MASERU — The auditor-general’s report for the 2007/08 financial year has revealed why the much-hyped Know Your Status (KYS) campaign failed.
The KYS campaign was the government’s initiative to get all Basotho above the age of 12 tested for HIV.
At its launch in 2005 Prime Minister Pakalitha Mosisili said the KYS would see at least 1.3 million of Lesotho’s 1.8 million people being tested for the virus by 2007.
But the auditor-general’s report released last week says the campaign failed because there was a delay in deciding the means of communication strategies to reach the target groups.
“The audit revealed that the communication strategy (aimed at “building knowledge and changing behaviours”), was not developed until early 2007, more than halfway through the duration of the campaign,” says the report.
“The HIV testing and counselling (HTC) policy was supposed to have been communicated to all sectors of Basotho through all media channels in Lesotho. However, only two radio stations namely; Joy FM and People’s Choice FM and Public Eye newspaper were engaged in publishing the HTC policy and the campaign.”
Because the radio stations are not accessible in most areas in the country the majority of Basotho remained ignorant of KYS and what it stood for, says the report.
The report says because there were no funds readily available when the campaign was launched it kicked off late.
But even when the funds came, only a little of the budgeted money was used.
“In 2006 and 2007, the government of Lesotho and its partners threw in only M19 113 300 out of the budgeted M75 593 250 towards the campaign.”
“The delays in funding hamstrung detailed activities in the Operational Plan and that was incomprehensible because the contributed funds amounted to only 25 percent of the total budget.”
The audit reveals that financial (US$2.3 million) and material (nine vehicles) contributions made by the Global Fund were not recorded in the KYS’ financial statement of 2006/7.
There was inadequate coverage of the campaign, the report reveals.
The campaign did not reach all the villages of the country’s 10 districts as planned.
“According to the plan, the campaign was supposed to have been carried out in all villages of the 10 districts of the country. However, the auditors established that was not the case during their visits to Mafeteng and Leribe districts.”
“For instance in Leribe, out of 103 community members from 63 villages, 22 members from 16 villages told the audit team that there had never been any KYS activities carried out in their villages.”
Only 13 out of 28 KYS activities were undertaken in Leribe.
In Mafeteng, says the report, the audit team discovered that there were villages that were under the Kena Health Centre and Mafeteng Government Hospital that were not covered by the campaign.
It was discovered also that trainees were de-motivated when the campaign manager failed to release their daily allowances.
Each trainee was supposed to receive M50 per day.
The allowances were supposed to be released within six weeks from the beginning of training but were delayed by six to eight months.
“The district campaign manager claimed to have communicated the matter in writing to the campaign co-ordinator, who did not respond.”
It is said that the district campaign manager then decided to discontinue training of counsellors from clinics.
In Seshote trainees got frustrated over delayed training allowances, the report says.
“Relations got so bad that the campaign manager then decided not to deliver test kits and consumables.”
It further shows that there were some inconsistencies in the distribution of incentives for counselors.
The counselors were not well informed of the amounts and the frequency of the incentives.
Some counselors were given more money than others.
Some community-based care givers got demoralised and dropped out.
“The monies belonging to such counselors were not released to any one, and nobody (even the campaign managers) seemed to have any knowledge as to what could have happened to such monies as the people who had dispensed them never introduced themselves to the counselors.”
It was claimed that the money had been deposited back to the accounts at Standard Bank or Nedbank.
But the copies of the deposit slips were never availed to the auditors, the report says.
In some centres the audit team found out that counselors got the incentives even though they did not fully deliver the HIV testing and counseling results.
There was an inadequate access to prevention, care and treatment services, the report says.
There was lack of assistance and follow-up for people who tested HIV positive.
Some did not have access to the drugs.
“Not all HIV positive people in need of Anti Retroviral Treatment (ART) had access to the drugs. People in remote areas could not easily visit health centres for CD4 count and ART.
“Support services for HIV negative people were non-existent. Government’s commitment to help about 70 percent of Basotho that are HIV negative to stay uninfected was not realised. HIV positive people were not assisted in coping with their status.”
There was also improper quality assurance of test results.
There also was violation of the right to confidentiality and informed consent by counselors.
The report further says there was non-involvement of the community in the selection of counselors.
In communities where counselors were selected, there was limited monitoring and supervision of the KYS activities.
Moreover there was non-emphasis on couples’ counselling due to the ignorance of the counselors.
“Therefore couples could not devise effective strategies to protect their health.”
The mismanagement of vehicles also contributed to the failure of the campaign.
Not enough visits were made by the campaign manager due to misallocation of vehicles, “thereby resulting in non attendance to matters that needed the campaign manager.”
The report says even though the campaign proclaimed communication would play an important role in providing knowledge, yet not all the outlined strategies were implemented.
In 2008 a report by Human Rights Watch and Aids and Rights Alliance for Southern Africa (Arasa) said the KYS campaign was under-funded, incomplete and ineffective.
“From day one, the campaign was in trouble,” the Arasa report said.
“While the operation plan had provided a detailed script for a highly disciplined and systematic testing campaign, in practice KYS’s overall implementation was chaotic, uneven, lackluster and fraught with problems,” Arasa said.