The development of a digital NGO mapping platform in Tanzania, as a tool to strengthen civil society engagement, in pursuit of Universal Health Coverage

The role of civil society in economic development, improving livelihoods and in providing pathways towards achieving health for all has become increasingly evident. By mapping these organizations, the scope and scale as well as existing capacities, gaps, and opportunities are brought to light. This paper describes the implementation of a digital mapping platform for NGOs; an interactive site which collects, analyses, and visualizes data from a variety of sources about NGOs in Tanzania, through a series of interactive maps, graphs, and charts. We describe the approach and the technology used to develop the platform and its potential contribution towards improving health outcomes. A situation analysis and needs assessment exercise was conducted in February 2023. The developed system requirement specification document served as the guiding document in the design and development of new modules. Participatory techniques and agile iterative methodologies comprising regular stakeholder engagement were employed. A distributed revision control system was used to keep track of system revisions. The modules were deployed to the production server at the National Internet Data Center (NIDC) server room, followed by a system commissioning activity in October 2023. The NGO Information System, NGO Digital Mapping tool, NGO Analytic tool, NGO Search tool and NGO Opportunities module were designed, developed, and commissioned to support NGO operations in Tanzania. The platform was launched during the annual NGO Forum in Dodoma, Tanzania, on October 5, 2023. The modules are publicly accessible and are housed within the NGO Information System (NIS) platform. Investment in whole-of-society engagement to build health systems resilience for universal health coverage is crucial. Leveraging the unique positioning of NGOs draws us a step closer to the ambitious goal of achieving health for all. Through this one-stop web application system, information on the near real-time status, existing gaps, and opportunities for collaboration to serve communities is readily available for all stakeholders. Wide dissemination and enhancement of utilization of the platform across all sectors is now needed, for data to truly inform action.

Challenges of caregivers providing care to children with disabilities at non-governmental organisations in Tshwane townships, South Africa

Caregivers of children with disabilities are vital stakeholders when it comes to safeguarding the health, well-being and overall survival of the children that they care for. Caregivers, however, face many challenging conditions that make it difficult for them to optimally fulfil their caregiving role. Understanding these challenges is crucial for developing empowerment programmes for caregivers, which will ensure that children with disabilities receive comprehensive, optimal care and that caregivers experience a good quality of life. Objectives: The aim of this study was to explore and describe the experiences of caregivers providing care to children with disabilities at non-governmental organisations (NGOs) in townships of Tshwane, South Africa. Method: This study followed an exploratory, descriptive and contextual research design within a qualitative methodology. The population in this study included caregivers who care for children with disabilities at NGOs (n = 10). Participants for the study were selected using the purposive sampling technique. Data were collected by conducting semi structured interviews with caregivers. Data were analysed according to the six phases of thematic analysis proposed by. Results: The study revealed six themes that represent the challenges experienced by caregivers, namely (1) initial impressions, (2) rendering care, (3) stress, (4) lack of outside support, (5) coping and (6) poor community recognition. Conclusion: Support from the Departments of Health and Social Development and other institutions providing community rehabilitation services to townships should be provided to caregivers in order to empower them with skills and knowledge to effectively address the challenges they face so that they can render optimal care to the children they care for. Contribution: Results of this study could assist in ensuring improved recognition, resilience and supportive resources for caregivers in collaboration with community-based rehabilitation stakeholders in the community that would ultimately lead to improved care for children with disabilities in townships within South Africa.

Primary healthcare services in the rural Eastern Cape, South Africa: evaluating a service-support project

Background: In 2012, 38% of the South African population resided in the rural areas of the country. The professional healthcare services are concentrated in the urban areas, resulting in an imbalance between urban and rural healthcare services. Aim: The aim of this study was to evaluate the use of a non-governmental organisation (NGO)-supported mobile healthcare service in a remote area. Setting: Eastern Cape Province in South Africa. Methods: The walking distance between the community and the nearest fixed government healthcare service was evaluated and compared with the recommendations of World Health Organization (WHO). Services provided to people visiting the mobile community service were recorded, and descriptive data were analysed and compared with the anonymised patient records of the nearest fixed service clinic. Results: Of the 30 outreach points served by the NGO, 24 points were at a distance more than the WHO-designated walking distance and 11 points were more than twice the WHO-designated distance from the perspective of fixed clinic. The average headcount per annum of the outreach NGO mobile clinics exceeded those of the fixed Department of Health (DoH) clinics by an average of 250 patients per clinic session. The increase in services was also noteworthy, with a mean differential of 1774 services per annum for the same day above that of the DoH clinics. Conclusion: Mobile services could make a difference to the utilisation of essential healthcare facilities. The provision of augmented NGO-led mobile clinical outreach services and joint government­NGO partnerships holds possibilities for improving healthcare for those living in remote rural areas

The Challenges Experienced by Nongovernmental Organisations with Regard to the Roll-Out of Antiretroviral Therapy in KwaZulu-Natal

Background: Successful administration of antiretroviral therapy (ART) requires full adherence to the regimen by the patient. The introduction of ART needs a well-functioning health system with adequately trained health professionals; laboratory support; a constant supply of drugs and social systems to assist with patients' adherence and to prevent future treatment failure. Objectives: The objective of this study was to explore and describe the challenges experienced by nongovernmental organisations with regard to the roll-out of antiretroviral therapy. Design: A qualitative; exploratory and descriptive study was conducted to determine the challenges experienced by nongovernmental organisations (NGOs) with regard to the roll-out of ART in KwaZulu-Natal. Nine participants were included purposefully from the NGOs that participated in this study. Data were collected through semi-structured individual interviews. Open coding for analysis was used. Results: The findings revealed four themes: challenges relating to sustainability; adherence; health infrastructure and behaviour. Conclusion: The results indicate a need for multisectoral collaboration in the roll-out of ART to ensure a concerted; comprehensive and sustainable programme

Perceptions of HIV/AIDS Leaders about Faith-Based Organisations' Influence on HIV/AIDS Stigma in South Africa

The extent of the HIV pandemic - particularly in the hardest-hit countries; including South Africa - has prompted a call for greater engagement of all groups; including faith-based organisations (FBOs). Although FBOs are known to play a substantial role in providing care and support to those affected by HIV and AIDS; empirical evidence in regard to their actions in the broader context of stigma is limited. A qualitative; key-informant survey was conducted in South Africa as part of a six-country international study to examine perceptions of how FBOs have contributed to reduction in HIV risk; vulnerability and related impacts. The special emphasis of this paper is the influence of FBOs on stigma and discrimination. In-depth interviews were held with 34 senior-level key informants who act as key decision-makers in the response to HIV and AIDS in South Africa. Secular and faith-based respondents shared their perceptions of the faith-based response; including FBOs' actions in relation to HIV/AIDS stigma and discrimination. Our study revealed that while FBOs were perceived as taking some action to address stigma in South Africa; FBOs were also thought to contribute to HIV/AIDS- discrimination through conflating issues of sexuality and morality; and through associating HIV and AIDS with sin. The interviewees indicated a number of internal and external challenges faced by FBOs to deal effectively with stigma; including lack of information and skills; the difficulty of maintaining confidentiality in health services; and self-stigmatisation which prevents HIV-infected persons from revealing their status. Findings from this study may help both faith-based and secular groups capitalise on the perceived strengths of FBOs as well as to elucidate their perceived weaknesses so that these areas of concern can be further explored and addressed

Unrecognized Victims: Sexual Abuse against Male Street Children in Merkato Area; Addis Ababa

Background- Sexual abuse and exploitation of male children is one of the emerging social problems affecting the physical; social and psychological wellbeing of children in Addis Ababa. The magnitude of the problem seems much worse among the street boys because of their precarious living conditions. However; very little is known about the problem so far and it is apparently one of the least researched issue in the country. Objectives- This paper explores the extent of the problem and reasons that expose children to sexual abuse around Merkato area; Addis Ababa. Methods- The study employed a combination of quantitative (small scale survey) and qualitative methodology (indepth interviews; focus group discussions (FGDs) and case history interviews) involving a total of 221 children and key informants selected using convenient and snowball sampling.Findings- Quantitative data revealed that about 28.6of male street children had been abused. Physical and mental immaturity of the children; secrecy and lack of awareness; use and abuse of drugs; the nature of street life; exposure to pornographic films and limited legal enforcement were found to be major reasons which predispose street boys to the risk of sexual abuse. Conclusions- Sexual abuse against male children around Merkato area is rampant; but received less or no attention from concerned governmental and non-governmental organizations. Using child rights framework; the study suggested various preventive; protective and rehabilitative measures that should be taken to address the problem

Wellness Programme and Health Policy Development at a Large Faith-Based Organisation in Khayelitsha; South Africa

This paper presents a case study of wellness programme and health policy development based on an HIV/AIDS organisation's Khayelitsha site in the Western Cape Province; South Africa. The study examines the different challenges that the organisation faces in relation to its predominantly low-income staff; donor-driven structure; its limited resources and organisational capacity; and the highly stressful and demanding nature of HIV-related treatment and care. This case study also examines the significant and contentious challenges lying in the organisation's faith-based identity. Research began with a review of civil society organisations' responses to HIV in sub-Saharan Africa; as well as related topics; such as South Africa's public health system; and health-seeking attitudes; beliefs and behaviours in high-risk South African communities. The organisation's health policy was analysed and 'workshopped' with multiple employees. Focus groups were conducted with mid-management and fieldwork staff in the Khayelitsha office; while a comprehensive; anonymous; wellness questionnaire was distributed in order to collect quantitative data. Data acquired from the questionnaire responses and the focus group discussions indicated that wellness programme and health policy development faces its greatest challenges on two fronts; namely due to a critical lack of organisational development and capacity; and a host of practical; social and cultural challenges among the most vulnerable people whom the NGO intends to serve. The study's primary recommendations include: taking its employees' cultural and social norms into consideration; addressing issues related to capacity and organisational development with the major donors; broadening the scope of its health policy to extend beyond issues related to HIV; and examining and clarifying expectations of employee behaviour in light of its identity as a faith-based organisation. The study also issues a secondary list of recommendations for other resource-constrained NGOs that also wish to develop and implement wellness programmes and health policies in their workplace

Examining the Actions of Faith-Based Organizations and their Influence on HIV/AIDS-Related Stigma: a Case Study of Uganda

Background: Stigma and discrimination are widely recognized as factors that fuel the HIV/AIDS epidemic. Uganda's success in combating HIV/AIDS has been attributed to a number of factors; including political; religious and societal engagement and openness - actors that combat stigma and assist prevention efforts. Objectives: Our study aimed to explore perceptions of Uganda-based key decision-makers about the past; present and optimal future roles of FBOs in HIV/AIDS work; including actions to promote or dissuade stigma and discrimination. Methods:We analyzed FBO contributions in relation to priorities established in the Global Strategy Framework on HIV/AIDS; a consensus-based strategy developed by United Nations Member States.Thirty expert key informants from 11 different sectors including faith-based organizations participated in a structured interview on their perceptions of the role that FBOs have played and could most usefully play in HIV/AIDS prevention; care and support. Results: Early on; FBOs were perceived by key informants to foster HIV/AIDS-related stigma and discrimination. Respondents attributed this to inadequate knowledge; moralistic perspectives; and fear relating to the sensitive issues surrounding sexuality and death. More recent FBO efforts are perceived to dissuade HIV/AIDS-related stigma and discrimination through increased openness about HIV status among both clergy and congregation members; and the leadership of persons living with HIV/AIDS. Conclusions: Uganda's program continues to face challenges; including perceptions among the general population that HIV/AIDS is a cause for secrecy. By virtue of their networks and influence; respondents believe that FBOs are well-positioned to contribute to breaking the silence about HIV/AIDS which undermines prevention; care and treatment efforts

Expansion of HIV-1 Screening and Anti-Retroviral Treatment Programs in a Resource-Poor Setting: Results from a Faith-Based Organization in Jos; Plateau State; Nigeria

Background: Until recently; availability of anti-retroviral therapy (ART) in Nigeria has been limited to government and university based programs. Through the United States' President's Emergency Plan For AIDS Relief (PEPFAR); additional funding has become available for the treatment of HIV-positive patients. Objective: To report the expansion of HIV-1 screening; enrollment in an ART program; and treatment outcomes over twelve months among HIV-positive patients at a nonprofit; non-governmental faith-based clinic providing free and holistic care in Jos City; Plateau State; Nigeria. Design: This was a retrospective analysis of HIV-1 screening and ART received by patients at Faith Alive Foundation Hospital (FAFH). From January through December 2005; voluntary counseling and testing (VCT) was freely available to all patients who requested it. Also beginning in December 2004; HIV-1 infected patients were enrolled in an expanded HIV/AIDS program at FAFH; where patients in clinical stages 3 or 4 based on World Health Organiza- tion (WHO) clinical classification; or had a CD4+ cell count of less than 200/ ml; were initiated on a simplified highly active ART (HAART) regimen through PEPFAR funding. Data from the first six quarters of the FAFH-PEPFAR ART program are presented here. Additionally; analysis of 645 patients who have received ART for one year; including changes in CD4+ cell count from baseline is shown. Results: In 2005; a total of 7672 persons received VCT and 3869 (50.4) HIV-1 positive results were found. From October 2004 to March 2006; the total number of patients enrolled in the FAFH HIV/AIDS program rose from 1330 to 5946 people. Over the same period; the number of patients who received ART increased from 302 to 1667. A majority of patients received an oral ART regimen consisting of generic nevirapine; lamivudine; and stavudine. The number of patients initiated on ART each quarter ranged from 57-578; and the number of deaths of patients on ART was between 12 and 21 people per quarter. Analysis of 645 patients initiated on ART during the first quarter of the FAFH-PEPFAR ART program revealed that the median CD4+ cell count at baseline was 106/ml and the median increase was 173/ml (median time of follow-up; 7.0 months). Conclusions: Comprehensive HIV/AIDS care has been significantly expanded at FAFH; a free and holistic medical center in Jos; Nigeria. Cumulative data from the first year of this PEPFAR-funded ART program indicated that promising outcomes are achievable through delivery of care at this faith-based medical center

How to make ends meet in district hospital

In this text the author describes his own personal experience of how to finance a mission hospital in rural Zambia. Indeed; many small district hospitals in developing countries including some run by non-government organizations have to learn to live on the edge of bankruptcy. In Zambia; the author had at most 20.000 visits a year to his mobile MCH clinics that linked up with seven stationary rural centers run by medical assistants; and 23 village clinics run by community health workers. For most of the 16 years he worked there he was the only Doctor

The role of an African non-governmental organization in the field of HIV/AIDS control : the exemple of AMREF; Tanzania

Tanzania has reported 27396 AIDS cases up to june 1991. These represented 29.5 per cent of all AIDS cases reported in Africa and 7.5 of all cases reported globally. Therefore the African Medical and Research Foundation (AMREF); Tanzania; has; since 1988; developed a programme for HIV/AIDS control which covers the support of National AIDS Control Programme; HIV/Sexually Transmitted Diseases intervention project and HIV/AIDS education and condom promotion in high transmission areas