The Blue Cross Advocacy and Outpatient Treatment (BCAOT) Project 2018-2019
Background Blue Cross Lesotho (BCL) runs a national rehabilitation centre at Thaba-Bosiu (TBC) as a project aiming to curb the harmful use of alcohol and drugs. Blue Cross Norway (BCN) supported TBC with Norad-funding from 1991 until 2005, when the Government of Lesotho took over. TBC’s capacity is never sufficient to accommodate all the potential clients. In order to address this problem, BCN supported the Blue Cross Advocacy and Outpatient Treatment Project which operated in selected areas in the four districts of Maseru, Berea, Leribe and Butha-Buthe. The project also continued BCL’s efforts for the implementation of the draft National Alcohol Policy, in order to reduce the harmful use of alcohol in the country. The overall goal of this project has thus been to prevent the harmful effects of alcohol through policy advocacy and outpatient treatment. The project started in 2015 to 2017, and in 2018 the project was extended with Norad funding through Digni for another three years. The project period was then reduced to two years, and the planned final external project evaluation was thus undertaken in 2019. Purpose/objective The purpose of the evaluation has been twofold. First, to enable systematic and participatory learning for the project partners and our stakeholders, including the process of evaluation itself as well as its use after the completion of the project. Second, to produce an objective and systematic assessment of the project’s results. Methodology The evaluation team used a mixed-methods approach, combining qualitative and quantitative techniques. The qualitive techniques comprised direct observation, semi-structured interviews and group discussions with participants, as well as a desk study of project documents, and grey and academic literature. The quantitative data was obtained through questionnaires, which were analysed using relevant statistical methods. Key findings The evaluation concludes that the project was relevant in terms of Lesotho’s needs for a national alcohol policy and a decentralised healthcare system, as well as individual beneficiaries and their families’ requirements for substance abuse treatment and counselling. The evaluation could not assess if the project was in line with the remaining stakeholders’ requirements and aspirations. It found that there was no prior communication with stakeholders on what they required from the project, and what expectations and aspirations they had. The evaluation also found that there is little research on the harmful use of alcohol and drugs in Lesotho, making it difficult to convince some stakeholders of the need for interventions. In terms of policy advocacy, project participants received training in alcohol policy and advocacy, and they have taken initiatives for new advocacy activities. Moreover, they have employed different strategies to advocate and implement relevant activities in their own communities. In terms of outpatient treatment, the evaluation found that the project provided quality treatment for alcohol and substance problems, which was utilized by people in the four identified districts of Lesotho. However, the treatment team was not able to help children from affected families. Furthermore, the evaluation found that there were no manuals proposed in the project document or developed during the project period. This had a negative impact on the village health care workers ability to carry out their tasks. Due to internal and external challenges the project was unable to deliver on all its intended targets, making its effectiveness lower than intended. These challenges also made it difficult for BCN to contribute added value in the form of capacity building and similar activities, as their focus was on follow-up and control measures. The report had no substantial findings on efficiency. Although the project faced many internal and external challenges, it managed to continue throughout the project period. The evaluation team found that some of benefits of the project can be also continued after its closure. Other organisations will also carry on the advocacy work, but the unstable political situation in Lesotho combined with the heavy influence of the alcohol policy seem to hamper the prospects of the alcohol policy draft. At the individual level, follow-up is difficult due to the mobility of the clients and more importantly the uncertain future of TBC’s services. Recommendations Revise the existing alcohol policy draft. Identify and outline stakeholders’ needs in the project planning and include them in the baseline study. Address the research gap on alcohol and drugs in Lesotho to substantiate and legitimate the need for interventions. Develop manuals and related training on outpatient treatment and counselling for village health care workers. Continue to project and extend it to new districts. Comments from the organisation Both project partners found that the evaluation team came up with a report that documents the local need for the intervention and thus justifies sustaining and developing the intervention with other funding. The local partner appreciates the conclusions and recommendations made in the report and have followed it up with a workshop in Lesotho addressing its afterlife.