Download SWAZILAND BREAST CANCER NETWORK

SWAZILAND BREAST CANCER NETWORK
(SBCN)
SWA
REPORT
_______________________________________________
MID-TERM REVIEW (2007-2008)
WK KELLOGG FOUNDATION GRANT
Accredited Management &
Development Consultants
Website: www.lcc-capital.com
Report:
SBCN Mid-term Review
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TABLE OF CONTENTS
List of Acronyms
…………………………………………………………………………………… 4
List of Tables …………………………………………………………………………………………….. 5
Executive Summary…………………………………………………………………………………….6 - 9
1.
Introduction …………………………………………………………………………………….10
1.1
Program Management
…………………………………………………………..11
1.2
Gender
…………………………………………………………………………....11
1.3
Leadership
…………………………………………………………………………... 12
1.4
Planning & Coordination Capacity ………………………………………………… 12
1.5
Involvement Breast Cancer Survivors & Their Families
………………………..13
1.6
Access to Quality Services
…………………………………………………………..13
1.7
Care & Support
…………………………………………………………………...13
2.
Institutionalization …………………………………………………………………………… 14
2.1
Operational Premises …………………………………………………………………… 14
2.2
Stakeholder Confidence
………………………………………………………….. 14
2.3
Operational Structure ………………………………………………………………….. 15
2.4
Legal Persona …………………………………………………………………………… 16
2.5
Membership …………………………………………………………………………… 16
2.6
Liability
…………………………………………………………………………… 17
2.7
General & Extra-ordinary Meetings ………………………………………………….. 17
2.8
Management Duties …………………………………………………………………… 17
3.
Governance ……………………………………………………………………………………. 18
3.1
Board Meetings
…………………………………………………………………… 18
3.1.1 Board Minutes
…………………………………………………………………… 18
3.2
2007 Annual Report …………………………………………………………………… 18
3.3
Financial
…………………………………………………………………………… 19
3.4
New Funding Initiatives
………………………………………………………….. 19
3.5
Strategic Plan …………………………………………………………………………… 20
4.
Promotion of Breast Cancer Awareness
………………………………………………….
4.1
October Breast Cancer Awareness Month …………………………………………
4.2
IEC Material ……………………………………………………………………………
4.3
Fund Raising (Awareness Creation) ………………………………………………….
4.4
Use of Media ……………………………………………………………………………
4.5
Training & Workshops
…………………………………………………………..
5
Decentralization of Services …………………………………………………………………... 24
5.1
Rural Health Motivators
………………………………………………………….. 24
5.2
Clinics ……………………………………………………………………………………. 24
5.3
Public Education & Lobbying
………………………………………………….. 24
6.
Recommendations
……………………………………………………………………………. 26
6.1
Institutionalization …………………………………………………………………… 26
6.1.1 Operational Premises ………………………………………………………….. 26
6.1.2 Institutionalisation ………………………………………………………….. 26
6.1.3 Operational Structure ………………………………………………………….. 26
6.1.4 Cancer Association ………………………………………………………….. 26
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6.1.5
Legal Persona …………………………………………………………………...26
6.2
Governance …………………………………………………………………………… 27
6.2.1 Board Minutes
…………………………………………………………. 27
6.2.2 Disclosure & Transparency …………………………………………………. 27
6.3
Promotion of Breast Cancer Awareness
………………………………………… 27
6.3.1 Monthly Themes
………………………………………………………….. 27
6.3.2 National & Cultural Events ………………………………………………….. 27
6.3.3 Decentralization of October Awareness Month
………………………... 27
6.3.4 IEC Materials …………………………………………………………………… 7
6.3.5 Fund Raising …………………………………………………………………… 28
6.4
Decentralization of Services ………………………………………………………….. 28
6.4.1 Mobile Clinic …………………………...………………………………………. 28
6.4.2 Use of Stakeholder Facilities ……….…………………………………………. 28
6.4.3 Permanent Staff Allocation ………..………………………………………… 28
6.4.4 Public Education & Lobbying
………………………………………… 29
7.
Overall Evaluation Rating
……………………………………………………………………29
8.
Documents Reviewed
…………………………………………………………………… 30
9.
Interviews conducted
........................................................................................................31
10.
Data collection tool
........................................................................................................32
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List of Acronyms
FLAS
-
Family Life Association of Swaziland
FNA
-
Fine Needle Aspiration
ICW
-
International Community of Women Living with HIV/AIDS
PWC
-
PriceWaterhouseCoopers
HCF
-
Harrison Cooper Foundation
IEC
-
Information Education Communication
SI
-
Skillshare International
SBCN
-
Swaziland Breast Cancer Network
Network
-
Swaziland Breast Cancer Network
OSISA
-
Open Society Initiative for Southern Africa
NCD
-
Non Communicable Diseases
MOHSW
-
Ministry of Health & Social Welfare
Government -
Government of the Kingdom of Swaziland
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List of Tables
Table 1 .
SBCN Organization Structure
………………………………………………… 12
Table 2.
Income Comparison for 3 Years
………………………………………………… 15
Table 3.
Applications for Funding
Table 4.
Breast Cancer Awareness Activities by Month (2008)
Table 5
Clinic Attendance 2007 &2008........................................................................................ 25
Table 6
Breast Cancer Awareness Activities by Month (2008)
Table 7.
Overall Evaluation Rating
…………………………………………………………. 16
………………………. 18
………………………. 28
…………………………………………………………. 29
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Executive Summary
The Swaziland Breast Cancer Network is a non-profit making, donor-funded organization that is
established and guided by a constitution. In 2007, pushed by the demand and need for structured
coordination and management of activities, the Network established a secretariat by engaging the
services of an Executive Director. To date the network employs four other staff members including; a
clinics coordinator, research and evaluation officer, a project officer and a receptionist (see Table 1).
The Network has developed and implemented 3 strategic plans, 2001 – 2003, 2005 – 2007, and 2007 –
2010. Each strategic plan had action plans that were aimed at achieving specified key objectives
responsive to the needs of the target beneficiaries and these have evolved over time. Currently the
target beneficiaries are women from adolescence to menopause, but are extended to involve all of the
community, including men.
In 2007, WK Kellogg Foundation provided grant funding covering a period of two years to the
Network for various activities of the Network aligned to the promotion of breast cancer awareness in
Swaziland.
In direct reference thereto, the Network decided to undertake a mid-term review of the grant and an
introspection by engaging external parties, for impartiality, to assess the impact and achievements of
the grant. The aim of the mid-term review is to assess for the Network, donors and stakeholders the
effectiveness, efficiency and the impact that the Network had achieved during the period under
review.
When conducting the mid-term review, the consultants obtained and conducted a detailed review of
all relevant documents including: SBCN Constitution, audited financial statements, memorandum of
association and articles of incorporation, strategic plans, work-plans, reports, statistics, promotional
and advertising items, news paper articles published, and further conducted selected interviews with
Network Board, staff, stakeholders.
In Swaziland, breast cancer is largely perceived as a women’s disease. This is naturally so given the
vast majority of breast cancer cases among women. In Swaziland, additional social factors such as the
lack of empowerment of women, poor self-opinions and lack of opportunity or ability to take
responsibility for one’s health all contribute to late presentation for cancer diagnoses.
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Laudably, the SBCN is also contributing to a shift in perceptions, highlighting that breast cancer can
affect anyone. The more males that become educated and aware of the disease, the more men can
begin to encourage their partners to take the disease seriously and undergo routine checkup.
The Network has made significant strides in ensuring the participation and involvement in its activities
of breast cancer survivors. This helps in building a supportive environment for breast cancer programs,
including the reduction of possible stigma and fear of the unknown.
The institutionalization of the Network through the establishment of the secretariat in 2007 has
resulted in a mix of both challenges and successes. The premises have been deemed appropriate and
suitable to meet the current physical needs of the Network. Patients are now able to identify with an
organization whose operational premises are known, and can approach it when interventions are
sought. The transition of the delegation of administrative functions from the board to the secretariat
has thus far been handled fairly well
The Network has employed four professionals namely: Executive Director, Project Officer, Clinics
Coordinator and a Research and Evaluation Officer.
Findings
The Network over the period under review continued to abide by the provisions of the constitution.
The annual general meeting and board meetings were held as scheduled.
It was discovered that all board minutes are not signed yet pertinent resolutions including those with a
financial impact are adopted.
The financial activities of the Network were successfully audited by PriceWaterhouseCoopers. A
review of audited financial statements revealed that there is compliance to: accurate recording of
transactions, auditors did not find any material transactions that would lead to a qualified opinion.
The Network continues to employ all forms of information dissemination through electronic, audio
and newsprint which includes the two media houses, the Times of Swaziland and Observer and the
Nation Magazine. In total 17 articles were published. In furtherance the Network has successfully
launched a website.
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The work undertaken by the Network during the months of October each year is highly commended.
A lot of material is produced and articles are published in all popular media streams and the success of
the awareness during this month is also evidenced by the number of males that wear the pink ribbon.
A total of 54,457 promotional and awareness items were developed and distributed nationwide,
however the real impact of the IEC material could not be ascertained since a survey was not
undertaken.
A total of four fund raising activities were successfully undertaken by the Network wherein branded
materials were sold.
A review of the programs undertaken shows that all media houses were used during the period under
review. Of 17 articles, 13 were published by the Times of Swaziland; the lion’s share at 75%.
In 2007 thirteen workshops were conducted for; doctors, nurses, health teams, media and students. A
total of 985 rural health motivators were trained with the aim of taking the services to the people
including dissemination of information, education and support.
A surface review of services provided reveals that key services are still unavailable in the regions with
the exception of Mbabane and Manzini clinics resulting in the conclusion that the decentralization
process is still faced with challenges.
The Network has played a satisfactory role in engaging Government on areas surrounding policy
development, implementation, promoting “on-the-ground” operations, service delivery on breast
cancer interventions and institutional framework.
Recommendations
It is recommended that the Network should consider, through a staggered process, to move toward
positioning itself as a Cancer Association of Swaziland.
In furtherance to the immediately above recommendation, it is recommended as a matter of urgency,
that the Network should engage consultants to review the Memorandum and Articles of Association
and cause amendments to be effected as per the findings stated herein, to ensure compliance with the
Networks’ constitution.
It is recommended that the minutes of the Board must show the start and end times for each meeting
held, and that once adopted the minutes are signed by the chairperson and secretary.
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It is recommended that the Network intensifies efforts to educate the public on the fact that breast
cancer also affects the male population.
It is recommended that breast cancer awareness implementation work plan should be spread right
through the year, with each month allocated a theme.
It is further recommended that efforts must be intensified to take advantage of national events and
activities on the calendar to further create breast cancer awareness.
It is further recommended that the Network should develop a program for celebrating the October
Breast Cancer Awareness month circulated among the four regions of the country.
To compliment the current monitoring and evaluation tools in use, it is recommended that the
Network secure funding for a nationwide IEC impact assessment survey.
It is recommended that the Network intensifies discussions with Government and potential donors on
the need to secure breast cancer mobile clinics to provide basic diagnosis, counselling and advisory
services.
It is recommended that the Network should engage Government to allocate permanent staff to the
breast cancer clinics who can therefore rotate in clinics countrywide, rendering diagnosis, counselling
and advisory services.
Overall Evaluation Rating
The consultants were required after conducting a mid-term review to rate each programme outcome
/objective under the following:
highly satisfactory, satisfactory, less than satisfactory, highly
unsatisfactory. The rating was concluded as follows:
Activity Description
Performance Rating
Institutionalization of SBCN
Highly Satisfactory
Achievements of the Grant
Highly Satisfactory
Promotion of breast cancer awareness
Highly Satisfactory
Decentralization of services
Satisfactory
Contribution toward policy dialogue
Satisfactory
Overall Effectiveness
Satisfactory
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1.
Introduction
The Swaziland Breast Cancer Network (SBCN) was formed initially by a group of four women who
had directly and indirectly been affected by breast cancer. They were motivated to establish the
Network to provide information and support to survivors, guidance and counselling services which
were glaringly absent in Swaziland at the time. The Network was formally launched in 2000 with the
sole aim of raising awareness about breast cancer, promoting voluntary breast examination, diagnosis
and subsequent treatment of abnormalities identified.
The Swaziland Breast Cancer Network is a non-profit making, donor-funded organization that is
established and guided by a constitution. In 2007, pushed by the demand and need for structured
coordination and management of activities, the Network established a secretariat by engaging the
services of an Executive Director. To date the network employs four other staff members including; a
clinics coordinator, research and evaluation officer, a project officer and a receptionist (see Table 1).
The Network received funding for a period of 3 years, (January 2007 to December 2009) and has
undertaken various activities in Swaziland to promote breast cancer awareness. The Network has
further established relationships with local key stakeholders and further developed a pool of local
companies and individuals who frequently finance projects promoted and run by the Network. For
example, a significant amount of awareness and fund-raising support has been offered for two
successive years by the staff of a local hair salon. Furthermore, the Network has produced various
types of public communication including; pamphlets, publications, brochures, adverts, articles etc on
the subject matter.
The Network has developed and implemented 3 strategic plans, 2001 – 2003, 2005 – 2007, 2008 – 2011.
Each strategic plan had action plans that were aimed at achieving specified key objectives responsive to
the needs of the target beneficiaries and these have evolved over time.
Currently the target
beneficiaries are women from adolescence to menopause, but are extended to involve all of the
community, including men.
The Network frequently undertakes an introspection by engaging external parties, for impartiality, to
assess the impact that it had achieved in the fight for breast cancer awareness. The aim of the mid-term
review is to assess for the Network, donors and stakeholders the effectiveness, efficiency and the
impact that the Network had achieved since the commencement of operations. The mid-term reviews
focused on the following key objectives of the Network:
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
What has been the impact of institutionalizing the Swaziland Breast Cancer Network?

What outcomes were achieved with the WK Kellogg Foundation grant?

What new material has been developed in the promotion of breast cancer awareness in
Swaziland and what was the reach / impact of this material?

How successful was the decentralization of services through the training of grassroots peer
educators?

What has been the overall effectiveness of the SBCN?
In order to ascertain the above, the consultants obtained and conducted a detailed review of all
relevant documents including: SBCN Constitution, audited financial statements, memorandum of
association and articles of incorporation, strategic plans, work-plans, reports, statistics, promotional
and advertising items, news paper articles published, and further conducted selected interviews with
Network Board, staff, stakeholders.
The stakeholders of the Network were identified to include: Ministry of Health and Social Welfare,
Skillshare International, an international volunteering and development organization currently
represented in six African countries; the International Community of Women Living with HIV/AIDS
(ICW), a registered charity organization providing information and support services to women living
with HIV/AIDS worldwide, the Family Life Association of Swaziland, a family planning and
reproductive health non-governmental organization, the Coordinated Assembly for Non-governmental
Organizations (CANGO), Government and private hospitals, medical practitioners and the general
population of Swaziland.
1.1
Program Management
At a national level there is broad understanding and collaboration but the distinction of the roles
played by the different stakeholders, particularly Government, need review and re-alignment to
enhance the fight against breast cancer to minimize the possibility of overlaps in functions. The success
surrounding breast cancer awareness in Swaziland has been quite significant given: the limited
resources of all stakeholders involved, the different policy mandates, coverage and different project
time frames. However, a coordinated approach to planning, development of cross-stakeholder teams
and better communication could improve management. Government has not been totally responsive
to the Networks activities as junior officers are often sent to participate activities that require decision
makers, more support and involvement would benefit all parties.
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1.2
Gender
Breast cancer is largely perceived as a women’s disease. This is naturally so given the vast majority of
breast cancers affect women. In Swaziland, additional social factors such as the lack of empowerment
of women, poor self-opinions and lack of opportunity or ability to take responsibility for one’s health
all contribute to late presentation for cancer diagnoses.
Laudably, the SBCN is also contributing to a shift in perceptions, highlighting that breast cancer can
affect anyone. The more males that become educated and aware of the disease, the more men can
begin to encourage their partners to take the disease seriously and undergo routine checkup. A simple
change of perception by the male population will yield more positive results in the fight against breast
cancer.
It is encouraging to note that men, particularly professionals, have consciously decided to
participate in the endeavor of promoting the spreading of breast cancer awareness by frequently
wearing pink ribbons, a clear indication that the general awareness of breast cancer is spreading.
1.3
Leadership
The performance of any organization is to a great extent dependent on its leadership and the Network
has been fortunate enough to have a relatively strong board that oversees the daily activities of the
secretariat. The fact that some members of the board are breast cancer survivors, medical practitioners
and qualified nurses, enhances the capacity of the board to assess and deliberate issues from an
informed position.
The skills’ profile currently available within the board includes: a medical
practitioner with extensive experience, qualified nurses, breast cancer survivor, a qualified accountant,
a qualified counselor, a lecturer with a doctorate in education, a legal expert and a member with project
management skills. The diverse and relevant skills within the leadership, contribute positively to the
overall success of the network.
1.4
Planning and Coordination Capacity
The Network has strived to engage stakeholders in activities surrounding breast cancer awareness.
However, institutional arrangements for providing leadership in planning and coordination have been
less effective, particularly at the Government level. While the above measures indicate progress
towards a coordinated response, they do not reflect a shared approach to planning which is a direct
result of separately developed implementation plans by different agencies. While SBCN report a
number of attempts to engage relevant ministries and decision-makers in a number of Government
Departments, to a large extent, this has not been successful. This has resulted in no active participation
by Government in the development of Network plans and programs; the Government are informed of
these outcomes as a matter of courtesy. Planning and coordination through a consensus will ensure
that implementation plans of both parties are harmonized and complimentary.
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1.5
Involvement of Breast Cancer Survivors & Their Families
The Network has made significant strides in ensuring the participation and involvement in its activities
of breast cancer survivors. This helps in building a supportive environment for breast cancer programs,
including the reduction of possible stigma and fear of the unknown. The involvement of breast cancer
survivors presents a clear statement that there is hope and thereby minimizes the fear of the unknown
especially for those who have never undergone breast cancer testing.
1.6
Access to Quality Services
There are gaps in service provision across the spectrum, from prevention to treatment and care that
limit the effectiveness of the Network in the work of breast cancer awareness. A programmatic
approach is required in service planning if these gaps are to be filled, an approach that includes:
• setting operational objectives
• full scale treatment in Swaziland
• establishing quantifiable targets necessary to achieve operational objectives
• determining the human and financial capacity needs to develop/strengthen selected mechanisms
• reviewing policies, protocols and guidelines to implement programs
• developing monitoring and reporting systems, including quality management.
1.7
Care and Support
Access to adequate care and support, through rural health motivators, is the one measure that will
provide the greatest health benefit for people with breast cancer and survivors. However, maximizing
access to screening, counseling, access to complex treatments and ensuring quality of life also require
care and support services. Ideally this should include access to peer support and professional services
such as quality counseling.
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2.
Institutionalization
2.1
Operational Premises
The institutionalization of the Network through the establishment of the secretariat in 2007 has
resulted in a mix of both challenges and successes. It has to be noted that this is a normal cycle in any
developing organization that however requires prudent management albeit the fact that most
transitions are difficult to manage. The premises have been deemed appropriate and suitable to meet
the current physical needs of the Network. However the absence of directional signs makes it difficult
for one to locate the premises and seemingly the Network has not done much in letting the public
know the physical location.
2.2
Stakeholder Confidence
It is a fact that any organization that has a physical presence radiates a sense of seriousness and
effectiveness and thereby instils a feeling of security and reliability to stakeholders.
particular prefer dealing with organizations that have identity.
Donors in
The private sector also prefers
established organizations when donating funds as part of corporate responsibility. Patients are now
able to identify with an organization whose operational premises are known, and can approach it
when interventions are sought. The transition of the delegation of administrative functions from the
board to the secretariat has thus far been handled fairly well by the board and all efforts in this regard
are indeed commended.
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2.3
Operational Structure
The network has employed four professionals namely: Executive Director, Project Officer, Clinics
Coordinator and a Research and Evaluation Officer. New positions are created as and when the need
arises, in response to the requirements on the ground. Furthermore, it is noted that the Executive
Director has expended a lot of effort and energy in fostering and building strategic relationships with
key stakeholders, namely Government, a key ally in the sustainability strategy of the Network. A
detailed review and analysis of the current operational structure reveals that there is no defined policy
on human capital development and some key positions within the secretariat are held by non-Swazi’s
coupled with the fact that most services are provided on a voluntary basis. This brings into question
the sustainability of the Network post non-Swazi employment. It has to be categorically stated that the
Network and the consultants have no bias toward non-Swazi’s however from a sustainability angle it is
imperative that Swazi’s with skills developmental growth potential be appointed into positions that
shall allow them to understudy the work carried out by non-Swazi’s for succession and progression.
Further investigations and consultations revealed that almost all the non-Swazi staff are in essence
provided by Skillshare International whose policy is to provide expatriate expertise only. The current
SBCN operational structure is as follows:
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Table 1.
SBCN Organization Structure
Members
Constitution
Board of
Directors
Policy &
Implementation
Executive
Director
Work Plans
Project Officer
2.4
Clinics
Coordinator
Research &
Evaluation
Officer
Legal Persona
There is no proper legal machinery in Swaziland for the registration of NGOs which recognizes their
special character. In order to obtain some form of legal persona, NGOs have to register under the
Companies Act of 1912 as Non-profit Making Organizations (Section 21; companies). However, on the
ground, all NGOs, including SBCN, have constitutions that govern their activities.
There exists
therefore an inherent legal quagmire here, and in respect of SBCN it is outlined below.
2.5
Membership
Memorandum and Articles of Association section 3 (a) “….members of the company…is limited to fifty
(50)..” Yet sections 7 to 11 of the Constitution have no limit to the Networks membership.
Section 3 (a) of the Memorandum further defines members of the company by the number of shares
that they hold, which is restricted to one share, yet the Constitution in section 16 of the Constitution
defines a member as a person with fully paid up subscriptions.
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Section 8 of the Memorandum empowers the directors (3) with “…absolute discretion and without
assigning an reason thereof ..” yet the Constitution in section 9 (2) refers to the Board as having the sole
authority of approving membership applications.
2.6
Liability
Section 11 of the Memorandum “The directors may raise or secure the repayment of such monies in
such a manner and upon such terms and conditions in all aspects as they think fit…” yet section 44 (iv)
of the Constitution infers just “..any other sources”. However, in general, the liability is limited to each
member’s shareholding.
2.7
General and Extra-ordinary Meetings
Section 15 of the Memorandum “The Directors may, whenever they think fit, convene an extraordinary general meeting …convened by such requisitions as provided by section 63 of the Act..” yet
the Constitution in sections 19 to 21 outlines the conditions for convening general and extra-ordinary
meetings.
2.8
Management of Duties
Section 22 of the Memorandum “The business of the company shall be managed by the directors..” the
Constitutions under sections 40 to 42 confers management of operation to the secretariat.
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3.
Governance
3.1
Board Meetings
The Network over the period under review continued to abide by the provisions of the constitution.
The annual general meeting and board meetings were held as scheduled, albeit the fact that one board
member was asked to excuse themselves because of having missed a number of consecutive meetings.
A review of the board and executive directors’ reports to the board revealed the following anomalies:
3.1.1
Board Minutes
It was discovered that all board minutes are not signed yet pertinent resolutions including those with a
financial impact are adopted.
The board minutes never reflect the commencement and ending times of meeting, yet it is important to
know the amount of time spent by the board deliberating the Networks business.
Often names of individuals are mentioned in minutes without reference being made to their identity in
terms of status and relationship with the Network.
The minutes of a board meeting held in December 2007 captioned “…there were few requests made for
reimbursement.” In this instance the minutes are required to be specific as to who table requests for
reimbursement and for what.
3.2
2007Annual Report
Once again the Network was able to produce and release its annual report without hindrance, however
the following points were noted from the annual report.
The table of contents does not match or correspond with the contents in the report.
In paragraph 4 of the report, a consulting firm whose name is not stated, is made reference to as having
been appointed to conduct an evaluation.
Corporate governance requires full disclosure, which
becomes key information to members.
The report further makes reference to “relevant companies” being officially requested to tender for the
recruitment of the Executive Director, once again disclosure requires that the invited companies and
those that eventually submitted proposals be mentioned including the process through which they
were selected.
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3.3
Financial
The financial activities of the Network were successfully audited by PriceWaterhouseCoopers and an
inspection of the reports only revealed that fund income from fund raising has been comparatively
stagnant as per the table below, yet there evidently is potential for more fundraising income. The daily
financial activities of the Network are processed through Pastel Accounting and all relevant financial
documentation and processes are adhered to. The financial report is always promptly audited by an
international audit firm, PriceWaterhouseCoopers. A review of audited financial statements revealed
that there is compliance to: accurate recording of transactions, auditors did not find any material
transactions that would lead to a qualified opinion therefore rendering the financial reports a fair
representation of operations under review.
Table 2.
3.4
Income Comparison for 3 Years
New Funding Initiatives
The Network continued to source additional funding from various institutions in support of current
and newly identified projects and initiatives.
The requests for funding made during the period
included the following:
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Table 3.
New Funding Requests Made
Funding Requests Made
Funding Agency
Project Description
Date
Amount (E)
MOHSW
RHM Capacity Building
September 2008
Not Stated
OSISA
General Funding Enquiry
September 2008
Not Stated
MAMA CASH GRANT
General Funding
August 2008
233,999.78
NCD
General Funding
August 2008
Not Stated
UNFPA
Promotion & cervical cancer prevention
Not Stated
1.0m
3.5
Strategic Plan
The Networks’ detailed strategic plan (2008-2011) was reviewed and the following points were noted:
Political Economics Social Technological (PEST Analysis)
It is standard procedure when developing a strategic plan, as part of the environmental scan to
undertake a PEST analysis of the environment that the Network operates within. A PEST analysis
informs the planner of the four components and the challenges presented by each. The findings and
conclusions of the PEST analysis are combined with those of the SWOT analysis from wherein the key
action plans (strategies in this instance) are developed and defined. There was no PEST analysis done
in the current strategic plan.
Performance Indicators
The performance indicators are well outlined however, almost all of them are quantitative but no
numerical value has been attached, rendering them qualitative and subjective.
In this instance
therefore, it was difficult to measure the implementation success of the strategy even when read in
tandem with the work-plans. Furthermore, more detail is required within the performance indicators
for example in 10.1 (1)(i) “Number of regions where focal points have been established”, the time frame
provided herein has been specified as January 2008 to December 2010. It would have been prudent to
state the target number for each annual period in order to for the Network to know for certain the
actual achieved target for each period.
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SWOT Analysis
The SWOT analysis is quite elaborate however, we noted that not all items identified herein were
linked directly to the key action plans.
Organization Structure
It is standard procedure when developing a strategic plan to also review and redefine the current
organization structure. The strategy action plans encompass planned activities such as the provision of
new and extended services, but no mention is made with regards to human resource needs, current
and future of the Network. The net effect of this omission will only be realized and acknowledged
once the secretariat fails to achieve set goals as a result of inadequate staffing levels.
Future
organizational staffing requirements are dictated by the set goals/objectives of the strategic plan.
Staff Development and Training
There is no mention anywhere in the strategy on staff development and training of the secretariat to
ensure that requisite skills are developed and maintained to meet the changing and dynamic objectives
of the Network.
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4.
Promotion of Breast Cancer Awareness
The Network continues to employ all forms of information dissemination through electronic, audio
and newsprint which includes the two media houses, the Times of Swaziland and Observer and the
Nation Magazine. In total 17 articles were published. In furtherance the Network has successfully
launched a website.
4.1
October Breast Cancer Awareness Month
The work undertaken by the Network during the months of October each year is highly commended.
A lot of material is produced and articles are published in all popular media streams and the success of
the awareness during this month is also evidenced by the number of males that wear the pink ribbon.
However, an analysis of the 2007 and 2008 work-plan and the actual activities undertaken, reveal that
there is a general tendency to focus mostly on intense awareness activities during October only and a
few articles and radio programmes are undertaken during the other months of the year. The following
table has been compiled to illustrate the point.
Table 4.
Breast Cancer Awareness Activities by Month 2008
Breast Cancer Awareness Activities by Month 2008
45
40
35
30
25
20
15
10
5
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
NB: Based on actual activities undertaken and publications
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4.2
IEC Material
A total of 54,457 promotional and awareness items were developed and distributed nationwide
including: awareness cards, pink ribbons, golf shirts, a promotional video, pink stickers and bandanas.
A review of the materials revealed that the information was quite relevant and a lot of creativity was
exercised. The real impact of the IEC material could not be ascertained since a survey was not
undertaken.
4.3
Fund Raising
A total of four fund raising activities were successfully undertaken by the Network wherein branded
materials were sold. With all due sensitivities, it was however noted that the funding raising activities
seem to attract mostly the white community. Needless to say the Network is dedicated to undertaking
and effecting meaningful transformation for the direct benefit of the designated beneficiaries, it is
envisaged that the organization shall retain effective strategies and policies to ensure managed growth.
4.4
Use of the Media
A review of the programs undertaken shows that all media houses were used during the period under
review. Of 17 articles, 13 were published by the Times of Swaziland; the lion’s share at 75%. This is
largely attributed to the pro-activeness and willingness of the Times to offer the Network subsidized
rates and free adverts as a social contribution. On the other hand, The Swazi Observer has not been
responding positively when invited to cover the activities of the Network, hence the current statistics
between the two media houses. Also it must be noted that the Times of Swaziland has an average of
25,000 readers per day, while the Swazi Observer averages 16,000 per day.
Radio and television programs were also conducted and an average of two shows per month were
undertaken.
4.5
Training and Workshops
In 2007 thirteen workshops were conducted for; doctors, nurses, health teams, media and students.
The assessments completed by workshop participants and a review of the material covered at the
workshops reveal a high level of satisfaction from the participants. It was further noted however that
the workshop were conducted within the Manzini – Mbabane corridor and other regions were not
covered.
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5.
Decentralization of Services
5.1
Rural Health Motivators
A total of 985 rural health motivators were trained with the aim of taking the services to the people
including dissemination of information, education and support. The numbers reflect a high level of
success and the training highly commended for the intended output. As much of the training has
occurred only recently its effectiveness is largely unknown and could not be quantified. Effective
monitoring and evaluation mechanisms will be required in the future.
To this end, SBCN has
commenced to collect data on the number of people attending breast care clinics who were advised by
an RHM. A surface review of services provided reveals that key services are still unavailable in the
regions with the exception of Mbabane and Manzini clinics resulting in the conclusion that the
decentralization process is still faced with challenges.
5.2
Clinics
The Network successfully facilitated the establishment of two breast cancer clinics, located in Mbabane
at the Government Hospital which was opened in 2002 and in Manzini at the City Council offices
which was opened in 2008. The clinics are manned by volunteers and staff fully employed by the
MOHSW and the City Council of Manzini. They are operational only on specified days. The clinics
offer diagnosis and testing, counselling and advisory services. The commencement of fine needle
aspiration (FNA) biopsies in 2007 has continued during 2008, and greatly facilitated accurate and
timely diagnoses. The response to the clinics has been favourable, with increasing numbers of women
and men attending the clinics for screening and advice.
Below is a table showing clinic attendance figures for 2007 and 2008.
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Table 5.
5.3
Public Health Policy and Education
The Network has played a satisfactory role in engaging Government on areas surrounding policy
development, implementation, promoting “on-the-ground” operations, service delivery on breast
cancer interventions and institutional framework. The success can attributed to the successful opening
of the breast cancer clinics at the Mbabane Government Hospital and the successful partnership with
the Municipal Council of Manzini.
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6.
Recommendations
6.1
Institutionalization
6.1.1
Operational Premises
It is recommended that through IEC materials, the physical location of the Network must be stated,
furthermore, directional signs should be placed from Somhlolo Street to the turnoff into the premises.
6.1.2
Institutionalization
It is standard practice for organizations that have undergone considerable transformation to undergo a
change management workshop/training to enable better comprehension and acceptance of the shift of
roles and responsibilities to the secretariat.
A change management workshop is therefore
recommended in this instance.
6.1.3
Operational Structure
It is recommended that all non-Swazi employees of the Network should have an understudy to ensure
continuity and program sustainability.
Key duties currently performed by volunteers should be
brought under the wings of permanent and or contract employees.
It is further recommended that a structured capacity development and training program be developed
for the entire secretariat to ensure transfer of skills and development of key competencies. This should
be developed in line with the expatriate staff provided by Skill Share International.
6.1.4
Cancer Association
It is recommended that the Network should consider, through a staggered process, to move toward
positioning itself as a Cancer Association of Swaziland, due to the positive impact it has contributed
thus far in promoting and raising breast cancer awareness and diagnosis in Swaziland coupled by the
fact that the Network is already focusing on promoting cervical cancer awareness and facilitating the
availability of treatment in Swaziland.
6.1.5
Legal Persona
In furtherance to the immediately above recommendation, it is recommended as a matter of urgency,
that the Network should engage consultants to review the Memorandum and Articles of Association
and cause amendments to be effected as per the findings stated herein, to ensure compliance with the
Networks’ constitution.
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6.2
Governance
6.2.1
Board Minutes
It is recommended that the minutes of the Board must show the start and end times for each meeting
held, and that once adopted the minutes are signed by the chairperson and secretary.
6.2.2
Disclosure & Transparency
As a result of Board minutes for the 3rd quarter of 2007, it is recommended any references made in
Board minutes and or reports, to any person and or entity must stipulate their names, and the
relationship with the Network. Furthermore all requests and approvals made for disbursements,
especially to Board members, must clearly state the names of those whose submitted the requests, and
the amounts paid including specification of what the payment was for.
6.3
Promotion of Breast Cancer Awareness
6.3.1
Monthly Themes
It is recommended that breast cancer awareness implementation work plan should be spread right
through the year, with each month allocated a theme, and undertaken through articles, workshops,
adverts, radio programmes etc.
6.3.2
National Events
It is further recommended that efforts must be intensified to take advantage of national events and
activities on the calendar to further create breast cancer awareness including: Miss Swaziland Pageant,
Umhlanga Reed Dance, Workers’ Day, Business Woman of the Year, use of sporting icons.
6.3.3
Decentralization of October Awareness Activities
It is further recommended that the Network should develop a program for celebrating the October
Breast Cancer Awareness month circulated among the four regions of the country.
It has been
established that the Swazi community is more responsive to seeing than hearing as such the rotation
among regions of other activities such as the Jane King Memorial Run traditionally undertaken in
Mbabane would yield a higher level of tangible results.
6.3.4
IEC Materials
To compliment the current monitoring and evaluation tools in use, it is recommended that the
Network secure funding for a nationwide IEC impact assessment survey.
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6.3.5
Fund Raising
It is recommended that the Network should annually develop a schedule of potential donor companies
and through a developed fund raising plan visit the companies soliciting for donation support.
Once the above recommendations with regards to breast cancer awareness have been implemented, the
activities shall be reflected as follows, which is consistent with constant supply of information.
Table 6.
Awareness Activity Comparison by Month (2007/8)
Awareness Activity Comparison by Month (2007/2008)
100
80
60
40
20
0
Jan
Feb
Mar
Apr
May
Jun
2007
6.4
Decentralization of Services
6.4.1
Mobile Clinic
Jul
Aug
Sep
Oct
Nov
2008
It is recommended that the Network intensifies discussions with Government and potential donors on
the need to secure breast cancer mobile clinics to provide basic diagnosis, counselling and advisory
services.
6.4.2
Use of Stakeholder Facilities
It is recommended that the Network should continue to form strategic alliances with stakeholders such
as FLAS to use some of their clinics, on specified days, regionally to provide basic diagnosis,
counselling and advisory services.
6.4.3
Permanent Staff Allocation
It is recommended that the Network should engage Government to allocate permanent staff to the
breast cancer clinics who can therefore rotate in clinics countrywide, rendering diagnosis, counselling
and advisory services.
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6.4.4
Public Health Policy and Education
It is recommended that the Network continue making presentations and marketing its activities to key
state organs such as policy makers who play a pivotal role in approving the budget of MOHSW and
reviewing and refining Government policy and implementation frameworks.
7.
Overall Evaluation Rating
The consultants were required after conducting a mid-term review to rate each programme outcome
/objective under the following:
unsatisfactory.
highly satisfactory, satisfactory, less than satisfactory, highly
Based on the documents reviewed, interviews conducted, findings and
recommendation made herein, and taking into cognizance the challenges presented to the Network
especially the areas out of its decision level such as policy formulation and implementation, LCC
Capital Consulting hereby finds it appropriate to conclude the overall performance rating for the
specified categories as stated herein below:
Table 7.
Overall Evaluation Rating
OVERALL EVALUATION RATING
Activity Description
Performance Rating
Institutionalization of SBCN
Highly Satisfactory
Achievements of the Grant
Highly Satisfactory
Promotion of breast cancer awareness
Highly Satisfactory
Decentralization of services
Satisfactory
Contribution toward policy dialogue
Satisfactory
Overall Effectiveness
Satisfactory
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8.
DOCUMENTS REVIEWED
2006 Audited financial Statement
2007 Audited Financial Statement
2008 Audited Financial Statement
2007 and 2008 Annual Report
Board Meeting Report/Minute
-
5th December 2007
-
3rd September 2008
-
27th May 2008
2005-2007 Strategic plan
2008 Strategic Plan
SBCN Constitution
SBCN Strategic Plan 2008-2011
SBCN Human Resources Management Policy & Procedures Manual
Annual Workplan 2008
The Nation Magazine
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9.
INTERVIEWS CONDUCTED
Dr. R. T. Tshabalala -
Chairperson SBCN
Thobile Dlamini
-
Director SBCN
Bheki Hlatshwayo
-
Human Resource Manager (Manzini City Council)
Senelisiwe Ntshangase-
Country Director, Skillshare International
May Huang
-
Taiwan Embassy
Sbongile Dlamini
-
Nurse Assistant, Manzini City Council
Lindiwe Tsabedze
-
Ministry of Health & Social Welfare
Dorcas Nxumalo
-
Ministry of Health & Social Welfare
Dr. R. Magagula
-
Ministry of Health & Social Welfare
Gugu Dlamini
-
Municipal Council of Mbabane
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10.
MID-TERM REVIEW DATA COLLECTION QUESTIONNAIRE
1. How do you interact with SBCN?
2. In your understanding, what are the key objectives of SBCN?
3. In terms of raising breast cancer awareness, how effective do you think SBCN has been? On a scale of 1
– 5, 5 being the highest, how would you rate them in this regard?
4. How effective would you rate the breast cancer promotional strategy? Which do you think was most
effective?
5. SBCN recently moved into new offices, and in 2007 appointed a new Director, what impact do you think
this will have on the organization and its operations?
6. The organization recently opened a clinic at the Municipal Council of Manzini, adding to the one
operating from the Mbabane Government Hospital, how do you see this impacting on service delivery?
7. In what areas do you see SBCN complimenting Government and can you identify any overlaps and or
challenges?
8. A lot of rural health motivators have been trained in all the regions of Swaziland, what impact do you
envisage from this if any?
9. Do you think SBCN has had a meaningful impact in advocating for and influencing Government policies
related to its operations? If yes, in what way?
10. Do you think SBCN should diversify and embrace other cancers and develop into a Cancer Association?
11. On a scale of 1 – 5 how would you rate the overall effectiveness of SBCN?
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