STRATEGY DEVELOPMENT WORKSHOP FOR

THE FRIENDS FOR MATIBI (FFM)

DATES: 16-19 September 2012

VENUE: Matibi Mission Hospital

HISTORY• 4 October 1993 aimed at HIV clients (60km radius) doing CHBC in Maranda,

Mberengwa in the context of limited medical assistance• Also aimed at HIV workplace awareness and alerting community about HIV• Dr Ashwanden, Ssr Magret, Mr Madungwe (nurse), Redcross facilitators,

Driver Mr Gore• Fr Stoffel was mainly interested in IGPs including community garden but

became the focal person for FFM correspondences• Alleviated pressure on Hospital space by engaging home carers to manage

chronic illnesses• Wished to formulate self-help groups in the community and peer monitoring

for CHBC• Worked with district and provincial health authorities and local government• Mr Madungwe began with training in CHBC facilitated by FACT-Mutare then at

Murambinda Hospital where a similar project was taking place

History continued• FFM assisted the development of Matibi Clinic to become a Hospital with 125 beds• Infrastructural development e.g. female, male and children’s wards, outpatients hall, staff residences (9

houses), Munoti Centre, solar powered boreholes• Medicinal supplies, equipment e.g.. Fridges• Donations of cash, clothes and food through Ssr Leoba etc.• Assisted engagement and payment of more nurse aides and installation of Sister in Charge (formerly

Nurse in Charge)• Missereor (from Germany) constructed Matibi Clinic in 1985• When Dr. Ashwandern transferred to Dreifontein where he facilitated the construction of a Nursing

School, Mr Muller remained with Matibi• Dr. Berck did a dressmaking project, donating machines and materials as well as motivating staff• School supplementary feeding and Moyo weTsitsi orphan support (founded by Ssr Leoba) raised

enrolments in ward 3 primary schools. Currently some sisters from South Africa are still supporting Moyo weTsisti

• Stationery kits between 2006-08 kept the schools going eg Home Economics and other prac subjects• Case study of Olivia Shumba, an orphan who started with FFM in Form 1 and is now going to university• FFM came to operate in a context of incessant droughts leading to collapsed services but FFM

facilitated with aid in school fees and medical fees, seed fairs to promote drought resistance

History continued• Apart from FFM, Fr James built a school block, Mushonganeburi

school was supported by Holy Cross Sisters• Dr Ashwanden facilitated training a nurse in theatre and supported

with machines, beds, 4 sterilisers, 2 distillers, theatre regalia. Other clinics eg Neshuro send their machines to Matibi for sterilisation.

• Home craft has ever been supported by FFM with materials (Br Seraffim Fr James, Ssr Leoba, Sister Raphaels) but parents are taking long to appreciate the importance of the project and hence are discouraging saying that the skills may not help in finding employment.

• It can be noted that women who have had skills in Home Craft are finding it easy to handle many household chores and some of them are hired to do home décor outside the country.

St Ambrose• Started 1963 as a boarding boys-only Upper Primary School for Standards

4-6 during colonial era• It grew to become a conventional school between 1972 and 1973 when it

was teaching a national programme called Remove Class, a transitional phase between Standards and Grades

• Ceased operation 1975 during liberation struggle. • 1976 turned into a Home Craft Centre with Sister Gephardt of Gweru

Diocese. Feelings then turned towards the need for a secondary boarding school (Inclusive Community Meeting on -- 2012)

• Masvingo diocese Fr Matibini applied for reregistration in 1999 with a new feeling that the Boarding School should begin from primary to secondary for quality assurance

• Re-registered and resumed operation in January 2013 and is faced with maintenance of blocks,

Dentistry

• Matibi hospital used to have dental service done by Sister Leoba Bramlege who was a nurse trained to do dental work

• Registered dentists later advocated that only professionals do dental work, making it no more possible for able nurses to continue with the service

Dentistry• Dental service is both demanded and scarce in the province as a

whole. In Mwenezi district there used to be one dentist at Neshuro but who is no more.

• Taking it as a separate income generating project needs a different account to be opened

• The project can take a clue from the eye project at Morgenster Mission which has a separate account for their Eye Project

• It could be done by a visiting doctor once per fortnight because the demand is not steady

• Community leaders are willing to mobilise for the dental service as a way of advertising to raise the demand and they believe that people are going to demand the service as has been the case with Eye and X-ray services

CONTEXT• Information about FFM was not reaching to communities as widely e.g. Some knew Fr Stoffel as a donor but did not know about

FFM• Started in an environment where communities were not knowledgeable about HIV but now the project is very welcome• Village authorities supported FFM from start noting the pressure from sick subjects who needed help unconditionally• Other communities used to send their patients to Matibi from as far as Ngundu in Chivi to Sandawana in Mberengwa adding to

pressure on nurses but the CHBC programme engaged the communities successfully and the pressure on health facilities is now less• Government was finding it difficult to finance staff engagement but FFM paid allowances for up to 20 staff members who were not

on government’s pay sheet through a facility known as the Bruno Allowance named after Mr Bruno Muller until June 2013• Government is still faced with critical incapacities to cater for staff allowances so that if no assistance is given then many staffs are

going to lose jobs as many as 20• More than 1/3 of staff at Matibi is seconded from the district being attracted by the Bruno facility. As such the facility may not have

to cease, or at least it should find a replacement of some kind. All in all, about ½ of all staff may be affected directly or indirectly.• Matibi friends are a faith-based organisation who have supported the church at Matibi in many forms (e.g.. Décor cloths, chairs,

candles, garments). Indirectly they have partaken of evangelisation e.g. in educating and leading by examples, e.g. building the new church where communities actively participated e.g. carpenters)

• Currently FFM is operating in a context where government is battling with making social services free-for-all e.g. maternity, under-fives, elderly (65+), mentally ill, TB/OI/ART. Now the hospital has faced challenges in meeting the financial gaps since government has limited resources to support free services leading to deficits caused by advance expenditure based on government directives and promises. FFM has here and there assisted to cover some of these gaps e.g. in assisting the mentally challenged.

• FFM engages a non-discriminatory stance in terms of religion• VHWs have severally forked out their personal resources e.g. money, soap, groceries to assist know patients in the community

because of erratic procurement of allowances . Government and the Holy Cross Sisters used to assist VHWs and CHBC Care Facilitators with these incentives but have slowly failed to meet the level of need further leading to ceasing services.

• Sanitation toilets (30% of ward 3), clean/safe water 55% [District Environmental Health Dept.]

VISION

• A healthy, educated and self-sustaining Matibi community

Issues shaping the vision• Dura-walling of mission premises due to marauding animals and trespassers. As a result it is posing a challenge to

making the place neat.• The hospital is near a township but it is not capable of manning the gates (employing guards).• More houses/flats needed because some houses are housing too many families. • Blair toilets are now full, some of them collapsed (3 closed for siting reasons, 1 collapsed, 4 full)2 Muchingwizi Flats, 2 for Hostels the wards, 2 Mushonganeburi side, 2 church site, 2 at Hospital. There remains only 2 toilet blocks (1 with 5 holes and another with 1)• Food aid for chronically ill clients used to facilitate voluntary disclosure of sero-statuses and this should go on if an

AIDS-free generation is to be achieved• Preschool, primary school and supplementary feeding proving pertinent to cater for orphans and vulnerable children,

some are transferring from nearby schools• CHBC clients are beginning to decline seeking treatment due to erratic supply of food• Community garden serving too many people on smaller area so FFM may assist expand the facility. Gardeners are

faced with too steep slope from the well and they travel over 60m to fetch water. More boreholes needed at least 1.• Insufficient water/sanitation facilities and community volunteer support meaning risks of outbreaks• Matibi community faced with recurring droughts and erosion of household economies threatening to reduce school

enrolments• Communities from over the river Muchingwizi find it difficult to cross to the hospital during rains. HIV clients need to

revive support groups but find it difficult due to lack of food and livelihoods support. Visiting patients at home is still necessary to prevent chronically ill clients to slide back into bed as well as to prevent overcrowding of clients at outpatients department. Outreach also critically needed for rehabilitation patients e.g. metal cases and the disabled.

Vision contd.• Expansion of internet network needed for workers to enjoy the service• Murerezi river has a big donga which makes it difficult for ambulance service to General/provincial

hospital (105km). Worse, the Runde and Save bridges are uncross-able during floods. Via Neshuro 165km; via Zvishavane 182km.

• Staff residences at St Ambrose CPS is shared with Home Craft and very insufficient. The junior grades find it difficult to use the toilets because of too big holes for their age. Next year introducing grade 5. Need for computer lab to house +/- 40 computers. Currently have 9 PCs and a laptop donated from FFM.

• Community leaders promised to actively mobilise communities to own FFM as their own project. They remember drought relief episodes facilitated by FFM. They however, witness thousands of school fees defaulters due to reduced FFM support in that side. VHWs and other volunteers need support for their vital contributions.

• Matibi bridge has been a bone of contention between politicians and the electorate. • Muchingwizi Dam scooping is a necessary and urgent move because it receives rainwater once a year

which is needed for garden, hospital sewage, livestock, building, general laundry etc.• Musaverima Dam water can as well be tapped to serve the hospital since it is perennial located 3km

south of the hospital.• Need for a nursing school in the district to harness local human resources since even the neighbouring

districts Chivi and Chiredzi also have none, even Zvishavane district in the next province Midlands. Thus the nursing schools are concentrated only in the eastern half of the province.

Vision contd.• Congestion in postnatal ward e.g. not meeting the national standard of 3 days before discharge after

delivery, 4 more beds needed• No gadgets to facilitate diversion therapy in the hospital wards e.g. television• Staff ward is needed for nursing sick staff as a way of maintaining a felt-fair environment to retain staff• Currently we have 18 houses (15 for other staff, 3 docs) for 70 staffs thus 1 house shelters an average of 10

people. We need 5 more houses.• Home Craft department needs a craft workshop as well as a storehouse and a classroom. Currently we use 1

room for combined cooking, sewing and storage etc. We can also expand Home Craft to become a poly-disciplinary vocational training centre to incorporate boys as well because the idea is to help those that might have been unfortunate in the conventional schools.

• Need to motivate staff through staff competitions e.g. FFM Worker of the Year Award. Targeted support is needed in issues such as nutrition, maybe through shows or field days.

• Some talents are fading away without being recognised e.g. poets and dramatists• Other institutions have own transport. We need maybe a staff bus to ferry staff about once to and from town

etc.• We have 7 primary and 2 secondary schools in ward 3. Primary school has expanded recently to include Early

Childhood Development (ECD) ranging from 3-year olds implying need for supplementary feeding.• Need for compartmentalised hospital wards for privacy of patient consultation• Retention of doctors needs active strategies e.g. vehicles as benefits• Need for scanning machine and currently there is only 1 old machine

MISSION

• Safeguarding steady access to quality services for the general wellbeing of Matibi community

VALUES

• Commitment to duty• Diligence• Transparency• Honesty• Teamwork

CRITICAL OBSTACLES

• Economic instability• Under-communication• Poor coordination• Discontinuity• Political hijacking• Incompatible cultural expectations

STRATEGIC, LONG-TERM GOALS/DIRECTIONS

1. To facilitate comprehensive healthcare for Matibi community

2. To meaningfully involve individuals and groups of Matibi community in home-grown livelihood activities

3. To build the capacity of Matibi community to access and enjoy competitive educational services at all levels possible

INSTANT GOALS/OBJECTIVES

• 1.1. To contribute to the prevention of, and improving awareness on preventable diseases in Matibi community

• 1.2 To assist Matibi Mission Hospital in meeting the treatment needs of Matibi community

• 1.3 To facilitate comprehensive care and sustainable support for the chronically ill and/or disabled in Matibi community

Objectives contd.

• 2.1 To rehabilitate existing water sources and expand their capacities to cater for community gardens and livestock

• 2.2 To empower out-of-school youths in Matibi community with survival vocational skills

Objectives contd.

• 3.1 To assist St Ambrose Matibi Primary School in meeting its infrastructural and technical needs to offer valuable ECD and primary Education

• 3.2 To contribute to improving accessibility of secondary education in ward 3 of Mwenezi district

• 3.3 To facilitate enhanced local-based staff development and retention at Matibi Mission

INDICATORS OF SUCCESS/ BENCHMARKS

Objective Indicator

1.1 To contribute to the prevention of, and improving awareness on curable and non-curable diseases in Matibi community

• Quarterly rates of mortality and morbidity related to preventable diseases at hospital level

1.2 To assist Matibi Mission Hospital in meeting the treatment needs of Matibi community

• Number of patients treated versus those transferred

• Records of drug availability versus rate of uptake

• Records of equipment availability and functionality

1.3 To facilitate comprehensive care and sustainable support for the chronically ill and/or disabled in Matibi community

• Rate of bed occupancy by chronically ill patience

• Number of outreach visits to chronically ill patients and those with disability

Indicators contd.Obj. Ind.

2.1 To rehabilitate existing water sources and expand their capacities to cater for community gardens, livestock and hygienic needs

• Number of rehabilitated water sources• Number of households benefiting from

water rehabilitation

2.2 To empower out-of-school youths in Matibi community with survival vocational skills

• Number of out-of-school youths graduating from vocational training

• Number of self-help projects started by graduating vocational students

Indicators contd.Obj. Ind.

3.1 To assist St Ambrose Matibi Primary School in meeting its infrastructural and technical needs to offer valuable ECD and primary Education

Number of structures constructedAnnual students’ pass ratesRate of uptake of technical-vocational subjects

3.2 To contribute to improving accessibility of secondary education in ward 3 of Mwenezi district

Number of breakthroughs towards having a functional secondary school at Matibi Mission

3.3 To facilitate enhanced local-based staff development and retention at Matibi Mission

Number of breakthroughs towards having a functional nursing school at Matibi Mission

INFRASTRUCTURE ASSESSMENTProgramme In place Gaps

1. Comprehensive healthcare support

Activity 1.1 WASH • Staff members are digging and utilising rubbish pits but during rainy season they are unusable

• Bins are available but are now old

• The hospital has a big rubbish pit to empty the bins

• 16 households of Muchingwizi flats need blair toilets

• Houses of Mbare area have had their blair toilets closed due to siting reasons

• Church site and primary school need 2 blair toilets and 10 squat holes respectively

• Mushonganeburi suburbs need 2 blair toilets

ACTIVITY 1.2 Medical facilitiesActivity 1.3 Rehab • 15 clients as at August

2013• Physiotherapy home

• User-friendly facilities at clients’ homes

Programme In place Gaps

1. Comprehensive healthcare support

Activity 1.1 WASH • Staff members are digging and utilising rubbish pits but during rainy season they are unusable

• Bins are available but are now old

• The hospital has a big rubbish pit to empty the bins

• 16 households of Muchingwizi flats need blair toilets

• Houses of Mbare area have had their blair toilets closed due to siting reasons

• Church site and primary school need 2 blair toilets and 10 squat holes respectively

• Mushonganeburi suburbs need 2 blair toilets

ACTIVITY 1.2 Medical facilitiesActivity 1.3 Rehab • Hospital has 2

wheelchairs at Munoti Centre facing 15 clients as at August 2013 with Physiotherapy home

• Crashes 46 pairs in stock as at August 2013

• User-friendly facilities at clients’ homes needed

• No wheelchairs for 13 clients in the villages

• No walking frames and hearing aides at Munoti Centre

Infrastructure contd.Programme In place Gaps

2. Sustainable livelihoods intervention

• 1 functional borehole • A total of 5ha garden

(Vhure 2 = 0,8ha; Vhure 1 = 1,3ha; 3 other smaller gardens = 2,5ha; hospital garden = 0,5ha; Home Craft grapes garden = 0,5ha and Home Craft vegetable garden = 0,5ha)

• 8 dysfunctional boreholes

• Silted dam (6000 cubic metres)

• Dam structure vs size and soil erosion leads to siltation

Infrastructure contd.Programme In place Gaps3. Enhanced educationalisation assistanceECD & Primary

Home craft

• Primary school operating at minimum scale

• The classes (total 197 pupils) full showing serious business

• Home craft centre manned by 3 staff members

• Sewing machines, charcoal stoves, ready supply of fibre for fibre work

• Play centre available but has no materials

• School borrowed furniture from church

• No houses for 7 teachers

• No offices, no library, too small computer laboratory

• Using only one classroom for the various disciplines

• Primary school and ECD using same blair toilets posing a risk to smaller kids

• Need for play centre materials and more classroom blocks

IMPLEMENTATION PLANActivity Responsibility Resources

1.1 Rehabilitating 8 dysfunctional boreholes by March 2015

Hospital Administrator • Pumping pipes• Pumping arm

1.2 Procuring medical/surgical/sundry materials as an on-going exercise

Matron • Budget for drugs

1.3 Monitoring services for people with disabilities and the chronically ill as an on-going exercise

HOD Outpatient Department

• Outreach vehicle and fuel

Implementation contd.Activity Responsibility Resources

2.1 Putting back Muchingwizi dam into operation by mid-2014

Hospital Administrator • Earthmoving machinery

2.2 Upgrading Matibi Home Craft Centre into a functional multi-disciplinary vocational centre by December 2015

Head of Home Craft • Building materials• Learning kits for various

vocations (home craft, carpentry, motor mechanics, welding, cookery)

Implementation contd.Activity Responsibility Resources

3.1 Renovating worn-out structures, constructing required infrastructure and procuring provisions by 2014

Teacher in Charge of St Ambrose

Budget and community support

3.2 Mobilising stakeholders towards establishing a secondary boarding school at Matibi Mission by 2017

Teacher in Charge of St Ambrose

Bureaucratic will and community support

3.3 Mobilising staff incentives for hospital and school staff and stakeholder support towards establishing a nursing school at Matibi Mission

Sister-in-Charge of Matibi Hospital

Bureaucratic will and community support

DISSEMINATION PLAN

ActivityTimeframe in Quarters

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11

Adopting strategic plan

Launch of strategic 3-year plan

Staff orientation

Review of implementation

World Health Day CommemorationWorld Literacy DayWorld Telecoms DayInternal evaluation

External evaluation

Strategic plan