In the onion fields at Dutoit Agri’s Kromfontein farm, Annah Khontsiwe chats with farmworkers after educating them about the risks of heat stress. (Photo: Sue Segar/Spotlight)News & Features
6th February 2026 | Sue Segar
The health department in the Western Cape is partnering with farms in the Cape Winelands to provide easier access to healthcare for farm workers. Spotlight unpacks one such partnership and why it is a triple win for workers, businesses and the government.
It’s a sweltering January afternoon on the Kromfontein farm in the Koue Bokkeveld, north of Ceres in the Western Cape. At least a hundred farm workers are busy harvesting red onions in a vast field, with the rugged Cederberg mountains as a backdrop.
A quiet stillness hangs over the fields. Workers are covered from top to toe to protect themselves from the sun as they fill the yellow crates with freshly picked red bulbs. Not far from where they are harvesting is a water truck, where the workers can go to cool down and rehydrate.
As they work, a bakkie rolls up with two community health workers who walk onto the field. Annah Khontsiwe and June Jantjies are from Kromfontein farm’s clinic. They are based there as part of a unique initiative between Dutoit Agri and the Western Cape Department of Health and Wellness. Through this partnership, clinics have been set up on their farms in line with the department’s focus on place-based care. This system makes healthcare significantly more accessible for workers who once needed to travel long distances and miss work to visit a clinic.
Dutoit Agri has 11 clinics on their Western Cape farms and packhouses, employing 14 community health workers, all overseen by four clinical nurse practitioners. The figures speak for themselves. “From January to December 2025, our Western Cape farm health workers saw 18 545 people and the sisters saw 16 959,” says Mariette le Roux, who coordinates healthcare services for Dutoit Agri.
Inviting the workers to gather around her, Khontsiwe tells them about the dangers of heat stress. She and Jantjies urge them to watch out for signs of heat illness in themselves and their fellow workers, such as dizziness, excessive sweating, or a fast pulse. “If that happens, you must sip water and go and cool down in the water wagon,” says Khontsiwe.
These are seasonal workers paid between R9 and R18 per crate depending on the cultivar. At the end of February, they’ll start harvesting potatoes. Each year, Dutoit Agri grows and harvests approximately 250 000 tons of fresh produce, including apples, pears, stone fruit, onions, potatoes, sweet potatoes, pumpkins, and garlic.
Established in 1893, the Kromfontein farm forms the core of Dutoit Agri’s fruit and vegetable farming operations. Dutoit Agri operates as part of the Du Toit Group, one of South Africa’s largest family-owned businesses of its kind. The company manages multiple farms across the Western and Eastern Cape, spanning more than 5 000 hectares, with packhouses located nationwide. During peak harvest season, it employs over 8 000 workers.
Into the Cheeky pear orchards to talk health
An hour or so later, having driven through endless acres of fruit trees, Khontsiwe and Jantjies arrive in an extensive orchard where more workers are picking pears. “These are the Cheeky pears,” says production manager Werner Lubbe.
This time, Jantjies explains to the gathered workers how tuberculosis spread through the air, and that its symptoms include coughing, chest pain, and general fatigue. “We don’t have to die from TB. We can take treatment,” she says. Jantjies then discusses the risk factors, the tests to diagnose TB, and what treatment entails.
What’s noticeable on both farms is how the farm workers engage willingly with the healthcare workers. That’s because Khontsiwe and Jantjies have already built relationships with most of the workers, through being available at the farm clinic every day, to deal with most aspects of their health. “They know us and they trust us,” says Jantjies.
Back at Kromfontein’s clinic, which offers a comprehensive package of primary health services, Jantjies says: “We can take blood pressure, test blood sugar, and test for HIV and TB, as well as do HIV counselling.” The clinic’s work extends to family planning, epilepsy, and emergencies like cuts or other farm accidents. “Whatever condition we can’t help the patient with, we refer to our nurse.”
Sister Sophia Kötze, a clinical nurse practitioner and head of health for Dutoit Agri’s clinics, visits Kromfontein’s clinic twice a week to help with more complicated health issues.
Jantjies, 53, has lived on Kromfontein all her life and Khontsiwe, 52, started as a general worker in 1999. They do regular home visits to their clients. Both were identified as leaders by the farm community to train as health workers. Originally from the Eastern Cape, Khontsiwe added the much-needed resource of speaking isiXhosa, a language spoken by many of the farm workers.
“We have more than 200 HIV-positive people on treatment at our clinic, and only one who is not viral load suppressed,” says Khontsiwe.
Long distances to clinics in the Witzenberg farm district
Dutoit Agri’s Kromfontein and Tandfontein farms are in Witzenberg, which is the smallest sub-district in the Cape Winelands in terms of population but the biggest in geographical area. The long distances make delivering healthcare services a challenge. The six government mobile clinics operating in the area travel 7 000 kilometres a month to get to the people they serve. Patients on the Dutoit farm Tandfontein would have to travel nearly 40 kilometres to their nearest clinic at Op die Berg had it not been for the outreach service.
Thousands of people come to work on farms in the area, from the Eastern Cape and other areas – and they regularly present with health issues, says Handri Liebenberg, director for comprehensive health services in the Cape Winelands.
At Ceres Hospital, Spotlight meets Witzenberg medical manager Dr Elton Titus who oversees private partnerships in the district. He says reaching farm workers through traditional health systems has always been a challenge.
“Farm workers operate in a ‘no work no pay’ environment so they sometimes delay seeking medical treatment,” he says.
“The kind of partnership we have with the Du Toit Group and others gives us the opportunity to get services to the people rather than them coming to the facility. This model sees the farm managers being willingly involved in healthcare,” Titus says. “It keeps their employees well, and well employees are productive,” he says, adding: “It improves access to health, and decongests our facilities.”
To Nooitgedacht farm and the Dutoit packing house
At Dutoit Agri’s Nooitgedacht farm, healthcare worker Nolonyuko Siboto helps farm workers with a range of health needs. She says she’s in constant contact with the nurse who supports her, and who visits the clinic twice a week. In the afternoons, Siboto helps at the farm creche.
Next, Spotlight visits one of Dutoit Agri’s enormous packing facilities where fruit is sorted, cleaned, packed and stored, and where more than a thousand people come to work every day, and where Sister Annemarie Rust runs the dedicated clinic.
“We do everything here, from TB and HIV care to general primary health care, family planning, and chronic treatment,” she says. “Then if there are any work injuries, we deal with those too.”
Johanna van Wyk, who has worked as a packer for the past ten years, says she previously had to go to the clinic in Prince Alfred, but this is way more convenient for her. “It’s very good to have Sister Rust here. She knows me and listens to me, and she explains step by step what is wrong with me,” she says.
The partnership between the health department and Dutoit Agri is a win for all parties, says Madelein Bester, deputy director for comprehensive health services in the Cape Winelands. “For the patient it’s a win, because of easier and better access. For the employer, it’s good for productivity and for staff wellbeing and for the department, it gives us a bit more capacity to deal with patients in our government clinics.”
Fourteen years in the making
About 14 years ago, while Liebenberg was overseeing the clinics in Witzenberg, it became clear to her that more needed to be done to support healthcare for farm workers.
“The pressure on the clinics in the area was enormous because a lot of people coming to work on the farms were not healthy. They suffered from chronic diseases – HIV, TB, and diseases of lifestyle. They needed the full range of care, including medication, counselling and different types of interventions,” says Liebenberg.
She explains that, in the past, farmworkers often had to travel long distances to reach the nearest clinic, with little or no public transport available. Mobile clinics usually visited farm communities only every six weeks, which meant workers often waited a long time to get the help they needed.
We knew we needed to do something, but the biggest motivation came from the farmers,” she says. “Dutoit approached the health department, saying they wanted to look after their people, but couldn’t send them to the clinic for the whole day.”
And so, the partnership was forged.
“We started very small, with the department of health offering training to farm health workers, and then Dutoit appointed their first professional nurse. It grew over the years. They now have three paid nurses (with a fourth to be appointed) with 14 community health workers in full-time clinics,” says Liebenberg. For her, the Dutoit collaboration is a “blueprint” for similar projects.
She says the health department has agreements with two other big farming groups Graaff Fruit and Laastedrif, with a third due to be signed soon.
Liebenberg says the department employs a different model in the Breede Valley. “For instance, through a collaboration with the Department of Agriculture, we have trained nearly 100 healthcare workers to work at the wine cellars, including Slanghoek, Opstal, Goudini and most of the big cellars in the Breede Valley area. They now have community health workers on the farms,” she says.
“Through funding from an NGO, and assistance from SA Winery, the department of health provides a farm nurse to assist the community health workers. We haven’t established clinics yet in these Breede Valley farms, and we focus more on preventative services. That project has been going for three years, and we are building on it to provide a similar service to that on the Dutoit [farms],” says Liebenberg.
“In other districts, including Stellenbosch, Drakenstein and the Langeberg, we have public-private partnerships related to nurses at the clinics. We have different models, and different types of service-level agreements with different farm clinics, and we are constantly looking at new possibilities for partnerships,” she says.
According to Liebenberg, more and more farmers are expressing interest in collaborating with the department. “There are good people out there who want to do good things,” she says.
