NATICC

Evalueringsrapport av det første årets drift

Etter ett års drift har GBV prosjektet i Swaziland blitt evaluert. Les og bli inspirert. (Rapporten er på engelsk)

Ved Bjørn S. Olsen
Oppdatert: (02.9.2013)



NATICC (Nhlangano AIDs Training Information and Counselling Centre)
Care and Support Department Assessment Report 2013
Overseen and Reported upon
by Peace Corps Volunteer Lauren Cuddy Egbert (Maseysini Inkundla)

INTENT OF STUDY

The intent of this study, the NATICC Care and Support Department Assessment Report 2013, is to determine the scope of services offered to NATICC clients and the effectiveness of those interventions. The study will impact how NATICC conducts care of clients in the future, and it will inform outside organizations and individuals about the services NATICC currently offers, as well as the impact of those services. We must understand the situation of clients before and after receiving NATICC support to see what interventions and techniques are working for the Care and Support Department, and what gaps are reducing the effectiveness of their work.

METHODS

Methods used in this study were selected to:
 1) put clients at ease as information was collected from them
2) reveal a picture of what the Care and Support Department is succeeding at and what needs improvement
3) limit the influence of NATICC employees on the study

Data for this assessment was gathered by NATICC staff and third party individuals hired solely for the duration of the project. Data collection was supervised by and results were turned over to Peace Corps Volunteer Lauren Cuddy Egbert for third-party assessment.

The clients involved in this study were randomly chosen from NATICC’s database of clients. The total number of clients seen by the Care and Support Department for the calendar year July 1, 2012 to June 30, 2013 was 324. Each 5th person was selected for the study, resulting in 65 targeted clients. A client was only discarded when he or she was not the primary client (the client bringing the case, as opposed to a tangential party in the case), if the case was too recent to see any results, or if the client refused the interview. In this case, the next client on the list was selected.

All information for this study was collected through guided interviews based upon an interview form developed by NATICC team. Each interviewer was introduced to clients by NATICC staff known to clients. This gesture was intended to increase clients’ trust by proving that the interviewer’s validity was vouched for.  We expected that increased trust of the interviewer by the client would produce interviews with more detail and honesty. The NATICC staff member known to the client removed themselves before the interview was conducted to encourage honest responses about any failings on the part of NATICC.

The interview form was designed to obtain both quantitative and qualitative data. Questions included: gender, age, location, month of first visit with NATICC, number of visits with NATICC, services rendered, perceived understanding and respect levels of their service providers, and referrals. The interviewer then asked the client five questions to gauge how the client’s problem was affected by NATICC intervention.

These questions included:

  1. What problem did you face when you came to NATICC?
  2. What did you expect NATICC to do?
  3. How did NATICC help you?
  4. What could NATICC have done better?
  5. How is your situation now?

A code of ethics signed by the third-party individuals ensured that all sensitive information about clients will remain confidential.

EXECUTION OF STUDY

The surveys were completed over the period of eleven days, with appointments spanning from Friday, August 9th to Monday, August 19th. The interviewing team was able to reach 61 clients who were qualified and willing to be interviewed. The greatest challenges interviewers met were clients who were unwilling to respond to some questions or were forgetful about some details of NATICC’s support.

QUANTITATIVE RESULTS

Gender of Clients Interviewed

Gender of Clients Interviewed

Number of People

Percentage

Men

13

21%

Women

48

79%

Total

61

100%


Number of Visits Client Received from NATICC

Number of Visits

People

Percentage

1 Time

16

28%

2 Times

8

14%

3-4 Times

26

46%

5+ Times

7

12%

Services Clients Received and Their Levels of Satisfaction

Services

Total

Seen

Percentage

Seen

Very Satisfied

Satisfied

Partially Satisfied

Dissatisfied

Very Dissatisfied

CASE MANAGEMENT

Face to Face Counselling

59

97%

49

9

1

Placement

2

3%

2

Medical Support

7

12%

2

5

Couples Counselling

11

18%

7

4

Family therapy

31

51%

24

4

2

1

Child counselling

12

20%

11

1

Rehabilitation counselling

0

0%

LEGAL SUPPORT

Court Preparation

4

7%

4

Legal advice

14

23%

11

3

Court support

9

15%

8

1

OTHER

Transportation

19

31%

16

3

Clothing

3

5%

2

1

Food

6

10%

3

3

Educational Support

4

7%

3

1

Did you feel understood by your service provider?

60

49

8

1

2

Did you feel respected by your service provider?

60

49

9

1

1

Overview of Results:

  • Many women are seeking the help of NATICC vs. men (79% women vs. 21% men). Some of the men interviewed had even been sought out by NATICC, instead of the other way around.
  • 97% of clients received face to face counselling.
  • 82% of people said that they felt “very satisfied” with the levels of respect and understanding from their NATICC care providers. 95% of clients felt at least “satisfied” with the level of understanding received, and 97% felt at least “satisfied” with the level of respect received.
  • Clients reported being “very satisfied” with services above any other choice in every area, except in the cases of medical support and food, which had more people reporting as only “satisfied.” It is important to note that these areas, as well as the areas of clothing and placement, are third-party services, which NATICC accesses but does not administer.
  • Additionally, some clients also reported receiving spiritual support and human rights knowledge.
  • Partners of NATICC (institutions or organizations NATICC referred clients to) include: Nhlangano Police, Emafini, Pasture Valley, Mental hospital of Matsapha, Nhlangano Magistrate Court, Social Welfare, Hlatikhulu Government Hospital, Nhlangano Health Centre, Lusendvo, ART clinic, and Khulisa Umntwana.

QUALITATIVE RESULTS

Based upon the narrative questions asked of clients by interviewers, some areas of success and difficulty could be identified. NATICC seems to have earned great respect from people she has served. Clients spoke highly of the counselling offered and of the sensitivity NATICC care providers showed. NATICC care providers were able to insert themselves into families, communities, and disagreements with a great level of success. NATICC’s ability to resolve disputes is respected in communities.

The case of a girl reported missing from her homestead provides a good example of the decorum NATICC service providers show. NATICC went to the girl’s community to speak to her boyfriend and ask if he knew her whereabouts. Although he also didn’t know where she was, the boy didn’t feel attacked and suspected. In fact, he felt “very satisfied” with the level of understanding and respect he felt from the service provider. NATICC’s intervention resulted in returning the girl to her parental homestead, while uncovering the fact that she had run away because she was pregnant. After learning this, NATICC offered couples’ counselling to ensure that the boy and girl could manage their relationship with the new knowledge that they were going to have a child.

Clients’ main complaint against NATICC was overwhelmingly the same. Many people were unhappy with what they felt was a lack of follow-up by NATICC. In some cases, the need for follow-up may have been perceived by the client even if it could not be NATICC’s first priority. In some cases, however, there were legitimate complaints about things NATICC service providers had promised to do and never did.

A female in Nsongweni who received 3+ visits from NATICC reports, “NATICC should do (its) job fully and keep it in mind that people really need the service… it must be done holistically. I’m not happy with NATICC because if NATICC continued helping us my child was going to be well.”  According to this woman, after her child’s rape, NATICC provided transport to the Matsapha Clinic and removed the perpetrator from the homestead. She felt that follow-up was neglected because they didn’t make an appointment with the doctor for her child, and that they did not provide the on-going counselling her daughter needed. She reports feeling “dissatisfied” with the amount of respect her service provider offered her, which one can surmise is a result of the lack of follow-up.

When the group of these “unsuccessful” interventions (cases in which the original problem was reported to be the same or worse as before NATICC intervention and/or the client was dissatisfied) were examined, it became clear that these cases, on average, fell into the “3-4 visits” range. Whether these cases were in need of more follow up to be successful or lacked additional follow-up because they were unsuccessful for reasons beyond NATICC’s control is unclear. As stated previously, even if follow-up is a priority of a client, it cannot always be the first priority of NATICC. NATICC must be sure to provide follow-up when there is a compelling reason to do so, or when follow-up has been promised. The case of one woman, who came to NATICC to request further assistance and was told to go home because NATICC would visit her tomorrow, though they never did, is unacceptable.

Another complaint was expressed by only one man, but seemed worthy of note. The man felt that while he was generally happy with his counselling with his wife, he felt that NATICC should be sure to “always give couples same advice, (instead of looking at the situation from) one side. As a man, (I feel) not comfortable about that. Always listen (to) both of us.”
On the other hand, two other men made sure to express satisfaction with how even-handed their care provider was as they discussed marital and family issues. They felt that they were able to express their concerns about their wives behaviour while learning how they were contributing to their problems at home.

An example of the best of NATICC’s holistic assistance was described in the account of one woman who was being physically, sexually, emotionally, and economically abused. The woman recounted, “before sleeping with me he (would) insult me, beat me, then force himself on me. When I got paid, he took all of my money. We are both HIV positive, so he refused to use protection. We do not have children together, but he has his own who were abusing me. I would buy food, which they stole and sold. They chased me from the homestead.” This problem continued for so long that “(NATICC) offered me counselling because I was on the verge of committing suicide. NATICC became my family. NATICC conducted couples counselling. When my husband didn’t change his behaviour, NATICC assisted in terms of applying for a Peace Binding Order. NATICC offered legal advice and court support. My husband was arrested because he breached the order. NATICC facilitated this process.” In this scenario, NATICC’s role was that of an individual counsellor, couples counsellor, legal aide, and liaison to the police. This case took more than simply offering counselling and referring the client to another institution. NATICC has a very compelling role in helping along cases reported to the police, because it has greater ability to advocate for action than do most clients individually. 

CURRENT SITUATION OF CLIENTS

19 out of 65 clients (31%) reported that their situation was the same or worse than before NATICC intervention. The other 75%, however, reported that the problem they came to NATICC with had a positive resolution.  These two groups were termed the “successful cases” (the latter) and the “unsuccessful cases” (the former).

Some “successes” were only partially resolved. One example is a case in which a mother was preventing her child from taking ARV medication. After NATICC’s counselling, the child is now being given her ARVs regularly, although the mother is still not taking them due to her religious convictions. In these cases, the fact that NATICC intervention had produced some positive result for some of the parties involved was enough to consider the intervention a success. It is clear that some people and situations will not change, no matter the degree of intervention by an outside party.

RECOMMENDATIONS

It would be useful to help clients understand the overall process of receiving assistance from NATICC. This would help clarify the expectations of clients so they would understand that NATICC can offer them support in certain areas, for a finite amount of time. Such clarification could help clients understand that being assisted by NATICC requires partnership and their own initiative, as well as initiative on the part of NATICC. This would be especially useful to solve the issue of follow-up appointments. NATICC currently understands that a follow-up appointment is requested when the client physically returns to NATICC. Clients may be waiting in the community for NATICC to come visit then. Clarification of expectations may really help empower clients to work with NATICC support for what they need.

Similarly, it may help to develop clearer guidelines for staff and clients about what NATICC can do and cannot do, as well as responsibilities of the client and responsibilities of NATICC service providers in each specific case. A clear list of responsibilities on both sides could be written out by staff so clients are aware of what the terms of the arrangement are. This would help staff be sure not to make promises they can’t fulfil and would help clients to understand their role in their own case.

Some of the happiest clients were those who had finally seen police action due to NATICC support, and some of those who were most disappointed had not received peace binding orders, police intervention, or legal enforcement. For this reason, a continued and growing relationship with the police can go far to make sure that cases don’t slip through the cracks where NATICC’s intervention ends and the police’s begins.

It could help to see more male outreach in terms of encouraging healthy family dialogues. As NATICC is telling families that disagreements can’t be resolved by violence, some conflict resolution training may be needed in communities. If men in the communities are struggling to learn to resolve conflict without violence, NATICC could be helpful in providing counselling and teaching those skills. Furthermore, if men feel that they can trust and turn to NATICC, NATICC’s ability to resolve couple or family disputes may improve.



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