Love Life on their programmes and on the 2010 Annual Report

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Health

30 August 2011
Chairperson: Ms B Ngcobo (ANC)(Acting)
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Meeting Summary

The Committee was briefed by loveLife on its 2010 Annual Report. loveLife reported 1 500 000 enrolments in educational programmes, training of 9 452 peer educators, 1 447 groundBREAKERS, and 8 005 mpintshis. There were 760 102 calls logged to call centres and 1 702 621 site event participants. The main spikes in infections were apparent among female youth of between 25 and 29 years old, and women reduced use of condoms as they became older. 87.4% of males said that they had used condoms during their last sexual interaction. The HIV prevalence amongst 15 to 24 year old males had dropped to 3.8%. loveLife’s strategies for fighting HIV included creating a demand for bio-medical prevention technologies, sustaining media and youth leadership initiatives, and outreach to schools. loveLife participated with the Department of Health on integrated school health programmes and primary healthcare re-engineering. There were challenges in collaboration with District Management teams, some capacity problems that delayed training of Primary Healthcare staff and unpredictable cash flow. loveLife had the capacity to create an average of 2 500 temporary employment opportunities

Members asked which of the programmes had the most impact, questioned whether funding had increased locally as the overseas funding reduced, and asked the reasons why women tended not to use condoms as they grew older. The Committee was concerned that female condoms were not as accessible as male condoms, and that they had been marketed in a negative way. The Committee heard that loveLife had a firm association with the National Youth Development Agency through the sharing of data and programme design. The 2-14 age group of HIV prevalence was explained as resulting from mother-to-child transmission. Members asked if there were any tools to measure impact. They questioned the relationship with the Department of Basic Education, through the groundbreaker and mpintshis programmes, and the extent to which loveLife would teach in schools, and also asked if loveLife was intending to develop its own primary healthcare nurses to work in youth centres. Members asked to what extent loveLife was involved in family planning and other teen/youth concerns, how the goGogetters were empowered, and if they received stipends.

The Committee then asked why loveLife appeared to have qualifications in the audit report, and called for clarity on travel costs, and ‘other expenses’ mentioned in the report, which amounted to 37% of the budget. A full explanation would be sent to the Committee. The Committee also questioned the under spending by the Department of Health on loveLife, and it was later explained, by a Departmental official, that the second tranche of payments was not requested, although loveLife claimed that there was a misunderstanding about what was owed. A full expenditure report would be sent to the Committee.

The difference between reducing prevalence and reducing incidence was explained, in view of the apparent contradiction between loveLife’s claims to reducing numbers of infections, and the Deputy President’s remarks that South Africa was not winning the battle against new infections. The work with the United Nations was explained. Members asked where offices and staff of loveLife were based, and loveLife promised to send a full report on location of youth centres and clinics. Members y asked if loveLife had visited rural areas and informal settlements, and engaged in awareness-raising with traditional leaders and faith based communities. The Department of Health mentioned that loveLife had the potential to make a huge impact in these areas, as also with commercial sex workers.

Meeting report

Ms B Ngcobo (ANC) was elected as the Acting Chairperson.

Mr M Waters (DA) expressed concern that documents for this meeting had only been received this morning. According to the rules of Parliament, documents were supposed to have been sent to Members 48 hours before meetings were held.

The Acting Chairperson agreed with Mr Waters and asked that in future documents should be sent to the Committee three or four days before meetings took place.

An ANC Committee member asked how loveLife expected full and proper participation from the Committee if documents were received so late.

Ms Grace Matlhape, Chief Executive Officer, loveLife, apologised for the delay in sending the documents through. The initial documents had been sent the previous week, but then some changes had to be effected to the Annual Report before it could be presented.

loveLife Briefing
Ms Grace Matlhape, Chief Executive Officer, loveLife, provided a performance summary of loveLife, outlining all its areas of work and the numbers of staff located within the relevant areas. In particular she highlighted 1 500 000 enrolments in educational programmes, training of 9 452 peer educators, 1 447 groundBREAKERS, and 8 005 mpintshis. There were 760 102 calls logged to call centres and 1 702 621 site event participants.

Ms Matlhape reported that the main spike of infections of HIV/AIDS were seen among female youth aged between 25 and 29 years of age. Young women had reduced their condom use as they became older, while condom use among males had increased.

loveLife’s methods for fighting HIV were outlined, noting that these included creating a demand for bio-medical prevention technologies, sustaining media and youth leadership initiatives, and addressing attitudinal knowledge gaps in schools through massive outreach programmes. loveLife was aligned to the strategic priorities of the Department of Health (DOH) through integrated school health programmes and primary healthcare re-engineering.

The implementation challenges included some problems in full collaboration with District Management teams, capacity problems delaying the training of Primary Health Care staff for Youth Friendly Services delivery, the unpredictable cash-flow and the capacity to deliver clinical services at youth Y-Centres.

Ms Matlhape said that combination prevention had to be used in the fight against HIV and AIDs. Significant inroads had already been made, as 87.4% of males said that they had used condoms during their last sexual interaction. The HIV prevalence amongst 15 to 24 year old males had dropped to 3.8%.

loveLife was implementing its programmes at an ever-increasing scale. The programmes to schools increased by 127% over five years, number of participants increased by 450% over five years and Community Sites increased by 29% over five years.

loveLife had the capacity to create an average of 2 500 temporary employment opportunities

Discussion
Mr D Kganare (COPE) asked which programmes, judged qualitatively, had more impact than others.

Mr Scott Burnett, General Director: Programmes, loveLife, replied that in an evaluation of loveLife programmes in 2004, it was found that the more intensive the interaction was in a sustained face-to-face communication, the more effective it would be in determining health outcomes. Increased interaction through the groundBREAKER programme had reduced the risk of contracting HIV /AIDs.

Mr D Kganare (COPE) asked about the impact of the reduction of global funding, and asked if government had been prepared to increase its funding to compensate for this. He also asked why the Department of Health and the Department of Social Development (DSD) were giving more money.  

Ms Matlhape said that funding from the Department of Health (DoH) and the Department of Social Development appeared to have increased as a result of the decrease in global funding. In 2005, the DoH and DSD funding had increased significantly, when loveLife and government had lost funding from the Global Fund for Youth and Community services. At that time, loveLife was also getting funding from the Kaizer Family Foundation and the Bill and Linda Gates Foundation. These funding arrangements came to an end in 2010.

Mr Kganare asked if loveLife’s international funders had reduced their funding because of their own problems in their own countries, or because they had wanted certain programmes to be implemented.

Ms Matlhape said that this was certainly the case with the Kaizer Family Foundation, whose agreement with loveLife was initially for five years ,then extended by another five years. The Kaizer Family Foundation had decided that it was no longer able to invest in South Africa, save for one small investment, due to the erosion of its capital base. This Foundation had invested $89 million dollars in South Africa since 1999.

Mr Kganare asked if there had been an analysis of why there was a reduction in condom usage by women as they were older.

Mr Burnett responded that the data showed that about 28% had stopped using condoms because they were trying to fall pregnant. However, about two thirds of pregnancies were not planned. The one in five women who wanted children said they had wanted children for personal affirmation. 3% of women said they were forced to have sex against their will. When loveLife measured the self-efficacy of condom use between those two groups, it was found that there was not a major difference. Most of those interviewed knew that they should use condoms, and knew how to use them. loveLife had theorised that when a young person left school, their attitude to their place in society changed, and often, in the outlying areas, women who were faced with little access to the formal economy, jobs, employment and further education opportunities that might be found in well networked communities in urban areas believed that the only way to re-establish their identity was by falling pregnant by a man with some level of power, money and access to better opportunities. That seemed to be the main driver in the reduction in condom use. This had informed the new campaign that loveLife was trying to launch, called Nakanjani, which encouraged young people to take charge of their destinies, and not to give in or give up by behaving in a risky way.

Mr Kganare asked if loveLife had any programmes with National Youth Development Agency (NYDA), or if the NYDA had approached loveLife.

Mr Burnett said that the association with the NYDA was very real. The mpintshi and groundBREAKER programmes were registered youth programmes. Data was shared between the two organisations. They also shared programme design capacity as far as the advancement of the National Youth Service was concerned. loveLife was also doing an international exchange programme with the NYDA in France, by sending ten groundBREAKERs were going to France. There was a lot of room for development with the NYDA.

Ms M Dube (ANC) referred to the graph on page 5 of the presentation, which illustrated HIV prevalence by age group. She asked what the ‘2-14’ age group meant, and if the very young group would represent children who had been raped.

Mr Burnett said that the prevalence in 2 to 14 year olds was mainly due to mother-to-child transmission. These children were still on treatment.

Ms Dube said that there was a difference in the numbers in the report, and asked for clarity on the numbers shown in respect of partnerships and non-government organisations (NGOs).

Mr Burnett said that the presentation gave a summary of franchises and outlets as if they were one type of site. However the Annual Report distinguished between NGOs and partners, which were franchises and outlets - very often schools - who had agreed to partner with loveLife. Another reason for the differences was that community partnerships tended to fluctuate from time to time.

Ms Dube asked where the Youth centres (Y-centres) were, and if they were located across the whole country.

Mr Burnett replied that this information would be forwarded to the Committee. The presentation did show the names and towns of Youth Clinics.

Ms E More (DA) asked if any measuring tools were available to do an impact assessment, and whether loveLife used measuring tools at all.

Mr Burnett said that the answer was both yes and no. loveLife had recently established a research function to do ongoing evaluations of its work, and this would become a permanent part of the programme structure. The training centres, groundBREAKER programmes and Y-centre programmes were evaluated on an annual basis. 

Ms More asked if loveLife had a strategic plan, and performance management development systems.

Mr Burnett replied in the affirmative and added that the three-year Strategic Plan for 2012/2014 was currently being finalised at Board level. A new, more computer-based performance management system had been in place for about one year.

Ms More asked how and when programmes were conducted in schools, what their structure was, and who did the work.

Mr Burnett said that loveLife engaged regularly with the Department of Basic Education (DBE) on this. Sometimes, the Life Orientation study period would be conducted by the groundBREAKERS and mpintshis, as the Department of Basic Education did not want to do this. However, Life Orientation studies were assessed, and it was important that the classes be properly managed, so in most cases loveLife would send in support teachers, to assist the class teacher.

Ms More asked about loveLife’s working relationship with Primary Health Care (PHC), and if there were plans to develop its own PHC nurses to work in Y-Centres.

Mr Burnett said that staff shortages had been dealt with quite aggressively this year, and the number of staff had risen from four to twelve. Partnering sometimes occurred at Y-centres and proved to be very helpful.

Ms More asked if there was a working relationship with Family Planning, and, if so, how the services were integrated.

Mr Burnett said that loveLife did address family planning and a broad range of adolescent issues. The Vitality Providers were trained in dealing with teen pregnancies, counselling, and talking about relationships.

Ms More asked how goGogetters were empowered, if they got stipends, and the criteria to be a goGogetter.

Mr Burnett replied that goGogetters were trained annually. There were now 67 support groups around the country. The facilitators were trained by counsellors. The support groups were really about problem solving, and were the main network of support for a group of goGogetters in any particular geographic area. A goGetter had to be over the age of 55, and should have a proven track record in working with vulnerable teenagers, as well as a strong social network. The stipend was R300, with R100 for transport and R100 for cellphone usage. If the budget was increased, then goGetters would be paid more money.   

Ms More asked how many qualified and unqualified audits were received from the Auditor General, since loveLife started in 1999.

Mr M Waters (DA) asked for feedback about the current qualified audit opinion, and what was being done to prevent a recurrence of this situation.

Ms Matlhape stated categorically that loveLife had never been given an adverse report of any nature from the Auditor General. The “qualification” to which Mr Waters referred was actually one that was routinely given for all NGOs, who did receive cash. The Non Profit Organisation (NPO) Act, which used to be the Fundraising Act, gave NGOs permission to get cash from the population. What the comment meant was that loveLife could have had other money come into the organisation through cash collections, and the Auditor-General gave no guarantees that all the cash collected had been accounted for.

Ms Matlhape said that in the previous year, loveLife had an issue with the DoH, and this had produced a different comment, although this was also not a qualification, from the Auditor-General. It was related to the Kurisani Trust, which was established in 2005, as a separate Trust, with a different set of trustees. This Trust would obtain equity in South African companies as a Broad Based Black Economic Empowerment (BBBEE) company. The purpose of that Trust was to create a pipeline of opportunity for groundBREAKERs coming out of loveLife to participate in the investment stream. Although the investment stream was not fully established, loveLife was looking at it as a long-term investment possibility. The Auditor-General had therefore reached the decision that because loveLife was the sole beneficiary of the Kurisani Trust, this information had to be consolidated with the loveLife audit report. However, the Auditor-General noted that at the time, this had not been done. The consolidation had now since been completed, but it was too late for insertion into the Annual Report. The consolidated report was not qualified, and would need to be approved by the Board in October 2011. It would be distributed to the Committee, once approved.

Mr M Waters (DA) asked for clarity about the transport and travel expenses and the local and overseas costs.

Ms Matlhape said that travel referred to the costs of attending meetings and such like, and transportation costs, which were high, referred to transport in pursuance of the programmes. loveLife had 9 400 young people across South Africa doing its work, and they also needed a small travel allowance to travel to different points to attend training sessions. Between travel and transport there was a fleet of about 90 cars, which amounted to R4 million in total. The costs included those of groundBREAKERS, goGogetters and mpintshis’ transport to schools, and taxi fares. The overseas travel amounted to R70 000 and was mostly funded from overseas.

Mr Waters asked for clarity on ‘Other expenses’ mentioned in the Report. The ‘Other expenses’ amounted to R68 million, which was basically 37% of the entire budget.

Ms Matlhape said that the ‘Other expenses’ represented a number of categories, so there was no quick answer. All other expenses, such as overhead costs, would be programme specific costs. LoveLife would confirm all the budgetary items in writing and submit a report to the Committee within seven days.

Mr Waters said that the reduction in infections for young persons was heartening. The Deputy President, however, noted that South Africa was not winning the fight against new infections, which seemed to be in contradiction to loveLife’s claim that there was a reduction in infections. He asked for an explanation.

Mr Burnett replied that the Deputy President was correct. There was a difference between reducing incidence, and reducing prevalence. The prevalence was still increasing, but the rate at which this was done was slower than it used to be amongst young people.

Mr Waters asked for clarity on the statement that male condom use had increased, whereas use of condoms by females decreased after they were about 16 years old.

Mr Burnett replied that the more exposure a person had to condoms, the more likely s/he would be to use them. loveLife’s graphs showed “confidence levels” which meant that although it was certain that the graph was an accurate depiction of what young men were saying, it could not be sure that this was what they were doing. However, more young men were seeing it as normal to use condoms.

Mr G Lekgetho (ANC) asked where the 450 person staff complement of loveLife was located.

Ms Matlhape said that the report showed the numbers of staff per district. There were nine provincial offices in South Africa. The main office in the Western Cape was in Observatory, but there was also one in Worcester, covering the Winelands district, and one in Langa, covering the metro. In provincial offices there were about 15 people per office. The staff complement at regional offices was based on the size of region.  

Mr Lekgetho asked for comment on the stance taken by some young people to ‘condomise’ or abstain from sex and be proud to being virgins.

Mr Burnett said that loveLife’s approach has always been to focus on identify first, and talk about young people’s perception of themselves. It was important for them to feel proud of themselves, and to feel that they had a place in the world. loveLife was not the main distributor of condoms, but believed that when the first sexual encounter took place, condoms should be available, to ensure that it was safe. loveLife engaged with young people on what a relationship meant, and the mpintshis and groundBREAKERS were well trained in this.

Mr Lekgetho said that female condoms were scarce. He asked why this was so, and if it perhaps reflected the perpetuation of the domination of females by males.

Mr Kganare asked what feedback loveLife had received about female condoms

Ms Matlhape agreed that female condoms were not as accessible as male condoms, and they had been positioned in an unfortunate manner. Better marketing could reposition Femidoms in a more positive way.

Mr Burnett said that it might be a perpetuation of male domination. Female condoms were one way for women to control sexual decision-making. Many rights groups felt that placing the responsibility on a woman was unfair. 

Ms L Makhubele-Mashele (ANC) asked why the call centres were located at the national level.

Ms Matlhape said that call centres were toll free. If young people did not have airtime, landlines provided free access. It was convenient to manage from the National office. Young people could also send ‘please call me’ messages, which would provide access to loveLife counsellors. Access to land lines was not uniform across all areas, and it was difficult to find public phones in some villages.

Ms Makhubele-Mashele asked how loveLife planned to assist with the anticipated challenges for young people who tested positive for HIV.

Mr Burnett replied that loveLife did not have the capacity to provide psycho-social support for young people who tested positive. This was why national call centres were helpful, because they could link young people with psycho-social support, even if it was not face-to-face. In the next year all groundBREAKERS would have mobile phones, to be able to send a ‘please call me’ SMS to call centres.

The Acting Chairperson asked if loveLife had visited areas not spoken about in the report, like farm dwellers, farms and informal settlements.

Mr Burnett said that all geographic areas were targeted, including informal settlements and rural communities. There were complexities with accessing farms and some communities were hard to reach. This was recently discussed with the Department of Social Development.

The Acting Chairperson asked if loveLife was participating in an imbizo for traditional leaders or raising awareness with traditional leaders and faith based communities.

Mr Burnett said that there had been a number of engagements, some of its community partners were faith-based organisations, and some of the programme drivers were traditional leaders. There was not a structured national way of engaging on programmes. However, groundBREAKERs and mpintshis knew their community, knew the centres of power, knew the network within that community and were being able to leverage those centres of power, as appropriate.

The Acting Chairperson asked to what extent loveLife worked with commercial sex workers and how their concerns were dealt with.

Mr Burnett said that currently loveLife did not have a programme with commercial sex workers, partially because loveLife was designed as a scaled work programme targeting the 12 to 19-year old age group. There were a number of commercial sex workers who fell into this age group, but they were addressed as adolescents, and not specifically as commercial sex workers. Currently, 41% of the adolescent population was reached, but loveLife intended to reach 50% coverage.

The Acting Chairperson asked if loveLife was comfortable with the current levels of alleged behavioural change, and if there were actually changes in behaviour.

Mr Burnett said that loveLife was not comfortable with the current levels, as there was a lot more that could be done. There were still too many dogmas and strange beliefs around HIV and AIDs. There was still a lot of resistance by men, who felt a sense of entitlement. Through its new Strategic Plan, loveLife was aiming at zero deaths and zero mortality.  

The Acting Chairperson asked if loveLife was participating in the Declaration by the United Nations (UN) for zero new infections and zero mortality, and if it aimed to effect this change by 2015.

Mr Burnett replied that there was a strong and growing relationship with the United Nations (UN), which was refining its HIV prevention strategy. The United Nations Children’s Fund’s (UNICEF) global office in New York had invited loveLife groundBREAKERs to participate in developing the HIV prevention strategy, with a focus on children.  This engagement was planned for October and would allow loveLife to participate in a process of strategy refinement and realignment for the UN.

The Acting Chairperson asked for comment on data from the DOH, which revealed that far less men than women were tested.

Mr Burnett said that this was a serious concern. One of the reasons why loveLife had a strong focus on activities and sports was to try to recruit an equally gender-representative group to loveLife. Very often, young women were the first to express willingness to join the programme, whilst the young men would stand aside. loveLife used sports, arts and cultural activities to drive the HIV Counselling and Testing (HCT) campaign around the country, and part of the strengthening of youth services would be to ensure that these activities took place around the clinics. Sport was a particular way to ensure that young people were tested.

The Acting Chairperson said that Limpopo seemed to be doing very well, and asked if it had been established why this was so.

Mr Burnett said that since he had been at loveLife, people in Limpopo showed overwhelming energy, enthusiasm and brightness, and he added that many of the people in the call centre were from that province.

The Acting Chairperson noted that the National Treasury had reported that the DOH, in the third quarter of 2010, had under spent on Love Life, and asked why.

Ms Matlhape said that loveLife had an agreement with the Department of Health, but there had been substantial staff changes in DOH, resulting in some confusion as to what was owed to loveLife, and the money was not in fact distributed, resulting in loveLife’s own cashflow being unreliable and pressurised.

The Acting Chairperson asked how many women loveLife knew of who used termination of pregnancies as a way of family planning.

Mr Burnett said that he could not quote a specific study on this, but anecdotal evidence was that the Choice on Termination of Pregnancy (CTOP) was a very traumatic process.

The Acting Chairperson asked whether loveLife felt that, from 1999 to date, it had made a remarkable impact in the improvement of health status, particularly with regard to HIV /Aids, TB, and other sexually transmitted diseases.

Mr Burnett said that over the past few years young people had started talking about sex, and sexual behaviour had also started to change. The incidence of HIV in teenagers and young adults showed  lower infection rate than expected. Although no studies made a direct link to loveLife, it had certainly contributed as part of a concerted national effort driven by many players, including the DoH.

The Acting Chairperson said that she would have appreciated the opportunity to interrogate the financial statements.

Ms Matlhape said that a full expenditure report would be made available to the Committee.

National Department of Health input on loveLife partnership
Dr Thobile Mbengashe, Chief Director: HIV and AIDs, National Department of Health, said that he would to like address a few issues around the partnership with loveLife. The National Department of Health was in the process of changing its systems, and the National Service Delivery Agreement with the Minister of Health would set a number of new priorities. There would also be a greater opportunity for DOH to work with partners through the re-engineering of Primary Health Care. This approach targeted the integrated school health programme, which was run between DOH and DBE, and under this approach, nurses would be placed in schools to deal with problems.  

He then expanded further on the issue of the money under spent in the third quarter. National Treasury had correctly stated that there was no request for money from loveLife. DOH therefore owed money at the closure of the financial year’s books, because only one tranche of R38 million had been transferred, while a second tranche was outstanding. Ordinarily, there would need to be a request for a rollover, but no specific request was made. It had become apparent to the DOH, DSD, DBE and the Department of Sport and Recreation that loveLife programmes should be integrated and responded to uniformly. loveLife had raised the need to have some transition to do this integration.

He noted that in difficult areas like farms, informal settlements and work with commercial sex workers, where transmission rates were highest, loveLife could add more value. These areas had been prioritised by the Minister. Any approach taken should combine all the efforts to deal effectively with the social determinants that put people at risk.

Prevention was a key component and allowed the exploration of issues such as how people should be empowered to deal with their reproductive health, and how the youth should be supported to become resilient to the pressures they faced when they left school. The new National Strategic Plan had integrated all these programmes. The programmes did work, but had to be implemented on a very broad scale. He concluded that all efforts should be combined in a multi-sectoral response. This would be the only way to make a difference in HIV /Aids between 2012 and 2016.  

The following questions were raised but not answered:

The Acting Chairperson asked for a breakdown of the gender amongst loveLife’s staff complement of 450 people.

Ms More asked how loveLife reached out to youth, orphans, and other vulnerable children.

Ms More asked how loveLife intended to deal with the issue of trans-generational sex.

Ms More asked if loveLife had a self-evaluation system.

Ms More asked how the groundBREAKERs and mpintshis were recruited.

The meeting was adjourned.

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