5) Description of health product/service offering: The South African Depression and Anxiety Group, have launched an innovative tool called "Speaking Books" which is a interactive book with colourful pictures, text and a soundtrack which guides the person through a step by step journey to recovery. The product complements the service delivery of building capacity for home based care givers, community leaders, teachers, social workers, church leaders, traditional healers, patinets and their families. The speaking books and our community based workshops contribute to the wellness of the community by offering a service and invaluable product for free to a rural, under resourced area where there are little or no resources. Communities in the North West Province where there is a population of 3.8 million there is only one psychiatrist for the population.For a low income community the access to health care is limited, if there is any at all. Our program goals are to: Capacitate Home-Based Care Workers, through workshops, to enable them to correctly identify Depression and Psychiatric Illness in their patients with HIV and AIDS; Assist Home-Based Care Workers and community health workers with the formal establishment of fully- fledged Support Groups for themselves so that the huge drop out rate due burn out can be eliminated through adequate debriefing. These Support Groups will be affiliated to the South African Depression and Anxiety Group and will therefore receive ongoing support and assistance by way of training and regional conferences; Empower patients to run Support Groups for themselves within the communities focused on developing knowledge of the link between HIV and AIDS and mental illness; In addition, we will provide workshops for patients on how to establish sustainable Support Groups within their communities; Educate communities about the signs and symptoms of Depression, especially for those people living with HIV and AIDS.

6) Description of innovation: The South African Depression and Anxiety Group is the only organisation in South Africa to introduce "Speaking Books" to rural communitites. Our rural out reach program model has been recognised by the World Bank, The World Federation of Mental Health and National Department of Health in South Africa. The South African Depression and Anxiety Group's expertise lie in identifying needs in the mental health sector of all illnesses and facilitating appropriate and necessary change. In South Africa it is indeed true that the poor are trapped in a second economy and it is for this sector of the population that we address service delivery, especially with regards to HIV and AIDS and mental illness. Through capacity building workshops conducted by our dynamic staff, SADAG is able to address skills development at grassroots level.

Our collaboration with Home-Based Care Workers assists them in recognizing mental illness in their patients as well as in themselves. In creating greater awareness about mental illness we have prevented suicide deaths related to HIV and AIDS. Research by Prof. Schlebusch (2003,Nelson Mandela School of Medicine) indicates that people living with HIV and AIDS are 36 times more likely to commit suicide. Our programme aims to reduce the high number of suicides in this group. Research explicitly shows that 89% of Home-Based Care Workers are themselves depressed. We believe that in order for Home-Based Care Workers to be effective they should have as much knowledge as possible about maintaining a healthy state of mind.

7) Operational model: Launched in 1995, the South African Depression and Anxiety Group was the first NGO to address the issue of the link between Depression and HIV and AIDS in rural areas. We are one of the few organisations prepared to go to exceptional lengths to ensure that those living with HIV and AIDS in impoverished areas can get the help and information they need relating to Depression and suicide prevention.

We put down a trained Support Group in their community whom they can approach regarding their experience of Depression. This emotional state may be due to the loss of family members and friends, fear, shame, rejection, guilt, isolation, hopelessness, lack of self worth, powerlessness and particularly Depression. The benefits of the Support Group is to enhance the mental wellbeing of both people infected with HIV and AIDS, and of their Home-Based Care Workers, by promoting mental wellness and improving their quality of life. • Each area has a 3 day period allocated. • During that time, four to eight counselors from SADAG work in the area to present workshops and talks with all local relevant stakeholders. • Participants in each area are patients, family members, social workers and Home-Based Care Workers. • From the participants we are able to select at least two people in each area to run a local patient-led Support Group as well as a Home-Based Care Worker psychosocial Support Group. The distribution of the speaking books are implemented within the program. One speaking book will reach 8-27 community members.

8) Human resources: Zane Wilson, as Chairman of The South African Depression and Anxiety Group launched this project and still monitors it personally. Ms. Wilson represents thousands of people living with HIV and AIDS. In particular her direct focus and that of our organization is to mediate the negative effects of the illness on the psychosocial aspects of the individual. She is also the author and editor of many articles and publications and has been the subject of many features in various medical and consumer magazines. She has spoken at many seminars and workshop on the issue of mental illness in developing countries. Miss Lucette Mukendi has taken the position of Rural Outreach coordinator for SADAG the past 2 years. She is a Psychology Honours graduate and has in-depth knowledge of social work as a result of extensive training and experience. Miss Mukendi has also been instrumental in several fundraising initiatives. These include raising funds for teen suicide prevention and extensive community development. Her specialties are training and communications. Miss Motsabitsabi is a Psychology Honours graduate from the University of the Witwatersrand who is also managing projects.

9) Key operational partnerships: Our private-public partnerships involve government department of health, social development and education and private partnerships include pharmacutical inductry and corporations with an interst in mental health.

10) Financial Sustainability

          • Fees charged to clients?: No

          • How do you assure affordability?: We have various fundraisers annually to sustain our finances, in addition to this we are a chosen service provider for private-public sectors for rural outreach work.

          • Earned incomes as a percentage of operating costs: 10%

          • Other funding sources: Other sources of funding for our sustainability include fundraisers, service level agreements with funders and donors.

          • Strategy for long-term sustainability: Our strategy in the past has been to deliver valuable work. This has earned us a good reputation in the sectors where funding is made readily available. In the past elevn years the core funding has been from governemnt and private sectors.

11) Current and Future Impact

          • Total number of clients: + 2 million

          • Clients in the past year: 1,750,000

          • Percentage of low-income clients: 85%

          • Impact: Our speaking books reach on average 8-27 people in a community. The speaking book allows for communities to understand mental illness and how to start a suppoprt group. We empower communities to understand what mental illness is and how to go about changing their situation even if they are in an under serviced rural area.

          • Overall "market": Our program is replicable. The speaking books are available in any lanuage. Our target is communities where there are little resources, low income and the potential demand can exceed 2 million people. In any given country, especially where there are low level literacy groups.

12) Scaling up strategy

          • Stage of the initiative: Scaling Up stage.

          • Expansion plan: Develop the speaking books further, reach more people and communities and replicate our project in other SADAC countries.

13) Policy change: Access treatment for patients who are mentally ill.

14) Origin of the initiative: The World Bank recognized Ms. Wilson's commitment to mental illness by awarding SADAG the Development Marketplace Award for Achievement. Ms Wilson is also the recipient of the prestigious award: South African Woman of the Year for Health (1998) and the World Health Organisation. She developed the speaking book when she realised that many communities where illiterate! By introducing the speaking book, many more communities were able to understand and began to go on a road to recovery. There is more information on www.booksofhope.com.

Contact Information:
Zane  Wilson
Founder
The South African Depression and Anxiety Group
(NGO)
South Africa
Website: www.sadag.co.za