January 2013

2012 Activity REPORT

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ALAFA was established in 2006 as a public-private partnership to address the potentially detrimental effects of Lesothos HIV epidemic on the countrys textile and apparel industry. This industry accounts for over 80% of Lesothos manufacturing employment and is key to Lesothos sustainable economic development. ALAFA provides a range of integrated health services at the workplace that include prevention, testing and treatment of HIV, TB and Sexually Transmitted Diseases as well as advice and education on family planning, parent to child transmission.

Lesotho Textile Exporters Association

LIEA

Lesotho Industrial Employers Association

The initiative is a pioneering collaboration between industry, government, trade unions and a network of regional and international brands, donors and aid partners. ALAFA places employee wellbeing at the heart of social and economic sustainability and development in Lesotho. Through the ongoing support of all those who are part of the ALAFA community, the initiative currently reaches over 90% of the sectors workforce with preventative services and 80% with care and treatment services. ALAFAs mission is to release the social, commercial and economic value of worker health and wellbeing through the delivery of factory policy development, prevention, and treatment and care of HIV / AIDS and other illnesses.

ALAFA working together

LEVI STR AUSS & CO.

National & international recognition

ALAFA was awarded the 2011 International Health Promotion Award in the workplace category for the work it is doing in the apparel industry in Lesotho. In 2008, ALAFA was recognized in the Business category of the Drivers of Change awards.
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WELCOME
Welcome to ALAFAs report on activities in 2012. It was certainly a dynamic and fruitful year, with programming going from strength to strength, new and exciting partnerships developed, and key steps taken towards sustainability. In 2012, ALAFA factory-based programmes continued to support workers and industry productivity in measurable ways. Some of the highlights of the year included an almost 10% increase in clients registered for pre-HAART and HAART services, a remarkable success rate of 98% amongst the 188 babies born through the PMTCT programme, exceptional coverage of factories becoming compliant with HIV at the workplace policies, and the distribution of the 5 millionth male condom. We have received positive feedback from donors, partners and factory management on the new look of ALAFA, which took effect in 2012. I believe this more dynamic approach to communications allows us to share programming information better and to highlight the support of our donors and work of our partners more effectively. ALAFA partnerships were a major focus of 2012. A significant core funding grant agreement with the Delegation of the European Union to the Kingdom of Lesotho, through funding from GIZ was signed in July. This support provides a vital time frame in which to enhance local partnerships and move towards a truly sustainable model of ALAFA. During the year ALAFA also began working closely with Philips on HIV initiatives in their factory in the new Ha Tikoe industrial area of Maseru. The foundations for relationships with other factories were also established in preparation for them to join ALAFA in 2013. It is truly exciting that workers are actively seeking ALAFA-based services at their work places and that vital health services will be available to even more workers in the new year. Building on momentum established in 2012, 2013 will also maintain a strong emphasis on the strengthening of our key partnership; the relationship with government ministries, to explore together ways to build local sustainability and increase the reach of services to Basotho workers. Avenues to increase participation and ownership of the Apparel and Textile Industry itself, the original host of ALAFA, will be also be further explored. ALAFA will remain on the cutting edge of HIV prevention initiatives in the new year, with two key developments. Firstly, ALAFAs innovative SMS health promotion campaign, developed with USAID funding, experienced a successful pilot stage in 2012. We aim to roll this out to all factories in 2013. Secondly, we will be launching a new partnership with JHPEIGO to support the Ministry of Healths innovative Voluntary Medical Male Circumcision (VMMC) initiative. This exciting development will make VMMC available, at no cost, to male workers and partners of workers in the industry. It is this type of exciting, innovative, resultsbased initiatives that ALAFAs strong partnerships facilitate and support. ALAFA looks forward to taking up the offer of affiliate membership with the Global Funds Private Sector Delegation, hosted by the Global Business Coalition on Health, in 2013. We can also celebrate the continued relationship with brands sourcing in Lesotho, such as Gap Inc. and the Levi Strauss Foundation, and the support we receive from international donors who recognize the excellent opportunities made available through providing healthcare services at the workplace. Through these partnerships and innovative, successful programming, ALAFA makes substantial differences to workers and their families, and with it, industry productivity and competitiveness. I invite you to join us in celebrating the successes of 2012 and in looking ahead to the exciting plans for 2013. Khotso, Pula, Nala! Donna Bawden

Donna Bawden CEO ALAFA

CONTENTS
1. Workforce health and wellbeing 2. Industry development 3. Prevention 4. Care and treatment 5. Medical monitoring 6. Support groups and counseling 7. Monitoring, evaluation and reporting 8. Industry rollout 9. Meetings & events 10. HR & recruitment

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63% of all workers in the sector are female, internal migrant workers and many of these are the sole breadwinners in their families.

1. Workforce health and wellbeing

The textile industry, employing approximately 40,000, is well aware of the link between the health and well being of these employees and the growth and sustainability of the industry. This sector is responsible for over 19% of manufacturing GDP in Lesotho, and securing its future is key to economic stability in Lesotho. ALAFA offers the members of this workforce access to a range of health and wellbeing services at their place of work, by focusing on increasing the reach and quality of our services, we aim to help release the social, commercial and economic value of a healthy and productive apparel industry.

Integrated model for health and wellbeing

Prevention

Industry Development

Bringing healthcare to the workplace

Care & Treatment

Support Groups & Counselling

Medical Monitoring

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2. Industry development
Supporting factory policy
ALAFA assists factories in developing HIV at the workplace policies in line with the requirements of the Ministry of Trade and Labour. By the end of 2012 33 factory policies were either developed or revised with the support of ALAFA; 87% of the factories we work with, ensuring that close to 40,000 workers are employed in a legally compliant environment.

87%
of all factories have new Ministry of Labour and Employment guidelines in place

Management training
Training is offered to factory management on issues around HIV, TB, and other health services, policy requirements, benefits of workplace interventions and ALAFA programming, and range between one and two days. In 2012 52 Sesothospeaking managers were trained. At their request, 25 union officials (5 from each of the 5 textile unions) also received training in HIV and general health issues. Training for management and unions will continue in 2013 and a focus on Mandarin-speaking management will be present. Table 1: Number of factory management staff trained on HIV management
66 52

52

Managers trained in 2012 in 2012

56

Actual Managers Trained Sesotho 2011 Mandarin 2011 Sesotho 2012

Over 90% of manufacturers in the sector are signed up to the ALAFA initiative.

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810,495
Male Condoms Distributed in 2012

By educating peers and supervisors, ALAFA empowers the workforce to sustain itself.

3. Prevention 168,378
Female condoms Distributed in 2012

3.1 Condom distribution

ALAFA sources male and female condoms through local partner organisation Population Services International (PSI). The condoms are distributed through ALAFA-trained peer educators in the factories and are reported on monthly. Targets in 2012 were 3 male condoms and 0.25 female condoms distributed per worker per month. On average in 2012 1.89 male condoms and 0.39 female condoms were distributed per worker per month. The female condom distribution was particularly successful due to the strong partnership with PSI and to two initiatives in the factories the rollout of female condom-specific peer educators, trained by PSI, to all factories by the end of the year, and a strong effort by the Prevention Department to support this partnership and the peer education efforts.
Table 2: Numbers of male and female condoms distributed in ALAFA factories Male Condoms Year Quantity # per worker per month Female Condoms Year Quantity # per worker per month

6,125,506
Male & Female condoms Distributed Since 2006

Total 2006 Total 2007 Total 2008 Total 2009 Total 2010 Total 2011 Total 2012 Cumulative Total to date

152,507 598,668 1,036,803 1,093,508 894,152 1,011,903 810,495 5,598,036 2.05 2.58 2.51 2.08 2.40 1.89

Total 2006 Total 2007 Total 2008 Total 2009 Total 2010 Total 2011 Total 2012 Cumulative Total to date

10,606 31,793 80,116 94,270 66,718 75,589 168,378 527,470 0.20 0.28 0.22 0.15 0.18 0.39

In 2012, the prevention department released a press release following distribution of the 5 millionth male condom, and by December 2012 the distribution had reached 5,598,036 male condoms and 527,470 female condoms.

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3.2 Mobilisations
Mobilisations, lunch-time events which take place at factories to inform workers about programmes, address identified gaps in knowledge and answer related questions. These are large-scale events conducted by ALAFA staff or, at times, partner organisations. Topics include information on new programmes being introduced as well as regular ALAFA programming, including condoms, testing, treatment and adherence, PMTCT, TB, STIs, policies and worker rights, peer education, and family planning. Also included in mobilisations were 5 factories where a new SMS campaign will be rolled out in early 2013.

Mobilisation Activities
HIV testing and counseling Peer education TB treatment Family planning Care and treatment STI treatment PMTCT

3.3 Peer education

Workers from each factory are trained as Peer Educators, with a target of at least 1% of workers trained. They are first trained in a basic HIV/AIDS understanding and prevention curriculum, followed by a broader life skills curriculum which focuses on contributing factors to HIV transmission, health issues and relationships. In 2011 3 additional curricula were introduced under a USAID-PACT grant. Peer educators now receive further training in materials and tools to specifically engage either male workers, female workers, or workers 25 years old and younger, in order to target the needs of each group of workers more effectively. In releasing workers from the factories with no loss of pay, employers provide a valuable in-kind contribution to programming. Trainers also visit factories each month to provide follow-up support to peer educators.
Table 4: Peer education targets and actuals for 2011 and 2012 Curriculum Target 2011 50 150 50 60 30 Actual 2011 62 126 21 29 45 Target 2012 85 100 98 40 50 Actual 2012 147 153 98 62 64

Basic HIV and TB Life skills Male workers Female workers Workers 25 years old and younger

Factory management makes valuable in-kind contributions through releasing workers for trainings and to visit health clinics with no loss to pay, and in providing clinic space and furnishings.
Donna Bawden, ALAFAs CEO

With support of the Levi Strauss Foundation a very successful Annual Peer Educators Day was held in October 2012.

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In 2012 ALAFA partnered with the Ministry of Health and Social Welfare to improve quality of HTC service provision in factory clinics.

111 %
Of target HIV tests for 2012

3.4 HIV Testing & Counselling (HTC)

HTC is offered by counsellors and nurses in all participating factories. Workers may also seek HIV testing elsewhere and bring their HIV result to an ALAFA staff member to enrol in the programme.
Table 5: HTC numbers and positivity rates to date and cumulatively HIV tests Total 2006 749 2,370 8,923 12,930 6,395 4,550 7,729 43,880 HIV positive 303 864 2,730 3,321 1,300 769 1,111 10,408 HIV negative 446 1,506 6,193 9,609 5,096 3,781 6,618 33,472 % HIV positive 40% 36% 31% 26% 20% 16% 14% 24% Testing target 1,000 3,400 10,000 13,000 10,000 7,000 7,000 51,400 % of target 75% 70% 90% 99% 64% 67% 110% 87%

42.7%
HIV prevelance amongst factory workers

Total 2007 Total 2008 Total 2009 Total 2010 Total 2011 Total 2012 Cumulative total to date

The results of the 2012 sero-prevalence study indicated a HIV prevalence of 42.7% amongst the factory workers. This is in line with national statistics when demographic factors are taken into account.

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3.5 Pregnancy and PMTCT

Cumulative December 2011 Pregnancies ever reported Live births recorded Still births, miscarriages and abortions 729 677 32 2012 195 69 7 Cumulative end June 2012 924 788 39

195

Pregnancies enrolled in PMTCT programme 103% of 2012 target

The total number of pregnancies enrolled in PMTCT in 2012 was 195. Women are encouraged to speak to their doctors before becoming pregnant and to register with the programme as early as possible.

3.6 Infant monitoring

In 2012, PMTCT monitoring tools were adapted from the MoH obstetric record. These were provided, along with training, to all service providers. The use of these improved tools has resulted in improved data quality.
Cumulative end 2011 HIV DNA /PCR done HIV Positive Reported HIV Negative Received Breast feeding Received Formula Feeding 464 10 393 8 650 Cumulative end December 2012 527 11 437 24 745

2012 63 1 44 16 95

Gap Inc were instrumental in the roll out of the PMTCT programme.
Tinashe Chinyanga, ALAFAs Medical Director

In 2012, of the 45 babies that received their DNA/PCR results, only one was reported positive.

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FACTS
There are approximately 40,000 workers in the Lesotho textile industry. This makes up 80% of all manufacturing jobs in Lesotho. There are thirty nine apparel and textile factories in Lesotho. There is just one textile mill in Lesotho. Inward investment has come from Taiwan, RSA, China and Mauritius. The value of exports in 2012 reached $241,827,000. The volume of exports to the U.S. in 2012 reached 55,174 million square meters. 11.4% of the GDP for Lesotho in 2012 was generated through apparel and textile manufacturing activity.

FAST

INDUSTRY

APPAREL

* Information supplied by LNDC

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FOR THE PEOPLE, THE INDUSTRY AND THE ECONOMY.

ALAFAs mission is to protect and sustain the health and wellbeing of the workers of the apparel industry in Lesotho.

80%
The industry makes up

of all manufacturing jobs in Lesotho.

A healthy and productive workforce drives industry competitiveness, and is central to sustainable economic and social development in Lesotho. As a key partner of ALAFA, the Government of Lesotho, through the Ministry of Health and Social Welfare, supports factory-based care & treatment through provision of supplies such as antiretrovirals (arvs), tb drugs, hiv testing kits and other drugs and through laboratory services.

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9.45%
increase in all patients in 2012

4. Care and treatment

4.1 HIV Care & Treatment
Table 1: Total number of clients ever registered with ALAFA for pre-HAART and HAART
739 113

10%

New patients for 2012

increase in male patients in 2012

8791 Cumulative ALAFA patients end Dec 2012

1081

5,456

Female

Male

active patients on progamme

The total number of patients ever registered on the program increased by 9.45% in 2012. The percentage of males registering in 2012 was 13% of the total, an increase from 10% in the past year. Total number of active patients by December 2012 was 5,456, a slight increase from the 5,419 reported at the end of 2011. The increase in the number of clients registered was almost offset by the number of clients who transferred out of the program, notably due to the closure of one factory in Maputsoe.

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4.2 STI Treatment

874 8825 7951 STI cases 2011 Female Male 900 8004 7104 STI cases 2012 Female Male

The STI treatment component of the program is available to every factory employee. In 2012 8,004 STI cases were treated. An M&E audit was conducted during quarter 2, which revealed that there is consistency between data submitted on claim forms and data on STI reports. However site data verification is not practical since service providers do not keep records of clients treated. Contact tracing also needs strengthening because most partner slips are not returned to issuing clinics to confirm that the partner has been treated. In view of the above, an STI register and modified contact slip were developed, piloted and rolled out to all factory clinics in 2012.

8,004
STI cases treated in 2012

4.3 TB Treatment
Cumulative TB patients Dec 2012 515 Completed Treatment Currently on Treatment Ever Defaulted Died On HAART HIV Negative

452

63

16

458

27

New TB cases were diagnosed and commenced treatment in 2012

57

During 2012, 57 new TB cases were diagnosed and commenced on treatment. All clients who are treated for TB are offered HTC, with a 100% uptake rate. 2 patient deaths were attributable to TB disease during the period. 25 nurses and 10 adherence counselors were trained on TB and TB/HIV in 2012, with sponsorship from the Global Fund to Fight AIDS, Tuberculosis and Malaria. After the training, TB screening was rolled out to factory clinics. Tools to facilitate TB screening, such as sputum bottles and the TB suspects register were distributed to all factory clinics. Defaulter tracking and follow up: Tracking defaulters who have left the industry continued to be a challenge. The program awaits new tools that are being developed by the Ministry of Health to facilitate better tracking of clients.

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Effect data gathering and monitoring is key to the success of the ALAFA programme.

5. Medical monitoring
Five doctors with a high client load were provided with additional laptops to improve the process of data entry and reporting. New modules (PMTCT, TB, STI, HCT and Support groups) were added to the electronic medical monitoring system as a way of consolidating ALAFA data. Service providers will be trained on the new comprehensive system in the 1st quarter of 2013 before the system is rolled out.

100% 13,139

ALAFA continues to support the Ministry of Health in the dissemination and implementation of recent national ART and PMTCT guidelines.

of factoriies have workers attended active support 424 support group groups sessions in 2012

6. Support groups and counseling

Support groups contribute positively to the welfare of people living with and/or affected by HIV as they share experiences and healthy living tips. Such groups have been functioning since 2008 in the majority of factories, and have been supported by ALAFA ambassadors and nurse case managers.
End of 2011 2012 424 Cumulative Total 2,056

Number of support group sessions Total ever participated Average participants

1632

EVERY FACTORY IN ALAFA HAS AN ACTIVE SUPPORT GROUP

Tseliso Soai, ALAFA Ambasador/ Expert Patient

52105

13,139

65,244

32

31

32

The process of registering support groups continues. Three members from each support group were trained on a manual adopted from the Ministry of Health in the 3rd quarter of 2012. Going forward, support group sessions are now based on the said manual, and the trained members are expected to offer step-down training to their peers.

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7. Monitoring, Evaluation and Reporting

The ALAFA scorecard, which tracks performance against targets, has been finalized for 2012 and targets set for 2013. An M&E audit was conducted for the Care and Treatment indicators in May 2012. A Knowledge, Attitudes and Practices (KAP) study was commissioned by ALAFA in 2012. The results indicated very high levels of knowledge amongst workers of ALAFA programming, increased HIV-related knowledge levels, a decrease in stigma and a correlation between participation in ALAFA peer education activities and reported healthier behaviors.

8. Industry Rollout
At the beginning of 2012, the number of workers with access to ALAFA prevention services was 31,185 and those that had access to both prevention and care & treatment services was 29,110. By the end of 2012 the numbers have increased to 37,970 and 34,124 for prevention and care and treatment respectively. In fact, total employment in the industry declined somewhat in 2012 due to uncertainty within the American market over potential expiry of the AGOA third country fabric provision clause. An increase of over 6000 workers accessing prevention services and an increase of over 5000 factory workers accessing care & treatment in 2012, despite overall reduction of employment figures, indicates successful extension of services and increase in accessibility of services. Improved reporting by the factories was also supported.

37,970
Workers had access to prevention services

34,124
Workers had access to care and treatment

36,279 31,180 PC&T Prevention 29,110

37,970 32,386 34,124

Period

January

July

December

ALAFA 2012 ACTIVITY DASHBOARD PAGE 15

9. Meetings & Events

ALAFA held a high-level Stakeholders Forum in Maseru on February 9th to discuss issues of sustainability. The meeting was chaired by the Honourable Minister of Trade and Industry, Cooperatives and Marketing, and was attended by the EU Ambassador to the Kingdom of Lesotho and representatives of partners and stakeholders including DFID, EU, GoL, Unions and factory management. The forum resulted in the creation of a Sustainability Working Group, comprised of representatives of ALAFA, Ministry of Health and Social Welfare, and the private doctors.

Quarterly HIV coordinators meetings took place throughout the year

An ALAFA HIV and AIDS at the Workplace Policy was drafted for internal use ALAFA participated in the Global Business Coalition on Health Conference in May

Refresher trainings were held for HIV Coordinators during the third quarter of 2012. The Medical Director hosted meetings with Doctors supporting ALAFA in each quarter.

ALAFA attended the private sector pre-board meeting of the Global Fund to fight Malaria, TB and HIV/ AIDS in November.

As part of the commemoration of the World AIDS day, ALAFA participated in the event held at Ha Thetsane on the 01st of December 2012, with a stall set up to display ALAFA information.

The ALAFA Management Committee held quarterly meetings on 22nd March, 26th June, 11th October and 11th December.

A Peer Educators Day was held In 2008, ALAFA at the Maseru was recognized Club on 21st in the Business October for 103 category of peer educators the Drivers of through the Change Awards. support of the Levi Strauss Foundation. There was a 90% turn out of the peer educators.
The Prevention Department facilitated four quarterly meetings with participation of 98% of the HIV Coordinators.

Mobilizations for the Pilot phase of the SMS campaign were held in December 2012 in 5 factories in Maseru and Maputsoe.
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ALAFA with the support of the Prevention department organized a Wellness Day for staff on the 23rd of November 2012.

The ALAFA team

10. HR & Recruitment

In 2012 ALAFA welcomed 4 new staff members to the team, Ntate Relebohile Tshehlo, Me Mpoi Lebakeng, Me Mapaseka Dube and Ntate Ntaso. These added new capacities and talents to a truly dedicated team that through their enthusiasm, hard work and dedication to our mission has helped accomplish great things for the workers of the industry.

STAY IN TOUCH WITH ALAFA

Website: www.alafa.info facebook.com/alafaforlesotho Join our mailing list: [email protected] Follow us on Twitter: @alafaforlesotho

ALAFA 2012 ACTIVITY DASHBOARD PAGE 17

ALAFA DASHBOARD
CARE AND TREATMENT
CARE AND TREATMENT SERVICES IN THE WORKPLACE

34,124 85%
OF ALL WORKERS

Workers with access to ALFA HIV-TB-STI care and treatment services in the workplace

Patients active in ALAFA care and treatment programmes

5,440
1081

8004

89% of target STI case treatments

Treatments

57

Total patients treated for TB in 2012

9872
PATIENTS

Total patients in ALAFA care and treatment programmes from 2006-2012

Female Male

113

852

New patients for 2012

Female Male

NEW PATIENTS

8,791

739

INDUSTRY DEVELOPMENT
MANAGEMENT TRAINING

Sesotho Managers trained

52

FACTORY GUIDELINES

16

87%
OF FACTORIES

33

33 factories have new M  inistry of Trade & Labour guideline policies in place

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2012 AT A GLANCE
PREVENTION
PREVENTION SERVICES IN THE WORKPLACE

90%
OF ALL WORKERS

Workers have access to ALAFA prevention services in their workplace

37,970

7,729
6,125,506
Total condom distribution to date

HIV TESTS

HIV Tests in 2012 (111% of target)

CONDOM DISTRIBUTION
627,470

6,125,506

Total condom distribution to date

Female Male

80%
of all manufacturing

industry makes up

The apparel

5,598,036

jobs in

Lesotho.

PREGNANCY AND PMTCT PROGRAMME

188
126

BABIES BORN UNDER PMTCT IN 2012

98%
31

OF PMTCT BABIES ARE NON-INFECTED

ALAFA PEER EDUCATors

165

291

Peer education training total

Life Skills Basic HIV and TB

103
72

Peer education training in 2012

Female Male

ALAFA 2012 ACTIVITY DASHBOARD PAGE 19

Lesotho Chamber of Commerce & Industries Building Orpen Road Maseru Lesotho Tel: +266 22 326512 Fax: +266 22 325829 Email: [email protected]

Postal Private Bag A279 Maseru 100 Lesotho Southern Africa Chief Executive Officer Donna Bawden Email: [email protected]

Finance & Administration Director Muso Ramakhula Email: [email protected] Medical Director Dr Tinashe Chinyanga Email: [email protected] Policy & Prevention Director Relebohile Tshehlo Email: [email protected]

www.alafa.info

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