UNGWERU

UNGWERU

From: Social Work Student.

Post Office Box 20350,

Luwinga.

To: The Executive Secretary

Post Office Box 20350,

Luwinga.

RE: REPORT ON THE FACT FINDING VISIT TO EKWAIWENI.

Find attached a report on fact finding visit to Ekwaiweni.

Regards,

Alexander G. Mwale

SOCIAL WORK STUDENT

1.0.REPORT ON THE FACT FINDING VISIT TO EKWAIWENI.

1.1. INTRODUCTION

Ungweru as an organization, work with the vulnerable groups of people of which some are Home Based Care Committees and AIDS Support Groups. When support is available the organization provides the groups with it. However for support to be utilized to its optimum level require groups to be ready, well organized and focused. For instance, from Wednesday the 10th of March 2010, Ungweru Youth started a vegetable seed distribution to all the groups that work with Ungweru of which Ekwaiweni was one. During the previous visit to Ekwaiweni, it was noted that relations are strained between and within the ASG and HBC and possibly with the local leadership in the area.

According to them this manifested as discrimination especially when it comes to distribution of support meant for the vulnerable groups of people of which they feel they deserve. Management thought it wise that the issues be resolved first before seed distribution for it to serve its intended purpose. It is because of this that the CPC assigned Alexander to go to Ekwaiweni for Fact Finding/situation analysis. The visit was conducted on the 12 of March 2010 hence this report.

This report therefore,highlights issues that have been unearthed during a situational analysis visit to Ekwaiweni, an area of Traditional Authority Mtwalo. Areas of focus included relationship between AIDS Support Group (ASG) and HBC, composition of the executive committees, catchments area, number of clients registered by each group, partnership and type of support they get and concerns raised in the previous Ungweru visit to the area. The report is as follows:

2.0. PURPOSE OF THE VISIT

To find out the situation on the ground regarding the relationship among Home Based Care Committee, the AIDS Support Group and the community.

2.1. INFORMANTS

These included:

  • AIDS Support Group Executive Committee members.
  • Home Based Care Executive Committee members.
  • Medical Assistant for Ekwaiweni Health Centre (in charge of the Health Centre).

2.2. RELATIONSHIP BETWEEN HBC AND ASG.

2.2.1. Home Based Care and composition of Executive Committee.

According to Ungweru, the ideal situation is that a Home Based Care Committee is above an AIDS Support Group. It is responsible for the care ofall the chronically ill. It is supposed to source different types of supplies and support of which some is supposed to be given to ASGs.

However, during the visit it was discovered that for an HBC group bearing the name of Ekwaiweni, ASG is what is above the HBC. The situation is like this due to the fact that their HBC originated from the Support group. In addition to this, the other complication is that the area has more than one HBC committee. The HBC committees are as follows:

  • The first to be established was Tafika HBC group which is fully supported by Ekwendeni Mission Hospital. It has its own executive committee.
  • There is also an HBC committee run by YOGAFO. According to the information sourced, this is an established organization as such it writes and submits proposals to potential donorsto run their organization. They also have their own executive committee.
  • The third one is that of Ekwaiweni HBC that has links with Ungweru and is exclusively run by PLWHAs. (It is claimed that the second and thirdgroup receive support from the Health Centre). They claimed that they thought of establishing this to beat the discrimination of PLWHAs in the area, lack of confidentiality by non reactive volunteers, to adequately support and preserve the dignity of fellow PLWHA who are chronically ill. They observed that the difference in HIV status eroded their commitment. Not only this but also to further educate the community, they visit everybody regardless of the status.
  • The fourth HBC Committee is a Combined HBC Committee which has members from all the groups. This links all the three committees with the Health Centre (Government).

The role of the combined committee is to receive reports from all the HBC groups in the area, consolidate them into one and send it to Mzimba District Assembly.

The groups take it as their main committee, sometimes when they meet they share drug supplies which they get from different sources.

2.2.2.CATCHMENT AREA AND OPERATION.

According to the information sourced from Ekwaiweni ASG and HBC, except for the combined committee, each committee has its own volunteers. However, they all operate within the same catchments area what differs are the days of visiting the clients/the chronically ill.

2.3.0. REGISTERED CLIENTS.

Since the groups operate in the same catchment area and there are no boundaries, they have and serve the same clients. Thus the registered clients are the same for all the groups.

2.4. PARTNERSHIP.

Ekwaiweni and YOGAF HBC get their support from the health centre while Tafika gets it from Ekwendeni. However, it seems Tafika is well supported than the other two because for the other groups the last time they got support from the Health Centre was mid 2009. Thus one HBC kit for each, for Ekwaiweni it seems this was the only support they got as a group.

3.0. AIDS SUPPORT GROUP.

The group explained that there is only one support group. All the willing people that are positive regardless of the HBC group they belong to join Ekwaiweni Support Group. It is registered with NAPHAM.

While this might be true their need to find out why others are complaining about differential treatment when they go to Ekwendeni Mission Hospital if they all belong to one group.

RELATIONSHIP BETWEEN HBC AND ASG

  • ASG draw its membership from HBC.
  • In Ekwaiweni HBC set up, ASG help to contribute money and supplies like maize flour for the operation of HBC. In this set up the two groups is almost one.

RELATIONSHIP BETWEEN ASG/HBC AND THE COMMUNITY.

  • The groups claim that the relationship is fine with the community and are happy that they have several groups because this means increased resource base.
  • They also claimed that the relationship with chiefs is fine because before entering the village they ask for permission which they usually grant.
  • In terms of support, they said they have never embarked on an activity that requires community physical support, if required they think the community can provide.

OBSERVATION AND CHALLENGES THE GROUPS FACE.

These apply to all HBC and ASG.

  • Duplication of effort; since the groups have no boundaries despite operating in different days, they still find themselves directing more support at one household as clients do not disclose if they were assisted already especially for food aid.
  • Support meant for the vulnerable like them for instance coupons are shared with thewellto do of the society. Precisely, coupons sent are few and distribution is not honest thus procedures are flouted by the chiefs.
  • Chiefs’ failure to explain and stress to the community on priority of the support which misguide many of the community members which end up manifesting as discrimination.
  • K100 fee required to be paid at Ekwendeni Mission Hospital to access ARV which hinders others to consistently follow the clinician prescription. This is very dangerous as it result in the virus developing resistance.

SUGGESTED SOLUTIONS

After the discussion I tried to probe to explore possible opportunities available in the community which included the possibility of accessing ARV through:

  • Mzuzu Central Hospital where ART is free. The challenge here was transport which led us to explore other means of transport which included Ambulance from MCH or PLEM vehicle, a construction company that has a quarry site in the area. Again, the challenge was that there are no designated days when an Ambulance comes to the Health Centre, it comes on request thus when there is an emergency case. PLEM still remained an avenue to explore further.
  • For the K100 fee at Ekwendeni, I thought of consulting with the DHO starting with the Medical Assistant at Ekwaiweni. I suspect that the practice at Ekwendeni Hospital contravenes some of the provisions in the Malawi ART Policy otherwise there might be a better explanation to this.
  • PLWHAs of the area contributing transport money for several individuals to Mzuzu Central to collect ARV for others with the backing and certification of the Medical Assistant of Ekwaiweni Health Centre.

A DISCUSSION WITH THE IN CHARGE OF EKWAIWENI HEALTH CENTRE

When I brought the issues in question to his attention, he explained that he is four months old in the area therefore, he could not comment much on HBC-ASG relationship.

On Ekwendeni K100 fee he said he was as well surprised and that it was news to him. He asked for time to consult with the District ART Coordinator whether it is right for Ekwendeni to press the fee on PLWA when they get their supplies from Government. We shared the contacts and progress will be communicated.

He expressed doubt over sending clients representatives to Central Hospital considering the procedure required for one to access ARV as it mostly require an individual to be their.

REMARKS AND SUGESTIONS

  • There is a need to explore further the relationships among the concerned parties so as to identify opportunities that can be turned into solutions to some of the challenges the groups are facing. For instance, they all meet at combined HBC and some at ASG.
  • Capacity building/orientation of the combined committee to take charge of the situation thus embarking on restructuring and device better ways of operation that avoid duplication.
  • The ASG need several trainings of which one should be on advocacy to enable them lobby for their course both in the community and outside.

CONCLUSION

The practice of assessing the groups before rendering support is a good idea if the support is to serve its intended purpose. It is also helpful to both the sponsoring and benefiting organization because it leads to the deeper understanding of challenges, opportunities and device solution. In addition, it also helps identify other stakeholders’ role in solving some of the challenges. In consideration of this, I am of the view that the organization should continue with this practice. However, ensuring that solutions are found and implemented is of paramount importance.