SACBC AIDS OFFICE REPORT, JANUARY TO DECEMBER 2015
The antiretroviral (ART) programme which has been supported by PEPFAR since 2004 came to an end in May 2015. More than 45 000 people have been initiated on ART at 22 sites over the history of the programme. The patients at most sites had been transferred to Department of Health (DOH) facilities over a number of years as PEPFAR and Department of Health priorities were changed and re-focussed, and in 2015 only two of the SACBC sites remained. Nazareth House in Johannesburg and Tapologo in Rustenburg which had been among the first sites started by the SACBC AIDS Office were the last two sites remaining in 2015. Both now receive funding for their operations from the respective provincial Department of Health. The SEAD analysis of the two clinics and of DOH clinics in the same districts, requested by the Centres for Disease Control (CDC) managing the PEPFAR-funded programme, had indicated where the DOH capacity to treat people on ART could be complemented by Tapologo and Nazareth House, and how much it would cost the Department to support patients through the faith-based sector (FBO) sector. It proved a major challenge to ensure that funding was received in the current financial year to support the programme. Both sites will face challenges in the new year around whether they continue under the DOH, or whether patients will need to be transferred into DOH clinics. South Africa now has over 3 million people on treatment according to the latest estimates, and the SACBC AIDS Office made a major contribution, especially in the start-up phase. The challenge to programmes now is to accompany people on ART to ensure their adherence to treatment.
Funding for the Orphan and Vulnerable Children (OVC) programme which began initially in 2006 ended in May 2015. Because of its success and because of the needs facing orphaned
and vulnerable children, the Centres for Disease Control, the body overseeing PEPFAR funding decided to extend funding for the OVC programme, at least until September 2016. This time the SACBC AIDS Office is a sub-recipient of funding through three different PEPFAR partners, each working in different districts. Scale up of services is expected in certain priority districts. This has meant that the SACBC AIDS Office has had to give higher target numbers of children and guardians to be served in some of the projects. It has also meant that new project sites have had to be established in some districts. This has been very challenging for everyone as continuing sites have new expectations placed on them, and new sites have had to learn from the beginning about the programme. Staff of the SACBC AIDS Office have risen to a number of challenges as the sites are all over the country. Our new PEPFAR partners are Aurum, Beyond Zero and Health Systems Trust.
Our new PEPFAR funding is till September 2016, with at this stage no guarantee of funding beyond that.
The CDC requested evaluation on our OVC programme was completed in February 2015. The Department of Family Medicine at the University of Pretoria undertook the research on eight selected projects in different parts of the country. The findings outlined in the report are edifying and a tribute to everyone’s hard work. Certainly the project has made a difference in the lives of children, many of whom have no/little other support than what is received from project personnel.
A huge emphasis in 2016 will be on providing HIV Counselling and Testing (HCT) services and tuberculosis (TB) screening to people in response to the call of the Minister of Health and of the South African National AIDS Council. There are still too many people in the country who do not know their HIV status, and who remain at risk of transmitting the virus to others. A related challenge for everyone is treatment adherence, and much remains to be done to ensure that people on treatment do not default.
GLOBAL FUND and DFID: Home-based Care (HBC), TB screening, OVC services
In April 2015 we began the final year of the Global Fund programme which has supported both HBC and OVC sites. Over the course of the grant there have been changes to the programme around what indicators needed to be reported on, what districts the programme could operate in, and what sites could be included.
The National Religious Association for Social Development, the prime partner through which we have received the funding, has not been successful in being included as a prime partner in South Africa’s new application in 2015 to the Global Fund. This means that a number of religious sector programmes will not be continued under the Global Fund unless they are taken over by another organisation receiving Global Fund funding. One SACBC AIDS Office site has recently been transferred out to another funder to give it a better chance of having continuing funding beyond March 2016. Funding for the remaining SACBC Global Fund sites will more than likely end in March 2016.
The British DFID funded TB screening programme was completed in March 2015, having exceeded its targets, and having been extended into a number of additional sites over the life-span of the grant. This was in the main because of the drastic weakening of the Rand against Sterling, resulting in our receiving more money in Rand terms than had been budgeted for. The programme was extended into Swaziland as well as to additional sites in South Africa. An external evaluation was completed by the School of Nursing of the University of the Free State in collaboration with Dr Ruth Stark, retired country director of Catholic Relief Services. The study outlined the contributions made to the community through the door to door campaign making possible the screening of all household members in the houses targeted. Those found to be TB positive in follow up testing were initiated on treatment through their local clinics. Part of the TB screening programme was run with Department of Health funding at other sites. That DOH programme through the SACBC AIDS Office was not renewed in the new financial year 2015/2016.
ORPHANS AND VULNERABLE CHILDREN (OVC)
An Irish donor, Catholic Relief Services and Holy Family support have also ensured that vulnerable children in other smaller projects could also be supported. The most vulnerable children in these projects have been supported with services around health care and education, psychosocial support and food gardening. This small programme which runs in Swaziland and South Africa is expected to continue in 2016.
Homeplan, Misereor and private German funding have been received to continue building simple two-roomed houses for child-headed and grandparent-headed families in rural areas. Since 2010 the SACBC AIDS Office has overseen the construction of over 400 houses. In the second half of 2015, contracts were again signed with Homeplan in Holland for the construction of houses in Pomeroy (Dundee Diocese), Tzaneen, and Manzini (Swaziland). Misereor funding allowed for the training of several youth in basic building skills, and they have since then been employed in the construction of houses funded by both Misereor and
Homeplan. It is hoped that a new proposal to train youths in another diocese in basic building skills and have them build houses will be funded by Misereor.
The SACBC AIDS Office called for retreats for caregivers and grandparents, as well as some youth, across its programme, and one retreat took place in each of the projects receiving support through the AIDS Office. People have valued these retreats which give them time out for reflection and for debriefing. They pray and celebrate the sacraments, valuing in particular the sacrament of healing or a healing service, and have often called for more retreats or longer retreats. Funding for these retreats came from Mensen met een Missie, an anonymous donor and PEPFAR. Funding has been secured from Mensen met een Missie for some retreats in 2016, and it is hoped from another donor.
The SACBC AIDS Office managed part of the Fleizser Legacy funding at various projects in Gauteng at the invitation of Christian Aid in London. The funding had been bequeathed by a South African who had died in London to the “poor of Johannesburg.” Beneficiary projects are working with the handicapped (Sizananani and Little Eden), refugees (Mercy House, Bien Venu), children (Nazareth House, St Francis, Moya Kids Community Care, the Love of Christ Ministries, Emmanuel Place of Hope, Good Shepherd), the elderly (Frederic Place, Nazareth House, St Anthony’s Day Care Centre, Kholofela Centre, Holy Cross Home), drug addicts (Mercy House), the homeless (Catholic Women’s League).
The SACBC AIDS Office had some staffing changes related to funding uncertainties in the first half of the year, with some people resigning. However it was also possible to offer time limited contracts to some new staff. The AIDS Office now has 15 full time staff members, and the part time services of the finance manager of the SACBC.
The Global Fund Programme reached 1602 patients with home based care services, with a special focus on ART adherence support and 1564 OVC with child and youth care services in priority districts identified by the Global Fund within the 5 inland provinces of South Africa. There were four HBC sites, and four OVC sites. The sites supported are Ahanang (Gauteng: Sebokeng); Good Shepherd, Motupa & Mokgolobotho (Limpopo: Phalaborwa & Tzaneen); Vezokuhle and Tiyimiseleni (Mpumalanga: Hazyview).
15 home based caregivers at Ahanang were trained by NICDAM on HAST [HIV, AIDS, STIs and TB] and 9 careworkers from Ahanang, Ekuthuleni, Tiyimiseleni and Vezokuhle completed the full child and youth care course with National Association of Child Care
Workers (NACCW). Caregivers at Ahanang, Ekuthuleni, Good Shepherd Phalaborwa, Tiyimiseleni and Vezokuhle attended healing retreats at various times during the year.
40 HBC caregivers were deployed. These caregivers were deployed at Ahanang (11), Phalaborwa (10), Motupa (5), Mokgobolotho (5); Vezokuhle (9). There are at least 40 ART adherence support groups across all 5 HBC sites.
40 OVC caregivers were deployed. Ahanang had 10 caregivers and there were 22 caregivers each at both Ekuthuleni and Tiyimiseleni. Vezokuhle had 6 OVC caregivers. OVCs received food plates, food parcels, school uniforms, household goods as well as services such as counselling, homework assistance, referrals, etc. 612 children were counselled and tested for HIV across the four sites.
The major challenge is the high care worker turn over at the sites and the constant need for ongoing training. Another challenge experienced particularly with the program shift from traditional HBC to adherence support groups was the unwillingness of clients to disclose their HIV status and be part of the support groups, which led to shortfalls in targets set by the Global Fund.
The programme is designed to address the targets set by the Department of Health around HCT and early detection of TB through:
- Preventing new HIV and TB infections by means of HCT for youth and symptomatic pulmonary TB screening.
- Sustaining health and wellness through support groups for clients on ART.
- Ensuring protection of human rights and improving access to care through allthe services offered to beneficiaries at the various sites.
The programme is coming to an end in March 2016. We remain hopeful for more funding in order to continue with the good work that has already began at the sites, especially with HCT and support groups.
SACBC AIDS Office OVC programme provide following services to children, youth and guardians: HIV Counselling and testing, TB screening, HIV prevention education, child protection, psychosocial support, general education and household economic education.
Site implementation monitoring systems (SIMS) Visits were conducted at seven projects, namely Sithandizingane, Kroonstad, Tapologo, Sicelimpilo, PE AIDS Committee, Kids Care and Support Trust and St Elizabeth Children’s Programme. This enabled the sites to put in place necessary policies and guidelines and also ensure that they follow the South African National guidelines during service delivery. 2445 children were assisted with school uniforms and 171 households were renovated which benefited 602 children. There are high rates of HIV stigma among the OVC guardians which results in low numbers of children reached through testing. Teenage pregnancy is still a challenge.
In 2016 the programme will prioritize HIV testing and TB screening and aim to ensure that all children and guardians and youth tested HIV positive are initiated on ARV treatment; will strengthen adherence support and counselling for children, youth and guardians on ARV treatment; will encourage sites to conduct camps for boys and girls and strengthen the support groups for both HIV positive and negative children; and will also strengthen the referral system at a site level. It will also ensure that all the children eligible to receive grants are assisted.
The OVC projects managed to host HCT and TB Campaigns during March 2015 with the help of SACBC AIDS Office once-off funding. A total of 8710 children and 3425 adults were reached during these campaigns. A total of 4344 children was reached through HIV services from January to September 2015. The sites continue to offer bible sharing to the children during the after school care programme activities. The retreats for both child care workers and guardians were conducted at different sites during February and April 2015 and a total of 469 child care workers and guardians benefited.
Holy FamilyThe site funded through the Holy Family grant (receiving monthly tranches) was Sivile Housing Association (Kokstad Diocese). The main focus during this period was nutrition, health and education, through activities such as vegetable gardens, distribution of nutritional supplements, school attendance monitoring, homework assistance, HIV counselling and testing and TB screening.
168 children (93 girls and 75 boys) between the ages of 0 and 17 who are orphaned, vulnerable and poverty-stricken, benefitted directly from the Holy Family project in Shayamoya informal settlement, Horseshoe and Bhongweni villages. 6 caregivers and 3 managers were able to get stipends for their contributions.
The major challenge was of human resources, the stipends were not as substantial as the caregivers would have liked. There was a high staff turn-over, which ultimately resulted in the closure of Sivile Housing Association’s OVC Project.
The program of helping the most vulnerable children is continuing until March 2016 at 3 different sites: Good Shepherd (Manzini Diocese); Sizumndeni (Mariannhill Diocese) and Zanethemba (Dundee Diocese).
Catholic Relief Services
The programme is for the care of orphans and vulnerable children, with a special focus on children of school going age (07-17 years). The sites supported under this programme were Ikhaya (Archdiocese of Durban); Good Shepherd, Siteki (Manzini Diocese); Siyabathanda (Archdiocese of Durban) and Sizumndeni (Mariannhill Diocese). 818 children were reached through this programme, 458 girls and 461 boys. The main focus of the CRS programme during this period was nutrition, health and education, through activities such as vegetable gardens, distribution of nutritional supplements, school attendance monitoring, homework assistance, HIV counselling and testing and TB screening.
334 children had access to vegetable gardens and 595 children received nutritional supplements through this programme. Homework assistance and reading classes were given to 405 children to improve their performance at school. Voluntary HIV counselling and testing was offered to 189 children with the consent of their parents and 174 children were screen for TB symptoms using a questionnaire.
Home Based Care and OVC care is the main focus for the Irish Donor Programme. Ithembalethu Outreach Project (Durban), Kevelaer Mission Sukumani Sakhe (Mariannhill), Siphithemba (Durban) and Zanethemba (Dundee) were supported through this programme. Nutritional support through food parcels and food plates, HIV counselling and testing, TB screening, referrals for TB suspects and treatment support are the services that are offered to clients under home based care. Body Mass Index (BMI) measurements, clinical nutrition via nutritional supplements for severely undernourished children, nutritional support through food parcels and food plates, HIV counselling and testing, TB screening, referrals for TB suspects and treatment educational support and psycho-social support are the services that are offered to children between the ages of 0-17 years who are orphaned and vulnerable through HIV infection, who lack parental support and who live in resource-scarce households.
Clinical nutrition was given to 390 undernourished children. 276 children were trained and counselled in TB. 394 children were given food plates and 34 were given food parcels based on household needs as assessed by caregivers. Psychosocial support services such as memory box and tree of life were also provided. 231 Home Based Care clients were trained and counselled on TB. 284 clients were screened for symptoms of TB using a questionnaire. 231 clients were given voluntary HIV Counselling and Testing. 62 clients on TB treatment were given treatment adherence support in the comfort of their homes.
Some sites; e.g. Siphithemba and Christ the King had very weak relationships with local government clinics, so facilitating HCT was tricky for these sites. Kevelaer Mission was new to the programme and took a little while to catch up with the reporting requirements of the programme.
MONITORING AND EVALUATION (M&E), PEPFAR ART AND OVC PROJECTS
The SACBC M&E team supported two ART sites, Nazareth House and Tapologo in the Gauteng and North West provinces respectively. The programme came to an end at the end of June 2015. Patients were transferred to the Department of Health as part of the transition process. The two sites used the SQL patient database system (PDS) to report statistics data under PEPFAR. Patient data at these two sites was successfully imported into the Department of Health TIER.net system as part of the transition process.
The SACBC M&E team has also supported 39 OVC sites located in the Eastern Cape, Free State, Gauteng, Kwazulu Natal, Limpopo, Mpumalanga, North West and Western Cape. 24 of these sites were supported under the PEPFAR grant that came to an end in May 2015. Fifteen (15) of these sites are new and have been taken on by SACBC in conjunction with other PEPFAR partners namely HST, AURUM and Beyond Zero as of October 2015. In the period January to September 2015, 12839 OVC received services. 3465 received clinical nutrition, 12804 education support, 11118 OVC HIV prevention education, 4344 HIV services, 2026 household economic strengthening services and 5037 child protection interventions.
SACBC implemented the full paper based system and the SQL electronic Child Database System (CDS) at all 15 new sites in October 2015. 317 Caregivers were trained on M&E paper based reporting tools. About 34 M&E project site staff members were trained on M&E reporting tools including the paper based system, the CDS, management of filing systems to ensure that data quality assurance processes are in place at sites. SACBC M&E staff conducted periodic data quality reviews on sites’ CDS database systems to ensure data reliability and integrity. The CDS has been modified to align with the 2015 PEPFAR OVC priority indicators, including TB screening and HCT for guardians which will aid in reaching South Africa’s 90-90-90 targets for HCT and TB screening.
Site Implementation Monitoring System (SIMS) assessment visits were conducted at selected OVC sites by representatives from the Centre for Disease Control (CDC). Most of our sites visited were rated high (above 80%) during these assessments. These assessments aided sites in highlighting areas of strength and weakness. Plans have been put in place at sites to work on improving systems where they may be weak. Representatives from the Office of the Global Affairs of the USA Department of Health and Human Services visited one of our OVC sites in Erkurhuleni, Sithandizingane. The delegates got the opportunity to see how an OVC site operates. They also interviewed two OVC served by the project and one child care worker. They were able to clearly understand how the children have benefited from the PEPFAR OVC programme.
Challenges encountered during the reporting period include high child care worker staff turnover at some sites. Whilst every effort has been made to ensure that all sites report on all indicators some sites still under-report on some indicators. We continue to reiterate the importance of accurate reporting to all sites to prevent under reporting.
SACBC M&E is working towards exporting data from our electronic data system (CDS) to CBIMS, the Department of Social Development national reporting system, in order to align our M&E reporting with the government guidelines; this will especially aid the sites that also provide services under the Department of Social Development (DSD). The exports are in progress for different programs under PEPFAR and Global Fund. We expect these exports to be done in the first half of 2016.
Retreats were supported by PEPFAR, Mensen met een Missie and an anonymous donor. Spiritual retreats were conducted for caregivers, child and youth care workers, guardians and youth, allowing them the chance to debrief and deal with stress and burnout in a safe environment. Indirect beneficiaries are those who live and work with the retreat participants, and those who benefit from their services.
Sites in the existing network of the SACBC AIDS Office were identified, enabling many people to be reached across the whole programme. Some projects in the Catholic network not receiving other any funding from the SACBC AIDS Office also qualified to be included. Many participants in their evaluations of the retreat experience spoke of renewing their commitment to their work, and being energised to continue serving those in need.
31 caregivers were able to attend a life skills workshop aimed at strengthening their stress- coping abilities. Catholic students and other youths were also given an opportunity to participate in the beatification ceremony of Blessed Benedict Daswa through this programme in September 2015.
For the PEPFAR retreats, both child care workers and guardians were part of the retreats, conducted at all OVC sites during February and April 2015 and a total of 469 child care workers and guardians benefited from the program.
The anonymous donor supported training of retreat givers who went on to conduct retreats, and 16 retreats for 19 sites across the various programmes of the AIDS office. These covered 8 dioceses and 457 participants: Good Shepherd Siteki, Vezokuhle Home Based Care, Christ the King and Regina Mundi, Mariannhill Diocese AIDS Programme, Polokwane Diocese Welfare and Development, Kevelaer Sukumani Sakhe & St Michaels Mission HBC, St Nivards Centre, Ikhaya Community Development and Thandukuphila, Siphithemba Caregivers Elandskop, Sithembele Awareness Program, Ithembalethu Outreach Project, Sukumawenze Place of Care, Usizo Lwethu Clinic, Bloemfontein Youth Desk, Mamosa Home Based Care, Tiyimiseleni Home Based Care.
The Mensen met een Missie retreats project supported 17 retreats. 443 youth, and 357 caregivers and guardians were reached at Johannesburg AIDS Ministry, Zimiseleni DOTS and HBC, St Joseph’s Care and Support Trust, Good Shepherd Mission Clinic, Duduza Care Centre, Assisi Shelter for Children, Holy Cross Home, Catholic Health Care Association, Siwananedlala Multi-Purpose Centre, Ekuthuleni Multi-Purpose Centre, Siyabathanda CBO, Sizumdeni Care Centre, Sivile Housing Association RSA, Good Shepherd Care AIDS project, Mamosa Home Based Care. Seven retreats targeted youth specifically. In collaboration with the SACBC Youth Office, youth retreats were organised for the Diocese of Manzini, Youth Ministry in Umzimkhulu, Diocesan Youth Team, Catholic Vicariate of Francistown, KZN Cluster Retreat, Youth Ministry Port Elizabeth.
Matching the groups of retreatants to retreat masters who are based in the same diocese and speak the same language as the retreatants was a big challenge as the retreat givers had various commitments. There is a need for more retreats for the sites. There is now a bigger pool of retreat-givers for sites to choose from.