Final evaluation report for Thaba Bosiu Centre, Blue Cross Lesotho

Background

The evaluation team:
1) Mr. Joseph Hayuni (External consultant), leader of the evaluation team
2) Mrs Heidi Westborg Steel, Blue Cross Norway (BCN)
3) Mrs. Olive Makante, Blue Cross Lesotho (BCL)
4) Mrs Matsepo Letlola, Thaba Bosiu Center (TBC)
5) Mrs Mathabiso Mosala, Chairperson, TBC Board of Directors
6) Mrs Mamohau Matsoso, Ministry of Health and Social Welfare (MOH/SW)
7) Chief James Theko, Village Dhief and Community representative
8) Mr Motabang Thatho, Blue Cross Lesotho (BCL), Youth Coordinator

The Thaba Bosiu project was initiated in 1988, and has been operational as a project since 1991. The Thaba Bosiu Centre is a treatment and prevention centre on alcohol and drug problems, and it was set up by Blue Cross Lesotho (BCL) in partnership with Blue Cross Norway (BCN), and the Ministry of Health and Social Welfare (MOH/SW) of the Government of Lesotho (GOL). In the partnership expressed by two sets of agreements, the TBC was supposed to be run by BCL in coordination with BCN, but co-funded by NORAD through BCN and GOL through the MOH/SW. Further BCN was supposed to gradually reduce their contribution, with MOH/SW taking over full financial responsibility from 31.12.2004.

The overall objective of the project was to contribute to a reduction of alcohol and drug relates problems in Lesotho. The specific objectives were based on two components of the project: the prevention and the treatment programmes.

Specific objectives for the prevention programme include:
1) Increase the level of know-how on the dangers of alcohol and drugs,
2) Introducing the factors of alcohol and drug in ordinary statistics
3) Working for an increased understanding on the use of alcohol political means,
4) To contribute actively to a behavioural change in peoples perception of alcohol as a status symbol

Specific objectives for the treatment programme:
1) Developing and offering a good, family focused treatment methodology focusing on the children's problems
2) Developing an aftercare program in cooperation with local institutions and organisations,
3) Offering treatment free of medication

Purpose/objective

The evaluation was designed to facilitate continued learning and assess the performance of the project to date. The key issues for the evaluation are: 1) Finding out the effectiveness of the approaches used for the project, 2) Detecting the impact of the project on the lives of people in Lesotho, 3) Examining the sustainability aspects, 4) Documenting the lessons learned

Methodology

A participatory approach with the major stakeholders represented on the evaluation team was used to carry out this evaluation. All stakeholders were included from the first stage of the evaluation design to the interviews, and partly also the report. An external consultant was involved to manage the evaluation and write the final report to increase the level of objectivity. Rapid assessment methods were used to collect and analyze data. These methods include: Focus Group Discussion (FGD), Key informant interviews, literature review of relevant documents and Observation in the field. The evaluation team converged after the fieldwork to analyse the data and draw the conclusions together.

Key findings

The TBC project has been focused to their original specific objectives, and there are evident achievements for both the prevention and treatment components of the project. The MOH/SW, local leaders and the community at large, all recognize the centre's contribution to finding a solution to alcohol and drug related problems. The TBC project is therefore a viable social venture, and is in line with the MOH/SW mandated activities. The evaluation team, however, was not able to quantify the proportion of the contribution of TBC to the overall objective of reducing alcohol and drug abuse in Lesotho. And there are needs for improvement to make the results even better (jfr recommendations).

The sustainability of the TBC project was examined from two perspectives:
1) Financial sustainability: The financial sustainability of TBC depends on how soon the Government of Lesotho (GOL) decides to absorb the financial needs of TBC after BCN has withdrawn their financial support by the end of December 2005. BCL who are the legal owners of Thaba Bosiu have not substantially demonstrated capability of supporting TBC financially, at least not in the short run. Their hope is with the government. Without government funding, the financial future of TBC is at stake.

2) Organizational and Political sustainability.
There are no immediate threats to the organizational and political sustainability of TBC. The ownership is clear to all stakeholders. There are however a number of issues to attend to for the TBC project to continue smoothly in the long run. There are three main issues that need to be addressed in this regard: 1) The structure of BCL, 2) the agreements between BCN, BCL and MOH/SW must be reviewed, 3) human resources and management.

Recommendations

The improvements that can be done to make the results even better, is:
1) Review of agreements: BCL should initiate and lead negotiations or revisions of the agreements to facilitate a faster assimilation of the TBC budget by MOH/SW
2) Status of the TBC in the GOL structure: BCL should consider the proposal by MOH/SW to place TBC under the department of mental health
3) Source of income: The GOL should consider allowing TBC to broaden their income base by indulging income generated projects.
4) Service fee: A discriminative revision of the fees at the centre to relieve TBC of their financial worries.
5) BCL issues: BCL needs to address their internal weaknesses that may affect the smooth running of the TBC.
6) Expansion: The TBC should plan to cover the whole country with the prevention programme.
7) Planning: The management committee of TBC, in consultation with the board, should develop a strategic plan for TBC.
8) Networking with other organization in the field.
9) Develop a data trucking system to make statistics and information about clients and prevention activities available.
10) Doing social research
11) Offer capacity building to local Blue Cross groups in Lesotho.

Comments from the organisation

1) The most important issue with the Thaba Bosiu Centre evaluation 2004 was the methods used during the evaluation process it self. The participatory methods that where used, gave a fundamental possibility of learning as all stakeholders were included from the stage of the evaluation design to the interviews and partially also the report. An external consultant however managed the process and wrote the report to increase the level of objectivity. What is evident is that it has made it easier to follow up on and take action on those difficult issues that the evaluation states.
2) The process it self was also a learning experience for all the stakeholders that took part. The processes of designing the evaluation together with the external consultant, but also participating in the interview session gave an important introduction to the thoughts behind a more systematic approach to our work.
3) We do agree with the conclusions drawn that the Centre has been focused, that there has been achievements and that the Centre is recognized in the country. It has however been difficult to quantify what this contribution has been.
4) The evaluation report's suggestions have no doubt been followed up both continuously and during the Norwegian visit in November 2005.
a. The most important issue was the question concerning governmental funding after the withdrawal of Blue Cross Norway/NORAD. This has been followed up closely by the Management of the TBC and resulted in the Government fulfilling the agreement.
b. The question of broadening TBC's income base is an issue with the newly established Blue Cross Resource Centre and the TBC will work together on.
c. The question of BCL addressing their weakness as owners. First of all these issues were addressed during a strategy workshop in November 2005. One of the important actions was defined to secure new people into the Executive Committee. It is also a continuous question which will be addressed together with the Blue Cross Lesotho Executive Committee by BCRC.
d. The question of TBC developing their own strategy plan was also put on the agenda during a strategy workshop in November. In this strategy planning it was argued that with the limited resources the TBC had and would continue to have with government funding, it would be wiser to work in smaller catchment areas rather than spreading out in the whole country as the report suggest.
e. On the last three recommendations in the report; develope a data trucking system, doing social research and offering capacity building to local Blue Cross groups in Lesotho, the TBC and the BCRC is in a process of defining each others roles in future collaboration.
5) One less favorable element in the evaluation process is that the evaluation team focused more on the administrative and organizational elements of the project, with special focus on sustainability, than on technical prevention and treatment issues.