SINOSIZO – KOKSTAD
An Historical Perspective
As a response to the widespread and growing problems of extreme poverty and the spread of HIV/AIDS, Sinosizo – Kokstad was established in 1999 as an initiative of the Catholic Church by Bishop William Slattery, Bishop of Kokstad. Up until that time parish clergy and local groups of parishioners had organized themselves to address problems at local level, but while some support was available to them from the diocese, it was limited and inadequate to meet the needs of so many people who were in immediate need of nourishment and medical assistance. The local aid workers were often poor and sick themselves despite which they worked on a voluntary basis to alleviate the plight of their neighbours.
As the situation worsened and the statutory and NGO services struggled to cope, the need for more co-ordination and consistency of approach became more apparent. Government-led social and medical services began to be developed at Central Government and Local Municipality level, and, while they faced an up-hill struggle with few staff and limited resources, it was clear that a well organized voluntary contribution would continue to be required. The need for this contribution was recognized by the Government which articulated the need for community home-based care services. Communities needed to be mobilized to care for the poor and the sick, many of whom were dying before medical help could be made available to them. As a response to this need Sinosizo was established, initially working closely with Sinosizo Durban but eventually forming its own strong local identity.
From the beginning it was clear that the provision of some basic training would be essential for the volunteers. Their obvious poverty required that all aspects of such training would have to be financed by the diocese and, for this, the diocese relied mainly upon external donations. Training programs had to be developed to encompass the variety of problems to be addressed and substantial numbers of volunteers benefited from them. Through this activity the role of Home-based Carers became established and the quality of service offered by the volunteers improved and came to attract recognition by communities and by the evolving statutory service departments. Almost 250 carers were given the benefit of this training, and largely because of financial inducements from the state sector, many of them took up employment in that sector, while many others remained working with Sinosizo without regular financial support, although it was possible to pay their expenses for their work.
The problem of the growing number of Orphan and Vulnerable Children (OVCs) made added demands on carers, as the number of young mothers, in particular, who were dying, increased. Many such children were found to have no birth registration and , for this reason, were ineligible for a statutory grant payable on their behalf. Obtaining the necessary documentation to effect a late registration has proven to be a difficult and time consuming experience for the carers. Support for the relatives, neighbours or family friends who have undertaken the care of such children, and the support of child headed households, became a major area of work for Sinosizo.
The need to address the area of the prevention of infection emerged as the infection spread rapidly throughout the many communities in the area covered by the diocese. The target group were identified as adolescents who could be accessed through schools and community organizations. Parents were encouraged to support their children in attending meetings where relevant issues such as relationships, responsible sexual behaviour and personal responsibility were discussed in an interactive environment. Awareness programs emerged from this activity and eventually an Education for Life program which was delivered at many venues.
At this time the management structure of Sinosizo was a flat one with a general manager, working on a voluntary basis overseeing the work of a large number of volunteers with the help of a number of supervisors. Certain experienced volunteers undertook the role of trainers in specific areas of the work. It gradually became clear that an organization of its size required an improved management structure.
While the organization developed as described, funding became more and more available from church and private donor sources, making it possible to make the payment of stipends to caregivers more frequent, though rarely more often than on a quarterly basis. Given that the workers were drawn from communities in which extreme poverty was the norm, they were glad to receive even a small stipend while retaining a large voluntary commitment to the work.
In September 2006, with the promise of increased funding from non-statutory sources, the management of Sinosizo was reconstructed. Under a general manager, the area was divided into three geographical regions, each with a regional manager and a team of three co-ordinators, one for Home-based care (HBC), one for OVC and one for Education for Life (EFL). With the help of local community supervisors, these managers organize the work of the different sections, account for local budgets and produce the necessary data to demonstrate the cost-effectiveness of the work, under guidelines set , in the main, by funders. A major addition to the Sinosizo functions is the provision of counselling support and adherence monitoring services to the seven hospital based Anti-retroviral Treatment (ART) clinics in the area, with the assistance of PEPFAR funding. Alongside the HBC service this scheme has the potential to greatly extend the outreach of the clinics to areas not previously reached and to add substantially to the number of patients on ART. The joint HBC/ART scheme has a
target patient figure of some 700 and this is capable of being extended, subject to the availability of funding to do so. In the first year the target is to add 200 patients to those already on ART and there is every sign that, in this heavily infected area, this target can be reached. In order to reach it Sinosizo has embarked on providing accredited counselling and monitoring training for its caregivers. The initial group of 32 were trained in December 2006 and are already working in the field.
Another important element in the current approach is to provide a stipend to each caregiver for the performance of their work. The commitment of the workers to helping the sick in their communities has been enhanced by this measure, many of them undertaking the support of more than the number required. Hence, while providing a minimal income to the caregivers themselves, their output has been increased and indications are that the number of patients tested and placed on treatment programmes will be increased.
Sinosizo-Kokstad is committed to raise the additional funding required to implement its program. Already 150 workers are in the field and more can be recruited to extend the pool of sick and poverty-stricken who can be referred to the hospital based clinics for necessary testing and treatment.
Sinosizo has acquired widespread from the communities it serves at different levels. It is already well known for the service it provides for the sick and poor as a result of consultation which takes place with the local community when the service is introduced. With the co-operation of the head-men and other community leaders, members of the community learn of the service and are encouraged to avail of it. The demand usually outstrips the capacity to deliver. There is already a substantial record of service delivery both on a voluntary and stipendiary basis, and, of course, there is no shortage of referrals of both patients and orphans.
Another aspect of community support is evident when the Sinosizo workers present a HIV/AIDS awareness program, a respite program for orphan children and their guardians, or, indeed, a behaviour change prevention program for teenagers and young adults. The amount of help and support offered in running such events and providing refreshments and/or meals is most encouraging. In the belief that it is positive to allow the community to have a stake and make a contribution, despite the poverty of the contributors, the community is invited to contribute according to their means and invariably responds in a generous manner. These programs are attended and delivered by members of all faiths and become important community occasions. Support is also forthcoming from the Provincial and Municipal Government Departments and from other NGOs, all of whom are aware of Sinosizo work. The staff of Sinosizo feel greatly encouraged by communities in their work and derive both pleasure and satisfaction from it.