Capital

Communication and service delivery

By Dr Gebeyehu Haile, Medical Director, Metahara Sugar Factory

Background
Metahara Sugar Factory was established in 1968/1969 and is located 200km south east of Addis Ababa on the road to Harar in the upper Awash Valley. Previously under Dutch ownership, it is now a very profitable government-owned factory with an annual gross turnover of 700 million ETB. The company is certified in ISO 9001-2000 and ISO 14001-2004 by ISOKAR of UK and ETA umwelt management of Austrian EM respectively.
The work force includes professionals, semi-professionals, clerical staff and manual labourers. At peak time the work force reaches 11,000. There are 3,700 permanent employees and the remaining employees are seasonal workers. Employees are based in the factory and in the plantations and live on site in factory housing. All employees live within the concession area in the main headquarters, village, and seven camps located at convenient places within the plantation. The company provides free housing, water and electricity services to its employees.
I am the Medical Director at Metahara Sugar Factory and am in charge of the Medical Services Department and the Metahara Hospital. I am also head of the Project Advisory Committee under which the HIV/AIDS committee is a sub-committee.
HIV/AIDS at the Metahara Sugar Factory
Many workers were previously dying of HIV/AIDS at the factory. In terms of production and overhead costs, of particular concern was the loss of skilled supervisors and engineers who were expensive to replace. The factory was concerned and set up an HIV/AIDS committee and we now run a number of different HIV/AIDS services and programs.
The HIV/AIDS Committee
The HIV/AIDS Committee was established and successfully functions with a focal person in charge to facilitate all related activities. Its achievements have included:

· Ensuring the smooth progress of HIV/AIDS activities at the Metahara Hospital through health education. We use a number of ways to get our message across including audio visual and leaflets. Education is run particularly during lunchtime and break times;
· Scaling up of the VCT, PMTCT, PIHCT and ART programs;
· Promoting the linkage with the support groups at the community level with the people with HIV/AIDS (PLWHAS);
· Coordinating for the technical support with the concerned stake holders;
· Emphasizing family focused care.
The Metahara Hospital
The hospital is on the factory premises and there are six satellite clinics based two to three kilometers away from the hospital. The hospital has preventive and curative health services and all services are provided free to workers and their families. The surrounding community also attends the hospital and clinics but pay a fee for treatment. The hospital serves around 35,000–40,000 people living in the factory housing, this includes employees and their families. Most services are given on site and as it is a government hospital, ART is provided on site.
Voluntary Counseling and Testing (VCT)
There is one VCT room and the VCT clinic is open six days a week and provides service for eight hours of the day. There are five health care workers trained on VCT and 17 on Provider Initiated HIV Counseling and Testing (PIHCT). One VCT counselor is expected to see ten clients a day.
Antiretroviral therapy (ART)
We have 14 health care workers trained on ART and one physician. The ART clinic is open for eight hours a day for six days a week. There are currently 216 patients on ART care. We use a number of mechanisms to retain a patient in care, these include; keeping confidentiality, creating a linkage with a social support group, involving PLWHAs in different activities and the proper handling of patients.
There are difficulties at community level in supplying ART due to stigma and discrimination and the awareness of the community of the HIV/AIDS services that are being supplied, is very low. We are trying to combat this by working in collaboration with different stakeholders and partners for example; the World Health Organization, HAPCO and the Ethiopian Business Coalition Against HIV/AIDS.
Solidarity Fund
Previously we were provided with a budget of 80,000 ETB annually from the company for HIV/AIDS. We are now however in the process of setting up a Solidarity Fund where each worker will contribute 1ETB on a monthly basis. This is being finalized and all employees have agreed. In fact, when the idea of a Solidarity Fund was raised, our employees were very willing they asked why we hadn’t raised the idea previously. The money from the Solidarity Fund will go towards non-medical services such as nutritional support and orphan care.
Working with the Ethiopian Business Coalition Against HIV/AIDS
We were very pleased to be recognized for our hard work by the Ethiopian Business Coalition Against HIV/AIDS. We were awarded second place in their Best Practice category at the EBCA Exhibition in June this year. We have become the motivation for a number of factories in our surrounding areas who want to work better on their HIV/AIDS programs so they too can win awards.
These factories around Metahara need assistance from the Ethiopian Business Coalition to achieve HIV/AIDS mainstreaming within their businesses. There is a need for support to employees and the outreach community. I feel the training should involve the management groups, particularly the factory managers and focus on ensuring management commitment and the mainstreaming of HIV/AIDS within the companies.
The current situation at Metahara
Stigma and discrimination is still a problem. Because the employees and their families all live together, on the factory premises, they often don’t want to go to the factory hospital to get treatment because they will be seen so they travel to Adama Hospital so that no one will see them. It is therefore difficult for us to work out exact statistics about how many workers and family members are getting treatment for HIV/AIDS. However, an informed estimate is that there are currently about 600 people living with HIV/AIDS in our workforce.
At present, and through observations from our clinical staff, the rate of people dying from the disease has decreased significantly, opportunistic infections have decreased as have hospital admissions. This year for example, there has only been one death due to HIV/AIDS.
We are working to strengthen our collaboration and partnership with different partners – governmental and non-governmental, such as the Ethiopian Business Coalition Against HIV/AIDS. We are also concentrating on scaling up our linkages between the private and public sectors to assist us with the scaling up of our services and we are working to strengthen the impact of the peer educators trained among the PLWHAS to scale up patient retention and HIV care.