Project Reference No: 12- A-081 PROJECT REPORT Project Name: Container & Fit-out for health clinic in squatter camp, Rustenburg Organisation Name: SERVE (in partnership with Tapologo) Date Funds Received: 02/10/2012 Referee: Ms. Valerie Little Notes to Reporters: A brief, concise, and to-the-point report of two three pages is what we require. Insert as much text as you feel is appropriate, but do not feel obliged to write a long report when a short one would suffice. The questions in Sections 1-5 must be clearly addressed. A report must be sent within 12 months of funding – even if the project is incomplete. Failure to do so will disqualify you from consideration for further funding.
Transcript
Project Reference No: 12-A-081
PROJECT REPORT
Project Name: Container & Fit-out for health clinic in squatter camp, Rustenburg
Organisation Name: SERVE (in partnership with Tapologo)
Date Funds Received: 02/10/2012
Referee: Ms. Valerie Little
Notes to Reporters:
A brief, concise, and to-the-point report of two three pages is what we require. Insert as much text as you feel is appropriate, but do not feel obliged to write a long report when a short one would suffice. The questions in Sections 1-5 must be clearly addressed.
A report must be sent within 12 months of funding – even if the project is incomplete. Failure to do so will disqualify you from consideration for further funding.
Reports should be submitted by e-mail to [email protected]. In exceptional circumstances, hard copies may be sent to:
Ireland1: Projects Outcomes – the results achieved.
(Include here a brief comparison between original project goals and actual outcomes.)
The main aim of this project was to purchase and install a new container (completely fitted-out) at Tapologo's HIV/AIDS Wellness Clinic in Boitekong community, near Rustenburg, South Africa. The new container was needed to provide additional work space for staff, improve the quality of health services and increase the number of people the clinic can manage. Briefly, the expected benefits included:(i) Resolution to problems of overcrowding and long waiting periods for patients;(ii) More privacy for patients during consultations that can be very sensitive and personal;(iii) Ability to meet increased demand (expected to grow by 20-30% in medium term) for services at Boitekong;(iv) Improved attendance rates for approximately 400 patients registered on the Anti Retroviral Treatment programme;(v) Improved working environment for staff working at Boitekong;(vi) Reduction in occurrence of cross infections and opportunistic infections affecting clinic users; and(vii) Ability to maintain Outreach Programme to over 550 people who benefit from visits from 14 Home Based Caregivers who use Boitekong Wellness Clinic as their base.
Progress
The project work was started in October 2012 and was completed by early June 2013. The new clinic has been in use since June. The following results were achieved:
(i) According to the project coordinators, the problems of overcrowding and long waiting periods have been resolved. The additional space has significantly improved the options for staff to manage large numbers of patients;(ii) Patients have more privacy during their consultations due to additional space being available at the clinic. This is important for people considering the ongoing stigma around HIV and AIDS, and the fact that each day new people receive the difficult news that they are HIV positive;(iii) In the short term the number of people using Boitekong Wellness Clinic has dropped (see Section 3 below for the reasons). Tapologo assess user numbers in a block of 6 months, and across 4 categories - number of clinic visits, number of regular patients, number of patients on ART and number of patients benefitting from Home Visits from Home Based Caregivers based at Boitekong. The trend is best presented in the following table. As noted in Section 3, Tapologo expect the user numbers to increase in the short term and medium term.
Care Category Jul 12 - Dec 12 Average Jan 13 - Jun 13 Average %
changeClinic Visits 576 477 -17%Number of regular patients
560 524 -6%
Patients on ART 289 120 -58%Home Visits 676 715 6%Total 2101 1836 -13%
(iv) The ART Programme suffered the biggest drop off rate due to the reasons outlined in Section 3. At the time of the application (June 2012), there were 394 patients registered on the ART Programme. As of June 2013, there are 115 patients registered. Tapologo expects this number to increase in the coming months;(v) The key staff at the Boitekong Clinic have reported better working conditions, allowing them to provide a better level of care to patients. There is one full time professional nurse, one full time auxiliary nurse and counselling staff working from the Centre (along with Home Based Caregivers);(vi) Health staff have reported a decrease in the risk and occurrence of cross infections and opportunistic infections. The additional treatment space has allowed staff to separate patients who are at risk of infecting others e.g. with TB and bacterial pneumonia; and(vii) There are now 12 Home Based Caregivers based at Boitekong clinic. The number of beneficiaries from Home Visits has increased by 6% since December 2012, and the additional storage space and services offered as a result of the new container will help to maintain this improvement.
2: Financial Accountability – how the money was spent.
(Include here a brief financial account of the spending of the ElectricAid funding. Also account for any unspent balance. Receipts as appropriate should be attached.)
Application Expenditure Report No Narrative Budget € Electric Aid € SERVE/Local €
11 x 12m insulated container divided into 4, including transport costs & VAT
15,061 15,061
2Extend cabling and tie into new container 946 946
3Paving at front of container and link up with existing 2,247 2,247
4Extend water supply to new container 378 378
5Extend waste water to new container 662 662
6Removal and replacement of gates to facilitate delivery 236 236
7Roof over paved area at entrance doors 1,192 1,192
8
Local contribution of expertise from Head of Tapologo Physical Infrastructure and Operations and Maintenance Department
900 900
9Labour contribution from Tapologo Operations Team - 12 days @ €88 per day
1,058 1058
10Annual running costs €18.92 x 12 months (Excluding staffing costs, see note below)
227 227
Total 22,907 15,061 7,846
The project was achieved as per the budget because the price for the container was agreed with the supplier and the costs of additional work were set by Tapologo and carried out within budget.
3: Project Process Narrative – how the project was implemented or progressed to date.
(Include here difficulties encountered, problems overcome, lessons learned etc. We are particularly interested in your experience in implementing projects such as solar power, micro-finance, rotating credit schemes.)
Funding was transferred to Tapologo on October 4th 2012. Site preparation work started in January 2013 with the ground being levelled and plinths installed. Plinths were necessary due to the weight of the container and the soft soil conditions in this area. The container was ordered in January. There was a slight delay in delivery, which took place in early March. The electricity, refuse and water connections were installed within two weeks. Work began on the external site in mid March including roofing, seating and paving. This was done to connect with existing roofing which improves conditions for patients who have to queue outside. This work was completed by the end of April. The clinic was used for the first time in June 2013 and there have been no problems reported to date.
The main difficulty was that Tapologo experienced a significant drop-off in beneficiary numbers (especially on the ART Programme) between October 2012 to June 2013. Tapologo’s ART Programme funding from PEPFAR (USAID) ended as scheduled in May 2013, meaning that Tapologo faced a significant reduction in funding for ARV drugs and blood testing services if no alternative was put in place. For the previous two years, Tapologo had been negotiating with the South African Department of Health (DoH) to meet the costs of ARVs and blood testing services. Tapologo wanted this agreement to be finalised well in advance of May 2013 so
there would be enough time to inform donors, partners and patients to minimise the disruption to services. A formal agreement between DoH and Tapologo was finally agreed in April 2013. However, in the absence of this formal agreement Tapologo was forced to start transferring its ART patients to the nearest DoH clinic to collect their ARVs at a rate of 285 patients a month. From October 2012, this had a major impact on beneficiary numbers and affected Tapologo targets. At Boitekong, there was a 58% reduction in the number of people receiving ARVs from the clinic between January - June 2013. The formal agreement resolved this serious issue and patients are currently being moved back to Tapologo clinics, although given the numbers involved this is an administrative challenge. Tapologo are confident that patient numbers will increase from June 2013 onwards. The improved facilities at Boitekong will help Tapologo continue to provide comprehensive HIV and AIDS care to this community. 4: Visual Report – photographs.
(Attach some photographs in electronic format of project implementation & results).
Container Placed on Plinths
Container on Plinths, opposite side and prior to other works
Roofing Works Commenced
Roofing in Progress
Paving Completed
Patients Waiting to Use new Container in the Clinic
Electricity Connection Inside Container Water Connection Inside Container
5: Your Comments.
(Include here any other comments, learnings, or suggestions you have for ElectricAid)
One of the most significant learnings to emerge from Tapologo's difficulties with the ending of PEPFAR funding is that patients prefer to deal with Tapologo rather than DOH clinics. This is because Tapologo provides holistic services (counselling, support groups, nutritional support and home visits) which DOH clinics do not provide. The location of Tapologo clinics in squatter camps also reduces transport costs for patients. In addition it emerged that the local government clinics could not handle the increased number of patients. Doctors in these clinics wrote to the DOH requesting that patients be returned to Tapologo. This shows the crucial role played by the NGO sector in South Africa's response to the HIV and AIDS pandemic, in a context where government structures cannot cope with the numbers of people needing treatment. Although it was a challenge for Tapologo to secure agreement, the current model whereby the government covers the costs of ARVs and blood testing services, and Tapologo uses its experience to implement the ART programme, is an excellent example of coordination and maximising resources.
