Second issue of the Success Stories booklet

Success Stories

in capacity building forHIV and AIDS response

Volume 1, Number 2

R e g i o n a l a i D S T R a i n i n g n e T w o R k

SucceSS StorieS

in capacity building forHIV and AIDS response

Volume 1, Number 2

Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

1. Building a Constellation of Women and Young Women Leaders in Combating HIV/AIDS In-Service Training Trust (ISTT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2. HIV Testing and Counselling for the Deaf and the Hearing Impaired Kenya Association of Professional Counsellors (KAPC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

3. Capacity Building Programme AIDS Information Center (AIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

4. Enhancing Strategic Communication for Health and Development The AfriComNet Centers of Excellence Programme .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

5. The Mildmay Mobile Training Project Mildmay Uganda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

6. Using Attractive Animations to Promote HIV Testing Health Economics and HIV & AIDS Research Division (HEARD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

7. Sunshine Smiles Clinic Gertrude Children’s Hospital Professional Training Centre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Table of Contents

SucceSS StorieS in capacity building for HIV and AIDS response–Volume 1, Number 2iv

Acronyms

AIDS - Acquired Immune Deficiency Syndrome

BHB - Bethel Health Builders

BMI - Body Mass Index

CWP - Community Works Programme

DASCOs - District AIDS and STIs Committees

DEK - Deaf Empowerment Kenya

HEARD - Health Economics and HIV & AIDS Research Division

HIV - Human Immunodeficiency Virus

HTC - HIV Testing and Counselling

INSTANT - Initiative for Strengthening HIV and AIDS Networking and Training

KAPC - Kenya Association of Professional Counsellors

MOH - Ministry of Health

PWD - People with Disabilities

RATN - Regional AIDS Training Network

UON - University of Nairobi

MUg - Mildmay Uganda

MMTP - Mildmay Mobile Training Project

ART - Anti-Retroviral Therapy

NGO - Non-Governmental Organisations

CBOs - Community Based Organisations

PLHIV - People Living with HIV

VCT - Voluntary Counselling and Testing

M & E - Monitoring and Evaluation

PMTCT - Prevention of Mother-To –Child Transmission

PATA - Paediatrics AIDS and Treatment for Africa

USAID - United States Agency for International Development

PEPFAR - Presidential Emergency Plan for AIDS Relief

FHI - Family Health International

ISTT - In-Service Training Trust

OVC - Orphans and Vulnerable Children

TCAHZa - Trust for Collective Action on HIV and AIDS in Zambia

SBCC - Social and Behaviour Change Communication

AfriComNet - African Network for Strategic Communication in Health and Development

CES - Center for External Studies

SucceSS StorieS in capacity building for HIV and AIDS response–Volume 1, Number 2 v

Foreword

The Regional AIDS Training Network (RATN) is a Kenya-headquartered NGO representing a consortium of more than 35 Member Institutions (MIs) from 11 countries in Eastern and Southern Africa region.

RATN exists to foster south-south capacity building of individuals (men, women, boys and girls), institutions (for profit and not for profit), organisations (governmental and non-governmental), governments and other stakeholders to respond effectively to HIV and AIDS and Health issues.

In a bid to foster information sharing and ensure effective capacity building, RATN launched a Success Stories booklet in January 2012 to ensure that the efforts put in capacity building are documented and shared widely for replication and sharing of lessons learnt. The first issue was a success read going by the feedback you gave us.

RATN therefore takes this opportunity to bring to you the second issue of the Success Stories booklet. In this issue, seven stories of success are featured. It presents stories, lessons learnt and best practices in projects that have been implemented in the recent past from across the Eastern and Southern Africa region.

These stories may be freely used for education and learning purposes so long as the publication and the authors’ rights and privileges are protected through appropriate credits.

We hope this issue will be enjoyable, educative and informative as much as issues of capacity building of health and HIV and AIDS are concerned in Africa. We look forward to your feedback to enable RATN to continue sharing Success Stories of value for replication to scale up capacity building in health and HIV and AIDS response.

Thank you for your continued support.

Kelvin StoreyExecutive DirectorRegional AIDS Training Network

SucceSS StorieS in capacity building for HIV and AIDS response–Volume 1, Number 2vi

SucceSS StorieS in capacity building for HIV and AIDS response–Volume 1, Number 2 1

1 Building a Constellation of Women and Young Women Leaders in

Combating HIV/AIDSBy Mungule D. Chikoye

In-Service Training Trust (ISTT)

Introduction In-Service Training Trust (ISTT) and the Trust for Collective Action on HIV and AIDS in Zambia (TCAHZa) teamed up to implement this programme aimed at developing a cadre of women and young women leaders to contribute to raising awareness and building community responses to halt the HIV and AIDS epidemic. The project was implemented in Livingstone and Solwezi districts of Zambia Southern and North-Western Provinces respectively.

Women in church groups, salon owners and hairdressers, as well as petty and cross border traders were targeted. The initiative was based on the assumption that these target groups often do not get the opportunity to access information and are not in organised structures that would support their HIV responses. Training focused on building their leadership skills, providing accurate and up to date information on the status of the epidemic in Zambia, exploring the issues that affect vulnerability and risk especially for women and young women.

The project also sought to explore innovative initiatives for the women participants to undertake, and improve their capacity to meaningfully engage in prevention activities to halt the pandemic.

Fifty nine women were targeted including church and local leaders. Most of the women were stay-at-home mothers, with some

experience in home-based care and OVC projects. They were targeted because they needed capacity enhancement for concerted quality programming and prevention messages and to build their advocacy capacity to influence and drive the HIV agenda at district and national level. Salon owners, hairdressers and petty traders were also targeted since growing informal businesses are owned and operated by women. This target group is precarious and fluid with low pay, poor and unstable working conditions. These factors render women in this sector vulnerable to risky behaviour in order to meet the conflicting domestic demands of food, shelter, and clothing for themselves, children and other family members.

Goal and ObjectivesThe goal of the programme was to contribute to the development of a constellation of women leaders engaged in conversation and practical learning on what it would take to reverse the HIV pandemic and rebuild communities in Zambia.

Objectives of this model were to:1. Strengthen the capacity of women

leaders to fight HIV and AIDS through conversations and dialogue across all sectors in Zambia.

2. Establish a women cross-sector alliance against HIV and AIDS through conversations and dialogues with women church leaders and women in the informal sector.

ZAMBIA

SucceSS StorieS in capacity building for HIV and AIDS response–Volume 1, Number 22

Execution of the programmeThe project had three main activities:

1. Baseline survey in Livingstone and SolweziThe baseline survey was conducted to ascertain the need and identify the target populations for the project and other stakeholders.

2. Leadership training using U-process

1. CO-INITIATING:Build Common Intent stop and listen to

others and to what life calls you to do

5. CO-EVOLVING:Embody the New in Ecosystems that facilitate seeing and acting from the whole

2. CO-SENSING:Observe, Observe, Observe go to the

places of most potential and listen with your mind and heart wide open

4. CO-CREATING:Prototype the New in living examples to explore the future by doing

3. PRESENCING:Connect to the Source of Inspiration,

and will go to the place of silence and allow the inner knowing to emerge

Figure 1

The project was implemented using the five-step methodology of the U-process to enhance personal and collective leadership. The U-process is a social technology for helping to bring about profound innovation and change, and has been developed by Otto C. Scharmer of the Presencing Institute.

Figure 1: The U-process model used for training

The methodology is a five step process of diagnosis and critical analysis of a given social situation, and exploring innovative ways or options for tackling the social problem. The five levels of critical analysis seek to provide answers to the questions: ◆ What is our calling in tackling the HIV and

AIDS problem of in our communities?

◆ What can we do in our individual capacity, as a community collectively to stop the wreck of households and communities?

◆ How do we challenge the current status quo (cultural practices, stigma and discrimination, insufficient resources and inadequate access to essential services), inertia and paralysis that obstruct our capacity to act and heal our families and communities?

The methodology provided an opportunity to question popular opinions, our beliefs and value systems, and our perception of diseases particularly HIV and AIDS. It also allowed the participants to question their prejudices and how their actions contribute to either arresting stigma or perpetuating stigma, as well as how their behaviour increases or decreases their vulnerability and that of others.


The last level offered opportunity for change and innovation. The process was a personal journey of discovery and change and encouraged the women to use their leadership skills to catalyse change in their families, churches, salons and business communities. It also enabled the women to effectively initiate change in their communities and families, by contributing to eliminating stigma, and supporting people and families affected and living with HIV and AIDS, while linking to larger processes within their districts.

3. Alliance building and planning workshopThe third stage of the project supported the women to actualise their leadership, following the leadership training workshop. This was in a two-day workshop of planning and continuing analysis of key problems identified in their communities. The issues discussed included the practice of multiple and concurrent partnerships, inadequate information on PMTCT, alcohol and drug abuse among youth as a risk behaviour, and lack of men’s involvement and participation in HIV and AIDS project activities. The women also learnt strategies for mobilising communities and linking with other programmes in their churches and districts. They also agreed on modalities for implementing the knowledge learnt.

AccomplishmentsThe project set out to establish a cross-sector alliance of women church leaders and women in the informal sector and strengthen their capacity to fight HIV and AIDS through conversations and dialogue with the following results:1. The women were able to dialogue with

family members, women in the church, choir groups and youth groups.

2. They encouraged their partners and other family members to go for counselling and testing.

3. The salon owners and hairdressers successfully introduced talks with their colleagues, shared information with their clients, and supported colleagues to go for counselling and testing.

4. The cross border traders linked up with nursing staff at the local clinic to offer individualised counselling and testing for their members.

5. A college lecturer introduced HIV and AIDS talks at the beginning of each class for college students, and facilitated support for those who needed it.

6. The Livingstone Group established an oversight committee to monitor and coordinate project activities.

7. The Solwezi Group established an organisation called Woman Ascends to


strategically position themselves and their work within the district.

Challenges

1. Reaching the targeted number of women was difficult at the start of the project. This was because of salon owners and petty traders’ fear of loss of business and fear of conflict of interest among some churches in discussing issues of HIV and AIDS.

2. Insufficient community and movement building skills to enable the women’s groups move to the next level of organising contributed to delays and difficulty in getting the targeted numbers.

3. Simplifying and using appropriate language for the participants.

Constraints

1. Planning of available time to accomplish the project between the two implementing organisations was tricky.

2. Lack of support mechanisms to monitor training and support the women in their chosen implementation plan.

3. Insufficient documentation of the changes that occurred as a result of the new learning process.

Way forward and Recommendations

1. There is an opportunity to monitor the women’s learning process and support their plans.

2. There are opportunities to replicate the approach while responding to the increasing demand for services, created by new interactions with the first cohort of participating women.

Lessons Learnt

◆ There is need for a pre-workshop discussion on the methodology to ensure better support and understanding of expectations.

◆ There is a need for clearly defined roles and responsibilities between implementing partners to ensure clear definition of responsibilities and accountabilities.

◆ Poor documentation of the process failed to capture the personal case stories to support the project’s successes and monitoring support to guide the women’s leadership transformation.

◆ There is need for a clear monitoring strategy to support the learning process and sustain the women’s enthusiasm.

◆ Greater transformation occurs at individual and group level when a group of people from different backgrounds meet to tackle a common problem.


HIV Testing and Counselling for the Deaf and the Hearing Impaired

By Cecilia Rachier

Kenya Association of Professional Counsellors (KAPC)

IntroductionIn Kenya, people with disabilities (PWDs) experience barriers to accessing health information and services due to restrictive cultural norms, stigma and prejudice. This is compounded by high poverty levels, low education, low self esteem and negative attitudes by employers and the community towards them. In addition, the rights of PWDs to medical confidentiality are not assured while health services in most institutions are inaccessible. This situation is worse for the Deaf and Hearing Impaired whose disability is not visible. Access to Sign Language facilities is hampered by the exorbitant interpretation fees required even for HIV Testing and Counselling (HTC) services, which the hearing population enjoy for free. Worse still, the presence of a Sign Language interpreter removes their right to medical confidentiality. These people are, therefore, vulnerable to sexual assault and contracting HIV and AIDS and Sexually Transmitted Infections (STIs) due to low awareness levels.

These challenges motivated the establishment of the Deaf and Hearing Impaired HIV HTC project by Kenya Association of Professional Counsellors (KAPC) and Regional AIDS Training Network (RATN) in 2011.

The programme targeted the Deaf and Hearing Impaired community in three Districts of Kasarani, Embakasi and Njiru in Eastlands region of Nairobi and was implemented in

four Health Centres within the three Districts. The beneficiaries of the project were the Deaf and Hearing Impaired persons and District AIDS and STIs Committees (DASCOs) in the three districts, Health care workers in the four Health Centres, the Ministry of Health (MOH), the Deaf Empowerment Kenya (DEK) organisation, the University of Nairobi Sign Language project, KAPC and RATN. The programme was implemented in Kariobangi North Health Center, Dandora II Health Center, Kayole II Health Center and Umoja Health Center all East of Nairobi. The Deaf and Hearing Impaired and general population were served.

Goal and ObjectivesThe project’s goals and objectives were to:1. Improve and increase HTC services uptake

by the Deaf and the Hearing Impaired persons.

2. Advocate for the Deaf and Hearing Impaired people’s enjoyment of health rights, their greater involvement and, HIV and AIDS prevention, care and treatment access.

Execution of the programmeKAPC held meetings with the Ministry of Health (MOH) and DASCOs in the three Districts and sensitised them on the project. The project involved providing trained HTC Deaf and Hearing Impaired counsellors in the four Health centres to offer HTC services to the Deaf and Hearing Impaired persons. MOH

2KENyA


team agreed to provide support and space for Deaf HTC counsellors to perform HTC to the Deaf persons. The project also involved equipping health care workers in the four health centres with Basic Sign Language and Sign Language interpreter knowledge and skills. The MOH and DASCOs helped in the selection of 10 appropriate health care workers for the training using a selection criterion. The 10 were then trained at KAPC by the University of Nairobi (UON) Sign Language Project through DEK.

The Deaf and Hearing Impaired persons to be trained in HTC were to be selected from the KAPC/RATN alumni who had gone through the certificate in HIV/AIDS counselling. KAPC worked with DEK to help find and recruit 10 of them from the three Districts using KAPC’s selection criteria. The 10 then underwent the two weeks HTC course by KAPC and NASCOP. DEK together with the Deaf HTC counsellors sensitised and mobilised the Deaf and Hearing Impaired community in the three Districts about the project. This activity continued throughout the project. The Deaf HTC counsellors together with the Health Care Workers trained in sign language and Interpreters collaborated in the provision of HTC and other health services for the Deaf persons that came to the four Health Centres. KAPC offered counselling support supervision to the Deaf HTC counsellors monthly at DEK premises. The KAPC project coordinator held monthly administrative meetings with the MOH staff, health care workers, DEK and the deaf HTC counsellors.

AccomplishmentsThe project targeted PWD, a group that is considered vulnerable and often marginalised. The project served 432 Deaf and Hearing Impaired persons, of which 12 turned to be HIV positive. Stigma among the health care workers towards deaf people was reduced.

The capacity of the health care workers to serve the deaf population was improved as well as their ability to communicate with Deaf

and Hearing Impaired. Client confidentiality which was a major concern to the Deaf and Hearing Impaired was enhanced and is maintained with the elimination of Sign Language interpreters in health provision. The statistics generated helped establish the HIV and AIDS prevalence and reference among deaf people in the region. They also highlighted the fact that sign language is unique to deaf people and that there exists the Deaf Mother Sign Language for communicating with illiterate community members.

Most health care workers were not aware of the existence of the Deaf and Hearing Impaired people in the areas covered by their health facilities. With good training and patience the Deaf and Hearing Impaired can make good HTC counsellors and can offer services not only to the Deaf population but also to the hearing population.

Through the project many partners such as MOH, DEK, UON Sign Language Project, KAPC, RATN and the Deaf community met and networked. The Health care workers promised to discuss the issue with their seniors to get the deaf counsellors to be absorbed by the government on permanent contract. Partners who were willing to offer HIV positive Deaf and Hearing Impaired with Home Based Care were identified and will assist in establishing a post-test support group and nutritional support.

Challenges and ConstraintsDuring the programme’s execution, the project could not find a room at Umoja Health Centre and had to share a room in turn with the hearing HTC counsellors. On the other hand, the health facilities often ran out of supplies and equipment and we had to let clients go, hence losing them in the process, which demoralised the Deaf counsellors.

Due to annual leave or increased work load in their departments, the health care workers trained at Umoja Health centre to support our staff were rarely available while in other health facilities others got transferred within the project period. One of our expectant female


counsellors would occasionally be off to attend maternity clinic while three of our counsellors were involved in Kenya Deaf Football and this required last minute adjustments.

We had anticipated capturing more deaf people but we later learnt that other organisations were offering similar services to them and those who had been tested could not be tested again in less than three months. For the illiterate deaf people, it took more time to serve them and required that the counsellors forgo their break times or leave late. Our counsellors were not trained on adherence counselling and post-test support group formation and were not equipped to support the HIV positive clients in the area. The project ended just when the deaf community had been well mobilised and the Health care workers, deaf HTC counsellors, deaf persons,

DEK and KAPC regretted that the project could not go on.

Way forward and RecommendationsA steady supply of equipment and a portable tent should be provided - just in case a facility doesn’t have a room and for mobile outreaches. More health care workers should be trained in Sign Language from every facility, during which it should be ensured that counsellors are available. HTC should be made a continuous process and it would be important to have a phase II of this project to look into sustainability and continuity of the project.

HIV positive clients should be provided with nutrition and transport allowance to seek out those who cannot come to the health


facilities but need the services. The Deaf HTC counsellors need to be further equipped with knowledge and skills in other areas such as Adherence, PMTCT, TB and FP as they do community mobilisation for the Deaf persons. They also need to be equipped with

knowledge and skills on how to run post-test support groups for those Deaf persons who test HIV positive. Lastly, they also need supervision knowledge and skills to offer each other peer support as they continue with their HTC work.

Lessons Learnt◆ Integrating Deaf HTC counselling in Health centres can improve and increase access to HTC

and other health services for the Deaf community.◆ Training Deaf counsellors in HTC and Health care workers in Sign Language and Sign

Language Interpreting and collaborating in Health centres can go a long way in attracting the Deaf community to seek HTC and other health services at the Health centres.

◆ Involving relevant partners who are stakeholders in the planning and execution of a project is beneficial.

◆ There is need to be proactive, versatile and plan to deal with obstacles that may derail the project.

◆ That there exists the Deaf mother sign language used by deaf people to communicate with illiterate community members who have not learnt Kenyan Sign Language and that only the Deaf themselves understand.

◆ There are Deaf and Hearing Impaired people living within the precincts of the health care facilities. With good training and patience the Deaf and hearing Impaired can make good HTC counsellors and can offer quality services not only to the Deaf but also to the hearing population.

◆ It is possible to improve client confidentiality by training health care workers in Sign Language and Sign language interpretation.

◆ There is need to train deaf counsellors on adherence counselling and for deaf community health workers to attend to the deaf community. Post-test support groups and nutrition for the Deaf & Hearing impaired clients are important.


Capacity Building Programme in Mbarara Uganda

AIDS Information Center (AIC)

IntroductionAIDS Information Centre – Uganda with funding from CSF is implementing a new strategy to involve the communities in HIV and AIDS activities. This initiative was a result of assessment of the current HIV and AIDS situation in Uganda, which will contribute to the reduction of the spread of HIV in the country.

A strategy called Know-Your-Status-Clubs (KYSC) was used to mobilise the people at household level for HIV Counselling and Testing (HCT), care and support, while providing HIV and AIDS messages through interpersonal dialogue to promote behaviour change.

The Behavioural Change Communication programme is implemented through members of the KYSC who disseminate messages in the community using the home-to-home (interpersonal communication) approach. For example, prevention messages are delivered during HIV Counselling and Testing (HCT) outreaches through Health Education talks. Condoms are distributed to most at risk populations such as sex workers, truck drivers, waitresses, discordant couples and to the members of post test club members.

Objectives

1. To improve HIV and AIDS service delivery, access, practice/prevention messages.

2. To equip KYSC members with skills on how to conduct community and social mobilisation.

3. To provide communities with opportunities to participate in addressing HIV and AIDS.

4. To improve knowledge about accessing HIV counselling and testing, treatment, care and support.

5. To reach the hard to reach communities with necessary information about HIV and AIDS.

Execution of the ProgrammeKYSC members spread messages on Abstinence, Being Faithful, Safe Male Circumcision, Family Planning, HIV Counselling and Testing and Condom Use to promote behaviour change communication through interpersonal communication methods. They also distribute condoms in the community through various outlets, and mainly target sex workers, long distance truck drivers, boda boda cyclists, lodges and other high risky populations.

UGANDA

3


The KYSC members held regular meetings in Nyabuhama, Nyakinengo and Biharwe parishes. Discussions focused on mobilising the communities for HCT, safe male circumcision outreaches, care and treatment. The meetings were also used to share successes and challenges faced during the implementation of the BCC strategy.

Through capacity building the KYSC members were oriented on the referral mechanism and linkage strategies in which the communities are referred to nearby health facilities for general and HIV and AIDS-related services.

Health Workers in Biharwe HC III and St. John’s Community Health Centre were also introduced to HIV counselling and Rapid HIV testing protocols. This was made possible through on-the-job mentorship, which enabled KYSC members refer people from the community to nearby health centres.

AccomplishmentsAIC Mbarara branch in collaboration with Mbarara District Health office prioritises the quality and scale of services delivered to the communities. Working with KYSC Members to enhance their capacity has leveraged its comparative advantage in the communities to address other social behavioural problems.

The community has been empowered with information on HIV and AIDS, and as a result there has been reduction in stigma towards HIV- related services in the community.

There has also been reduction in STI and related incidences due to the successful implementation of the communication strategy and the intensive condom promotion in the town of Biharwe.

“There used to be many STI cases reported in this health centre. But since this programme was implemented here the cases have reduced. Many people still come from the community to seek HCT services to know their status. The KYSC members have empowered the community to demand for

the services”. – Officer in charge of Biharwe HC III.

ImpactA survey conducted to find out the effect of the activity on the community at the end of September indicated that there was a decrease in the number of people reached with prevention messages from 78% in the third quarter (July- September) to 22% in the last quarter of the year (October-December).

The table below shows the impact of capacity building at AIC Mbarara.

July-Sept Oct-Dec

1 People reached with messages on prevention messages

4738 1321

2 Number of people counselled, tested and given results

6191 3529

Number of people reached with prevention messages

QTR (July-Sep)

QTR (Oct-Dec)

22%

78%

Similarly, there was a decrease in the number of people counselled, tested and given results from 64% in July-September to 36% in October.

Number of people tested, counselled and given results

QTR (July-Sep)

QTR (Oct-Dec)64%

36%


Implementation EfficiencyAIC Mbarara supported KYSC members to facilitate their communities’ access to HIV and AIDS services. The KYSC Clubs have trained a good number of volunteers and community resource persons. By using a peer approach and interpersonal dialogue they assist people to understand the messages.

Sustainability KYSC club engaged people in communities to address HIV and AIDS, and this has a long term impact on the capacity of the club to

address HIV and AIDS in the communities. The KYSC members are community resource persons who work on a voluntary basis. It is hoped that even without AIC support they will continue disseminating messages in the community.

ReplicabilitySince all communities have community resource persons, the KYSC approach can be replicated in other areas if the existing community health structures that include VHTs can be incorporated. This would eliminate the need to create parallel structures in the community.

Lessons Learnt◆ Community empowerment with information regarding HIV and AIDS is essential in combat-

ing HIV and reduction of stigma. ◆ The community resource persons need to be motivated for them to be effective in

disseminating behaviour change messages. Thus, they need facilitation in terms of transport and lunch.

◆ Through the use of community resource persons, the community is referred to HIV care and other related services.



Enhancing Strategic Communication for Health and

Development

The AfriComNet Centers of Excellence programme

IntroductionIn Africa, there is urgent need for training and capacity development for strategic HIV and AIDS communication. Inadequately trained personnel managing Social and Behaviour Change Communication (SBCC) interventions and programmes in government and non-governmental organisations, has resulted in ineffective social and behavior change communication programmes at local, national and regional levels. It has also led to low levels of funding and a belief that SBCC does not work.

To redress this situation, the African Network for Strategic Communication in Health and Development (AfriComNet), a regional network of over 1500 strategic communication practitioners, launched the Centers of Excellence programme.

The programme is a collaborative partnership between AfriComNet and African universities and training institutions in East, Central and Southern Africa to develop and offer courses in strategic communication for health and development.

Goal The main aim of the initiative is to contribute to the long-term goal of establishing within African universities, undergraduate and graduate degree programmes in strategic communication for health and development with a special emphasis on HIV and AIDS.

Execution of the programmeIn 2005 AfriComNet conducted an assessment amongst its members to identify the gaps in knowledge and skills of the social and behavior change communication practitioners. A call for expression of interest was sent to universities to collaborate with AfriComNet to develop short courses on different aspects of strategic communication.

Five Universities from Uganda, Ethiopia, Kenya, and South Africa were selected in the initial phase based on their interest and commitment.

Through Memorandums of Understanding with the universities, the lecturers and teaching staff are involved in the design and development of the curricula, while AfriComNet provides technical and logistical support for the pretest and finalisation of the courses.

Each university develops a course which is shared across the other universities such that collaboratively, all the universities have a set of courses which they can offer at their respective universities.

On completion, the courses are advertised and offered by the universities as short in-service courses to professionals working in the field of social and behavior change communication and also integrated into ongoing courses within the universities.

4UGANDA, ETHIOPIA, KENyA, SOUTH AFRICA


Accomplishments Over 500 in-service practitioners have attended the courses and hundreds of university students are undertaking modules from the short courses as part of their degree or diploma programmes.

At the School of Journalism and Communication in Makerere University in Uganda, modules from the HIV and AIDS and strategic communication course were incorporated and are offered as part of the communications degree programme.

In Namibia, modules from three of the courses (Applied Skills in HIV Communication and Counseling, Strategic Communication for Health and Research, Monitoring and Evaluation of HIV communication programmes) were incorporated into the new Diploma in HIV Counseling and Management offered through the University of Namibia’s Center for External Studies (CES).

AfriComNet has so far established Memorandums of Understanding with ten universities and training institutions in seven countries, to collaboratively develop and offer the courses. Universities in the region are now adapting the courses to make them appropriate for their participants. The School of Public Health at the National University of Rwanda for example is currently reviewing the curriculum on Community Mobilisation for Health and Development originally developed by Jimma University in Ethiopia, to adapt it for participants in Rwanda.

There is remarkable improvement in the skills and quality of social and behavior change programmes managed and implemented by former participants of the courses.

“After attending the strategic communication course, I comfortably led the development of the national communication strategy on male circumcision, which was approved by the Ministry of Health,” –Venansio Ahabwe, an alumni from Uganda

To date, eight courses have been developed and offered through seven partner universities.

Course Institution

1. HIV and AIDS and Strategic Communication

School of Journalism and Communication, and School of Public Health, Makerere University, and Mildmay centre, (Uganda consortium)

2. Research, Monitoring and Evaluation of HIV and AIDS Communication programmes

Department of Information and Communication studies, University of Namibia

3. HIV and AIDS Stigma and Discrimination

School of Journalism, University of Nairobi, Kenya

4. Community Mobilisation for Health and Development

Faculty of Health and Behavioral Sciences, School of Public Health, Jimma University, Ethiopia5. Social Marketing

6. Applied Skills in HIV Communication and Counseling

Office for Institutional HIV and AIDS coordination, Stellenbosch University, South Africa

7. Strategic Communication for Health and Development

Department of Mass Communication, University of Zambia

8. Understanding and Using Demographic and Health Surveys

MACRO

Two new courses - Health Communication Materials Development and Testing and Advocacy are currently under development by the schools of Journalism and Communications at Makerere and Moi Universities in Uganda and Kenya respectively.

ChallengesThe courses are practical and participatory which requires strong facilitation skills. This is a different teaching style from what most lecturers are accustomed to.

Due to training fees, raising the required number of participants per training session is difficult. Fee payment is against the general


belief that most HIV-related training courses are free or sponsored.

ImpactDue to the introduction of the different courses at the different Universities, Strategic Health Communication is enhanced.

It is envisioned that the trainees now have even more varieties of courses to choose from and which are specific as per their needs.

SustainabilityAfriComNet has established Memorandums of Understanding with the partner universities clarifying the roles of each party. Under

this arrangement, the university lecturers are involved in the course design and development, and training of the participants, which ensures ownership of the programme by the universities.

Lecturers and teaching staff involved in the training programmes are oriented on all the courses developed by the partner universities which ensure there are sufficient resources to teach the courses in the universities.

The course fees paid by the participants are used to cover the lecturers’ time, training materials and other logistical requirements. This facilitates smooth organisation of the courses and ensures continuity of the training programmes.

Lessons learnt

◆ By strengthening institutional capacity, universities in Africa will contribute to producing qualified health communication specialists.

◆ Partnering with universities and training institutions is critical in ensuring the continuity and sustainability of training programmes.



The Mildmay Mobile Training ProjectBy Irene Kambonesa

Mildmay Uganda

IntroductionMildmay Mobile Training Project was carried out in Kamwenge District from 2005 and was implemented in Western Uganda in Kamwenge district, targeting persons living with HIV and AIDS in the underserved area. The project was implemented for five years from 2006 to 2010. The first phase, 2006-2007, involved designing and piloting a district training strategy. Activities in the second phase, 2008-2010, focused on using participants from the first phase to carry out activities.

At the time of problem assessment, the HIV and AIDS prevalence was 10%, doctor-patient ratio was 1:75604, far less than the national ratio of 1:25000. Kamwenge had no hospitals and only 12% of the deliveries were done by professional health workers.

The project aimed at reaching people who lived in rural areas in critical need for HIV and AIDS services. Mildmay Uganda (MUg) has contributed significantly to the knowledge and skills of health workers and other allied professional groups in Uganda.

Goal and ObjectivesThe goal of the Mildmay Mobile Training Project was to ensure access to ART services in rural areas, despite the relative ART availability in Uganda.

The objective of the project was to equip health workers with skills and knowledge to provide and scale up ART services in underserved communities.

Execution of the programmePhase One: District Strategy components Phase One aimed at developing and implementing a strategy for strengthening training at the district level in HIV and AIDS care with capacity to provide quality care for PLHIV and as a preparatory phase for continuity of the project into Phase Two.

MUg made initial visits to the district to plan for a training needs assessment of all the facilities, Non-Governmental Organisations (NGO), Community Based Organisations (CBOs), district leaders and other key staff. MUg implemented the Mobile Training modular programme within Kamwenge district. At the same time other HIV and AIDS training programmes were on-going at Mildmay main office.

Two participants were selected for a diploma/degree programme in HIV and AIDS (one from a health facility and another from the community). A third person on the degree programme was an Assistant District Education Officer.

The programme manager identified suitable religious leaders, teachers, laboratory personnel and others to attend short courses

5UGANDA


at TMC, while ensuring that there were at least two places in each of the short courses for participants from Kamwenge district.

A trainer was appointed from MUg to act as the MUg District Co-ordinator of Training to liaise with the district to ensure that participants attended the training programmes, network and liaise with the alumni in the district.

The programme manager linked with other organisations in the district for synergy and resources utilisation. A Monitoring and Evaluation (M&E) strategy was developed to assess the impact of the district training strategy. Ntara Health Centre was developed and accredited by MoH to offer ART services.

Phase two: Utilisation of the trained participantsThe aim of this phase was to use participants trained at district level to build capacity of lower cadre of staff and community to set up quality VCT and ART services for PLHIV. Trainers from Mildmay worked with Phase One trainees to build the capacity of other health care workers, religious leaders and community leaders. They also networked with other NGOs, CBOs, and Government (GOs) and planned on how to address the gaps identified in the Phase One needs assessment.

Activities centred on community development through community mobilisation, training of volunteers, providing VCT services at Ntara Health Centre, and collaborating with the district leadership and other stakeholders to provide quality ART services in the district. The health centre was the first in the district to offer quality ART services. MUg continued to support the participants through the MUg District Co-ordinator, who was later on replaced by a student from the district who had a Bachelor’s Degree in “A Health Systems Approach to HIV and AIDS Care and Support” validated by The University of Manchester (UK). MUg also supported groups to write proposals and implement activities, while carrying out M&E activities to measure impact of the programme.

Accomplishments

◆ A district training strategy was developed, piloted and used to train 319 health workers of which 224 were men.

◆ A total of 13 HIV and AIDS care treatment and management courses were conducted and successfully piloted during the project time.

◆ A HIV and AIDS clinic was opened in 2007 to provide services for PLHIV in the hard-to-reach region. By September 2010, 1639 clients were enrolled into care and 626 of the clients were male.

◆ The participants continued to conduct training to the community at district level and in the lower health units.

◆ One organisation in Kamwenge collaborated with Mildmay Uganda to support building of an outpatient building to accommodate the increasing number of clients. Samaritan Purse contributed $20,000 and Mildmay Uganda contributed the rest.

Impact

◆ The problems of access to ART were solved as a result of the project.

◆ Project benefits have been sustained through scale up of HIV and AIDS services.

◆ Indirectly, the project contributed to health system strengthening component of critical human resources for health service delivery.

◆ The benefits have been sustained and used widely. Mildmay Uganda handed over the programme to another partner (Baylor Uganda).

◆ Since the PLWHA accessed care/treatment, the quality of life of persons improved in that District.

Challenges and ConstraintsThere is only one site in the district providing ART. This means that many patients have to travel to neighbouring districts for ART and other HIV and AIDS care services.


Way forward and RecommendationsThere is need to strengthen the co-ordination and networking of participants trained

through Mildmay Uganda in the first phase while ensuring people with varied training needs in the focus districts are present. Phase two should address the needs of HIV and AIDS clients on a broader level.

Lessons Learnt

◆ The project was relevant and suited the critical service needs of the PLWHA in the rural setting.

◆ Resources were efficiently used as local capacity was harnessed.◆ All the project objectives were met as per the planned schedule.◆ The mobile training project by Mildmay Uganda contributed significantly to improving the

knowledge and skills of health workers and other allied professional groups in Uganda and specifically in Kamwenge District.

◆ The quality of life of PLWHA in the district and the sustainability of the project improved.



Using Attractive Animations to Promote HIV Testing

Health Economics and HIV & AIDS Research Division (HEARD)

IntroductionBethel Health Builders (BHB), Regional AIDS Training Network (RATN), and Health Economics and HIV & AIDS Research Division (HEARD) collaborated to develop animations for health promotion and disease prevention. This intervention was informed by the fact that there have been low HIV testing and awareness on the importance of the same in the regions targeted. Rural Zululand in KwaZulu-Natal, South Africa is characterised by high HIV prevalence, low availability of HIV testing at village level, and relatively high HIV and AIDS stigmatisation.

InterventionTo increase use of HIV testing and referral services, three original English and Zulu animations were created to improve the rural population’s understanding of HIV testing, stages of HIV infection and how HIV medicines work among. A health training manual was developed and a training of trainers course conducted concurrently with the Health Builder training.

With support from the RATN’s INSTANT initiative, 27 village women and one man were selected for training as local health promoters. Selection criteria was based on peer selection and matriculation pass. They were trained to assess, appropriately refer and monitor blood

pressure, blood glucose, rapid HIV antibody status and Body Mass Index (BMI). Ethics of confidentiality was demonstrated and learned. All training was performed by board-certified family physicians.

All certified Health Builders were equipped with kits including wheeled portable point of care testing labs, tents, chairs, record keeping supplies, portable DVD players with Zulu and English videos on relevant health topics. They spent two days weekly performing health building and received supplemental income from the government’s Community Works Programme (CWP). Majority of the Prospective Health Builders demonstrated mastery of skills while accompanying the doctors on home visits, and 25 out of 28 completed the training, graduated and were certified.

Impact In the first four months after certification, the 25 successful Health Builders made over 3000 referrals for uncontrolled high blood pressure, over 1000 for elevated blood glucose, and over 300 for newly detected HIV-positive antibody status. Thousands of people viewed HIV animations, which stimulated lively discussion in the communities. About three quarters of women and one quarter men received HIV testing. HIV antibody positive prevalence was 21.6% (16.3M, 24.8F) in the testing population. Nursing staff of the Dlangubo clinic who received referred patients were pleased with the referrals and the level of confidentiality maintained.

SOUTH AFRICA

6


ConclusionHIV testing uptake, referral, and treatment initiation increased through the use of animations and Health Builders Training. Multimodal health screening and portable

animations were highly desired by people in the rural setting and could be distributed widely in the community for maximum impact. Health Builders became effective leaders of CWP teams.

Lessons Learnt

◆ When the project was conceived, the idea was to have larger screening portable clinics, staffed by a team of five or more health builders per site. But instead each health builder was equipped with the means to perform their own outreaches, while encouraging them to work in teams of two or more. The portability of the equipment was advanced by using a soft portable field case, on wheels and with insulation. This design is superior, and will continue to equip future health builders in the same way.

◆ Producing animated professional quality video in multiple languages is very challenging. From conception to completion, these types of animated videos take about a year to produce. However, once produced these are invaluable tools for health promotion and disease prevention. These were necessary for the success of the rural health screening programme.

◆ Health builders ran through huge quantities of glucose strips because everyone wanted repeated free sugar screening. It was difficult for health builders to refuse their community members tests in the majority cases that were not medically indicated. After project completion, donations towards the sugar strips were introduced, which the community was willing to donate for this service. The result was much less test wastage. To improve sustainability income generating projects alongside the health building programme have been introduced.

◆ The training of health builders is labour intensive. During the process of training, health builders who have mastered skills more quickly are encouraged to share what they have learned by tutoring other students under the direct supervision of the trainer.

Bethel Health Builders is based in Durban, South Africa. For more information, please contact Drs. Rick and Anita Gutierrez at [email protected].


Sunshine Smiles ClinicBy Phoebe Auma Ongadi

Gertrude Children’s Hospital Professional Training Centre

IntroductionThe Sunshine Smiles Clinic was started in 2004 after Gertrude Children’s Hospital staff came face to face with the challenges the parents of nine HIV positive children were going through at the hospital. The hospital management then approached USAid, Pepfar, Path Finder and Family Health International to set the Sunshine Smiles Clinic.

Goal and Objectives

◆ To provide free HIV care and treatment through a holistic family centred approach

◆ Train multidisciplinary teams on HIV care and management

◆ To provide mentorship for other relevant programmes.

Execution of the programmeThe Sunshine Smiles Clinic is operated in Nairobi, Nakuru, Kisumu and Kitui. The clinic targets the entire family infected with HIV with special focus on the child. Although the child was the focus, the guardians would also be taken care of. Services such as HIV screening and treatment, and other diagnostic tests such as CD4 count and viral load is done free of charge.

Each case seen is attached to a community health worker for follow-up. In addition,

support groups have been created to enable the families start income generating activities. At the end of each day, the health experts review the patient’s files while difficult cases are deliberated on at the end of every week.

AccomplishmentsSince the establishment of the Clinic, there have been a number of achievements. ◆ The Clinic helped decentralise the services

offered to the other six Gertrude satellites located in Komarock, Dohnholm, and Githogoro, and in April this year Embakasi.

◆ The Clinic effectively catered for 60 per cent of the needy patients.

◆ The clinic contributed towards lowering the mortality rate of children, with five deaths being reported in a year.

Treatment literacy sessions

7KENyA


◆ Prevention of Mother-To–Child Transmission (PMTCT) services were successfully implemented with less than one percent infections reported.

◆ 1,400 health workers were trained on HIV paediatrics care.

◆ Despite donor funding delays, the services offered at Sunshine Smiles clinic have continued.

◆ The Clinic served as a unique adolescent clinic.

◆ The Clinic has prompted the establishment of income generating activities for the support groups. For example, the group making soaps was contracted as suppliers in Gertrude’s cafeteria.

◆ The project has attracted a partnership with Paediatrics AIDS and Treatment for Africa (PATA).

◆ The support groups opened savings accounts to accumulate their income.

◆ One of the oldest beneficiaries, a 21 year-old girl, was sponsored to study Environmental Science in the United

Kingdom. She was attached to Gertrude hospital when she received the scholarship.

“I was first diagnosed HIV +ve in the year 2005. I am a single mother of five children. I was pregnant then and I was attending PMTCT clinic. Denial stress and frustration sank in and frequent opportunistic ailments attacked me. I was admitted at Kenyatta National Hospital for three months having lost all hope in life. When I was discharged I was encouraged to join a support group and this is how I accepted my status and started taking drugs. I was introduced to Gertrude’s Children’s Hospital’s Sunshine Smiles Clinic where I assist as a patient expert. We mainly do counseling and supporting others who have just discovered their status and are still in denial. Many families have benefited from house to house visits we conduct, and some simply know me as ‘daktari’,” – Rosemary, Sunshine Smiles Clinic Patient Expert.

Microfinance trainings by hand in hand organisation


Challenges and Constraints

◆ One of the challenges is sustainability since most of the services offered are free of charge and are donor dependent. The surety that the activities can be made to live far well beyond donor funding is tricky and cannot be assured as yet.

◆ Funding constraints as 60 percent of the clients are needy cases.

◆ Defaulter tracing is challenging especially when the clients come from distant places.

Way Forward and Recommendations

◆ There is need to decentralise and expand the operations of Sunshine Smiles Clinic to six other Gertrude’s hospitals.

◆ More research is needed to improve the quality of services being offered by the Clinics.

◆ It is important to create more youth friendly clinics to cater for the growing number of adolescents in need of HIV and AIDS care.

Lessons Learnt

◆ There is need to sustain the clinic to benefit more people.◆ Public-Private Partnerships are crucial for the successful roll out of the clinics◆ The family-centred approach has improved the well being of the child.◆ Patient empowerment helps reduce their over reliance on free services.◆ HIV and AIDS training needs to be included in Teacher Training Curricula.◆ Early disclosure is important in HIV care and management among adolescents.


For more information please contact:The Executive Director, Regional AIDS Training Network,

Morningside Office Park, 4th Floor, Ngong RoadP.O. Box 16035, 00100 GPO, Nairobi, Kenya

Tel: +254-20-3871016, 3872201, 3872129, 3872235Mobile (Office): +254 734 999975, 724 255849

Fax: +254-20-3872270Email: [email protected]

h t t p : / / w w w . r a t n . o r g

Regional AIDS Training Network

Developing Capacity of HIV and AIDS Programmes in Eastern and Southern Africa Region

STRATEGIC PLAN 2009 - 2014

RATN SUPPORTERS

International Kenya

Published by:

Regional AIDS Training Network (RATN)Nairobi Business Park, Unit C, First Floor, off Ngong Road, Adjacent to the Ngong Racecourse.P. O. Box 16035-00100 GPO,Nairobi, Kenya. Tel: +254-20-3871016, 3872201, 3872235, 3872129Fax: +254-20-3872270 Email: [email protected]: http://www.ratn.org

© Regional AIDS Training Network (RATN)

CIDA

Grap

hics

& D

esig

n: an

todez

igns@

gmail

.com

Documents

Second issue of the Success Stories booklet