Pretoria was the location as field staff that have been part of HPCA’s CaSIPO Project shared their experiences working in the project and more importantly the lessons learned. We heard from District teams namely: eThekwini, Ugu, King Cetshwayo, Thabo Mofutsanyane, Alfred Nzo, Capricorn, Mopani, Johannesburg Health District, Dr Kenneth Kaunda, City of Cape Town, Sedibeng, Tshwane, Gert Sibande, Ehlanzeni, Nkangala & NITAs.
In this 8-part blog series we will be highlighting each district and hear first-hand the individual lessons learned for future activities. Today we highlight the Eastern Cape (Alfred Nzo) and the success that came out of that district and as mentioned before the lessons learnt for future efforts.
Background
The Eastern Cape is home to powerful heroes such as the late tata Nelson Mandela, the courageous Mama Madikizela Mandela, the Spirited Steve Biko, Walter Sisulu, Former President Thabo Mbeki and Enoch Sontonga. The CaSIPO Project operated out of Alfred Nzo primarily in 2 sub-districts (Umzimvubu and Maluti) whereby more than 80% of the CaSIPO adherence clubs are located (in rural areas mainly). 
Unique ways they worked
There were a couple of unique ways in which the CBOs (Community Based Organisations) worked in the Eastern Cape, for example, Masakala Traditional Guest House situated in Masakala in Matatiele which attracts hikers and tourists is owned by the community and the accumulated income is used for community development activities. Furthermore, the CBO runs a sewing project which helps to generate further income for the sustainability of the CBO. 
Obstacles found along the way & how we overcame them
Each district faced unique challenges and in the Eastern Cape this was no different. Some of the obstacles found along the way were for example inaccessibility of some roads due to bad weather which disrupted the Adherence Clubs on return dates. Some more of the obstacles are noted below:
- Driving long distances in rough terrains to attend Adherence Club (AC) return dates restricted time to attend to other project demands such as SIMS development. Combined mentorship was done on the same day to ensure that AC mentorship and SIMS development was done efficiently.
- Some CBOs did not have strong relationships with the clinics that they were supposed to be working with and this therefore threatened the role of CBOs in decanting patients to communities. CBOs were introduced to their respective clinics and follow up mentorship meetings were done leading to the establishment of monthly WBOTs and CBO caregivers progress meetings which helped to strengthen their relationship.
- Adherence clubs were not well received in some clinics and the operational Managers preferring CCMDD and spaced and Fastlane. Training and Mentorship was done with clinic staff including Operational Managers on Adherence Guidelines and SOPs to increase the understanding and buy in.
- The potential challenge of duplication of AC return dates as AC establishment intensified. Multiple clubs being done on the same day at different times.
Learning is growing. What have we learned during our CaSIPO’s journey?
Many lessons were learned in this respective district namely: to always value and make good use of local CBOs, supporting partners, community cadres in your area of operation. To always practise record keeping and documentation of all work done which will reduce unnecessary delays especially when it comes to report writing.
The impact CaSIPO has made in the Eastern Cape and why we are so proud!
Following SIMS assessments, reassessments, SIMS development and mentorship given to CBOs (Ubuntu, Mt Frere Paralegal, Yomelela and Sinethemba), there was an improvement in their operational systems and policies as reflected by the progress in their scores on SIMS Dashboard. Through the project we have helped to strengthen the relationships between CBOs and clinics and this improved the decanting of patients to communities.
CaSIPO has helped to improve the tracing, referral and reintegration of loss to follow up patients through increasing collaboration of WBOTs and CBO Caregivers activities.
The CaSIPO legacy being left behind in the district
Through the project we have strengthened the tracking, referral and retention of loss to follow up patients. We have helped to strengthen relationships between the CBOs and clinics. A case example is Philisani CBO and Paballong Clinic.
We have decanted 5256 HIV positive patients and 272 clubs which constitutes an achievement of 88% towards our District target of 5982. 14 CBOs and Clinics decanting patients to communities through adherence clubs were given equipment which included scales, MUAC tapes, BP machines & BMI machines to support the facilitation of adherence clubs.
Well done to all involved in this district and on the CaSIPO Project!
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