KAP survey

As part of the project, we have to do three KAP surveys, one at the start, one in the middle and one at the end. KAP stands for knowledge attitudes and practice and the idea is that we survey the areas that we are working in and assess the levels of knowledge, right attitudes and correct and safe practices with regards to HIV and nutrition, measuring the impact of the project on the communities.

We asked a local social marketing NGO to collect the data, after I had designed the survey method, the questionnaire and the analysis template. They know the areas and the key people to ask directions etc from. I am so glad we did. They came back with stories of thigh high rivers, and impenetrable roads.

There has been a crazy amount of rain recently and this made it all much more difficult. They had one bumper dented, after they slid in the mud into a ditch, two tyres punctured, and a punctured oil tank, probably from a stray stone. They had to cross borders into South Africa and Mozambique to get oil and sealant for the tank, as it was the nearest place. I was told that when they asked where the nearest mechanic was they were pointed towards a big mountain that they would have to walk over, as there was no transport.

Normally when you are collecting data for a survey you employ this technique where you choose a house to survey, following a complicated and long random selection process. Then you go to the next nearest house on the right. In Swaziland the houses are very spread out, for many reasons, and when the data collectors asked one man where the next nearest house was in a certain direction, the reply was, “40 minutes drive.” As a result of this drama it took four days longer than planned. Not bad really considering the conditions.

Initial results look good - really good actually. It seems that levels of knowledge and attitudes have improved, and even though practices have often not improved significantly, people are aware that it’s not good to have a diet consisting of only maize in various forms. The barrier is no longer mostly a lack of knowledge and financial means, mostly just financial means now. This is a major step forward!!

The training sessions for year one are now over and have been very popular in the communities with lots of positive feedback. Participants express that they have learnt a lot of useful information and also that they have had a good time - exactly what I was going for! I thought I’d include this picture taken from one of the final training sessions that we were doing in Shiselweni, in the south of the country. A nutritionist, Patience showed me the picture she had taken and said “Look! Even the cows want to come and be trained!”



Next year we will revisit everyone we have trained and do refresher days, in addition to visiting them in their communities and supporting them to integrate the nutritional information we have given them into their daily activities as a community health worker or volunteer.

Stars are being born!

We are officially seeing results - almost a year after the project started, but it's a good strong start. I believe in starts!

This lovely lady is Takhona. This photo is of her concentrating during the training we were giving in her are. She laughed her head off when she saw it. I'm going to try and get a print to her. This might be a bit difficult as she lives in the most remote place. She lives in Hosea which is a very rural are of Shiselweni, mostly it's remote because of the quality of the roads. You can't imagine! A normal car would definately not make it! She has a son, and volunteers in her local neighbourhood care point (NCP). This is a small structure, sometimes supported by a charity, which provides food and basic education for children in the area who are either orphaned or otherwise identified as vulnerable. So, they eat together, play together and often can be found singing songs together. The volunteers from these NCPs seem to be the least educated of all the groups we are training. They don't have too much trouble learning, as we have designed everything to be accessible for people who have limited literacy and have not attended formal education, but it is clear that this is the group with the most difficulties in literacy.

Back to Takhona (which means she is here!), she has become a star. She has begun regularly screening the children who attend the NCP where she works and has so far identified 5 children in need of supportive malnutrition treatment. She refers them to the clinic as we taught her and then gives us a call to let us know she has found some malnourished children, and what state they were in. We then inform the ACF nutritionists who work supporting the health facilities, who know to look for these children next time they visit the clinic for a monitoring visit.

Here she is screening the children. Hopefully in the future there will not be the need to track these children so closely after referral, but it helps us sleep at night to know that once referred they arrive and are admitted to the programme for care. Quite often after referral, the children actually do not attend and this is why the tracking is needed. There are many reasons for this. Sometimes the clinic is quite far away and the family don't have money to pay for the transport. In these cases, we get a call from the people we have trained in the communities, asking for advice. We encourage them to visit these families at home and try and communicate how important it is to get treatment and save the lives of their children. I think I have spoken here before about how difficult it is when this fails.

For now, we have trained 4205 people. We are following up as many as possible and helping them to help their communities. When it works, it's tremendously exciting - for the ACF trainer/nutritionists and for me! I keep telling them - "Don't underestimate the importance of the work you are doing!". When the someone they have trained in the community identifies children who are malnourished, sends them for treatment and the children get better, this is so much easier to believe!

Field visits

We had a field visit yeaterday from IBFAN - the big breastfeeding campaign NGO. They have some funding to do some training in Swaziland as part of a bigger programme in many countries. They wanted to come and see what training was happening in Swaziland and therefore visited us an our project. They attended a training in Siphofaneni, and arrived just in time for breastfeeding and infant and young child feeding practices session.

Their conclusion was that the training was excellent. I was so proud of the nutritionist delivering the training. IBFAN were tranlating for those who didn't understand siSwati and so I was able to hear exactly what she says when she is training the community workers on breastfeeding and complementary feeding. She is good. They said, she is excellent. :o) I texted her to congratulate her and I get the impression she was a bit overwhelmed at the complement. She was'teary eyed'! I always tell the team that I will give them both good and bad feedback when I hear it from other people. It's great to be able to give good feedback.

It's looking increasingly unlikely that we will be able to find a Swazi national to replace me when I finish here. People are either brilliant technically (they know about nutrition and HIV) but have no project management experience and so would struggle to run the project well, OR, they are great project managers, but have no knowledge or interest in the technical side and would rather command a boardroom than chat to RHMs about the difficulties of preparing a balanced meal. The latter also tend to want double my salary too. I think they might be shocked to find out what I earn. It's totally fine for me and my lifestyle but most Swazi's seem to want more.

Maybe that's because they have more familial responsibilities, everybody has children. Also, families have no qualms about asking for support from those relatives who are employed. Culturally, it's impossible to refuse to help.

On the otherhand, they need to recognise that ACF is a humanitarian NGO and this concept seems to have difficulty in the translation. Don't get me wrong, I'm all for professional salary for professional job but in the context of a humanitarian NGO, the expectations, (normally from expats, who are footloose and fancy free) are mostly different.

Maybe this should change, but who wants to fund enormous salaries for a humanitarians, who mostly have the image of cigarette in hand, sandals, cotton shirts and bead necklaces?!? Maybe the humanitarian NGO worker needs a spot of PR, to be taken more seriously, if the salaries are to reflect the level of professionalism of the work that is delivered.

Like I say, it works for me, but then I'm footloose and fancy free. Let me just check the label of my shirt to see if it's cotton...... :o)