The Blue Cross Advocacy and Outpatient Treatment (BCAOT) Project 2015-2017

Background

Project implemented by Thaba Bosiu Center, Blue Cross Lesotho, with support from Blue Cross Norway and Norad funding. Main goals; 1) to ensure an effective evidence-based alcohol policy in Lesotho, 2) to make out-patient treatment available and used for people in the districts of Lesotho. Impact goal is to reduce harmful effects of alcohol in Lesotho.

Purpose/objective

To evaluate the impact, results and effectiveness of the project. And make recommendations for future projects/ project phases with focus on lessons learnt, sustainability, leveraged future support from Blue Cross Norway, and immediate possible response mechanisms.

Methodology

The evaluation employed a combination of qualitative and quantitative methods to assess the project’s performance and solicit lessons learned. Data and information for the evaluation were derived from both secondary and primary sources. Academic literature and relevant project documents were assessed. The evaluation carried out semi-structured in-depth key-informant interviews, focus group discussions, interview guides and participant observation.

Key findings

In terms of outpatient treatment, the evaluation concludes that quality treatment for alcohol and substance abuse is available for and used by people in the four identified districts of Lesotho. Inmates take a larger portion of those who have quit. Although this is highly commendable, the lack of relevant programs to integrate them into communities when released, and limited follow-up thereof, have contributed to non-realization of some results.

A staggering number of community leaders, local authorities and the youth know the content of the evidence-based alcohol policy; can document its violation and react upon it. And they have employed different strategies to advocate and implement relevant productive activities in their
communities.

As advocates of the policy, stakeholders complain though that due to lack of jobs and the unstable economy, they still face reluctance from members of their communities who drink alcohol and use drugs as a means of stress-relief.

Further reluctance, as claimed, comes from local bar owners who feel threatened by the advocacy of the policy. However, with stated challenges, respondents still maintain that the BCAOT project is very important in the lives of their communities, and they, therefore, wish for it to continue and spread throughout other communities.

With all achievements and challenges by the project, the evaluation concludes that the harmful use of alcohol is reduced and treatment for substance abuse is available for people in Lesotho.

Thus, there is a huge impact of the project on intended groups.

Recommendations

• Increase more stakeholders’ participation in project design and implementation.
• Improve relations and networking with government and other bodies they cooperate with important to achieve results.
• Improved reporting tools and M&E system for the project. Including training off staff.
• Revise recruitment, workload and remuneration packages for staff mobile treatment teams.
• Consider incentives for Village Health Care Workers involved in the project.
• Further increase treatment staff’s competence, for example on child therapy.
• Strive to include livelihood into treatment and follow up of clients, possibly in collaboration with other NGOs or governmental initiatives.
• Increase advocacy efforts on a national level with a top-down approach targeting national decision makers and using the role of Southern Alcohol Policy Alliance Lesotho (SAAPA) as an important network.
• Cooperate with academic institutions or other who can address the gap in limited research on issues concerning alcohol and drug use and its effects and cost in Lesotho.
• Consider extending the project term and geographical scope.

Comments from the organisation

We are grateful that the report shows that the impact on the lives of clients is extremely good. This is the “reason for being” for Blue Cross all over the world, and a main purpose of the project. We are also very grateful to hear that local communities, community leaders and others trained in the alcohol policy and prevention have the knowledge and have taken action to follow up prevention measures in their local communities, and that several of them find this is making an impact on their community.

The main challenges are related to project management. While we do agree too, and recognise most of these, we do question the importance of a different baseline study when it comes to achieving the goals of the project. BCN has a different perspective on what the baseline study contains than the evaluation team.

A background study was also done 3 years earlier for the project preceding this one, information which is carried on. Baseline in terms of indicator values was also established. Unfortunately, the evaluation team builds a lot of their findings on what they see as a lacking baseline study. That said, we do recognise a need for increased involvement and ownership from more stakeholders. A need for improved capacity in M&E is another area we recognise, and which is addressed by BCN through our cooperation.

A main factor for not achieving the goal of a revised alcohol policy in Lesotho is the political instability of the country these years. This is only briefly addressed in the report.

When it comes to recommendations, these are mostly very good, and will be taken into account in the continuation of the project. Several recommendations would require increased resources, which is difficult in a situation where we plan to exit this partnership and funding will decrease. Will still take the advice and will work hard to ensure good and lasting project results.

Further comments are attached to the evaluation report.