project aimed at eradicating the DOP system and reducing alcohol abuse among rural farm residents in the area. The project began as a loose network of interested service providers, university public health staff, rural development non-governmental organisations (NGOs) and interested individuals in 1995. It has subsequently been formalised as a non-profit NGO and was officially launched in June 1997 as the DOPSTOP Project.

The aims of DOPSTOP are to end the Dop system, prevent alcohol abuse and reduce excessive alcohol consumption in farms in the region, by providing social alternatives and raising awareness of the hazards associated with alcohol abuse. DOPSTOP plans to implement a comprehensive programme over a 3- to 5-year period in the Stellenbosch area which could serve as a model for other areas in the Province, many of whom face similar, if not worse, alcohol problems.

DOPSTOP embraces four broad areas of work, adopting a comprehensive health promotion approach to the question of alcohol abuse. These include:

1. Education and training for farm residents and management with a view to primary, secondary (early detection) and tertiary (support groups) prevention, as well as training for health service providers and other caregivers. Such training aims to learn from other experiences in alcohol prevention, particularly with marginalised groups in other countries with similar experiences to farm workers in South Africa.
2. Facilitating provision of clinical and counselling services for alcohol-addicted individuals, including referrals for detoxification and in- and out-patient treatment. Preventive work with farm workers will be severely undermined if clinical services are not able to support the identification, referral, management and follow up of individual workers with drinking difficulties.
3. Research, both quantitative and qualitative (using anthropologic and ethnographic approaches), to inform interventions and provide baseline indicators for evaluation. Research, in the form of a mobile clinic-based survey, was also used to provide empirical data to back early lobbying and awareness-raising activities, which was critical for credibility of attempts to place the issue on agendas of decision makers at the outset of the project. These data have only subsequently been published in the scientific literature.⁴
4. Advocacy to promote healthy policies and practices, raise community awareness and mobilise support. Use of the media has been relatively successful in raising public awareness and interest.

This set of activities focuses primarily on developing community-based interventions working with farm residents and management to achieve shared goals. Use of peer experience as key vehicles for behaviour change among both farmers and farm workers, and of using both group and individual approaches, are critical. Also important has been the mobilisation of political support among farmers to ensure that the objective of eradicating DOP practices is seen as being in the long-term interest of the entire farming community. With this understanding goes the recognition that simply stopping the DOP system alone will be insufficient to achieve real gains for those most in need. In the absence of alternatives to alcohol, withdrawal of the DOP system may lead to substitution with other forms of substance abuse or to farm workers finding other, more expensive (shebeen, or commercial bottle store) sources of alcohol, placing a further burden on already marginal household economies.

Some of the lessons from the project’s experience

1. Health promotion cannot address the DOP system nor the problem of alcohol abuse in isolation. A broad developmental approach placing alcohol in the context of general health and social needs is required. In light of this, DOPSTOP is presently completing a large, baseline survey of a wide range of health and social indicators to provide baseline data on which to evaluate the impact of the programme over the coming years. Such data will also assist district health planning for farm workers, and help shape the interventions developed.
2. The understanding of the nature of drinking in the farm culture is critical to informing the most effective intervention. Simplistic analyses of bad farmers and innocent, vulnerable, victim farm workers are neither correct nor useful for developing coherent strategies and may serve to further disempower workers in an already paternalistic environment. The DOP system has served a peculiar functionality for employers and employees alike, for example, by providing a unique ‘cultural space’ for farm workers in which the consumption of the daily dop "created a social movement in which farmers could not share".³ This ironic functionality must be explicitly addressed by carefully constructed anthropologically informed interventions.
3. The multidisciplinarity of the team required for such an intervention needs to mix a very wide range of skills: legal, clinical, public health, health educational, advocacy, media, community development and health promotion.
4. Buy-in of all stakeholders has been critical to the progress of the project, with the commitment of the Stellenbosch Agricultural Association to the aims of addressing alcohol abuse, and the support of the provincial and national departments of health and social services in both financial and organisational terms.

Future work of the DOPSTOP will be greatly advanced by the appointment for the first time of a full-time co-ordinator in March 1999, a nurse seconded from the local Winelands District Council health services in a partnership arrangement. The challenges are substantial but the groundwork for a comprehensive intervention project to address a difficult environment has been laid, which will hopefully provide valuable lessons for novel approaches to substance abuse in the future for South Africa and other countries.

References

1. London L, Sanders D, Te Water Naude J. Farm workers in South Africa – the challenge of eradicating alcohol abuse and the legacy of the "dop" system. (Editorial). SAMJ 1998; 88: 1093-1095.
2. Provincial Administration of the Western Cape. Strategic Management Team for health. Draft Provincial Health Plan. Cape Town: Ministry of Health and Social Services, 1995.
3. Scully P. Liquor and labour in the Western Cape, 1870-1900. In: Crush J, Ambler C, eds. Liquor and Labour in Southern Africa. Athens: Ohio University Press, 1992: 56-77.
4. Te Water Naude J, London L, Pitt B, Mohamed C. The DOP system around Stellenbosch – results of a farm survey. SAMJ 1998; 88: 1102-1105.
5. London L, Nell V, Thompson ML, Myers JE. Health status among farm workers in the Western Cape – collateral evidence from a study of occupational hazards. SAMJ 1998, 88: 1096-1101.
6. Louis Jonker, KWV chair, quoted in the KWV Producers Newsletter, July 1997.
7. London L. The "dop" system, alcohol abuse and social control amongst farm workers in South Africa: a public health challenge. Soc Sci Med, (in press).
8. Kritizinger A, Vorster J. The labour situation in the South African deciduous fruit export industry. Executive Summary. Sociological Research Programme. Stellenbosch: University of Stellenbosch, 1995.