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Section B - Community Needs
(1) Describe benefitting community including location.
Swaziland is 17363 km2 (roughly the size of the State of New Jersey) and is landlocked by Mozambique on the east and South Africa elsewhere. The benefitting communities of Maphiveni (estimated 3,500 people) and Vuvulane (estimated 2,000 people) are located in an isolated area on the eastern side of Swaziland. The communities are surrounded by large scale sugarcane plantations and undeveloped "bush". The higher density of individual homesteads make Maphiveni and the surrounding communities unique.
(2) What community needs have been identified?
Swaziland has the highest HIV-AIDS infection in the world at 26%. Life expectancy has dropped from 64 in 2000 to less than 32 as of 2010. The little country faces extinction without strong intervention in HIV-AIDS coupled in most cases with tuberculosis. The impoverished and isolated villages of Maphiveni and Vuvulane lack access to the distant government supplied services because of the high cost of obtaining transportation. HIV prevalence in the initial target population is as high as 49%. Literacy and vocational training is needed to help villagers provide for their families, many of which are headed by children in absence of deceased HIV infected parents. Food is scarce in a country where 75% are subsistence farmers with many victims of the epidemic. In 2006, 69% of the population was considered to be living less than $1.25 USD a day.
(3) How are these needs currently being addressed with local resources and government agencies, NGO's; etc?
The government furnishes Anti Retro Viral (ARV's) drugs for management of HIV-AIDS and medications for tuberculosis. Because of poverty and remoteness of these two communities many do not get to government facilities. Methodical and consistent follow-up of treatment of HIV infected children and their caregivers are essential to be effective. In 2008 a non-profit Children's HIV Intervention Programme in Swaziland (CHIPS) was started to provide proactive testing and care for children and their caregivers in these two villages. Another non-profit, Claypotts Trust, provided funding for 2008-2011 and is committed to continue funding when the cycle is complete. The Claypotts funding provides salary for Swazi staff who manage transport for patients and provide HIV counseling, testing and blood draws. Daran Rehmeyer and his oncology nurse-wife, Teresa, have been working in the urban and semi-urban areas of Swaziland since 2005.
CHIPS began as a program to address the inability of the HIV+ children and caregivers in these communities to access the available care at the closest hospital due to overwhelming transport costs. As an integral part of the CHIPS program, teachers, community workers and volunteers are trained to identify children and their caregivers that are candidates for HIV testing. Although many of the services originally sourced at the hospital have been pushed back into the community and performed by CHIPS staff (HIV testing, initial counseling, blood work, adherence counseling) the transport capacity has been exceeded for serving the increasing numbers requiring trips to the hospital for drug initiation, doctor intervention (primarily due to opportunistic HIV related illnesses), TB testing, etc.
Section C: Activity Description
(1) Summarize the proposed activities
The grant is to provide a replacement patient transport vehicle for bringing patients from Maphiveni and Vuvulane to Good Shepherd Hospital (GSH) in Siteki (about 50km). The CHIPS van carries on average 13 patients to GSH three times per week. Four years of constant use between the target communities and GSH and traveling on the unpaved roads in the sugar cane fields has been brutal on the van. Maintenance costs to keep the van on the road have consumed a large part of the CHIPS operational budget.
(2) List any cooperating organizations involved in the proposed project.
(3) Describe how the benefitting community will be involved in the activities
CHIPS staff are employed and trained from inside the community. Local staff provide the critical link in providing a services to these marginalized communities where a trust and confidentiality is essential.
(4) Has the benefitting community confirmed that it would like the activity to take place?
Over four hundred HIV+ children and caregivers from Maphiveni and Vuvulane rely on CHIPS transport to access HIV care and drug refills.
(5) Proposed Start Date - April 15, 2013
(6) Proposed Completion Date - May 15, 2013
Section D - Area of Focus.
Which area of focus is the proposal activity aligned?
1. Peace and conflict prevention/resolution ____
2. Disease prevention and treatment X
3. Water and sanitation ____
4. Maternal and child health X
5. Basic education and literacy ____
6. Economic and community development ____
(2) Describe how the activities will address the goals of the areas of Focus
a. Reliable access to health care for HIV+ children and caregivers is critical. Even missing three doses of drug in one month can cause a person to be non-adherent. Treatment adherence is critical in HIV care. Treatment adherence means following the treatment regimen closely every day-taking the correct dose of each anti-HIV medication at the correct time and exactly as prescribed. Adherence is very important for successful HIV treatment. Adherence affects HIV treatment in two ways:
• Close adherence to an HIV treatment regimen allows anti-HIV medications to work effectively to reduce the amount of HIV in the body. Skipping medications, even occasionally, gives HIV the chance to multiply rapidly. Preventing the virus from multiplying is the best way to protect your health.
• Close adherence to an HIV treatment regimen also helps prevent drug resistance. Drug resistance develops when the virus mutates (changes form), becoming "resistant" to certain anti-HIV medications. One or more anti-HIV medications in a treatment regimen can become ineffective as a result of drug resistance.
Skipping medications makes it easier for drug resistance to develop. HIV can become resistant to the anti-HIV medications in a person's current regimen or to other, similar anti-HIV medications not yet taken, limiting options for successful HIV treatment. And drug-resistant strains of HIV can be transmitted to others, too
Missing a refill appointment immediately puts a patient at risk of non-adherence. CHIPS provides the only free and reliable transport to GSH for HIV+ patients from Maphiveni and Vuvulane. CHIPS staff also remind patients of upcoming appointments during visits in the community.
b. Transport to GSH also allows the opportunity for caregivers and their children to access doctors and the services available at the hospital. On several occasions, CHIPS has provided the emergency transport for critical patients to the hospital as the defacto ambulance service from these communities. Several children have been either born on the way to the hospital or just after arriving. Child and mother health fare much better with a birth at (or nearly at) the hospital vs. birthing at home (which is what would occur without reliable CHIPS provided transport).
Section E - Project Outcomes
(1) What are the immediate and long-term outcomes of the activity?
Healthier caregivers mean better care is provided for children. Healthier children mean better opportunities to complete school. Caregivers on successful treatment for HIV mean fewer orphans in a country already burdened with an orphan population approaching 10% of the population.
(2) How will involved parties ensure sustainability?
Fiscal and Operational Sustainability: Numerous commercial activities are being developed to provide the long term operational funds for CHIPS. These are being developed in the Maphiveni and Vuvulane communities to raise the base economic level there while providing for the sustainability of CHIPS.
Current vehicle petrol costs are averaging E4000 per month. The following economic development projects and average monthly revenue will provide for the operational funds for the vehicle (running and maintenance costs):
Kudvumisa Glass (glass and granite etching): E3000/month
Marula Nuts: E600/month (projected)
Marula Shell Fire Logs: E2000/month (projected)
Marula Oil: E1500/month (projected)
Vuvulane Section 19 Sewing Project: E800/month
Moringa Leaf Powder: E500/month
Moringa Oil: E300/month (projected)
All service and maintenance will be performed by qualified mechanics at the dealer in Swaziland.
The directors of Kudvumisa Foundation are committed to developing the management and operational personnel from within Swaziland and preferably from the affected communities who are committed and capable of ensuring the long term operation of CHIPS with excellence.
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