Program Report - Cabrini Ministries Swaziland

Program Report

2012-2013

(01 October 2012 – 30 September 2013)

A special thanks to our funders:

Anonymous Donors, Bonino Foundation, Bristol-Myers Squibb Foundation, Cabrini

College, Cabrini Health Australia, Cabrini Mission Foundation, Centers for Disease

Control and Prevention, ELMA Foundation, ICAP (Columbia University),

Missionary Sisters of the Sacred Heart, PACT, PEPFAR (US Government),

SAFAIDS, Sahee Foundation, Solon Foundation, United States Agency for

International Development, and individual donors worldwide.

Cabrini Ministries Program Report // 2012-2013

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TABLE OF CONTENTS

1. Letter from Executive Director .......................................................................................... 4

2. Letter from Deputy Executive Director ............................................................................. 5

3. Executive Summary ........................................................................................................... 6

4. Organization information ................................................................................................... 7

History.................................................................................................................................... 7

Vision / Mission / Values ....................................................................................................... 9

Staff and Leadership .............................................................................................................. 9

5. Situation in Swaziland ..................................................................................................... 11

6. Programmatic Overview .................................................................................................. 13

Health Care .......................................................................................................................... 14

Service Delivery............................................................................................................... 14

Program Impact ................................................................................................................ 22

Key Accomplishments .................................................................................................... 23

Strategic Partnerships....................................................................................................... 25

Child Care ............................................................................................................................ 27

Assessments ..................................................................................................................... 27


Program Impact ................................................................................................................ 32

Key Accomplishments ..................................................................................................... 33

Strategic Partnerships....................................................................................................... 36

Social Services ..................................................................................................................... 36

Program Development ..................................................................................................... 37


Impact and Expansion ...................................................................................................... 39

Agriculture ........................................................................................................................... 40

Food Security Programming ............................................................................................ 40

Program Transition .......................................................................................................... 40

7. Monitoring and Evaluation systems................................................................................. 41

8. Organizational Development ........................................................................................... 43

Identified Emerging Issues .................................................................................................. 43

Strategic Priorities ................................................................................................................ 46

Becoming a “Social Service Organization” ......................................................................... 47

Future Projects ..................................................................................................................... 48

9. Get involved ..................................................................................................................... 50

10. Appendices .................................................................................................................... 51

Cabrini Health Care Analysis of Services ........................................................................... 52

Clinical Cascade Results and Exits ...................................................................................... 56

Cabrini Impact Mitigation Analysis of Services .................................................................. 57


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1. LETTER FROM EXECUTIVE DIRECTOR

Dear Friends of Cabrini Ministries,

I greet you with joy from the Lubombo Lowveld of Swaziland.

It is truly a year of joy for the people of this region because this

summer we are experiencing rain – lots of life giving rain. For

those of you who are familiar with the 20 year drought this area

has endured, you know how important this is. The changes here

go deeper than the weather. Everywhere I look, I see the new

joy that accompanies lives being restored!

I also greet each of you with thanksgiving and gratitude for your prayers, interest and support

for the people of this area. As you read this report I am sure you will also give thanks with

me for the enormous work being done by this small faith-based and community-based

organization. You will see what your support, interest and prayer have wrought and where

you have brought this area over the last 10 years: from grave sickness, death, poverty and

abandonment, to life and hope for today and for the future.

In this last year, Cabrini Ministries has continued its work with the HIV/AIDS and TB

afflicted people of the area, as well as the orphaned and vulnerable children whom this great

pandemic has produced. Despite the daily struggles and real risks, we are moving from acute

care to chronic care as more people are alive and working. We are moving to more children

being able to live with their families and guardians due to the increasing stability of some

homesteads. We are moving from emergency support to once again dreaming about what the

future can hold. Your support this year has also allowed us to make a dream come true...a

new Social Service Department is now serving homesteads facing situations which Health

Care and Child Care have observed and reported, but have not been able to adequately

address. The family unit has truly become the center of our work.

God’s great love is poured out like a river in the desert and the desert has become a place of

life.

Many blessings to each of you.

Sr. Diane DalleMolle, MSC


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2. LETTER FROM DEPUTY EXECUTIVE DIRECTOR

My Dear Friends,

It’s been a great year of us working together to fulfill the mission of

Restoring Life and Rekindling Hope. It takes so many people to

make our work possible and we are deeply grateful to all of you for

your interest, prayers, donations and support. Without you our

Cabrini family here on the ground couldn’t continue this work of

love.

Cabrini Ministries in this past year realized our desire of opening a Social Service

Department. The impact of this movement is immense. As a Catholic faith-based

organization we continually think about how we can best serve and love the people in this

area with HIV/AIDS, TB and those impacted by these diseases. Our underlying framework

utilizing a psychosocial approach to care allows us to compliment the significant gains that

have been made in the scientific world regarding HIV. In Swaziland there has been a steady

upward trajectory in health care delivery. More people know their HIV status, more eligible

people are on treatment, and families and communities are starting to stabilize.

Despite all the scientific advances there are still a large number of families who lack the

necessary resources – physical, emotional, intellectual or spiritual – to adhere to treatment

regimens. Many factors converge to contribute to this challenge, including poverty,

education, and social beliefs. Our Social Service Department is able to assess the challenges

and barriers that families face in trying to manage adherence and the lack of governmental

social welfare supports. The interventions of the Social Service Department creates a safety

network to alleviate these struggles by providing food, health care, child protection, legal

assistance, and individualized human rights advocacy, to name just a few supports. As

families become stronger and more cohesive, they rely less on Cabrini Ministries’ help and

steadily move to a more independent functioning.

I am proud of the steady quality improvements in Cabrini Ministries over the years. The

most important factor in all of this is the staff at Cabrini Ministries, who each day grows in its

own capacity to love as Jesus loved and to know what it means to love.

United in this work of love,

Sr. Barbara Staley, MSC, LCSW


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3. EXECUTIVE SUMMARY

For over 40 years the Cabrini Sisters have been serving in Swaziland. During that time, their

work has always been driven by a connection to the community and a willingness to focus on

the most pressing needs. During the past decade, that work has been dedicated to helping

those people infected and affected by HIV/AIDS and Tuberculosis. This care delivery has

largely been carried out through Cabrini Ministries’ work in Health Care and Child Care.

The commitment to the community and its needs has never changed, yet this year represents a

significant period of transition for the organization. The work of Cabrini Ministries is

moving from crisis care to chronic care. The primary focus is still on keeping people alive

and ensuring that they are cared for, but now more people are able to think about

transitioning toward the future – a luxury many in the area haven’t had for over a decade.

The most concrete example of this transition is the recent formation of the Social Service

Department. Originally designed to address the community needs that exist between our

work in Health Care and Child Care, today the nascent department is providing a solid

framework for addressing the holistic needs of the community we serve.

In this report, you will read about the impact of the Social Service Department as well as the

on-going efforts of our existing departments. The programmatic year for Cabrini runs from

October 1st through September 30

th and this report seeks to draw together a detailed overview

of significant activity that has occurred in this period. It pulls from a variety of data sources

and reports to present a broad understanding of the organization and its impact.

While it is impossible to capture the breadth of what Cabrini does by simply looking at

statistics, the following figures provide a quick snapshot of what has happened this past year:

A total of 2,806 individuals received direct care from Cabrini

Our Health Care staff provided clinical services for 1,932 clients

o 872 HIV+ patients were given access to life-saving ARV medicine including

123 new initiations

o 89% of those initiated on ART were alive and on treatment one year later

874 Orphans and vulnerable children were served through Cabrini Child Care

o 151 of those received a full complement of comprehensive services

o 333 healthy child physicals were conducted at area schools

The Social Service Department assessed 1,067 individuals on 131 homesteads

o 177 interventions have already been initiated

In addition to the Social Service Department, several new initiatives have been

launched: a Medical Circumcision Clinic, on-site laboratory services, expanded

community health education, outreach academic enrichment, enhanced OVC

support groups and new strategic partnerships


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4. ORGANIZATION INFORMATION

Cabrini Ministries Swaziland is a Catholic

faith-based and community-based not-for-

profit organization (Section 21: R7/26820)

working in the Lubombo lowveld of Swaziland

to show God’s love in action through service.

Cabrini Ministries is based at St. Philip’s

Mission and operates for the good of the larger

community including the chiefdoms of Mamba,

Ngcamphalala, and Gamedze with recent

expansion into Shongwe, Mkweli and Nceka.

Our work is fundamentally about meeting the psychosocial needs of our community which

includes addressing issues of health, nutrition, education, and protection, as well as ensuring

mental and spiritual wellbeing. Service delivery is primarily achieved through three

integrated departments: Health Care, Child Care and Social Service. Individual interventions

are necessary, but can only be adequately assessed and understood in the context of family

and community. This contextual understanding of the people served by Cabrini is the core of

Cabrini Ministries’ effectiveness in responding to and providing for the many challenges

experienced by the people we serve.

History

Cabrini Ministries is founded on the work and principles of the Missionary Sisters of the

Sacred Heart (MSCs) and their founder, St. Francis Xavier Cabrini. The sisters have worked

in Swaziland for over 40 years after originally coming to the country at the request of King

Sobhuza II in 1971. For the first 25 years, the work at St. Philips Mission was focused on

education, basic health care, skills building and spiritual formation. By the early 1990s, the

Cabrini sisters were considering leaving the country because their work in community

development had yielded such positive results.

Unfortunately, as the millennium came to a close,

Swaziland was faced with a triple crisis of drought,

unemployment and – most damaging – the HIV

pandemic. In the span of less than a decade, an

entire generation of Swazis had been devastated and

the social fabric of the country began to unravel.

Bright young people who had been educated

through the hard work and sacrifice of their families

along with the support of the sisters were dying just

as their working lives were beginning. Families

were left without their children and consequently the

Sr. Anne Maria counsels a child

in the early 1980s


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social safety net they had expected to exist in their later years of life.

In 2002, in response to the crisis, a strategic decision was made to refocus the apostolic

mission of the Missionary Sisters of the Sacred Heart. All resources, human and financial,

were shifted to respond deliberately to the havoc caused by HIV and TB. With the support

and encouragement of the local leaders, a free hostel was established to care for orphans and

vulnerable children of the area. Initially, 50 children were enrolled, 98 showed up on the first

day and none were turned away. The work in health care moved from the clinic-based to

home care-based since most clients were simply too sick to travel. What started as

emergency palliative care eventually evolved into a systematic approach of educating,

testing, and linking to care. In 2006, Cabrini Ministries was officially incorporated as a

Swazi not-for-profit organization.

In recent years, the southern Lubombo region of Swaziland remains an area remarkably

underserved by care providers. The ongoing impact of HIV, along with the co-morbidity of

TB and the resulting number of parentless children is compounded by continued years of

drought and high unemployment. These realities intensify the problems already associated

with poverty, food insecurity, and low levels of education of the people living in these remote

rural chiefdoms.

Since its inception, Cabrini Ministries has established a strong track record demonstrating

creativity, determination and competency in responding to community needs. The

organization provides health care services of the highest quality to the people in the

catchment area and maintains on-going cooperative partnerships with families and neighbors

in the care and upbringing of children orphaned or vulnerable due to HIV/TB.

In the last decade, Cabrini has served over 6,000 people living with HIV and/or TB and

provided care to over 1,500 orphans and vulnerable children. What began as just a few

people doing what they could to help their neighbors has evolved into a full service

organization deeply rooted in the

community, providing

comprehensive integrated care as

well as targeted care to thousands

of others. In 2013, a Social

Service Department was launched

in order to better meet the multi-

faceted needs of the homesteads

receiving services from the

organization and to enhance the

quality of care provision.


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Vision / Mission / Values

VISION:

Restoring life…..kubuyisela imphilo

MISSION:

Sharing the love of Jesus Christ through

Health Care Services for HIV, AIDS and TB at the homesteads and access to health

care and supportive services for HIV, AIDS, and TB

Care of orphans, vulnerable children and extended families/guardians

Economic strengthening and skills development of local people through employment

VALUES:

Hope Kwetsemba

Mercy Sihawu

Passion Kutinikela

Quality Care Kunakekela ngelizinga lelisetulu

Staff and Leadership

Cabrini currently has 55 staff members and operates with the following service departments:

Health Care Outreach, Child Care and Social Services. They are supported by work in

Administrative Services, Maintenance, and Transportation. Of the current staff members

who are employed, all but five are African, with the vast majority coming from the catchment

area served by the organization.

Executive Team

The Executive Team of Cabrini is comprised of five staff members who are responsible for

decisions related to the day-to-day operations of the organization. The members are:

Sr. Diane Dalle Molle – Executive Director

Sr. Barbara Staley – Deputy Executive Director

Mr. Pius Mamba – Cultural Liaison

Mr. Bongani Khumalo – Director of Health Care Outreach

Mr. Mzamo Sikhondze – Director of Human Resources

Board of Directors

The official board of Cabrini Ministries is comprised of members of the Provincial Council of

the Stella Maris Province of the Missionary Sisters of the Sacred Heart of Jesus. However,

the duties of advisement and oversight of the organization have been delegated to a local

Swazi Board comprised of the following members:

Nathi Gumede (Chairperson)

Executive Director, Conciliation Mediation and Arbitration Commission


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Mavis Dlamini (Vice Chair)

Head Teacher, Duze High School

Langalakhe Dlamini (Head of Finance Committee)

Finance Manager, Swaziland National Provident Fund

Khosi Mthethwa

Health Systems Advisor, WHO

Mary Da Silva

Coordinator, Swaziland Democracy Campaign

Zee Musuku, MSW

Social Welfare Advisor, Health Finance and Government

Cabrini Children perform traditional Swazi Dance.


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5. SITUATION IN SWAZILAND

Swaziland is a small land-locked country in Southern Africa extending roughly 175 by 135

kilometers (110 by 85 miles) and having a population of approximately 1.1 million. The

country is considered to be Africa’s last true monarchy with King Mswati III ruling the

country.

By technical definition, Swaziland is a middle-income country with a per capita income of

$5,246.1 However, 63% of the population lives on less than $2/day with 37% living on less

than $1/day.2 This illustrates the significant gap between the rich and poor in this small

country. The poorest 20% of the population account for only 1.4% of the national

consumption and Swaziland as a whole consistently ranks as one of the 25 worst countries in

the world for income inequality.3 The unemployment rate has risen in the last five years and

currently stands at 66.3% with even higher rates in the rural areas.4

The health situation in Swaziland is

even worse. The country holds the

unfortunate distinction of leading the

world in HIV rates as well as

incidence of Tuberculosis. According

to a recent national survey, 31% of

Swazis ages 18-49 are infected with

HIV and every year 2.38% of

previously uninfected people will

contract the disease.5 Swaziland

yearly has 1,350 new cases of TB for

every 100,000 people; compare that

to the world average of 122.6

While the deadly diseases of HIV and TB receive the most attention, Swaziland’s health and

sanitation systems face challenges as well. Even though basic health services are available

for most of the population, the country has an infant mortality rate of 7.9% and an under-five

mortality rate of 10.4%.7 One in ten children born in Swaziland won’t live to see their sixth

birthday. Only 53.8% of Swazis have access to adequate sanitation facilities and in the rural

areas of the country, 40% lack access to adequate drinking water sources.8

1 World Bank, 2012. Swaziland is ranked 112 out of 180 when adjusting for Purchasing Power Parity.

2 Swaziland MDG Progress Report, 2012.

3 Based on GINI coefficient.

4 Swaziland MDG Progress Report, 2012.

5 SHIMS Report, Columbia Univeristy.

6 WHO Global TB Report, 2013. Other rates for reference include: Africa as a whole – 220, Australia – 6,

United States – 4, Europe – 5. 7 Swaziland MDG Progress Report, 2012.

8 MICS Survey, 2011.


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Recent statistics paint a worrying social

picture as well. The HIV crisis has

overwhelmed the social safety net of the

country with a significant amount of children

becoming orphaned or vulnerable in a short

period of time. This, coupled with the lack of

wage earners, makes for a dangerous

situation. Currently, 45.1% of Swazi children

are officially classified as orphaned or

vulnerable. Of these children, 38% do not

have their basic needs met.9 Less than one in

four children live with both their biological parents. Protections that are considered basic in

many areas of the world are lacking from daily life for Swazi children: 42% of children ages

5-14 engage in child labor activities and 89% are regularly subjected to violent forms of

discipline.10

The combination of economic, social and health factors impacting the country of Swaziland

have produced a complicated situation, but it is not without hope. In the fight against HIV,

Swaziland has reached the tipping point – the rate of new initiations on life-saving drugs is

higher than the rate of new infections.11

In the economic arena, new opportunities are

emerging. For the lowveld in particular, sugar cane holds the potential to be an economic

engine. Even technology is changing for the better as more and more Swazis are connected

to the internet even in the most remote areas.

The next ten years promise to be pivotal in the history of Swaziland. Either the devastation

caused by the HIV crisis will prove too much to overcome, or the country will find its footing

and restore stability.

Despite the ongoing challenges, this country

certainly has reason to be hopeful. Cabrini

Ministries is committed to partnering with our

community, and country as a whole, to turn the

corner on this desperate situation.

9 Ibid. Defined as having a minimum of one meal a day, two pairs of clothing and one pair of shoes.

10 Ibid.

11 AVAC 2013 Annual Report.


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6. PROGRAMMATIC OVERVIEW

The goal of Cabrini Ministries, as a Catholic faith-based and community-based organization,

is to form a relationship with each family and individual it serves. Who are these family-ies?

What are the health problems, social problems, financial difficulties with which they struggle

daily? Over the years, Cabrini Ministries has come to know the strengths and challenges of

each of the families and individuals it serves, creating a covenant bond of faithful service.

Cabrini Ministries is committed to being faithful and persevering in helping these HIV, TB

and poverty stricken communities become healthier and stronger.

It is the great desire of Cabrini Ministries to love the people of this area with the same faithful

covenant love God has for each of us. We express this love during all our encounters through

a relationship based on respect and dignity – while encouraging those who have defaulted to

adhere to their medications; while teaching and supporting families about protecting the

rights of women and children; while reuniting and strengthening families who have been

overwhelmed by sickness, death and loss.

For the past decade Cabrini Ministries has focused its work on responding to the crisis caused

by HIV/AIDS and TB and the devastating corollaries of these illnesses. Historically, this has

taken the form of health care services for adults and children and impact mitigation measures

aimed primarily at orphans and vulnerable children.

The last year has brought a marked

transition from providing emergency

care to focusing on comprehensive

and integrated social, child care and

health services for families and

children in chronic conditions of

illness, abandonment, abuse, and

poverty. The communities we serve

are awakening from a dark night of

debilitating illness and death to new

beginning of working, caring for

their children and having hope for a

future.

This shift towards chronic care provision does not erase the very real day-to-day realities of

disease, death and poverty – these issues remain as devastating as ever. However, this

change in approach does point to something much greater: the communities we serve in

Swaziland once again have a hope for tomorrow.


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Cabrini Ministries has worked intensively in this last year to consider all of these changes as

we reshape our existing programs and develop new ones in order to meet the growing and

emerging needs of the communities we serve.

Health Care

The primary objective of the Health Care Program is: To provide a comprehensive,

community based, integrated health care to children and adults living with HIV/AIDS and

TB over their lifetimes.

Service Delivery

The Health Care program at Cabrini Ministries provides a full complement of services for

area clients who are affected by HIV/AIDS and Tuberculosis. The work of this department

occurs in three distinct arenas: Cabrini Drop-in Clinic, Community Health Outreach, and

Targeted Programs.

Drop-in Clinic

The primary point of service for Cabrini Health Care is the

Cabrini Drop-in Clinic located on St. Philips Mission. This

facility serves as the hub for HIV/TB work for the entire

catchment area.

Upon coming to the clinic, clients are checked in, their vital

signs are taken and they receive education and psychosocial

support which is offered by our trained staff. They then

meet with a treatment support counselor before visiting a

skilled nurse who specializes in HIV/TB care and

treatment. All clients, regardless of the purpose of their

visit, receive a TB screening. Basic medical care is also

provided for those who participate in the HIV Testing and Counseling program. For clients

that are in relatively good health, but for whom transportation is a problem, we provide

drivers to bring them to the clinic.

The following services are offered on-site:

HIV Test and Counseling

During an average month, 30-40 individuals come to Cabrini’s on-site facility to find out

their HIV status. If clients are negative for HIV and TB, they are counseled on strategies to

maintain their negative status and encouraged to come back for regular testing. If they are

positive, clients receive a full complement of support care services so they are prepared for

the treatment journey ahead. HIV Testing and Counseling is also regularly offered at

community events.


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Support Care (adherence counseling, support groups, health education, etc.)

Cabrini’s Health Care Services are not just focused on the medical aspects of care. Every

client, whether new or returning, is provided with psychosocial support and health education

activities.

Pre-ART / ART Initiation and Treatment

The center of Cabrini’s HIV program is treatment. Cabrini nurses are trained and equipped to

initiate clients on life-saving anti-retroviral treatment as well as pre-treatment antibiotic

prophylaxis (cotrimoxizole). Clients receive refills at regular intervals ranging from weekly

to quarterly, along with clinical assessments and personalized care.

Ongoing supportive Health Care

Because HIV suppresses the immune system, it often leads to a wide range of other health

issues. Cabrini integrates care for opportunistic infections and other complicating disorders,

into its regular continuum of care. Clients who are HIV or TB positive are guaranteed access

to the best comprehensive care possible.

Connection to Sexual and Reproductive Health Services

Cabrini works with other organizations to connect our clients with the services they need

including access to sexual and reproductive health interventions.

Basic Labs

As of this year, Cabrini has a small laboratory which provides its new clients with basic

laboratory results including CD4 counts (a basic measure of how advanced the HIV virus is

in a person). Other diagnostic services such as liver and kidney function tests are outsourced

to area laboratories.


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Food by Prescription

For clients who are clinically malnourished (as determined by body mass index), Cabrini

provides emergency food services as part of its comprehensive care provision.

Transportation to Other Services

Because Cabrini’s Health Care focus is on HIV and TB, not all treatment options are

available onsite. However, because of the covenantal relationship our organization has with

its clients, we are committed to connecting patients to other clinics that can provide the

services they need. On a weekly basis, clients are transported to other hospitals, and in

emergency situations, they are provided with transportation to the closest emergency care

facility.

The Drop-in Clinic also functions as the primary location for all missed appointment follow

up and Health Care data collection/analysis.

Community Health Outreach

In addition to extensive care and treatment for Cabrini

clients, several community health outreach activities

have been implemented:

Homestead Visits

Often, clients are too sick to make it into the clinic for their refills and appointments. In these

cases, Cabrini sends nurses into the catchment area to provide clinical support for the most

vulnerable. These sessions are designed to provide the same level of care offered at the

clinic, but are utilized in the most dire of situations. Nearly every day, a nurse is out doing

these visits. During homestead visits, patients are provided with treatment (pre-ART, ART,

TB, opportunistic infections etc.) as well as psychosocial support through nutritional

supplements, spiritual uplift and counseling.

Remote Refill Locations

Cabrini’s catchment area is approximately 50km in length and width and covers terrain with

only rudimentary dirt roads. Because of this, many clients find it difficult to come to the

In the last year, 1 in 3

Cabrini patients received

care away from the

clinic. This includes

remote refill locations

and home visits.

Patients line up outside a Remote Refill location awaiting care


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clinic for regular service. In order to alleviate this burden, Cabrini initially began offering a

shuttle service to clients in remote locations. However, as the number of clients served

steadily increased, it became essential to create a new solution. The result was mobile refill

stations. Every week, a nurse, counselor and support staff member head to a remote section

of the catchment area on a regular schedule to provide medication refills and on-site clinical

care. We currently have four refill locations throughout the region: Bhadlane, Mconcwane,

Ncandweni and Sinyamantulwa. These sites provide the same services as the drop-in clinic

(HIV testing and counseling, TB screening, treatment, care and support), but are mobile and

are designed to meet the needs of clients in the most effective way possible.

Missed Appointment Follow up (including partner clinics)

Cabrini recognizes that initiating a person on treatment is only effective if that person

remains on treatment. For this reason, the organization employs one of the most aggressive

missed appointment tracking protocols in the country:

Missed appointments are identified at the end of each day

Clients are contacted immediately to inform them of their appointment status

After 3 days of tracking, a register is opened for the client

If phone calls are not effective, a default tracker is sent to client’s home

If client has not returned in 7 days, they are classified as a defaulter

Follow up continues until client returns or refuses treatment

After 90 days, if client does not return, they are considered lost to follow up as per

national protocols; however, Cabrini continues to track them.

Tracking data is collected and analyzed on a quarterly basis

Cabrini has found that this level of client tracking

is very time and resource intensive, but has

resulted in return rates much better than the

national average. It also provides insights into our

clients’ needs and challenges that would not be

possible otherwise.

In addition to tracking regular Cabrini clients,

Cabrini has entered into partnership with two

government clinics (Sinceni and Siphofaneni) to

provide default tracking and community linkage support. These clinics lie on the outer edge

of the Cabrini catchment area and many of the households our organization serves have

clinical ties with the institutions. In the last year, Cabrini employees followed up with 342

unique clients from these government clinics.

Targeted Programming

In order to address specific health care needs, targeted programs have been established to

focus on the most significant barriers to a healthy community. Cabrini’s targeted programs


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include: Tuberculosis Care, Prevention of Mother to Child Transmission, Medical

Circumcision, and Community Education.

Tuberculosis Care

While Tuberculosis Care is integrated into the comprehensive health approach Cabrini

implements, its impact necessitates a focused effort on prevention, case finding, diagnosis

and treatment. TB is one of the leading causes of death among HIV+ patients. In order to

decrease its effects, Cabrini has implemented the following systems:

Case Finding

The cornerstone of any TB program is case finding. Regular patients are screened for

symptoms of TB at every visit. Additionally, patients who are suspect for TB are encouraged

to have other members of their homesteads tested to identify if the disease has spread. TB

screening has also been incorporated into everyday aspects of Cabrini programming such as

homestead assessments and healthy child physicals.

If a patient is identified as being a TB suspect, they

are coached through giving a sputum sample for

testing. If other identification measures such as a

chest X-ray are needed, Cabrini arranges for those.

In FY13, roughly 10% of TB suspects were identified

as having the disease.

TB Prevention

Preventing the spread of Tuberculosis is always

preferable to treating the disease. Cabrini takes a

multi-pronged approach to prevention that includes

medical as well as behavioral interventions.

From a medical side, Cabrini offers its clients access

to TB prophylaxis (isoniazid). In the last year, 103

high-risk clients received this preventative care to

reduce their risk of contracting the disease.

In addition to medical interventions, Cabrini also provides existing clients with alternative

living arrangements to prevent the spread of the disease on their homestead. In instances

where a TB-positive client would have to live in the same dwelling as non-infected family

members, Cabrini provides alternative living arrangements so the individual can be cared for

while decreasing the risk of transmission.


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Treatment and Support

In Swaziland, it is estimated that 15,000 people each year will contract Tuberculosis. A

standard treatment regimen is six-months long, and Cabrini provides this service to over 130

individuals per year. Unlike with HIV on its own, treatment failure bears additional

significant risk – namely the development of Multi-Drug Resistant Tuberculosis (MDR-TB)

which can take up to three years of expensive treatment to cure and has a much higher

mortality rate. Therefore, Cabrini not only provides the treatment, but also focused support

for TB clients. This includes ongoing observation and intentional orientation to the treatment

process and the risks of non-adherence. In the last 3 years, Cabrini has not had any clients

default on TB treatment. This not only guarantees better outcomes for the clients, but also

reduces the risks of MDR-TB which can have devastating effects on the community as a

whole.

Transportation for MDR-TB Clients

Due to the high risk and intensive treatment regimen for MDR-TB clients, a government

hospital has been established to care for these patients. Clients of Cabrini who are suspect of

having MDR-TB are provided transport to the government hospital in order for them to

receive the best care possible. If appropriate, these clients can continue their treatment at

home with Cabrini nurses serving as treatment supporters.

Prevention of Mother to Child Transmission (PMTCT)

Cabrini has implemented a comprehensive education and support program to guide

prospective mothers in maximizing the potential for babies to be happy, healthy and HIV

negative. This requires a dedicated approach to care and support. Once an HIV positive

client in our catchment area is found to be pregnant or intending to become pregnant, a

Cabrini nurse consults with her to discuss options. She is encouraged to attend a support

group with other expectant and new mothers. These groups are led by nurses and include

lessons and open discussions about PMTCT issues. Food supplements and at-home care are

provided as needed. In addition to support care, participants receive ongoing clinical

assessment and support, nutritional support, treatment of opportunistic infections,


20

prophylaxis, ART treatment for those with advanced HIV,

and ante-natal care in cooperation with partner

organizations.

In the last year, 49 new expectant mothers were reached

through our PMTCT program. These new clients joined

the nearly 100 other mothers who were already being

supported through PMTCT programming. Of those, 27

newborns from this year with known HIV statuses, only 2

became HIV positive representing a rate of 7.4%. While

any child becoming HIV positive at birth is tragic, it

should be noted that this rate is significantly lower than

average the mother to child transmission rate of 25%.

Medical Circumcision

Studies have shown that men who are circumcised have a 60% lower chance of contracting

HIV; this ultimately reduces the spread of the disease.12

These encouraging statistics have

prompted a nationwide effort to increase Medical Circumcision (MC). In partnership with

two other NGOs in the country, Cabrini opened a local MC clinic to meet the needs of men

who are willing to participate in this prevention strategy. In the last six months, over 500

school aged children have been encouraged to participate, and ongoing community dialogues

have occurred. Roughly 60 new clients have undergone the procedure at the Cabrini’s MC

Clinic

As the program establishes itself, Cabrini will continue to work with local service providers

to increase the uptake of this service.

Community Education

Cabrini firmly believes that successful prevention and treatment strategies must be built on

education and community engagement. In addition to the on-going education which occurs

during routine clinic sessions, Cabrini hosts regular community education sessions in a

variety of settings and targeting a diverse audience.

Homesteads

The core familial unit in Swaziland is the homestead. Most homesteads in the catchment area

are comprised of between 5 and 10 individuals and often include extended family. Because

of the close relationship Cabrini has with its clients, support often extends beyond the clinic

and into the communities. Several weekend education programs are regularly offered to

clients in order to reach those living with them. In the past year, this has included education

on HIV treatment, palliative care, TB infection control, and encouragement for TB screening

and HIV testing.

12

AVAC, VMMC Talking Points, 2011.


21

Traditional Healers

The clients Cabrini serves are deeply enmeshed in the traditional belief systems of the area.

This includes the regular consultation of Traditional Healers for spiritual, social and health

related issues. An informal survey revealed that over 80% of Cabrini’s clients see a

Traditional Healer at least once before, during or after medical treatment. Despite potential

differences in values, beliefs and approaches to illness, we feel it is essential to work with

these Traditional Healers so that the clients can best be served.

Currently, regular meetings

occur in all three chiefdoms

with the Traditional Healers.

These are facilitated by a local

nurse who is also trained in the

traditional practices. The focus

of the meetings has been on

education. Cabrini has provided

training on how ARVs work and

the unique health concerns of

HIV positive patients. There has also been education on reducing risk in their own practices

and identifying warning signs of HIV and TB. Referrals and continuing education are always

encouraged.

Traditional Leaders

Because the work of Cabrini Ministries is within a setting of traditional chiefdoms, it is

essential that strong working relationships be maintained with the chief and the traditional

structures. Since 2012, Cabrini has offered quarterly education and dialogue sessions with

the traditional leaders of each chiefdom. Topics include HIV/AIDS and TB education,

Medical Circumcision, Treatment adherence and child protection. By reaching the people

who have the most influence in the community, we can ensure the issues are taken seriously.

The leaders are not expected to teach their people but to direct them towards healthy living

for the common good of their chiefdoms. Because traditional values and cultural norms are

involved, the process is always deliberate and respectful. Change does not come quickly and

will take years of building trust to see the full benefits of these efforts.

Healthy Living Advocacy Days

On a quarterly basis, the Health Care Department hosts an education day in different

communities in its catchment areas for current HIV+ patients. The clients invited to the day

are those who are most adherent in caring for themselves and have seen the value of entering

into treatment. They are encouraged to bring a relative or neighbor who has not yet tested.

The day consists of education on positive living, health related discussions, encouragement

for testing for newcomers. The day ends with a full meal and time for socializing. These

well attended events have sought to recognize and encourage those who have adopted a

healthy life style and also to education new community members about positive living.


22

Program Impact

In FY13, the Cabrini Health Care Program served 1,932 unique clients. This includes 1,590

clients from Cabrini Clinic and outreach as well as 342 from the government clinics in

Siphofaneni and Sinceni. Over 20,000 services were provided to these patients. A full

overview of this service provision is available in the appendices, but the following figures

provide a glimpse at the overall impact of the program.

1,932 total clients served (1,399 of these were HIV+)

o 1,590 through Cabrini Clinic (Drop-in Clinic, Remote refill clinic and home

visits)

o 342 through Government Clinics

617 individuals received HIV Testing and Counseling

327 clients received Pre-ART services

872 received ART services

123 were initiated on ART

130 clients with tuberculosis received treatment

o 58 were newly initiated on treatment this year

o 6 new MDR-TB clients were identified

87 clinically malnourished patients received therapeutic food supplements through the

WHO’s Food by Prescription program

103 clients received TB prophylaxis (INH)

89% of clients initiated on ART are known to be alive and on treatment 12 months

after initiation

631 clients received CD4 results

969 missed appointments were followed up on

o 492 from Cabrini

o 477 from Government Clinics

80.5% of clients who missed appointments returned to care.

o 95.9% of Cabrini Clients returned to care13

Over 400 individuals engaged in community education events

o 130 individuals participated in events at the chiefdom level

o 131 participated in HIV testing events

o 91 Rural Health Motivators attended trainings

o Over 100 traditional healers participated in dialogues

49 new mothers were enrolled in programming designed to prevent mother to child

transmission of HIV

13

Lower rates for Government Clinics are due to employee transitions as well as difficulties experienced while

transitioning to a new data tracking system.


23

Key Accomplishments

Alive and on Treatment Rates

The greatest measure of success in the Health Care Department is the number of patients who

remain healthy and productive. When working in the field of HIV, this success is most often

measured by looking at the proportion of clients who are alive and on treatment one year after

their initiation. In Swaziland, the alive and on treatment rate has historically been around

80% -- in other words, even when enrolled on life-saving anti-retroviral treatment, one in five

clients still either default on treatment or die. Over the last 3 years, Cabrini’s Alive and on

Treatment Rate has hovered around 90%. Many factors that influence this figure.

In 2011, Swaziland experienced a stock-out of CD4 reagent which is essential for monitoring

the advancement of HIV in the body. Without these test results, clients were unwilling to

initiate on treatment.14

This delay in initiation led to a decrease in new initiations, which in

turn meant that people started treatment later. All across the country, this decrease in

initiations was noted.

In response to this issue, Cabrini was proactive to ensure patients had the best chances for

survival. Health Care employees advocated at the highest levels of government for

restocking of the vital CD4 reagents. Nurses participated in a national program to allow them

to provide initiations (rather than having to wait on a doctor). Initiations were done when

14

In Swaziland, standard treatment is to start ART at a CD4 level of 350.


24

possible on clinical staging rather than CD4 count. Eventually a point of care CD4 machine

was acquired in order to perform the labs on-site.

As the chart above illustrates, the lack of lab work resulted in decreased initiations and

consequently decreased rates of clients being alive and on treatment. However, once

corrective measures were put into place, the rate rose higher than ever before. It is currently

projected to end the year at nearly 95%!

Keeping people on treatment is not only essential for the health of individuals, but also for

the health of the country as a whole. Clients on treatment are less likely to transmit the

disease and individuals who remain healthy are better able to support their family and their

community.

Launch of MC Clinic and Laboratory

Cabrini realizes that quality health care services must also be accessible in order to be

effective. This approach has resulted in numberous partnerships regular expansion of point-

of-care services. This ensures our clients are as close as possible to the care that they need. In

the last programming year, two such expansions have occurred: the launch of an on-site

laboratory and the launch of a Medical Circumcision Clinic.

Laboratory

Cabrini has always partnered with government clinics to provide laboratory services to our

clients. However, the faster laboratory results can be obtained, the faster proper treatment

can be initiated. Therefore, this year, Cabrini launched its own mini-laboratory. For now its

primary function is providing rapid CD4 counts for clients while they wait. This allows


25

clinicians to quickly pursue the best treatment course of action. In coming months, the

services offered are expected to expand.

MC Clinic

Medical Circumcision holds the promise

of reducing HIV transmission rates in

high prevalence countries such as

Swaziland. Because of this, Cabrini has

been active in encouraging clients and

other men from the area to be

circumcised. In collaboration with

several local and international agencies,

Cabrini launched a “Clinic in a Box”

which is designed to provide rapid

deployment of MC services. This semi-

permanent structure was constructed to

quickly provide the necessary structure to carry out circumcision procedures. Cabrini

currently oversees recruitment and education, and in the future is looking to expand into

providing the point-of-care service itself.

Strategic Partnerships

The following strategic partnerships are essential in implementing the work of the Health

Care Department at Cabrini Ministries:

Ministry of Health

Provides access to medication, technical support and training, reporting oversight, and

supervision of national health care services.

Area Hospitals and Clinics

Serve as referral locations for clients who need services not regularly provided by Cabrini

Ministries.

Family Life Association of Swaziland

Provides access to Sexual and Reproductive Health services for Cabrini patients. This

includes access to care and support as well as education.

PSI

Clinical management of Medical Circumcision Clinic as well as education and training.

Clinton Foundation

Technical assistance and guidance on national campaigns. Assisted with the formation of the

Cabrini on-site laboratory.

PACT / ICAP / PEPFAR

Financial and technical assistance around a wide variety of issues. Also supports area

organization provide assistance to Cabrini.

US Ambassador James and a Ministry of Healthy

representative officially open the MC Clinic.


26

URC

Training and technical assistance.

Community Health Motivators

Connect clients with local services and also assist with missed appointment follow up and

defaulter tracking.

Cabrini Health Australia

Provide financial and technical assistance. Coordinate with area staff to host extensive

healthy child physicals and work with clinicians to improve quality of care.

SAFAIDS

Partners in work aimed at community leaders and increasing uptake of ART treatment.

TASC

Training for HIV Testing and Counseling.

Mothers to Mothers

Support group facilitation for HIV+ mothers and their babies.

Baylor Clinic

Assistance with pediatric HIV cases.


27

Child Care

The primary objective of the Child Care program is: To Raise orphans and Vulnerable

Children in partnership with their guardians in local communities to help them develop

into happy, healthy, and independent Swazis.

Cabrini Ministries provides

comprehensive care for those in the most

desperate situations as well as targeted

support for individuals and families only

requiring specific assistance. Service

delivery is based upon on-going

assessments of a client’s situation and all

interventions are designed with the larger

family and community in mind.

Assessments

Cabrini’s work with Orphans and Vulnerable children takes into account a person’s needs

and strengths when designing an appropriate intervention. All clients who receive services

through the department undergo an assessment process to ensure the services provided are

tailored to their situation. We believe that the best care comes from a person’s own

community and family and therefore, an emphasis is always placed on utilizing all resources

available.

Needy families are identified through local community

leaders and self-referral. The assessment evaluates not

only the financial situation, but also issues of health,

protection, education and access to non-material

resources and services. These evaluations provide the

basis for future interventions and take into account the

situation of the entire family. Because these assessments

are with high risk and high need individuals and families

and address sensitive issues, the work often takes several

hours as staff members engage in psychosocial care and

support throughout the assessment process.

On-going assessments for current comprehensive care

clients are being performed to determine if, and when, it

is possible to transition these children into a care

situation that is supported on their own homesteads.

Service Delivery

The Child Care program at Cabrini provides services across six domains of care: Shelter,

Nutrition, Health, Education, Legal / Protection, Economic Strengthening and


28

Psychosocial Support. These domains are based on the national Quality Service Standards

for Child care and are integrated into Programs, Events and One-Time Services which are

delivered through the department. As a result of the organization embracing an approach to

service where caring for the whole family unit is understood as the best way to assist the

individuals in that family, the work of Child Care is increasingly being done in collaboration

with Health Care and Social Service.

Service areas

The following service areas are available to children as part of regular programming and as

required in need-specific situations:

Shelter

Provision of shelter is reserved for clients in the most desperate situations; this includes

individuals coming from child-headed homesteads or instances where the safety of a child is

at risk. Shelter services are provided as both long-term and short-term arrangements.

Nutrition

In addition to nutritional support for children

enrolled in comprehensive care, emergency

food provisions are available for families who

need short-term support. Growth monitoring

and appropriate follow up is also included in

the provision of nutritional care for those

served by Cabrini.

Health

The Cabrini Clinic provides access to health care services for children with chronic

conditions. Additional health services are available for community children through regular

physicals and referral to care and treatment, either through Cabrini or in collaboration with

another service provider.

Education

The Child Care Department provides access to education both as a direct provider and as a

liaison with traditional educational structures. As a direct provider, Cabrini offers a Bridge

School as well as after-school tutoring services and special events. In connection with the

national education system, Cabrini helps students overcome issues related to access by

assisting with schools fees, uniforms, boarding costs, etc. We advocate on educational rights

and act as parentis in locus.

Legal / Protection

Cabrini’s work in Legal and Protection is carried out in partnership with the Social Service

Department and commonly includes assisting children in obtaining legal documents such as

birth certificates, parent’s death certificates, identity cards, etc. Cabrini also regularly works

with area entities in issues of child protection. This includes responding to reports of rape or

abuse and helping victims navigate the way forward. Cabrini also provides training and


29

sensitization on child protection issues to staff, children’s guardians and the community at

large.

Economic Strengthening

Various programs in the Child Care department connect children with opportunities to

increase their skills and provide the ability to live a sustainable life on their own. This

includes access to education and trade programs, hands-on job training, and technical skills

development in areas such as agriculture and handicraft.

Psychosocial Support (PSS)

Psychosocial support is care designed to influence the

individual and social environment of a person and

includes social, spiritual, emotional and psychological

elements. For Cabrini, this work is at the heart of all

activities and interventions. PSS is not an activity in

and of itself – rather, it is a methodology that Cabrini

embraces on all levels.

Comprehensive Care Programs

Individuals with the greatest level of need and least availability to services and support may

qualify for comprehensive care services. In the last year, over 150 children received this type

of care. Even when comprehensive services are offered by Cabrini, a partnership with the

client’s homestead is critical to our collaborative model of care. Cabrini staff may have a

parental role with these children, but it is only part of the co-parenting relationship as the

person’s homestead is expected to also provide leadership and support. This is monitored

and encouraged through regular meetings with the guardians.

Hostel

The free on-site hostel for orphans and

vulnerable children is the most intensive

program of care. Participants receive

support in a co-guardian structure wherein

children spend the school year in the Cabrini

hostel with 24 hour care, and then during

school breaks they return to their families

and/or homesteads. Shelter is provided 9+

months a year along with daily meals. All

participants receive regular primary health

care, including checkups and screenings and

additional health referrals are made when

necessary. All children participate in education enhancement activities outside of school four

days per week. Additionally, if necessary, school fees, uniforms, etc. are provided. Each

child receives legal and/or protection services through assessment for and assistance with

essential documents (birth certificates, parents’ death certificates, IDs, etc.). Through the


30

residential childcare staff and case management workers, all children receive ongoing

emotional and social support. This is delivered through prayer, counseling, support groups

and ongoing love; this aspect of our psychosocial approach is deeply integrated into all

aspects of the program. Some students in this group are offered economic strengthening

opportunities through the skills training programs. In the last year, 107 students were stayed

at the hostel.

Aftercare / Supported Independent Living

Not all children who receive comprehensive care live on-site. Cabrini also cares for students

in a variety of off-site living situations. Cabrini pays for many of these students to attend

boarding or trade schools as they continue their education. Additionally, older students may

participate in life transition activities that provide them with safety net of care while still

adjusting to life on their own. All services offered to the Hostel participants are also offered

to these Aftercare participants. Last year, 41 students received Aftercare support.

Respite Care

Cabrini’s respite care program is essentially a short-term enrollment in the hostel. All

services are provided as described above, but participation is not anticipated to be long-term.

Respite care is often offered in cases of abuse while the formal process to find a safe

placement is handled through the appropriate channels. Individuals with short-term, yet

intense, health care needs have also received this service. Services in this area are expected

to expand as the Social Service Department extends its reach in the community.

Targeted Support Programs

The vast majority of children served by Cabrini fall into the category “Targeted Support.”

These children have specific needs as identified in the assessment process and thus are

enrolled in programs and activities that adequately address their situation. Even if a program

does not regularly include some service areas, if they are needed by the children, it is offered

on an individual basis. So, if a student is receiving support for education costs, but also has

health issues that need to be addressed, Cabrini will assist in that area as well.

Academic Support & Sponsorship

Students who are enrolled in our Academic

Support program are usually children who have

their basic needs met, but require support for

things like school fees and uniforms. Even with

expanding assistance from the Swaziland

government, many families simply cannot

afford to send their kids to school since regular

tuition costs can easily be several month’s

salary for a general laborer. Because most

children in our catchment area struggle with


31

more than just academic problems, these children are also assessed for nutritional, health and

protection needs. Students’ progress is regularly monitored by the Education staff. Last year

121 students received this support.

Bridge School

The Cabrini Bridge School was created to facilitate accelerated learning for students who

showed great academic potential, but whose age was not appropriate for their grade level.

Older students who began school later than normal are given the opportunity to work through

multiple years of school in the course of one academic year so they can catch up to their

peers. Originally only offered to existing comprehensive care clients, in the last year, we

expanded this program to include students from neighboring communities as well. Currently

eleven students are enrolled in this program.

Life Skills Camps

Cabrini’s work with orphans and vulnerable children is not just about delivering services, but

also about providing positive environments where youth can learn, experience love, be safe

and ultimately thrive. This atmosphere is encouraged and facilitated through Cabrini’s inter-

term camps. We have observed that the most significant issues our children face present

when they are away from school, including teen pregnancy and abuse. For the past three

years Cabrini has offered these short-term camps during the four annual school term breaks.

This year, the camps’ content included career planning, emotional literacy and developing a

positive outlook on life. By providing a safe environment, the risks to children during these

breaks are reduced. These camps are offered to both students regularly in Cabrini

programming as well as area children who are interested. This also serves as a way for us to

expand our reach into the community. During the most recent camp, over 140 students

participated.

Healthy Child Physicals

For the past three years, Cabrini’s Health Care

and Child Care Departments have partnered

with nurses and doctors from Cabrini Health

Australia to provide physicals for children at

area schools. These health outreach activities

provide the only connection with medical care

some of these students ever receive. The

health checkups include assessments for

malnutrition and common conditions, as well

as TB screening and the opportunity for HIV

testing. Basic clinical care is offered when

possible; for clients with more complicated

issues, a referral and access to care is provided. We make sure to follow up with all at-risk

clients. Nearly 700 unique children have received this access to care in the last two years.


32

CARE Tutoring & Outreach Education

As part of its comprehensive care package, Cabrini provides educational enrichment

opportunities for students living on-site. This program is known as CARE: Cabrini

Arithmetic and Reading Enhancement. Math and language skills have consistently been

identified as areas where students struggle, thus the intentional focus of the program. In

order to deliver high-quality educational services, several educators and tutors are employed.

While initially these teachers worked exclusively with the students at the hostel, in the last

fewyears this program has been expanded to children from area communities as well.

Through partnerships with local schools, Cabrini’s Arithmetic and Reading Enhancement

program was attended by over 200 students. These students have their basic needs met on

their homesteads, but needed some additional instruction outside the regular school day. By

focusing services towards those who need them the most, the impact of Cabrini’s existing

work has expanded.

Therapy and Support Groups

In addition to academic enrichment groups, Cabrini also regularly offers theraputic and

psychoeducation support groups. These groups provide a safe environment for peers to learn

and engage on important issues. In the past year, groups have been created around art-

therapy and life transition support. These groups are led by trained staff and volunteers in the

areas of their expertise.

One Time Services

Not all needs encountered by Cabrini need to be addressed through programmatic

interventions. Sometimes, a one-time service is all that is necessary to allow a family to get

through a difficult situation. Therefore in addition to the programs outlined above, Cabrini

regularly offers short-term care provisions in all domains: Shelter, Nutrition, Health,

Education, Legal / Protection, Economic Strengthening and Psychosocial Support.


33

Program Impact

This year, the Cabrini Child Care Program served 874 unique clients. This includes 151 who

received comprehensive care. A full overview of service provision is available in the

appendices, but these statistics give a glimpse at the overall program impact:

110 children received care at Cabrini Hostel

o The respite program brought in 3 emergency cases included above

41 students participate in the aftercare program

The Academic Support program reached 121 students and is being expanded this year

330 students received Healthy Child Physicals in October

90 new students were enrolled in outreach education

140 students participated in inter-term camps

46 individuals were provided with one-time services

Key Accomplishments

Planned Transitions

The work of Cabrini Ministries in Child Care is largely comprised of long-term care

provision where success is measured over years rather than days or months. Many of the

children who receive care at the hostel have been enrolled in the program for close to a

decade. Because the goal of the department is to help develop orphans and vulnerable

children into happy, healthy and productive members of their community, transitions out of

comprehensive care are always watershed moments for the organization and the individuals.

This year, Cabrini staff has identified 18 students ready to transition from full on-site care

into a supported care situation. For many of these students, their homesteads have achieved a


34

new level of stability as a result of on-going treatment for previously debilitating illness and

new income from expanded economic opportunities, most notably the introduction of sugar

cane. Other students have shown such promise and maturity, that they are ready to transition

into life on their own homesteads.

Some of these students will transition into other targeted care programs at Cabrini, and all

will receive ongoing psychosocial support and transition assistance. For many, the prospect

of a stable life outside of Cabrini was only a distant dream, but now it is a reality.

Student Cultural Exchange Program

Cabrini Ministries has a long-standing relationship with Cabrini College in the United States.

Over the past several years, many collaborations and exchange opportunities have been

created. Cabrini Education staff members have received training at the college, while faculty

and staff from the college have traveled to Swaziland to assist with our program

development.

This year, that cultural exchange was significantly expanded as three of Cabrini Ministries’

brightest students traveled to the United States to participate in an immersion and education

experience through Cabrini College. These students explored academic and career

opportunities and were able to learn from and share with their peers from theUnited States.

Students from the college benefitted from the life perspective these Swazis could offer, while

the Swazi students were given the opportunity to examine a way of life very different than

what they experienced growing up in Swaziland.

Opportunities such as this not only provide avenues for expanding understanding and

compassion on both sides of the ocean, but also serve as a reminder for local students and

staff of how valuable and empowering education can be. In January 2014, the trip will be

reversed as students from the college come to Swaziland for a similar immersion experience.

Khatsiwe, Fanana, Celemusa and Nonhlanhla


35

Expansion of Camps

Cabrini’s inter-term camps have

continued to expand this year.

Originally conceived as a way of

providing a safe environment for

students during the school breaks,

this year has seen significant growth

in terms of content and participants.

In addition to guest speakers and

sessions geared towards life skills

and other psychosocial topics, these

camps have included group

activities, art projects, cooking

lessons and more. Each camp has introduced students to new people within their community

as well as new experiences. In addition to students already enrolled in Cabrini programming,

72 new students also participated.

Open Enrollment for Bridge School

As outlined above, the Cabrini Bridge School was designed to help accelerate the learning

process for students whose age is not appropriate for their academic grade. Whereas the

program was originally only offered to Cabrini hostel students, this year nine new students

from the community were enrolled. All of the students are in grade 7 and were targeted

because of their potential for success despite previous academic hurdles. The smaller class

size allows for more one-on-one attention in hopes that these students will be able to pass

external examinations and succeed in high school. In addition to a dedicated teacher, several

special instructors have been brought in throughout the year to assist.

New Psycoeducation Groups

Psychosocial support is always integrated into Cabrini’s care models. However, some

activities are specifically designed to address the emotional, spiritual and psychological needs

of individuals in our programs. An example of intentional programming has been the launch

of psychoeducation groups for children staying at the hostel. Groups are formed based on

peer groups and common challenges. Over the last year, various issues have been explored

including: self-esteem, body image, identity, good touch/bad touch and preparing for the

future. Currently there are seven groups meeting weekly that incorporatevarious interactive

activities, discussions, visual art, dance, and music. This psychoeducational approach to

group facilitation has also crossed over to the guardians meetings held at the beginning of

each term. The guardians were asked to participate in similar kinds of art and movement-

based activities along with the children. Additionally, many students are participating in one-

on-one care to increase the effectiveness and depth of this approach.


36

Strategic Partnerships

The following strategic partnerships are essential in implementing the work of the Child Care

Department at Cabrini Ministries:

SOLON Foundation

Partners in Academic Support programming

Swazi Government Agencies

The Child Care staff work with various government agencies to address issues of abuse and

protection. This includes the local Police Departments, the Department of Social Welfare,

the National Children’s Coordination Unit, Rural Health Motivators, Lihlombe Lekukhalela

and SWAGAA.

PACT / ICAP / PEPFAR

Financial and technical assistance, especially around psychosocial support models and

connection to external care services. Also supports national initiatives in which Cabrini

participates.

Cabrini College

Continued education and pedagogical instruction for staff. Partners in cultural exchange

program.

Cabrini Health Australia

Financial and programmatic support, especially around areas of palliative care and academic

reporting. Also partners in implementation of Healthy Child Physicals.


37

Social Services

The primary objective of the Social Service program is: To help families meet their

emotional, spiritual, physical and material needs through timely, expert and ongoing

support.

The department bridges the gaps outside the normal

scope of work of Child Care and Healthcare, and

navigates internal and external resources to address

challenges related to a range of issues, including child

abuse, mental and physical illness, food insecurity,

family reunification, and legal documentation.

Program Development

As part of an on-going evolution of program activities,

Cabrini Ministries formalized the establishment of a

Social Service Department in July 2013 after several

years of needs assessment and a full year of planning.

The department was developed in response to significant

gaps in service that exist for some of the most vulnerable

children and families in Cabrini’s catchment area. As a

result of the trusting relationship Cabrini Ministries has

developed with the community over the years, area stake holders -- including staff, current

clients, community leaders, and other service providers -- have increasingly been reporting

homesteads in desperate and dangerous conditions, necessitating the timely expert assistance

of a trained Social Worker and dedicated case managers. For example, Cabrini’s outreach

nurses often find cases of infants and toddlers unsupervised or otherwise neglected on their

homestead as a result of death, disease, poverty, or alcoholism.

The Health Care and Child Care staff have

always worked together to meet the needs in its

communities but these growing needs are

outside their capacity and scope of work. Cabrini

needed a way to provide a dedicated and focused

response with adequate infrastructure and staff

with specific training, tools and supervision to

meet the immediate and longer term needs of the

children and families in the catchment area.

Such a response was also necessary because of a critical lack of government resources

directed at meeting social and child welfare needs in Swaziland. The governmental systems

that are in place are limited to reporting and lack the ability to enforce child protection laws

or provide for extended care in cases of abuse or severe neglect. Sometimes the lack of

Understanding the challenges

that families face, and helping

them to find their own solutions

is most effectively accomplished

through a psychosocial, holistic,

community-based, and

culturally relevant approach.


38

resources of the relevant government agencies is as basic as a vehicle to arrest an alleged

child abuser, leaving the child at continued risk of harm until transport can be organized. .

In addition to filling the gaps in services, the Social Service Department’s development is

also related to an evolution in how Cabrini views the people it serves, moving from a focus

on individual patients and children to a focus on the family or homestead as the client. This is

fundamental to Cabrini’s psychosocial approach and understanding that individuals function

in families within communities. Understanding the challenges that families face, and helping

them to find their own solutions are most effectively accomplished through a psychosocial-

holistic, community-based, and culturally relevant- approach.

Service Delivery

Even before the Social Service Department was formally launched, Cabrini Ministries was

responding to the diverse needs of community members as they emerged. However, without

the formal structures and expertise it was difficult to ensure effective and efficient service

provision.

In order to develop the department, a

Masters Level Social Worker was brought

in to design a system of assessments,

interventions and follows ups tailored to

the local situation. Two case managers,

including a dedicated liaison between

Health Care and Child Care, as well as the

services of other support staff ensure the

department has the capacity to respond.

Currently, in addition to regular

assessments and case management, targeted interventions exist in the follow areas:

Nutrition, Health, Education, Protection, Psychosocial Support and Economic

Strengthening.

The first step to expanding service delivery was to broaden the annual assessment process.

Historically, this was a process to identify children who qualified for Cabrini Ministries’

educational support program. The goal of the annual assessments in 2013 was to complete a

comprehensive evaluation of the entire family and identify the challenges they face in

meeting their own educational, material, physical, and emotional needs. This involved

creating a more time-intensive and detailed assessment form and process, as well as training

staff. In addition to assessing social service needs, assessors incorporated TB screenings into

the process, resulting in over 60 positive screens which were then referred to our Health Care

Department for follow up and treatment if needed.

This improved assessment process has provided an avenue for improving the comprehensive

integrated service delivery that is based on a homestead’s strengths and challenges. Currently,


39

the Social Service Department is providing the following services to families in our

catchment area:

Educate and assist families in advocating for their rights when they are being abused

or when they have a disability.

Locate family members and obtain legal documents (for example, birth and death

certificates), especially when doing so has proved difficult for individuals whose

mothers have abandoned them or are otherwise unavailable to accompany them as is

required.

Confront short-term food emergencies.

Make referrals to Cabrini Health Care and/or other health facilities, and assure follow

through by arranging transport, advocacy and financial assistance where necessary.

Disclosure counseling for families with children who are HIV positive.

Psychoeducational and therapeutic support groups for children, pre-adolescents and

teens in our hostel program.

The assessment process has also resulted in an improved

referral system; this includes connecting clients with

services Cabrini already provides as well as linking them

to outside organizations who can better meet their

individual needs. The department has also made stronger

linkages with the Social Welfare and Child Protection

Departments in our catchment area as well as the national

referral agencies that support children who have been

physically or sexually abused for counseling and other

support services.

Impact and Expansion

Between August and October 2013, the Social Service department led the assessment process

of 131 homesteads resulting in 1,067 individual contacts. Ninety-two children were

recommended for educational assistance and 40 individuals were connected with health care

services. Forty-five additional homesteads received services in the realms of psychosocial

support, legal/protection, shelter and nutrition. Ongoing assessments, interventions and

referrals are occurring weekly along with regular case management of our clients.

Programs that are in process or are under consideration through the Social Service

Department include:

Forming a “teen club” in collaboration with Baylor Clinic to serve the 35 teens who

receive ART through our Health Care department.

Developing a 24 hour, 365 days a year short-term respite program for children who in

abusive or otherwise unsafe environments until a long-term safety plan can be put in

place in conjunction with community members, governmental resources and other

NGOs.

Working in collaboration with Child Care to create more formalized and structured

after-care services for our teens aging out of the hostel and moving on to independent

living.


40

Agriculture

Agricultural work has been a part of programming at St. Philips Mission since the 1970s with

the early work of the Missionary Sisters of the Sacred Heart. It has taken many forms and

has always symbolized the coming of new life inherent in the work of Cabrini as a whole.

This year the Agriculture Department has seen some significant changes as a Food Security

program concluded and the department transitioned to more integrated programming.

Food Security Programming

In 2013, Cabrini Ministries successfully completed an

agricultural education and food security training program. The

program, which ran from January 2012 to July 2013, included

the creation of a locally relevant permanent agriculture

curriculum which was then utilized to train 147 children and

health care patients. Cabrini staff worked with families on their

homesteads to design and create permanent garden spaces.

These individuals were provided with the necessary inputs

(tools, seedlings, technical support) to improve their ability to

grow nutrient-rich fruits and vegetables for their families.

Key Indicators

Completed development of Agricultural Education Curriculum

147 people trained on farming techniques, nutritional practices and the establishment

of door-sized gardens.

o Including orphans and vulnerable children and 55 area families

98% of the children and families trained went on to establish productive gardens

Program Transition

After a year of implementing the food security program, Cabrini Ministries decided to

reorient its agriculture work. Up to 2013, Cabrini operated a small commercial agriculture

department. The department provided both food for our hostel and health-care patients and

crops for market. However, the operation was resource-intensive, dealing with local markets

was difficult, and production did not always meet expectations. Because the department was

not an integral part of the mission of Cabrini Ministries, the decision was made to shift focus

from internal food production towards community education and training.

By scaling down the program, we are also able to offer more effective agricultural education

to children and teenagers. Using the knowledge and skills gained, we are continuing to

mentor those in our care on best practices in individual food security. These mentorships are

important for improving the capacity of our children and teenagers to provide for themselves

and their families later in life. Finally, Cabrini is also cultivating bananas and has already

enjoyed the first crop. Bananas are a low-cost, low-maintenance fruit to cultivate and provide

our patients and children a significant amount of fresh fruit each year.


41

7. MONITORING AND EVALUATION SYSTEMS

The Monitoring and Evaluation systems employed by Cabrini Ministries has been designed to

provide rapid programmatic feedback while also tracking relevant information needed for

grants management and collaboration with key stakeholders. It is built around a shared

database structure that utilizes appropriate primary source documentation for data entry and

quality assurance auditing. The overall M&E systems are then used on a regular basis to

review and improve program delivery and to provide accurate reports to donors and other key

stakeholders.

Every employee who assists with service delivery is aware of the importance of proper

indicator tracking; staff implementing programming play a vital role in providing accurate

and precise data about organizational impact. Cabrini currently employs a full time M&E

officer as well as a full time Health Care Data Officer. Two other Health Care employees are

cross-trained on data entry and basic reporting and support the operations. In Child Care,

primary source documentation is managed part-time by an administrative staff member with

the assistance of a Child Care focal person. The Social Service Department handles data

input on the case-management level. Regular reports can be compiled by all M&E staff,

while the Grants Manager is responsible for major report aggregation as well the

development of data tools and the compilation of trends and projections.

The current system is primarily based on three linked databases to track program enrollment

and service delivery. Work is currently underway to unify these into a single system. The

Health Care database is designed around tracking clinical services and appointment follow

up. The Child Care database focuses on program enrollment and event tracking. The Social

Service database links homestead assessments with interventions. All of these systems are

run in Microsoft Access with network capabilities that allow for multi-user sharing and easy

digital backups.

On a quarterly basis, the program enrollment in Child Care is reviewed and a full data audit

on one week’s worth of services is performed at Health Care. These reviews have resulted in

improved data quality, as corrective measures are constantly being implemented, particularly

as it relates to data flow and collection.

These M&E systems are used to collect over 400 unique indicators for various stakeholders

connected to Cabrini Ministries. Recent improvements in the systems have allowed the

organization to move from simply tracking program outputs to tracking the impact the work

has for those it serves

In order to improve the precision of the reporting, the Data Officers are primarily responsible

for maintaining data quality, while the M&E Officer oversees report generation. This ensures

continuity across all the statistics generated. An indicator aggregation tool has been

developed that converts a query of services offered into age and gender delineated results for


42

a wide variety of indicators. This approach reduces human error and increases the reliability

of results.

Over the past two years, Cabrini’s approach to data management has been to focus on the

creation of precise results (replicable figures based on primary source documents) and then to

expand the scope of data collection. This strategy has resulted in consistent figures that

improve in quality each quarter.

Two major transitions are underway in the M&E department at Cabrini. The first is the

integration of all data systems into a unified database. This will improve Cabrini’s ability to

deduplicate impact results for people who receive services from multiple departments. It will

also improve service delivery as relevant staff will have a broad dataset to work from. If an

adolescent Health Care client is consistently missing refill appointments, the default trackers

will be able to access information from the homestead assessments to ascertain if outside

factors may contribute to the non-adherent behavior.

The second major transition involves shifting the system to track all clients in relation to the

homesteads they belong to. This will not only provide a better understanding of the

interconnectedness of Cabrini’s service delivery across multiple departments, but it will also

provide new information on how best to address issues at the homestead level as Cabrini

seeks to continually improve its service delivery to the family as a unit.

The Monitoring and Evaluation systems at Cabrini continue to evolve with the ultimate goal

of using information to provide the best delivery of care possible.


43

8. ORGANIZATIONAL DEVELOPMENT

The ability of Cabrini Ministries to continue to offer high-quality, high-impact programming

is dependent on maintaining the support structures needed for implementation. The role of

Organizational Development is inseparable from

program delivery. Over the last two years, Cabrini

has been intentional about planning for the future

by looking at current and expected needs in relation

to the capacity of the organization and overall

expected internal and external transitions.

Concerted effort is being directed at continuing

development in the areas of: staff, programming,

funding and transitional planning.

Identified Emerging Issues

In the last decade, Cabrini Ministries has developed health care and child care programming

to address issues related to those infected and affected by HIV/AIDS and TB in its lowveld

catchment area. While significant immediate needs still exist, nearly everyone who wants

access to HIV/TB care is receiving it and the life threatening issues for orphans and

vulnerable children are being addressed. This movement from emergency care to chronic

care has resulted in a relative stability that now allows Cabrini Ministries to begin identifying

and responding to emerging issues.

The issues outlined below have been directly observed in Cabrini’s care context, yet are also

foreseen to have effects in the larger Southern African and Global context. Cabrini

Ministries is uniquely positioned as an “on-the ground implementer” while maintaining

significant connections with the larger structures in global health. This context can and

should be leveraged to impact future policy and funding movement.

Tuberculosis

TB is the leading cause of death among HIV+ positive clients. While a strong treatment

infrastructure and national protocols exist for TB and MDR-TB, implementation of national

public health policies regarding infection control are dangerously lagging behind. Rural

areas where eating utensils and sleeping arrangements are often shared are among the hardest

hit. Case finding in the rural areas is also more difficult due to poor infrastructure and lack of

regular clinical care. Treatment protocols are intensive and adherence often requires use of

public transportation which can be expensive and exposes more people to the disease as care

is given in the midst of other sick individuals. Additionally, monies dedicated to stopping the

spread of the disease have proven to be difficult to access, especially for civil society

organizations often tasked with orchestrating the community-based work.


44

Addressing this issue will require the following activities:

Increase in implementing staff to address issues of education and more intense case

finding on the homestead-level.

Development of a Monitoring and Evaluation plan to track process and ensure

connection to relevant services.

Increased training for all staff – not just nurses, especially around MDR-TB, case

finding and infection control.

Ongoing discussion with national and international stakeholders concerning resource

allocation. Structural issues must be addressed in order to ensure this work is done

effectively and efficiently.

Stay on the cutting edge of TB work through ongoing training and innovative

program development.

Sustaining Treatment

In the catchment area served (approximately 350

square miles or 5% of Swaziland), well over 2,000

clients are enrolled on life-saving ARV treatment.

This number is bound to increase as discussion of

Treatment as Prevention is becoming more

commonplace. Cabrini has been pro-active is making

on-going treatment as easy as possible for clients with

outreach nursing services and remote refill clinics.

However, even with the significant headway being

made in treatment availability, the effectiveness of

this work relies on sustained treatment. Currently,

10% of appointments are missed, and without time

and resource intense follow up, many of these clients

would default. Addressing this is a primary concern.

In the context of Cabrini’s current work, this means

an increased focus on consistent treatment for current

patients, that include improved pre-initiation

counseling and sustained follow up and counseling for those with chronic missed

appointments. Additionally, as clients become more mobile, it will be essential to improve

transfer and patient follow up procedures.

Cabrini currently is leading the way in Swaziland when it comes to patient tracking and

follow-up, but needs to emphasize the importance of treatment support on a larger scale so

this need is not overshadowed by the push for increased initiations. Additionally, as HIV+

clients are initiated on ART at earlier stages before they have experienced the devastating

effects of the later stages of the disease, it is likely that sustaining treatment will become

more difficult.


45

To further prepare to meet these needs, Cabrini needs to:

Research and provide training on Treatment as Prevention since this will complicate

and enhance work in this area

Improve intake processes (including interviews) so that clients are ready for ART and

its impacts

Expand connection with clients to their homesteads so we are better equipped to

address the issues that impact treatment

Identify and respond to factors influencing treatment default

Life Transition Programs

With the increased roll out of ARVs in the country and expanding Child Care services from

Cabrini, the urgency to simply keep people alive has evolved into a need to improve the

quality of life. Orphans and vulnerable children who would be dead are now alive; yet, many

have experienced the disintegration of family structures as multiple primary care providers

have died or abandoned them. These youth are now aging into adulthood with major issues

related to anger, depression and self-esteem. This, coupled with an intentional focus on

impact mitigation for only those under 18 has created a generation without the proper skills to

transition into a meaningful life experience. There is a high incidence rate of pregnancy and

increased risky behaviors that is being observed especially among those classified as Orphans

and Vulnerable Children.

Whereas meeting the basic needs (health, shelter, food, etc.) of at risk populations have been

relatively straightforward. These emerging psychosocial issues will require innovative

approaches and long term commitment. This will likely include:

life-skill development

relevant income generating opportunities

counseling and mental health care

mentoring and/or support groups

Responding to this emerging issue will require:

Increased staffing, especially amongst professionals and para-professionals.

Improved M+E procedures and systems to be able to track beyond “services

provided” and including future transitions and outcomes

(Re)Establish connections with children who have left the program to compile

“Lessons Learned”

Increased staff training and flexibility around broader life issues.

Expanded need for Social Service Provision

The issues mentioned above address emerging issues that are or will face the existing

departments at Cabrini. However, as the country of Swaziland moves to stabilizing in the

“new normal” of ARVs and broken families, a whole new category of need emerges: those

issues requiring Social Service intervention.


46

Cabrini’s recent launch of the Social Service Department has been designed to respond more

efficiently and effectively to growing needs such as child protection, abuse, psychosocial

support, counseling, etc. The role and function of this department will continue to evolve and

expand.

In order to respond to this need, the following actions need to occur:

Continue to develop the Social Service department headed by professional staff and

capacitated to assess and respond to social needs of those currently receiving services

and to the families in the catchment area as a whole.

Further integrate these services with the existing departments of Child Care and

Health Care.

Upgrade M&E systems to track activities and identify progress and ways for

improvement.

Work with existing and interested parties to push for a national system which

effectively addresses the national issues.

Strategic Priorities

In light of the items considered above, the following strategic priorities have been set by the

organization:

Continue focus on providing cutting edge work with measurable results

Cabrini Ministries is already known for its high quality work in a resource limited setting.

The organization has designed and modeled “best practices” that are utilized on a local and

regional setting. It has a rapidly improving Monitoring and Evaluation structure that has the

emerging ability to provide significant data points for program evaluation and future

planning. On the whole, Cabrini Ministries’ track record of success and accountability makes

it attractive for funding organizations.

If Cabrini Ministries is going to succeed in the future, it must keep its focus on innovation

and superior service delivery. Future development cannot occur without an emphasis on

current implementation.

Additionally, the M+E systems in place must continue to expand to include improved data,

more relevant indicators, and future trends. It must also include significant qualitative data in

the form of success stories and lessons learned. This will make Cabrini more attractive while

also positioning the organization to respond to new issues faced in the catchment area.

Strengthen existing funding relationships

It is easier to keep existing funds than it is to raise new funds. With this in mind, Cabrini

Ministries will continue to strengthen its existing relationships. This includes improved

reporting, better donor follow up, and expanded relationships. It is not only relevant to keep


47

the current funding sources, but to also explore expanded opportunities such as new grant

opportunities, increased funding and extended reach.

Position the organization to be ready to handle emerging issues

Cabrini Ministries has always “followed the need” and in doing so has positioned itself on the

cutting edge of many emerging global issues. Because of its structure and relationships, the

organization has been able to bridge the gap between high level policy makers and on the

ground needs. Cabrini is primarily an “implementer” but has the ability to make an influence

on a higher structural level. This unique status allows the organization to be an innovator and

the opportunities that arise from this should be optimized.

Moving forward, Cabrini will be attentive to

ways of positioning itself to receive funding for

emerging issues. This means that more attention

needs to be paid towards monitoring local needs

that are not being met and also the effectiveness

of interventions. This may require willingness

to “staff ahead of the need” and to invest in

work that is not yet funded.

As the organization expands to provide even more comprehensive and integrated services in

the area, new issues will be discovered. Cabrini is committed to continually evaluating the

assets and challenges in the community in order to be able to respond in the most appropriate

way possible.

Integrate development planning into organization's on-going life

As Cabrini grows, its programmatic footprint and financial needs also expand. As a result,

significant breakthroughs are being made in terms of community assistance and impact.

However, this also increases the burden of sustainability. More money is required every year

to provide existing and emerging services; additionally, there is more demand for

professional staff in a location that is not inherently attractive. Therefore, an intentional

focus needs to exist towards how the organization grows and develops. This includes the

need for

Further development of a long range succession plan for all key staff members as well

as training and staffing plans which are tied to organizational priorities

Movement towards multi-year budgets and funding forecasting

Strategic emphasis on developing new relationships with potential funders and policy

makers

Improved indicators which inform and shape the items described above.

Becoming a “Social Service Organization”

In 2013, Cabrini undertook a series of Strategic Development retreats to build an action plan

based on the realities outlined above. The apex of the dialogues revolved around a discussion


48

about the core business of Cabrini Ministries in light of programmatic transitions and

emerging needs. By identifying the changing circumstances in our organization, our

community and our world, the following conclusion was formed:

Cabrini is at a critical transitional moment in its understanding of itself and needs to

evaluate its mission, vision, value and work as it moves into the future.

Specifically, the team that gathered recognized that it is Cabrini’s integrated psycosocial

methodology to its work in the community that makes it unique and effective. That,

combined with our Christian identity and mission, undergirds the programmatic approach in

all departments. While the development of the Social Service Department was originally

conceived as a way to expand care to those who fall between Health Care and Child Care

services, in reality, all of our work is based on Social Service – Health Care and Child Care

programming are simply expressions of that.

Rather than looking at ways to integrate Social Services into the current work, the Cabrini

leadership believes that the organization is moving to a place where a Social Service

framework will inform and direct the organization as a whole.

While this is a transition which is in-line with Cabrini’s ongoing history and implementation,

it is a significant evolution. Additional strategic development sessions have already been

planned for 2014 to further explore and develop the implications of this transition. In the

end, the vision of “Restoring Life” will not change; instead it will only develop and expand in

its scope.

Future Projects

In evaluating future organizational development, investment in the following has been

identified as priorities:

Maintenance / Expansion of Vehicle Fleet – On average, Cabrini needs one vehicle

per year to keep up with the wear and tear of community based projects.

Expanded Staffing – This primarily involves professional and para-professional staff

for all departments including a Clinical Social worker, additional nurses, and child

care professionals.

Expanded laboratory– This includes a point of care GeneXpert and viral load

machine. These machines hold the potential to increase our responsiveness to HIV

and TB in our area.

Staff trainings / development – As Cabrini grows, it becomes necessary to develop

the professional capacity of existing staff in key roles as a way of increasing

organizational capacity and individual potential. This will require ongoing training

and most likely the sponsorship of education fees in areas like Pharmacy, Social

Work, etc.

Improved Infrastructure for Child Care – The Child Care department is in need of

capital expenditure around things like beds, desks, building remodels, etc.


49

Respite Care Facilities – In order to respond to emergency shelter needs for those in

Respite Care, a dedicated facility along with 24-hour staff is essential. This is

particularly true for care provision to those under 5 years of age.

Staff housing – As our staff increases, especially among professional staff, increasing

the availability of on-site housing will be essential.

Upgrading Remote Outreach – Our Remote refill and treatment sites have become a

large part of the work being done in the communities. Upgrades of the “borrowed”

facilities will improve the quality of work in these areas.

Expanded Health Services – Cabrini is investigating the possibility of integrated full

clinical care to meet the needs of those served in the catchment area. This would be

an expansion from our current focus on HIV and TB towards being a full service

clinic.

Scholarships for transitioning Cabrini Students – Students transitioning from high

school are often faced with the inability to attend tertiary education opportunities due

to a lack of funding. It is our desire to establish a scholarship program.

Energy Infrastructures – Cabrini’s work has been more sophisticated in the last 5

years while the infrastructure in the area, particularly electricity, has gotten worse.

Cabrini needs to install automated generators to ensure the highest level of care is

possible even during regular power outages. Additionally solar panels are being

investigated to achieve an overall cost reduction and improve environmental

sustainability.

Establishment of an Endowment Fund – In order to ensure the vital programming in

Swaziland is able to continue, the organization is looking to establish an endowment

fund that would support the work of the organization well into the future.


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9. GET INVOLVED

The work of Cabrini exists through the support of numerous foundations, organizations and

individuals across the globe. If you would like to get involved, please consider one of the

following.

Sponsor a Special Project

Our development team would love to work with you or your organization to sponsor one of

the special projects outlined above. To find out more, please contact the Cabrini staff at

[email protected].

Donate as an individual.

Regardless of your desired level of involvement, you can make a tangible impact in the lives

of people served by Cabrini Ministries in Swaziland. Consider the following:

Provide hope to marginalized youth by sponsoring a child

For $100 per month, you are able to provide for all the needs of one of Swaziland’s most at-

risk youth. This will cover food, shelter, clothing, education and healthcare for a child. You

will receive periodic photos and updates on your child.

Give life to the sick by supporting essential medical care

For $90 you can provide a year’s worth of comprehensive health care for someone suffering

from HIV or Tuberculosis. This includes testing, counseling, treatment, transportation and

follow up support.

Offer the promise of a better future through education

For $400 per year, you can sponsor the education of a child in Swaziland. This includes all

of the costs associated with schooling for a Swazi child including tuition, uniforms and exam

fees.

Donation Information

To support the work of Cabrini Ministries in the United States, please send your tax-

deductible payment and contact information to: Swaziland Donation, C/O Cabrini Mission

Foundation, 222 East 19th Street, Suite 5E, New York, NY 10003.

In Australia, staff at Cabrini Health Australia can work with their employer to make one-time

or ongoing contributions to the work in Swaziland. Please contact Kate Barker for more

information: [email protected]

For more donation options, please visit: www.cabriniministries.org/donate/


51

10. APPENDICES

Cabrini Health Care Analysis of Services ........................................................................... 52

Clinical Cascade Results and Exits ...................................................................................... 56

Cabrini Impact Mitigation Analysis of Services .................................................................. 57


52

Cabrini Health Care Analysis of Services

Report for the period of Oct 2012 - Sep 2013

TOTAL Clients Served (18)

Female Male

Grand Total

<18 201 168 369

18+ 862 492 1354

Grand Total 1063 660 1723

TOTAL HIV+ Clients Served (18)

Female Male

Grand Total

<18 60 54 114

18+ 620 352 972


TOTAL Visits (18)

Female Male

Grand Total

<18 781 657 1438

18+ 4823 2541 7364

Grand Total 5604 3198 8802

TOTAL Services (18)

Female Male

Grand Total

<18 1641 1357 2998

18+ 12095 6270 18365

Grand Total 13736 7627 21363

ART Clients Served (18)

Female Male

Grand Total

<18 52 44 96

18+ 488 291 779


ART Initiations (18)

Female Male

Grand Total

<18 13 5 18

18+ 66 44 110


Pre-ART Clients Served (18)

Female Male

Grand Total

<18 24 18 42

18+ 192 95 287


CD4 Tests (18)

Female Male

Grand Total

<18 73 75 148

18+ 864 410 1274


CD4 Individuals (18)

Female Male

Grand Total

<18 44 43 87

18+ 502 259 761


Visits with OI Treatment (18)

Female Male

Grand Total

<18 165 123 288

18+ 2262 949 3211

Grand Total 2427 1072 3499


53

Clients with OI Treatment (18)

Female Male

Grand Total

<18 48 46 94

18+ 568 299 867


TB Clients Served (18)

Female Male

Grand Total

<18 12 9 21

18+ 66 59 125


TB Clients Served by Type (18)

Ordinary MDR/XDR

Grand Total

Female 75 3 78

<18 12 0 12

18+ 63 3 66

Male 67 1 68

<18 9 0 9

18+ 58 1 59


HIV + TB Clients Served (18)

Female Male

Grand Total

<18 7 7 14

18+ 47 45 92


TB Initiations (18)

Female Male

Grand Total

<18 3 4 7

18+ 25 28 53


TB Initiations by Type (18)

Ordinary MDR/XDR

Grand Total

Female 26 2 28

<18 3 0 3

18+ 23 2 25

Male 32 0 32

<18 4 0 4

18+ 28 0 28

Grand Total 58 2 60

TB Initiations of HIV+ clients (18)

Female Male

Grand Total

<18 2 3 5

18+ 21 19 40


INH Initiation (18)

Female Male

Grand Total

<18 1 2 3

18+ 27 13 40


INH Completion (18)

Female Male

Grand Total

<18 0 2 2

18+ 28 12 40


Total Clients on INH (18)

Female Male

Grand Total

<18 2 4 6

18+ 63 34 97



54

Sputum Tests (18)

Female Male

Grand Total

<18 0 0 0

18+ 77 57 134


Clients with Sputum Tests (18)

Female Male

Grand Total

<18 0 0 0

18+ 60 47 107


HIV+ Clients with Sputum Tests (18)

Female Male

Grand Total

<18 0 0 0

18+ 48 37 85


HIV Tests by Age / Gender (18)

Female Male

Grand Total

<18 140 120 260

18+ 307 180 487


Total HIV Tests by Result (18)

Negative Positive

Grand Total

Female 378 69 447

<18 133 7 140

18+ 245 62 307

Male 244 56 300

<18 112 8 120

18+ 132 48 180


HIV Re-Tests Only by Result (18)

Negative Positive

Grand Total

Female 122 5 127

<18 7 0 7

18+ 115 5 120

Male 39 0 39

<18 6 0 6

18+ 33 0 33


% of HIV Tests Positive (18)

Female Male Grand Total

<18 5.0% 6.7% 5.8%

18+ 20.2% 26.7% 22.6%

Grand Total 15.4% 18.7% 16.7%

% of People HIV Positive (18)

Female Male Grand Total

<18 5.3% 7.0% 6.1%

18+ 33.2% 32.7% 32.9%

Grand Total 21.6% 21.5% 21.5% *Note: The figures above are the percent of all tests that are positive including people who are retesting. The figures here are total percent of people who test positive.

Blood Sugar (18)

Female Male

Grand Total

<18 0 1 1

18+ 61 46 107


Blood Sugar Individuals (18)

Female Male

Grand Total

<18 0 1 1

18+ 59 46 105



55

Nutrition Services (18)

Female Male

Grand Total

<18 12 3 15

18+ 73 68 141


Nutrition Individuals (18)

Female Male

Grand Total

<18 7 3 10

18+ 45 33 78


Total Visits by Site Totals

Bhadlane 103

Home visit 453

Mconcwane 256

Ncandweni 233

Sinyamantulwa 684

St Phillips Drop In Centre 7073

Grand Total

8802

Unique Clients by Site

Totals

Bhadlane 18

Home visit 302

Mconcwane 48

Ncandweni 53

Sinyamantulwa 160

St Phillips Drop In Centre 1365

Grand Total

1946

Exits (18)

<18 18+

Grand Total

Dead 3 32 35

Female 1 14 15

Male 2 18 20

Defaulted 1 2 3

Female 1 2 3

Transfer out 5 61 66

Female 5 41 46

Male

20 20


ART Exits (18)

<18 18+

Grand Total

Dead 3 21 24

Female 1 11 12

Male 2 10 12

Defaulted

1 1

Female

1 1

Transfer out 4 38 42

Female 4 23 27

Male

15 15

Grand Total 7 60 67

Defaulter Clients Tracked

OTHER ART ART, TB CTX CTX, TB TB Unknown Grand Total

Cabrini

358 11 119 3 1

492

Sinceni

69

11

1 81

Siphofaneni 1 222

160

13 396

Grand Total 1 649 11 290 3 1 14 969


56

Clinical Cascade Results and Exits

HIV Tests 716 100.0%

Negative 591 82.5%

Positive 125 17.5%

ART Eligible 83 66.4%

Initiated 68 81.9%

Via CD4 49 72.1%

Other 19 27.9%

Not Initiated 15 18.1%

Exit 14 93.3%

Dead 6 42.9%

Default / Refused 5 35.7%

Transfer 3 21.4%

Need Int 1 6.7%

Counseling 1 100.0%

Other 0 0.0%

ART Ineligible 42 33.6%

W/ CD4 28 66.7%

W/o CD4 14 33.3%

Exited 14 100.0%

Dead 0 0.0%

Default / Refused 3 21.4%

Transfer 11 78.6%

Need CD4 0 0.0%

Ongoing Client 0 -

HIV Test Only 0 -

Cabrini HIV Testing > CD4 > ART CascadeOctober 2012 - September 2013


57

Cabrini Impact Mitigation Analysis of Services

Report for the period of Oct 2012 - Sep 2013

Child Care Enrollment

Hostel After Care

Respite Care

Acad. Support

One Time Bridge TOTAL

Male 18+ 13 16

12 8

49

Male <18 41 6 2 45 40 6 140

Female 18+ 9 14

7 13

43

Female <18 44 5 1 57 38 3 148

18+ 22 30 0 19 21 0 92

<18 85 11 3 102 78 9 288

Total 107 41 3 121 99 9 380

*Level 5 is included below in “One-Offs”

Child Care Enrollment Impact Nutrition Shelter Health Education Legal PSS Economic TOTAL

Male 18+ 29 29 29 41 29 49 16 49

Male <18 55 49 55 100 55 140 6 140

Female 18+ 23 23 23 30 23 43 14 43

Female <18 53 50 53 110 53 148 5 148

18+ 52 52 52 71 52 92 30 92

<18 108 99 108 210 108 288 11 288

Total 160 151 160 281 160 380 41 380

Child Care One-Offs

Nutrition Shelter Health Education Legal PSS Economic TOTAL

Male 18+ 6 0 5 2 2 10 0 10

Male <18 18 0 171 59 10 233 0 233

Female 18+ 39 0 2 8 0 11 0 11

Female <18 50 0 166 67 6 240 0 240

18+ 45 0 7 10 2 21 0 21

<18 68 0 337 126 16 473 0 473

Total 113 0 344 136 18 494 0 494

*”One-Offs” are services provided outside the levels of care. Details included below.


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Child Care Full Stats Nutrition Shelter Health Education Legal PSS Economic TOTAL

Male 18+ 35 29 34 43 31 59 16 59

Male <18 73 49 226 159 65 373 6 373

Female 18+ 62 23 25 38 23 54 14 54

Female <18 103 50 219 177 59 388 5 388

18+ 97 52 59 81 54 113 30 113

<18 176 99 445 336 124 761 11 761

Total 273 151 504 417 178 874 41 874

Health Care Stats

Nutrition Shelter Health Education Legal PSS Economic Total

Male 18+ 51 564 564 18 564

Male <18 8 141 141 5 141

Female 18+ 78 1058 1058 34 1058

Female <18 12 169 169 5 169

18+ 129 1622 1622 52 1622

<18 20 310 310 10 310

Total 149 1932 1932 62 1932

Total Impact Mitigation Stats

Nutrition Shelter Health Education Legal PSS Economic TOTAL

Male 18+ 86 29 598 43 31 623 34 623

Male <18 81 49 367 159 65 514 11 514

Female 18+ 140 23 1083 38 23 1112 48 1112

Female <18 115 50 388 177 59 557 10 557

18+ 226 52 1681 81 54 1735 82 1735

<18 196 99 755 336 124 1071 21 1071

Total 422 151 2436 417 178 2806 103 2806


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Oct 2012 Healthy Physicals Oct 2012 Assessments TOTALS TOTALS

Male 18+ 2 Male 18+ 8

Male <18 168 Male <18 40

Female 18+ 2 Female 18+ 13

Female <18 165 Female <18 38

18+ 4 18+ 21

<18 333 <18 78

Total 337 Total 99

*Full Dataset in Jan 2013 ME+R folder *Figures for Level 6 Care

Outreach Education TOTAL

Male 18+ 1

Male <18 42

Female 18+ 2

Female <18 45

18+ 3

<18 87

Total 90

*Estimated Age/Gender based on register

Camp Term 1 2013 TOTAL LVL 1-3 LVL 4 NEW

Male 18+ 16 12 4

Male <18 25 17 8

Female 18+ 13 7 4 2

Female <18 52 22 23 7

18+ 29 19 8 2

<18 77 39 31 7

Total 106 58 39 9

*Totals taken from 2013 Term 1 camp register


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Camp Term 2 2013 TOTAL LVL 1-3 LVL 4 Camp 1 NEW

Male 18+ 15 10 1 3 1

Male <18 21 12 0 3 6

Female 18+ 12 7 0 2 3

Female <18 44 14 6 18 6

18+ 27 17 1 5 4

<18 65 26 6 21 12

Total 92 43 7 26 16

*Totals taken from 2013 Term 2 camp register ***For assumptions based on level, refer to table above

Memory Box Camp, Q4 2013 TOTAL LVL 1-3 NEW

Male 18+ 0 0 0

Male <18 7 4 3

Female 18+ 0 0 0

Female <18 9 4 5

18+ 0 0 0

<18 16 8 8

Total 16 8 8

*Totals taken from 2013 Memory Box Camp Register

Stand Alone One Offs -- Q1-2 Stand Alone One Offs TOTAL Nutrition Shelter Health Education Legal PSS Economic

Male 18+ 0 Male <18 4 1

2 1

Female 18+ 0 Female <18 9 3

3 3

18+ 0

0 0 0 0 0 0

<18 13 4 0 0 0 5 4 0

Total 13 4 0 0 0 5 4 0


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Stand Alone One Offs -- Q3 TOTAL Nutrition Shelter Health Education Legal PSS Economic

Male 18+ 1

1 1 Male <18 9

3 6 6

Female 18+ 1

1 Female <18 3

1 2 3

18+ 2 0 0 0 0 1 2 0

<18 12 0 0 0 4 8 9 0

Total 14 0 0 0 4 9 11 0

*Compiled from Social Service case files -- includes unique services occurring in Q3

Stand Alone One Offs -- Q4 TOTAL Nutrition Shelter Health Education Legal PSS Economic

Male 18+ 5

3

1 5 Male <18 7

3 5 2 7

Female 18+ 1

1

1 Female <18 6

1 3 1 6

18+ 6

3 1 1 6 <18 13

4 8 3 13

Total 19

7 9 4 19 *Compiled from Social Service case files -- only includes interventions occurring in Q4

**Above tables reflect only individuals receiving unique services

Combined One Offs TOTAL Nutrition Shelter Health Education Legal PSS Economic

Male 18+ 10 6 0 5 2 2 10 0

Male <18 233 18 0 171 59 10 233 0

Female 18+ 11 39 0 2 8 0 11 0

Female <18 240 50 0 166 67 6 240 0

18+ 21 45 0 7 10 2 21 0

<18 473 68 0 337 126 16 473 0

Total 494 113 0 344 136 18 494 0

*Total Previously uncounted clients **Includes impact from events above.


62

Cabrini Ministries would like to express their gratitude to all

who have made this program report possible:

All the staff who implement activities daily caring for and

loving their neighbors

To Phindile Tfwala and rest of the data management

team for their data compilation

To Joseph DalleMolle, Beth Kickert, and Katie McCaskie

for narrative composition and editing

Especially to Ben Kickert for coordinating the production

of this work; for his integrity and the generous,

passionate use of his intelligence and skill for the Mission

of Cabrini Ministries.

CABRINI MINISTRIES SWAZILAND

St. Philips Mission

Mhlatuze, Lubombo

Box 5183

Manzini, M200

Swaziland, Africa

(o) +268.2343.4944

(f): +268.2518.5598

[email protected]

www.cabriniministries.org

A ministry of the Missionary Sisters of the Sacred Heart

Program Report - Cabrini Ministries Swaziland

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