EVALUATION REPORT OF SUPPORT GROUPS IN ZAMBIA 2009

Background:
Nurses are part of the community as well as the health care system. Nurses are at the forefront of the HIV/AIDS epidemic in Zambia, caring for the sick and the dying, both at the hospital and in their homes.  However, there is no defined system to take care of the caregivers when they fall sick both at the hospital and at home.  This realization by Zambia Union of Nurses Organization gave birth to the establishment of a national network of support groups whose objective was to give support to fellow nurses and midwives who were either infected or affected.  Guidelines were developed on how to form support groups, which would provide assistance to these nurses and midwives, otherwise not cared for by the public healthcare system.

Purpose/objective:
• Evaluate the current status of a representative group of randomly selected support groups (SGs)
• Gather feedback from SGs about the transformation from Zambia Nurses Association (ZNA)  to Zambia Union of Nurses Organization (ZUNO)
• Consider the degree of integration of SGs from a project activity into ZUNO and their use of funds

Methodology:
A random selection of 12 SGs in three randomly chosen provinces were selected for visits by an evaluation team consisting of the Director for programmes and professional affairs from ZUNO, a Special adviser from NSF and the Chairperson for the public health nurses interest group from NSF. For each of the three provinces, 4 SGs were selected with a mix of general hospital SGs, district hospital SGs and health station SGs. This random selection of support groups is deemed to be representative of SGs nationwide.
The support groups were notified of the upcoming visit approximately one week ahead of the actual visit by the ZUNO secretariat in Lusaka. They were only told that a team from ZUNO/NNO would visit and evaluate the support group status and performance. 

Key findings:
The evaluation revealed a number of challenges; a large number of support groups were struggling in terms of membership turnover, available funds for activities, non-availability of past records on support group activities, no regular meetings specifically to plan for support group activities and lack of organizational physical infrastructure. Based upon the findings, the support groups visited were divided into three categories; good, fair and poor. Two (18.2%) support groups emerged good, five (45.4%) were fair and four (36.4%) were poor. The categorization was based on record keeping, financial accountability and general performance of the support group.

Results:
The support groups visited seen as a whole may be divided into three categories, good, fair and poor. In the following overview the support groups appear with the names they had given themselves. The individual questionnaires with answers are attached and provide all details.

Table 1: Categorization of Support Groups
Good Fair Poor
Chibombo Bwafwano Nurses SG Zuno-Nno Mansa General Hospital SG Nchelenge Zuno SG
Zuno HIV SG (Mwense) Red Solomon SG
(Solwezi General  Hospital) Solwezi District Hospital SG
 Kasempa Nurses SG Mukinge Nurses SG
 Kabwe General Hospital SG Kapiri Mposhi District Hospital Nurses SG
 Kabwe Mine Hospital Nurses SG 

The categorization is based mainly on general impressions, record keeping and financial accountability. Furthermore, activities, proof of initiative, the overview given of challenges faced and suggestions for improvement were taken into consideration.

Recommendations:
The following were suggestions from support group members on how best to improve support group performance.

• New and/or increased funding
• Transport
• Infrastructure
• Workshops in entrepreneurial/business skills
• New ventures
• Buy land, cultivate and sell products or renting out of land or space in buildings
• Regular meetings
• Exchange visits from/to other support groups
• Record keeping
• Written guidelines
• Being able to employ someone other than a nurse to run the relevant business

Comments from the organisation, if any:
Concluding remarks from the NSF/ZUNO evaluation team:

After two years of no visits and a major transformation of the ZNA to ZUNO to which the SGs belong, this evaluation tour was long overdue and crucial for the future of SGs performance.
The current reliance of the support groups on ZUNO for management and support and the complete integration of SGs into the ZUNO structure is evident and one of the major factors to consider for future development of the SGs. A large number of the SGs were struggling in terms of membership turn over, availability of funds for activities and lack of organizational structures, such as regular meetings and updated records. Reorganization and potential overall ZUNO management through the ZUNO headquarter to the provinces should be considered as a potential way forward. It would appear that the SGs cannot exist independently and indeed being a more formalized part of ZUNO may be beneficial.
Revival through reorganization of SGs not performing well would entail activities such as workshops, production and distribution of information packages and additional funding. The SGs provide significant assistance that is often not to be found elsewhere and thus as a support structure for sick nurses in need of support, deceased nurses without families to pay for a dignified funeral and orphans with no extended family, it is invaluable. It is to be hoped that the feedback and suggestions provided in this evaluation report may provide a backdrop for strengthening and reviving SGs in the years to come.