Front-Line Staff Overcome Growing Pains: The ... - CreativeBox

SUCCESS STORY

May 2016

Front-Line Staff Overcome Growing Pains: The Mphatlalatsane Project, Lesotho

The project is collaborating with existing OVC and child services in the communities to mobilize resources to increase access and uptake of HIV testing and treatment as well as psychosocial support, economic strengthening, and legal protection. MSH staff are trained and regularly supervised to deliver the intervention sessions. The staff are organized into teams of two an intervention facilitator and a community-based mentor. They have distinctly different, yet equally vital roles: •

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Background The Mphatlalatsane Project in Lesotho is part of the Orphans and Vulnerable Children (OVC) Special Initiative, which is funded and directed by the US Agency for International Development (USAID). The Initiative is a three-year effort that seeks to integrate community-based social programming with clinical services to improve the survival, growth, and development of OVC. Programs in three countries with large populations of OVC and some of the highest HIV prevalence rates globally Lesotho, Swaziland, and Zimbabwe will generate data through randomized control trials (RCT) to evaluate new strategies to reach children with integrated interventions. The evidence from these RCTs will be used to inform and improve coordinated programming throughout the southern African region. The Mphatlalatsane Project targets caregivers and children aged 1 to 5 years, providing holistic support for children’s minds and bodies at the most critical point in their development. It is expected to reach more than 1,000 child/caregiver pairs from 2015 to 2017. The project is being implemented in the district of Mokhotlong, a mountainous area with scarce arable land, high rates of poverty, endemic HIV infection, and a limited presence of civil society organizations. Health indicators in this district are poor. The Program Approach Meaning “early morning star” in Sesotho, the Mphatlalatsane Project is implemented by the USAID-funded Leadership, Management and Governance (LMG) Project of Management Sciences for Health (MSH). It uses a multipronged approach that delivers cognitive stimulation mentorship to a child’s caregiver (biological parent, grandparent, or other primary caregiver) through trained facilitators.

STRONGER HEALTH SYSTEMS. GREATER HEALTH IMPACT.

Intervention facilitators teach preschool teachers and the caregivers and their children to practice “book-sharing” an interactive shared reading strategy that stimulates the child cognitively and encourages caregiver-child engagement through episodes of joint attention. Caregivers will learn to use interactive behaviors—praise, displays of warmth, responsiveness, and sensitivity—to develop their children’s attention skills. Community-based mentors deliver key nutrition messages through practical demonstrations and activities. They conduct health assessments, and weigh children at the beginning and end of the program. They involve primary caregivers in monitoring their children’s growth, and provide referrals and follow up, as necessary. The community-based mentors also play a key role in motivation for HIV testing and adherence to medications for chronic conditions, such as HIV.

The First Challenging Weeks The Mphatlalatsane Project has been implemented in phases. The first pilot, conducted in May and June 2015, reached 70 children at four preschools in Mokhotlong Urban Council. The second pilot, in August and September 2015, reached another 97 children in seven preschools. The full-scale implementation of the project, starting in October 2015, shifted activities to rural and remote villages in Mokhotlong district.

The Mphatlalatsane Project? The Mphatlalatsane Project is a collaboration among the USAID-funded Building Local Capacity for Delivery of HIV Services in Southern Africa Project (BLC), USAID/PEPFAR, the Government of Lesotho, local civil society organization GROW, and Stellenbosch University in South Africa. To provide evidence for an effective and sustainable early childhood care and development (ECCD) model, the project will be evaluated by a randomized control trial, while it reaches more than 1,000 caregiver/child pairs from 2015 to 2017.

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office. It was easy to communicate with people in the office in the event that materials needed for the sessions were missing. The missing materials could be quickly delivered. The situation changed dramatically with the start of the full-scale project and the shift to rural and remote areas. Each team member had to adapt very quickly, to develop new skills to successfully deliver the interventions in the villages for a whole week. It was quite chaotic at first, to remember everything and to go through the checklist of materials to bring to the field. In time, a simpler checklist was developed and spot checks were instituted every Friday between each team and the Coordinator.

Discussions revealed that team members think of their partners as their “better half.” Lic to expe consedi squuntotat doluptur?

On December 11, 2015, LMG organized a feedback session with the 16 staff members who form the eight intervention teams. The purpose was to share their experiences of working in the field. Each team spends one week in a village, delivering the intervention sessions. Discussions revealed that team members think of their partners as their “better half.” The partners are really the only support structure they have while working in the villages. The staff admitted their trepidation when they started in their roles, knowing that at some point they would be shifting the focus of their work from the urban area to the villages in Mokhotlong. As the time approached, some team members felt conflicted fear, self-doubt, anxiety, and excitement. The first week of their work in the rural areas of Mokhotlong was the most memorable to date. “The fact that I had to cross a big river… I was so depressed. It was an emotional roller coaster. I had to regain my strength, but as time went on, it became easier to travel, and I didn’t mind crossing the river,” one staff person remarked. First, the staff wondered if they would be able to fit into village life and adapt to village norms. For some, conditions in the villages were similar to Mokhotlong Urban, with quality roads and close proximity to small shops. Some of the team members could even charge their phones by paying local people who had turned their solar chargers into an entrepreneurial business. However, other team members faced real difficulties. They had to travel to distant villages where the roads were little more than a cleared path, if they existed at all, and the only mode of transport to the village was a horse. In anticipation of this challenge, the project had arranged for riding lessons for team members. But, the landscape is not that forgiving, even on a horse. It is often very steep and very rocky, and these conditions shook even the strongest woman out of her boots. Full-scale project implementation has required a lot of organizational planning and communication, skills that the teams thought would not matter that much. To their surprise, getting to the villages was half the battle. For example, the teams use many print materials to deliver the project’s interventions. During the two pilot phases in the urban areas, conducting the interventions was not difficult. It was easy to travel to the schools and back to the


As mentioned above, each of the eight teams is based in a village for one week. It was sometimes challenging to travel from Mokhotlong town to the villages. Taxis were not always in good condition. Some team members have to ride horses from the village bus stop to the village, while others have to walk very long distances to the villages, carrying refreshments, books, and other materials. The travel day is Sunday for most teams. Travel is sometimes complicated when some team members spend the weekend visiting their families in Maseru. There is also the problem of poor or no cell phone connection in some of the villages. The team members therefore have to be very well organized and self-reliant; they cannot depend on a quick fix by or quick consult with the office.

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The distances and the need for well-planned preparations were not the only start-up challenges faced by the teams. There was also a language barrier in one of the villages. The people are called Bathepu (Xhosas) and their native language is isiXhosa. But the teams can only deliver the intervention sessions in Sesotho or English, which upset the two teams that were based in this community. They were worried that they would not be able to achieve success because of the language barrier. Staff from LMG’s partner organization in the Mphatlalatsane Project, Stellenbosch University, helped with translation during their periodic supervision visits, but they could not be in the village every day. The teams had to devise their own way to cope.

“They started recognizing the importance of neighborhood and it started spreading throughout the village.”

the hygiene of the children in their communities. “One would be scared to tell [caregivers about hygiene] at the first meetings,” but said that with a warm approach, the caregivers took their advice throughout the rest of their stay. Some caregivers were very harsh with the children; they used to hit and scold them a lot during the sessions and after them too. In the sessions with younger children, the children were either too clingy with their caregivers or they did not have a relationship with them at all. There was also some distrust that villagers felt towards one another and these outsiders. The combination of distrust of the intervention teams and the existing squabbles in the communities over resources were difficult to take when the teams first arrived. For example, one team was sent away when they tried to deliver the intervention session because the community demanded that they pay rent for using the preschool. In another community, there was a conflict between two groups over firewood, causing one group to cut off the water supply from the river to other group for over a week. Because of this, the teams survived on bottled water that they brought with them from town.

They allowed the caregivers to practice book-sharing in one-onone sessions communicating in isiXhosa, and some caregivers that could speak both Sesotho and isiXhosa assisted in translating as much as they could. The teams stated that it is easier to get villagers to attend the sessions, saying: “being among them, it was easy, we would say ‘hey, come here!’ but [getting caregivers to attend] in town was very difficult.” On the other hand, staff also reported that the actual intervention messaging was easier convey to the more urban participants. “People in town were easy to understand, but here [in the rural areas] it takes time to make sure they understand. [We had to] motivate them time and again, and understand how to implement work with them.” In a short period of time, the teams have observed positive behavior changes in the different villages. For example, initially, the caregivers and children in all the villages arrived at the sessions looking very dirty. One team said that they were concerned about


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Things improved as the sessions progressed. The villagers claimed that this was because they began to share with their families and friends some of the concepts they learned in the sessions, like talking about feelings and intentions. There were also changes that the teams experienced first-hand. For example, after a while, the caregivers were cleaner and no longer harsh with their children. They were also kinder to one another and other villagers. “They started recognizing the importance of neighborhood and it started spreading throughout the village.” All in all, entire communities seem to have been able to develop healthy relationships because of the book-sharing and nutrition sessions, and the growth and health messages the teams delivered. Although they have grown to love the villages to which they are assigned, staff still look forward to returning to Mokhotlong town every weekend. They come back to the office and submit claims for work-related payments, such as horse rental. They also attend supervision meetings on Fridays. Team members look forward to these meetings, where they have an opportunity to share how the week has gone, discuss the challenges they have encountered, and find solutions together, as a team. After these meetings, the organization work begins again, with preparations for the following

week, including spot checks by the Coordinator. And then everyone leaves for the comfort of their own homes, to rest and recharge electronic equipment. The field work is very rewarding for the teams. In the most recent supervision meeting, staff could not stop talking about how much the caregiver-child pairs have changed since the first sessions. “Since we have arrived, we have strengthened ‘Ubuntu.’ 1 ” The project is not only seeing significant changes in the communities, it is profoundly changing each individual team member, helping them to grow as individuals. The staff admire how most of the communities they serve, despite their lack of access to clinics, basic infrastructure, and schools, manage to cope with their hardships. They now greatly appreciate everything they have and do not have. “Ubuntu,” a word from the southern African region, literally means “human-ness.” It is often translated as “humanity towards others,” but is often used in a more philosophical sense to mean “the belief in a universal bond of sharing that connects all humanity.”

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Launched in 2010, the USAID-funded Building Local Capacity for Delivery of HIV Services in Southern Africa Project (BLC) strengthens government, parastatal, and civil society entities to effectively address the challenges of the HIV and AIDS epidemic.

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For more information contact: Building Local Capacity Project (Regional Office) Ditsela Place 1204 Park Street (Cnr Park and Jan Shoba Streets) Hatfield, Pretoria, South Africa Tel: +27 12 364 0400; Fax: +27 12 364 0416 [email protected]; www.msh.org

Access BLC publications online: www.hivsharespace.net/collection/blc


Throughout the Southern Africa region and with specific activities in six countries, BLC provides technical assistance in organizational development, including leadership, management, and governance in three key program areas: 1) care and support for orphans and vulnerable children; 2) HIV prevention; and 3) communitybased care.

Building Local Capacity Project (Lesotho) 1st Floor, NBC Sechaba House, Alliance Park Four Bowker Road Maseru, Lesotho (Next to Maseru Toyota) Tel: +266 22 316 096

This publication is made possible by the generous support of the United States Agency for International Development (USAID) under the Leader with Associates Cooperative Agreement GPO-A-00-05-00024-00. The contents are the responsibility of the Building Local Capacity for Delivery of HIV Services in Southern Africa Project and do not necessarily reflect the views of USAID or the United States Government.

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