REGIONAL AIDS TRAINING NETWORK
Success Stories in capacity building for HIV and AIDS response Number 1, Volume 1
Success Stories
in capacity building for HIV and AIDS response Number 1, Volume 1
Acronyms ACC
- African Centre for Childhood
AIDS
- Acquired Immune Deficiency Syndrome
ARC
- American Refugee Committee
ART
- Antiretroviral Therapy
CBVs
- Community Based Volunteers
CBWCY
- Community Based Work with Vulnerable Children and Youth
NuPITA
- New Partners Initiative Technical Assistance project
OCA
- Organisational Capacity Access
PCA
- Participatory Community Assessment
PEPFAR
- Presidential Emergency Plan for AIDS Relief
PLHIV
- People Living with HIV
PMTCT
- Prevention of Mother to Child Transmission
CDM
- Capacity Development Manager
CSO
- Civil Society Organizations
RATN
- Regional AIDS Training Network
CTRF
- Changing The River’s Flow
REPSSI
- Regional Psycho-Social Support Initiative
ESARO
- Eastern and Southern African Regional Office
SAFAIDS
- Southern Africa AIDS Dissemination Service
FHI
-Family Health International
SAIDE
GAAP
- Generally Accepted Accounting Principles
- South African Institute of Distance Learning
GBV
- Gender Based Violence
SSDL
- Situated and Supported Distance Learning
GHC
- Gertrude’s Children’s Hospital
TA
- Technical Assistance
GoK
- Government of Kenya
TO
- Technical Officers
HCT
- HIV Counseling and Testing
TOCA
HIV
- Human Immunodeficiency Virus
- Technical and Organizational Capacity Assessment
JSI
- John Snow, Inc
TOCA
- Technical Organisation Capacity Assessment
KPA
- Kenya Pediatric Association
UKZN
- University of KwaZulu Natal
LCVT
- Liverpool VCT Care and Treatment
UNAIDS
M&E
- Monitoring and Evaluation
- Joint United Nations Programme on HIV/ AIDS
MIs
- Member Institutions
UNICEF
- United Nations Children’s Fund
NACs
- National AIDS Councils
USAID
- United States Agency for International Development
NASCOP
- National AIDS and Sexually Transmitted Infections Control Program
VCT
- Voluntary Counseling and Testing
NGO
- Non-Governmental Organisation
NUAPROACH -Northern Uganda Access, Prevention, Referral and Organisational Assistance to Combat HIV programme
© Regional AIDS Training Network
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Success Stories in capacity building for HIV and AIDS response
Table of Content
Changing the River’s Flow (CTRF)’ A SAfAIDS Community Based Cascading Model .............................................. 1 Good practices Innovative Models in Capacity Development for an Effective and Sustainable HIV Prevention Response Liverpool VCT Care and Treatment ......................................................................... 5
“Community Based Work with Vulnerable Children and Youth” Regional Psycho-Social Support Initiative ............................................................ 9
systems for community based organisations American Refugee Committee...............................................................................15 Strengthening University Curricula on Injection Safety through the AIDSTAR - One Project ...................................................................................19 Building Capacity to Accommodate HIV-infected and affected children Gertrude’s Children’s Hospital Professional Training Centre .......................21 Fostering success: Institutional capacity building to mainstream HIV and AIDS into poverty alleviation programme ...................................... 25
Success Stories in capacity building for HIV and AIDS response
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Success Stories in capacity building for HIV and AIDS response
Foreword The Regional AIDS Training Network (RATN) has over the years been at the center of supporting capacity building of individuals and institutions in the Eastern and Southern Africa (ESA) region for effective HIV and AIDS response. Despite these efforts, ESA still remains one of the regions with high HIV incidence. In order to scale up the HIV response in the region, it is critical that institutions at the center of the response share Success Stories to ensure replication and implementation of effective interventions. This triannual publication aims at gathering Success Stories in capacity building for HIV and AIDS response that can be shared, replicated and applied to scale up the role of capacity building in responding to the HIV and AIDS pandemic in the ESA region. The seven featured Success Stories in this issue were presented during the HIV Capacity Summit held in March 2011 and may be freely used for educational or noncommercial purposes so long as this publication and the authors are credited. We hope you enjoy and gain much from the featured stories and look forward to your feedback to enable RATN continue sharing Success Stories for replication to scale up the role of capacity building in the HIV and AIDS response.
Kelvin Storey Executive Director Regional AIDS Training Network
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Success Stories in capacity building for HIV and AIDS response
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Changing the River’s Flow (CTRF)’ A SAfAIDS Community Based Cascading Model by Mojapele Maserame
SAfAIDS
Introduction Changing the River’s Flow (CTRF) programme is a behaviour change intervention that focuses on theoretical models of individual behaviour change. CTRF is a unique African intervention that encourages programmers and stakeholders in Southern Africa to confront harmful cultural practices and GBV to prevent HIV and to reduce incidence rates in the region. Communities need people who steer and drive programme activities at local level through doorto-door or face-to-face interactions. Through its innovative and creative approaches to programming under the CTRF, SAfAIDS developed pillars of interventions to ensure an effective and holistic response to the HIV epidemic in Southern Africa. Conducting capacity building activities for Community-Based Volunteers, who are the change agents, is one of the pillars or interventions to respond to HIV epidemic. These community change agents are commonly referred to as CommunityBased Volunteers (CBVs) in the CTRF programme.
Community-Based Volunteers selected from the community are people who “walk the talk”. They receive important information on gender, culture, women’s rights and HIV transmission through information materials. They also complete monitoring tools to facilitate tracking and receive continuous mentoring and periodic additional training.
Goal and Objectives The goal of the CTRF/SAfAIDS community based cascading model is to enhance the knowledge and skills of the target communities, reduce violation of women’s rights, harmful cultural practices, GBV and HIV as well as promote human rights. Objectives of the model are to:
◆
build common understanding of the programme methodology
◆
impart knowledge and skills to CBVs
◆
reach the “hard to reach” communities with necessary information to combat HIV
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Execution of the CTRF Programme SAfAIDS/CTRF programme was initiated in November 2006/7 to address violation of women’s rights, harmful cultural practices, GBV and HIV as well as to promote human rights and gender approaches that encourage use of sexual and reproductive health services by women and girls. The programme aimed at reaching 100,000 people with information. SAfAIDS used the cascading model that has a multiplier effect in reaching people with information related to triple linkage. In partnership with National AIDS Councils (NACs) and gender departments in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe, SAfAIDS focused on strengthening the capacities of organisations and CBVs. This is because of the realisation that there are links between culture, gender and women’s rights that worsen HIV transmission and Gender Based Violence (GBV).
Accomplishments CTRF programme is self sustaining as it invests skills in the key community members especially traditional leaders, volunteers and organisations. The programme improves communities’ capacity to develop and implement sustainable solutions and alternatives. Through the use of SAfAIDS cascade method, the capacity of 41 organisations was strengthened in addressing GBV through a culture concept. The project was implemented in 80 communities and is an ongoing activity as SAfAIDS continues mentoring and monitoring it. Partners conduct the community based volunteer training, which enables the participants to conduct the community dialogues and share
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information through door-to-door campaigns using CBV/GBV package. The results of the cascading model approach are shown in Figure 1.
Figure 1: Cascading Model Approach 34 Regional Trainers 161 National Trainers 1,860 Community Based Volunteers
86,000 people reached through community dialogues and door to door campaigns Out of those reached, 500 of the participants were the traditional leaders. Community leader’s perspectives were changed, and they are now able to objectively analyse norms and beliefs that undermine women. They are also utilizing platforms like ward meetings to challenge cultural practices that perpetuate gender inequality. The communities now freely discuss negative cultural practices which lead to GBV and HIV infection. The Chiefs have been involved in the project to the extent that some invite the CBV to their courts to assist them in their determination of cases of GBV.
Impact The trained Community Based Volunteers (CBVs) promote behavior change, change harmful cultural practices, fight domestic violence and promote women’s rights in the community. The following are some success stories:
Success Stories in capacity building for HIV and AIDS response
Promoting behavior change Community Based Volunteers are change agents who promote behavior change through encouraging positive behavior in the community. One woman in Seke Community in Zimbabwe explained: “… since I attended the dialogues and training with my husband and through the support of CBVs, it has become easy to discuss sexual issues and negotiate condom use with him.” One partner in Namibia reported that a CBV who had attended CBV training described her behaviour change: “Before I went through the GBV prevention training, I was rude and violent to my family but when trainers told that we are the peace bearers in our families and communities through door–to–door campaign, I started asking myself: what makes me violent? How will I reach out to people and yet I am violent to them? I decided to respect people’s feelings, before starting the door–to–door campaign.”
Changing harmful cultural practices, fighting domestic violence and promoting women’s rights in the community Domestic violence affects families as seen in the story of one of the CBVs below:
A male CBV’s daughter was sexually abused by a 45 year old man; the case was reported to the Police but dismissed because the girl is 16 years old. The man said he was worried about the possibility of his daughter being infected with HIV since he heard the offender could have been HIV positive. The CBVs have been
supportive of their colleague and has not chased his child and wife out of home as would have been the custom. In another incident, a woman in Mbekweni confessed to a CBV that she was being beaten by her husband. The CBV told her about the Domestic Violence Act No.116 of 1998 and arranged for her to see the area social worker, who counselled the couple and the abuse stopped. Traditionally, it is taboo for a woman to divorce her husband. There was, however, an exception where one woman divorced her husband because of his risky behaviour as seen in the following story: “I was married to a man who was known to have many partners. I asked him to use a condom but he refused. I went to the headman and explained the problem, who spoke to my husband, asking him to use a condom. When he refused, I had to divorce him and the headman supported it. My husband has since died. If I had stayed with him, I would also be dead’
Woman Beneficiary This is considered a major breakthrough for the programme, since in many Africa societies married couples do not usually use condoms, and thus its acceptance and uptake is evidence of success.
Constraints ◆ The programme created a demand for expansion to other areas in a resource constraint situation. ◆ The loss of CBVs to other formal employment opportunities due to their increased knowledge and skills, created a need to build capacity of other CBVs. ◆ There was a felt need to remunerate CBVs, who previously provided their services for free.
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Lessons Learned ◆ The use of the community based cascade method can reach many people with information within a limited time and cost effectively. ◆ Partnerships between regional, national and community based organisations/stakeholders are key to successful implementation of community based programmes. ◆ The project has uncovered community-specific information on HIV drivers, adding to existing knowledge on local epidemics.
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Capacity Building Local Indigenous Organisations for the HIV response in Africa – The LVCT Approach by Catherine Theuri and Dancan Omondi Liverpool VCT Care and Treatment (LVCT)
Introduction Liverpool VCT Care and Treatment (LVCT) has helped to establish over 500 of the roughly 1,000 VCT sites in Kenya. Through capacity-building of local partners over 200 VCT sites have been ‘graduated’ to be managed by the Government of Kenya (GoK) and other civil society organisations (CSOs). Clinical mentorship, decentralisation of services and capacity building are key to these achievements. Capacity development is engrained in the LVCT culture and practice. As a local indigenous organisation, LVCT offers south to south technical assistance (TA) to other autonomous organisations (hereafter referred to as sub-partners), mainly CSOs and government health facilities, through defined and targeted partnership. LVCT’s south to south TA has expanded to other countries in Africa, including Cote D’ivoire, Ethiopia, Tanzania, Uganda and Botswana.
Goal and Objectives The programme goal is to be a catalyst for long lasting positive change by increasing coverage and improving
the quality of HIV prevention, treatment, care and support services in East Africa and beyond. The objective of the programme is to strengthen the response of local indigenous organisations to establish operational organisational systems that foster successful high quality and sustainable HIV and AIDS programmes.
Execution of the programme LVCT’s capacity development model, which is locally developed and piloted, is based on World Health Organisation’s six health system strengthening pillars. It utilises an integrated mentorship approach, delivered through a multi-disciplinary staff team. The model distributes the six pillars of health system strengthening into the four broad categories highlighted below: ◆ Technical support: Focuses on skills building in the key programme areas with the aim of addressing service and coverage gaps. ◆ Managerial support: Aimed at strengthening organisational systems and structures that support successful programme implementation and the development of strategic organisational priorities, in response to the existing policy environment.
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◆ Financial support: Enhancing financial and procurement policies and structures of the sub-partners while, promoting accountability and transparency. Grants are offered through a sub-granting mechanism, and an online granttracker portal is used to facilitate the monitoring and financial reporting process. The sub-grants given include: ▶ Implementing grants/advances - This type is issued for purposes of funding of specific HIV focus areas such as prevention, care or support projects of day to day programme activities. ▶ Participatory Community Assessment (PCA) grants - This type is issued for conducting participatory community assessments that inform the projects. ▶ One off grants - This type is issued for the purpose of funding of short term, one-time events. ◆ Policy support: LVCT ensures that all subpartners align their programmes to the existing national policies and frameworks. The process begins with an assessment, using a uniquely designed assessment toolkit that considers cross-cutting issues affecting HIV and AIDS such as gender. This is then used to develop an individualized capacity development plan for each organisation. The plan and strategies employed are tailored to address the unique needs of each organisation, and this is done by staff members who perform similar duties on a daily at LVCT and hence are experts in their fields. Consultancy costs are therefore limited, making the model cost effective, without compromising the quality of capacity building offered. Technical Officers coordinate the capacity building activities for a cluster of sub-partners, who are
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Success Stories in capacity building for HIV and AIDS response
divided according to their programme’s main focus area. A Technical Officer not only has the core competency in the programme focus area of the subpartners such as HIV Testing and Counselling, but also has an understanding of the broader organisation system strengthening, and can make comprehensive follow-up using an all-inclusive checklist, during routine monitoring visits. The Technical Officers required are therefore as few as the broader programme areas, and they report to the Capacity Development Manager, who provides the overall managerial and leadership support for the programme. Supervisory visits are therefore reduced and so there is less interruption of services to the clients. A series of capacity building activities, aimed at growing the organisations towards reaching their optimum levels are carried out, enabling them to make suitable adjustments in their structures and systems. These include comprehensive managerial, finance as well as technical capacity building. LVCT’s capacity development is a participatory, continuous process, for an agreed period of time, following capacity building plans with clear milestones that demonstrate growth and foster sustainable transformation. This model has been tested and improved since 2003 and has been found to be replicable. For instance, it has been used by over 60 organisations dealing with different HIV programme areas over the years, and over 80 government health facilities. It has helped increase the numbers of implementers providing improved services that are aligned to the national policies and structures, while also increasing coverage. Quality services are, therefore, more accessible, stirring the country towards universal access to HIV prevention, care, treatment and support services. The beneficiaries, including populations with special needs, key populations, the youth and the general
Capacity Building Methods Used: Mentoring Coaching On-job-training Cascading
Clustering/ Twinning
Convening
population are better served, hence promoting the UNAIDS vision of ‘getting to zero’ – zero new infections, zero AIDS-related deaths and zero discrimination. Other advantages of this model include: ◆ It responds to the specific needs of an organisation as identified in the comprehensive assessments carried out during the inception of the project, and in the course of programme implementation. ◆ It is comprehensive, as it addresses the different facets of the organisations systems, as well as the technical needs. ◆ It makes use of tailor-made curricula, training materials, monitoring and evaluation tools developed and refined over time, and piloted specifically for the African context. ◆ It encourages partnerships and networking with GoK agencies, health facilities and other CSOs hence reducing duplication and ensuring that resources are not wasted. ◆ It encourages the use of the national M&E framework and tools, ensuring that the work done by the sub-partners is well captured and recorded as part of the national response.
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Accomplishment In the past three years, the achievements made through capacity building of the sub-partners include: ◆ Increased coverage to 31 of the 47 counties in Kenya due to direct capacity building of the subpartner organisations. ◆ Improved organisation systems and structures of 61 CSOs and over 80 GoK health facilities, increasing their prospects for sustainability. ◆ Enhanced technical skills of staff from the 61 CSOs and over 80 GoK health facilities, to improve quality and types of services offered to the communities they serve. ◆ Interventions of all sub-partners aligned to national systems and structures, that is, responding to the
national strategic plan, reporting using the national M&E tools and through the national M&E systems.
Constraints ◆ Nationally, there is no clear framework or guidelines on capacity development that gives an agreed upon definition, standards and indicators. This model has thus been built on different global models and LVCT’s local field experience. ◆ There is limited experience and little available documentation on structured capacity development done nationally and regionally, therefore little to learn from. ◆ Limited evaluation on capacity development programmes has been done locally and globally, which limits availability of benchmarks.
Lessons learned ◆ The mentorship approach, with principles of best practice and lessons learnt ensures that organisations engage in efficient and effective programme design, implementation and evaluation, as mistakes are not repeated. ◆ Aligning to government systems and structures ensures continuity of activities, programmes and support beyond donor funding. ◆ Creating a culture of networking and partnerships enables organisations to focus on their core competencies, while providing more comprehensive services to the community.
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REPSSI Situated and Supported Distance Learning (SSDL) Certificate “Community Based Work with Vulnerable Children and Youth” Regional Psycho-Social Support Initiative (REPSSI)
Introduction In 2004 REPSSI initiated a long term capacity building programme to develop an inventory of high quality learning materials. The principle goal was to develop materials for accreditation at university level and delivery at distance learning in the Eastern and Southern Africa Region. The target demographic for the new learning material was community based caregivers of vulnerable children and youth, with focus on programme implementing officers from Government and Civil Society organisations. This initiative was motivated by evidence1 that showed that although numerous institutionally based short training opportunities existed in the region, no formal university accredited courses were available. In partnership with UNICEF ESARO, REPSSI started regional stakeholder forums, curriculum development conferences, and writer’s workshops. In 2006, the first phase of the programme was completed - a 12 month, six module certificate course: Community based Work with Children and Youth (CBWCY) was developed. 1 REPSSI carried out a regional needs assessment and gap analysis.
Goals and Objectives of The CBWCY SSDL Certificate The central goal of this programme is capacity building of the community based social development workforce engaged with vulnerable children and youth. The specific goals are: ◆ Mainstreaming of Psycho Socio Support into community programming for vulnerable children and youth. ◆ Delivery of high quality accredited courses for the professionalisation of the sector. ◆ Delivery of SSDL courses to specifically enable community based caregivers to: a. Acquire new and relevant skills and knowledge b. Engage with formal accredited learning c. Build their academic credentials and enhance their formal learning opportunities ◆ Create strong and influential communities of learning and practice to influence both programming and policy for vulnerable children and youth at community level.
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Execution of the programme In 2007 in partnership with the University of KwaZulu Natal (UKZN) and UNICEF ESARO, REPSSI established the African Centre for Childhood (ACC) to oversee the SSDL delivery of the CBWCY Certificate Course. In 2009 REPSSI and her partners which included AusAID piloted the CBWCY Certificate in eight
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countries for over 500 students. The pilot was independently evaluated and found to be effective for transmission of new knowledge and skills to those working at community level with vulnerable children and youth. The CBWCY Certificate is currently being scaled out in ten countries with over 1000 students enrolled. REPSSI is engaged in the next phase of the programme which is the development of new diploma and degree level material.
Success Stories in capacity building for HIV and AIDS response
The CBWCY Certificate comprises six modules: MODULE
TITLE
UNITS
One
Self Management and Development
Skills for Life Project Skills Professional Development Positive Living
Two
Human Rights and Child Protection
Human Rights Approaches Challenges to Human Rights Approaches Child Protection Citizenship and Participation
Three
Child and Youth Development
Dimensions of Development Contexts of Care Development in Contexts of Adversity
Four
Care and Support
Basic Support Skills Levels of Support Direct Support of Children and Youth
Five
Integrated Development in Communities
Principles of Community Development Situational Analysis Developing Community Based Structures Development in Communities Affected by Adversity
Six
Field Practicum
Experiential Learning in a field placement resulting in a 5000 word reflection paper drawing together students knowledge and skill acquirement from course and practicum
The 18-month course uses a Situated and Supported Distance Learning model: ◆ Situated – all learning is done in the communities of practice with no need for learners to travel. ◆ Supported – all learners are part of a community based learning support group that meets four times during each module. These support groups are run by trained Learning Mentors drawn from the community or nearby towns or cities. They have a tertiary qualification, good facilitation skills and experience of working with children. ◆ Distance Learning – all learning takes place through the individual use of off-line print modules and the support groups. Individual written assignments
are assessed either by the UKZN or in-country academic institutions.
Accomplishment REPSSI and partners have completed one full course with over 500 students in eight countries2 resulting in an unprecedented 90% completion rate. Completion rates for traditional distance learning programmes in the region are 20% to 50%. A second scaled out course is nearing completion in the region with over 1000 students enrolled across ten countries, including Kenya and Mozambique. 2 Namibia, Lesotho, Swaziland, Zimbabwe, Zambia, Malawi, Tanzania, Uganda
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Demand for the certificate course is significant and REPSSI is currently planning for a third round (scaled out) delivery with additional students and countries involved. The materials have been translated into Portuguese. Academic institutions in five countries are collaborating with REPSSI, the ACC and the UKZN to offer the certificate. Some of these are accrediting the certificate course.
Constraints A number of countries are not yet equipped to accredit the certificate course and are reliant on the UKZN accreditation process. This means that student assessments have to be sent to the UKZN in South Africa for marking, which is logistically demanding and expensive. Most students cannot afford the fees and REPSSI has provided the fees for the last two courses. Student bursaries are, therefore, necessary. Making the transition to a model where countries can accredit the course and carry out formal assessments is a slow and intensive process.
Impact and relevance Evidence from an evaluation carried out by SAIDE3 showed that the innovative model of learning and teaching, which combines the use of learning materials, support by trained mentors in regular and well organised group sessions, and continuous assessment worked well for the students. Furthermore: 3 South African Institute for Distance Learning
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◆ Effective collaboration between partners created a stimulating learning environment for students. ◆ The high throughput rate indicated that the learning materials were adequate, relevant and useful. ◆ The model was well designed and decentralised for students and was regularly attended with organised mentor-led group sessions. ◆ Appropriate assessment with all elements of the assessment strategy shows a strong commitment to values such as transparency reliability, commitment to quality learning and teaching. ◆ Proactive and responsive central coordination resulted in a well coordinated assignment turnaround process. Subsequent Monitoring and Evaluation carried out by REPSSI with graduates has shown that learners were equipped with knowledge and skills that has enabled them to respond effectively to children’s issues, advocate for children and promote participation and protection: “Since the commencement of the programme there have been a number of initiatives aimed at supporting children. Parents have also realised that they are the epicenter of children’s wellbeing and that they are now able to care for their children. Also, increased reporting of child abuse cases in the communities I have been working in shows that people are aware of children’s rights.” —Graduate from Malawi “The programme changed my perception and understanding about children’s work. It is not only a matter of interest, talent and or experience but it is a profession with legal and ethical repercussions. There are theories and principles to follow which make it systematic, which makes it a profession.”
Success Stories in capacity building for HIV and AIDS response
—Certificate participant, Tanzania.
Implementation efficiency REPSSI strives to build and nurture strategic partnerships for development and delivery of the CBWCY Certificate. These partnerships with Governments, Academic Institutions, and Civil Society Organisations have created a unique and powerful implementation mechanism. As REPSSI continues to capacity build in-country academic institutions for the accreditation and delivery of the CBWCY Certificate, the implementation efficiency will increase.
Sustainability Governments are becoming more aware of the need to improve the capacity of their Social Development workforces. The demand for the CBWCY Certificate
and subsequent new learning material is likely to increase and REPSSI and her partners are currently engaged with a number of Governments and Academic Institutions on possible scaling out. Furthermore, the Civil Society has a significant need for capacity building of national programme staff and some International NGO’s are negotiating with REPSSI around their staff accessing the CBWCY Certificate.
Replicability Improving the skills of Social Development Workforce has become a major global issue over the last two years. A number of the major funding agencies are actively pursuing models for this much needed capacity building process.
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Lessons Learned ◆ REPSSI needs to be more active in discussions with all institutions for the third cycle of delivery. This includes active involvement in selection and training of the mentors crucial to the situated/ supported aspect of the delivery. ◆ The capacity building provided to partner institutions prior to the onset of the programme needs to be enhanced and tailored to the needs of each institution. ◆ The course material needs regular updating to be effective and relevant with a greater focus on child protection and referral systems for children. ◆ Although the certificate course is the only accredited training available for community workers focused on working with children, it is not readily accepted into the qualifications framework of most countries and this will require concerted lobbying and on-going work. The country task teams, initially envisaged necessary for the pilot phase, are now crucial to the success of this advocacy. REPSSI is resuscitating country task teams and establishing new ones with increased membership. ◆ As REPSSI prepares for the third cycle of delivery funding is critical. REPSSI is advocating for government ministries/departments and organisations to support students to take this course. Potential corporate funders are also being approached.
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Developing and implementing userfriendly financial management systems for community based organisations American Refugee Committee
time, effort and resources, processes can be facilitated by a clear set of tools and systematic procedures.
Introduction From 2008-2011, the American Refugee Committee implemented a comprehensive HIV and AIDS programme in Northern Uganda: Northern Uganda Access, Prevention, Referral and Organisational Assistance to Combat HIV programme (NUAPROACH). The programme was implemented in Gulu, Amuru, Nwoya, Agago and Pader districts in Northern Uganda, five conflict-affected districts that are transitioning to stable post-conflict settings. The programme targeted former internally displaced populations, focusing on those with increased vulnerability to HIV infection such as discordant couples, women of reproductive age and youth. The programme included prevention activities, free HCT services, PMTCT referrals, and capacity building for PLHIV networks and Community Based Organisations (CBO) working in prevention, care and support, which required strengthening for efficient and effective management. Although developing systems and providing support and capacity building for CBOs is intensive and requires
Goal Enabling CBO to have efficient, effective and transparent financial and organisational systems that can be readily adapted and/or replicated in a variety of settings.
Objectives â—† To develop and/or institute a set of user-friendly minimum standards/practices and tools for CBO partners to ensure financial efficiency, effectiveness and transparency which can be shared among CBOs. â—† To evaluate progress in core capacity building competencies where training and support needs were identified through organisational and capacity assessments to enhance technical, organisational and managerial practices using targeted set of tools.
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Human Resource Management
Execution of the Programme The NUAPROACH programme focused on three main intervention areas: 1. Community awareness raising on HIV issues
Mandatory Standard Provisions 2. Understanding the generally accepted good practices of financial management.
2. HCT and PMTCT service provision
Planning and Budgeting
3. Capacity building of local HIV/AIDS response actors.
Internal Control Systems
Basic Accounting System
Financial Reporting
Inventory Management
Capacity building Prior to selection of CBO partners, a pre-award assessment of the subgrant partners took place using USAID guidelines for developing CBO partnerships. Once three CBO partners was identified, ARC carried out capacity building assessments using a tool developed by USAID, the Organisational Capacity Assessment (OCA), to identify organisational capacity gaps and assist in developing a capacity building action plan designed for their needs. All the CBO partners cited lack of a strong and reliably consistent financial management and tracking system. ARC’s addressed this by hiring a financial expert who worked closely with the management teams and financial officers of each CBO. To ensure the guidelines and protocols were followed by the CBO partners, compliance training was carried out in the first quarter of the project implementation period focusing on: 1. Understanding the minimum standards of USAID requirements for sub-grant management. Financial Management Procurement Management
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Staffing and Human Resource
Governance
The finance staff was trained on standard finance tools and practices as per the Generally Accepted Accounting Principles (GAAP), donor and other stakeholder requirements. On-the-job training on bookkeeping, internal financial controls, procurements guidelines, human resource management, filing and safeguarding of documents, tax and benefits obligations, and proper financial reporting and accountability was also given to CBO staff. Support in instituting and strengthening organisational systems by standardising policies and procedures, and ensuring compliance through monitoring of performance and financial documents was also provided.
Accomplishment By the end of the project period the sub-grant CBO partners established, improved/or streamlined their internal control financial systems. They internalised and continued to use the financial standards for appropriate documentation and adapted the compliance tools necessary for donor requirements, including the Generally Accepted
Success Stories in capacity building for HIV and AIDS response
Accounting Principles (GAAP), with the following key components: 1. Cash and Bank Register 2. Petty Cash Verification Certificates
CBO staff who leave without proper handover in many cases creates a capacity gap and may not be replaced with similarly qualified staff. Also, recruitment of staff that does not have strong financial qualifications and experience results in weak financial management.
3. Bank Statements 4. Ledgers
Lessons Learned
5. Journals
◆ Consultative development of systems, tools
6. Vouchers
and processes is a basic requirement of a simple organisational system.
7. Accountability statements 8. Various Reconciliation Schedules
◆ Constant feedback and support to CBOs
9. Funds Requests
builds capacity and contributes to improving their overall systems sustainability and in ensuring quality control and fiscal wellbeing of the CBO partner.
By the end of the project, the CBO partners appreciated efforts to improve their financial management, compliance regulation, and financial supervision carried out by the ARC Finance Specialist.
◆ Accountability in financial management
should also focus on output and value for money. Financial contributions and use should be a reflection of the programme/ projects outputs, which determines the success of the programme/projects.
They developed and improved their finance, administration and monitoring and evaluation tools and systems with enhanced documented organisational policies and procedures.
Constraints
Impact/Effectiveness
Procedural requirements from other donors do not always promote uniformity of organisation systems in the CBOs. Some donors may not embrace the importance of strengthening organisation systems and capacity building, which focuses on financial management of projects they support.
◆ CBOs demonstrate financial transparency in projects/ programmes execution as a result of skills and knowledge acquired through capacity building.
Inability for CBOs to create and adapt structured organisation practices to support and strengthen their ability to sustain effective and efficient systems, policies and procedures.
◆ CBOs assess the organisation’s financial implications/ risk exposure, contributions for present and future requirements, plans to promote organisational growth.
◆ CBOs make informed strategic and finance plans due to established organisation systems.
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Relevance ◆ The flexibility of the finance systems and tools developed facilitated the uptake and sustainability of the efficient and effective financial procedures and practices. ◆ The established systems were easier and adapatable to other donor requirements without altering the core organisation systems framework and or set up. ◆ Intergration of the GAAP and other donor requirements in the systems development had a positive impact on the financial managment systems the CBO adopted.
Implementation efficiency ◆ Development of easily adaptable and replicated tools and systems in a variety of settings is a costeffective way to build the capacity of CBO partners as there is no requirement to develop a new set of systems for different donors.
◆ Low financial risk exposure due to adequate system controls saves resource loss through diversion, fraud and other financial mismanagement practices.
Sustainability Standard documentation and tools used during the project were easy to use and were acceptable for use with other donors. This made financial transaction processing quick, more accurate and complete. Funds utilisation levels could be determined daily to establish relevancy of the trends to the project outputs.
Replicability Generally Accepted Accounting Principles (GAAP), Statutory requirements, applicable international financial standard requirements and donor requirements, were considered in developing the Organisational Financial systems, since they are referred internationally in making organisational financial assessments.
Lessons learned ◆ Routine and constant supervision and follow-up, training and updates with the CBOs management and systems is necessary for strong, efficient and effective financial management systems. Without thsese, an organisation may fail to achieve project and organisational objectives and risks damaging its donor relations. ◆ To provide adequate financial and technical support, a capacity building workplan must be developed and intergrated into the project master workplan. Thorough capacity assesments have to be carried out to determine the nature of capacity building required to address identified gaps. Crucial to the success of the capacity building is the need for regular visits to ensure proper integration of all aspects of the financial system.
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Success Stories in capacity building for HIV and AIDS response
5
Strengthening University Curricula on Injection Safety through the AIDSTAROne Project AIDSTAR
Introduction Ethiopia is the second most populous country in SubSaharan Africa, with close to 78 million people. The HIV infection prevalence in the country is 7.7% in urban and 0.9% in rural areas. Several local studies have shown that unsafe injection practices in Ethiopia pose significant risks to patient, providers and communities. To alleviate the risk of medical transmission of HIV and other blood borne infections, the USAID - Funded Injections Safety Project provided technical assistance
to the Ethiopian government to reduce unsafe and unnecessary injections and ensure proper disposal of healthcare wastes. One of the strategies of the six-year project was to collaborate with the medical training institutions to incorporate injection safety and healthcare waste management in the pre-service training curricula.
Goal and Objective The project has conducted in-service training to health workers on injection safety. However, due to high staff turnover and the intensive nature of the
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training, in-service training is less likely to be owned and sustained in the healthcare system. Therefore, to make injection a norm in the health care a new health professional should master injection safety practices during pre-service training and acquire competence upon graduation.
Department level working groups were established to strengthen and follow the teaching process based on integrated content. Moreover, to standardise the knowledge and skill of instructors on injection safety, training was organised and provided by AIDSTAR-One.
Achievements Execution of the Programme Four public universities, with nursing and environmental health departments, were identified for the curriculum strengthening activity. In collaboration with experienced professionals and instructors from the four universities, the project sought to find out gaps in the curricular for injection safety and health care waste management. Core competencies in injection safety for new graduates of nursing and environmental health were developed and based on identified gaps the new contents were systematically integrated into selected courses. As the subject was already part of the curriculum, there was no need of adding extra hours for teaching the injection safety contents.
Relevant nursing and environmental health course syllabi were standardised and updated with injection safety and health care waste management contents. University instructors were trained on basic injection safety and effective teaching skills and instructional design to improve the delivery of the updated curriculum. Universities also established an educational development center to expand the AIDSTAR-One to other departments and sustain the initiative.
Constraints Almost all course syllabi from all universities were poorly written. Most faculties had little or no experience in instructional design and competence based teaching skills with poor facilities and systems for practical teaching.
Lessons Learnt â—† Since the universities and departments were autonomous, it was possible to work directly with the relevant departments to incorporate injection safety into course syllabi and implement it. â—† As the standard of course syllabi and teaching-learning process of undergraduate training in Ethiopian Universities suffers from several challenges, certain subject areas require a holistic approach to strengthen the pre-service education system. This includes working with faculty to encourage simulation in other skill teaching centers, standardise the entire course syllabi and also improve the knowledge of instructors and teaching hospital staff.
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Success Stories in capacity building for HIV and AIDS response
6
Building Capacity to Accommodate HIVinfected and affected children Gertrude’s Children’s Hospital Professional Training Centre by Gordon Otieno Odundo
Introduction Gertrude’s Children’s Hospital was founded in 1947 and is one of the few hospitals in Sub-Saharan Africa that is dedicated solely to the provision of healthcare for children. The hospital and its satellites attend to close to 300,000 patients as outpatients while close to 6,000 children are admitted annually as inpatients. An estimated 11.8 million young people aged 15-24 years are living with HIV/AIDS. Provision of ARVs is reaching only about 20% of the eligible children in Kenya. At the same time, professionals trained in managing paediatric HIV are few and there is, therefore, need to expand the bracket of health workers, to include village health workers and traditional birth attendants. Currently, less than 50% of the healthcare workers are trained in paediatric and youth HIV services. There is need for improved training of healthcare workers and managers to improve paediatric HIV prevention care and support services to reduce child mortality and morbidity. Clinical treatment of children with HIV/AIDS poses particular challenges; children need special care,
treatment, and drug formulations, and this means healthcare workers should get specific education, training, and on-going support. In the absence of suitable training for healthcare workers, Gertrude’s Children’s Hospital and Kenya Paediatric Association (KPA) approached National AIDS and Sexually Transmitted Infections Control Programme (NASCOP), United States Agency for International Development (USAID) and Family Health International for assistance to develop a curriculum that would train health workers in management of paediatric HIV infection.
Goal and Objectives In May 2004, a meeting was held at Gertrude’s Children’s Hospital in attendance was USAID, Family Health International, NASCOP, University of Nairobi, Department of Paediatrics and Moi University to address the growing demand for proper care and management of children with HIV/AIDS. A proposal was written by Gertrude’s Children’s Hospital to Family Health International for a Paediatric HIV Training and Treatment Capacity Development
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Programme. Gertrude’s Children’s Hospital become an implementing partner of the IMPACT: Improving AIDS Prevention and Care Project for Nairobi Area from 1999 – 2007. The goal of Family Health International and Gertrude’s Children’s Hospital partnership was to improve the quality of lives of children infected/affected with HIV/ AIDS through a comprehensive longitudinal paediatric care and ART training to upgrade the capacities among public and private sector health workers.
officers, nurses, counsellors and medical officers. Facilitators for the trainings were drawn from both public and private sector with teaching skills and expertise in the care and treatment of HIV infected children and adolescents. The first phase of the partnership focus of Gertrude’s Children’s Hospital was on: ◆ Review and packaging of teaching materials ◆ Training of paediatric HIV/AIDS master trainers ◆ Training of trainers on paediatric HIV/AIDS management
Execution of the Programme In September 2004, a curriculum was developed and Gertrude’s Children’s Hospital was tasked with training of 500 health care workers from private and public sector. Consequently, cadres of health workers trained under this programme included paediatricians, physicians, laboratory technologists, pharmacists, pharmaceutical technologists, nutritionists, clinical
◆ Training paediatric health providers on paediatric HIV/AIDS management ◆ Establishment of training centre at Gertrude’s Children’s Hospital The second phase consisted of the national roll out of paediatric provider training and to strengthen its paediatric HIV/AIDS treatment centre.
Training
Curriculum
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Success Stories in capacity building for HIV and AIDS response
Access and Treatment
3. Development of psychosocial curriculum for paediatric HIV management
on Paediatric HIV management. To date, close to 6000 health workers in Kenya have been trained using the curriculum which is reviewed bi-annually. The key objectives to end paediatric HIV and AIDS include family-centred care and nutrition, early infant diagnosis, treatment and access to appropriate medications. NASCOP estimates indicate that by the end of December 2010 there were 35,000 children on ART in Kenya.
4. Development of paediatric treatment guidelines
Constraints
Accomplishments Outcomes 1. National scale up of paediatric treatment and care 2. Development of mentorship programme
5. Increased support by development partners with regard to issues pertaining to paediatric HIV treatment and care Outputs 1. National Curriculum on Comprehensive Paediatric HIV Management 2. 1,000 health workers trained in Comprehensive Paediatric HIV Management 3. 300 children enrolled into treatment 4. 20 trainer of trainers trained. The curriculum has been adopted by other African countries as the national curriculum for training
Due to limited technical knowledge and managerial expertise at the Gertrude’s Children’s Hospital, adequate staff could not be easily assigned duties in the project due to budget limitations. Despite the training focusing on participants nationally, a number did not attend, which would have greatly enhanced their confidence and commitment in their work stations. The bottlenecks faced included inadequate health care worker training in the time provided and lack of/ unclear national policies and targets for scaling up access to paediatric HIV/AIDS services. To address policy problems there is urgent need for advocacy to entrench this in the national response strategy.
Lessons Learned ◆ Over 1,000 healthcare workers were trained from the private and public sector, thus the need for centralised coordination of training for effective national reach to support the initiative and continuously identify and fill in training gaps. There was need to increase the pool of trainers through follow up of those trained through mentorship and enhanced training of trainers. Continuous medical education and comprehensive resource centres is needed to keep abreast of new information on HIV treatment. Also, training and initiation of treatment must run concurrently to manage paediatric HIV. ◆ Gertrude’s Children’s Hospital has demonstrated that the public and private sectors can collaborate in developing a curriculum for use nationally and internationally to improve the skills of healthcare workers through a multidisciplinary approach to saving children’s lives.
Success Stories in capacity building for HIV and AIDS response
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Success Stories in capacity building for HIV and AIDS response
7
Fostering success: Institutional capacity building to mainstream HIV and AIDS into poverty alleviation programme John Snow, Inc. (JSI) by Katana, Milly; Ulaya, Patricia; Chinzewe (John Snow Inc); Sikapale (Tearfund Zambia)
Introduction John Snow, Inc. (JSI) is implementing the USAID/ PEPFAR funded New Partners Initiative Technical Assistance project (NuPITA) in Kenya, Zambia, Rwanda, Ethiopia, Nigeria, South Africa, Tanzania, and Uganda. The project provides technical assistance and organisational development support to 14 organisations that are implementing HIV and AIDS programmes with funding from USAID through PEPFAR. The NPI programme aims to build the capacity of such organisations to work at the community level, support long-term responses to HIV and AIDS and increase the number and diversity of organisations working with the USG to address HIV & AIDS around the world. One of the partner organisations with which NuPITA works is Tearfund, a Christian relief agency that focuses on supporting communities to address poverty. The organisation works through local churches and other faith-based communities to implement the programme, Scaling Up Demand for Prevention Services and Support Programmes through Churches in Zambia.
Neither Tearfund nor its sub-partners - all faith-based organisations - had prior experience in working with USAID on implementing HIV and AIDS programmes. NuPITA provided support to Tearfund to build its own capacity while strengthening the competencies of Tear fund’s sub-partners to implement the programme. JSI provided capacity building in social behavior change communication, home based care, implementing combination prevention programmes, and quality assurance and improvements. JSI also facilitated processes that include resource mobilisation skills strengthening, team building, support supervision improvement, financial management, strengthening governance and senior management functions, and managing USAID project close outs.
Goal and Objectives The overall goal of the capacity building intervention is to provide timely and tailored assistance to Tearfund so as to expand its reach to communities directly affected by HIV and AIDS in Zambia. The specific objective is to enable Tearfund and its subpartners to facilitate access to HIV and AIDS care and prevention services.
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Execution of the Programme
Accomplishment
JSI employs a number of approaches to build the capacity of Tearfund in implementing HIV and AIDS programmes. First, is the Organisational Capacity Assessment (OCA), followed by a Technical and Organisational Capacity Assessment (TOCA). Out of the two assessments that are facilitated by JSI, areas that need support are identified, from which targeted interventions are designed. One such intervention that has been implemented includes linkages with national level partners, teambuilding for the sub-partners, strengthening the HIV prevention activities and community PMTCT mobilisation. John Snow’s Approach for capacity building is represented in figure 1 below:
Two years after John Snow Inc. started working with Tearfund in Zambia, Tearfund and its local subpartners have joined mainstream HIV response in the country and can negotiate for local funding for HIV programmes. Tearfund’s ability to implement HIV activities has significantly increased with the number of community resource persons mobilised through the faith communities. This can be attributed to focus on strengthening social behavior change communication, home based care, solidifying combination approaches to HIV prevention, and quality assurance and improvement in programme implementation. In addition, the prime partner and sub-partners systems for resource mobilisation, team building and team management, support supervision, and financial management, have been substantially improved. The governance arrangements and senior management functions have been streamlined while managing USAID project close-outs has also been introduced.
Figure 1: John Snow’s Approach to Capacity Building Facilitated Technical and Organisational Capacity Self Assessment
Constraints The major limitation in the implementation of activities is the limited human resource of the Tearfund partners, who have a limited number of staff that can be dedicated to supporting HIV and AIDS interventions. Also, while committed to mainstreaming HIV in other programmes, Tearfund has only a few of its staff are based in Zambia.
Capacity building
Impact/Effectiveness Tailored targeted interventions
26
Ongoing dialogue on needs and interventions
Within only two years of ongoing partnership, Tearfund and the sub-partners exceeded their three-year targets. For example, from the first year to the second year, there was a 478% increase in the number of pregnant
Success Stories in capacity building for HIV and AIDS response
from which it helped to address other social and development issues such as improving farming skills, access to markets and education.
women tested for HIV (see table below). This was possible because of the already existing community reach that Tearfund had with the target communities,
Table 1: Impact of the capacity building intervention with Tearfund Core programme area
YI
YII
Pregnant women tested and received HIV results
1,419
8,198
9,617
478
8,500
19,204
52,057
71,261
171
52,400
3,240
18,288
21,828
417
9,604
11,427
18,274
29,701
60
19,300
Individuals reached with HIV prevention interventions
Individuals counseled, tested and received results
Adults and children who received care
YI+YII
% increase
Target for 3 years
Source: Tearfund Year 2 NPI Project report
Relevance Tearfund, as a social and community development organisation, prioritises on the quality and scale of services delivered to communities. Working with John Snow on enhancing their capacity, Tearfund has leveraged its comparative advantage in the communities to address other social problems.
Implementation efficiency By engaging the partners from where they are, JSI has supported Tearfund to identify key strengths that can facilitate access to HIV and AIDS services to the communities that they work with. The major advantage upon which TF has been able to build is the large pool of volunteers that are organised by the four subpartners. These include the Evangelical Fellowship of
Zambia, The Bretheren in Christ Ministries, Jesus Cares Ministries and Scripture Union of Zambia.
Sustainability Over two years, JSI has engaged not only Tearfund but also the sub-partners that Tearfund works with. This has a long term impact as the capacity of the organisations to address HIV and AIDS has been improved. In addition, because responding to HIV and AIDS was not the core business of Tearfund and its sub-partners, the other exiting programme areas have equally been positively impacted upon by the HIV interventions. For instance, as more adults living with HIV and AIDS access care, they are able to put in more time into economic activities. Also, from the capacity built, the partners of Tearfund can negotiate for additional resources in country to support their HIV programmes.
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Replicability John Snow Inc’s approach to capacity building is based on existing capacity needs identified by partners. Under the NuPITA programme, JSI provided similar support to 14 partners. Similarly, it is supporting Tearfund to mainstream other public health related interventions including nutrition and reproductive health in their ongoing core
activities. Tools are generally standardised and can be administered with partners engaged in social development areas - Nutrition within the Health System, Community Management of Acute Malnutrition, Family Planning, Integrated Community Case Management, Child Health/Expanded Programme on Immunization, Child Health/Integrated Management of Newborn and Childhood Illnesses, and Child Health/Paediatric and HIV.
Lessons learned ◆ The HIV and AIDS epidemic in Africa calls for innovation in engaging with additional partners to implement HIV programmes. One such way is identifying partners and recognising how they can add HIV into their core programmes while focusing on their primary missions. With such approaches that are grounded in organisations’ missions, the organisations can not only enhance their ability to mainstream HIV and AIDS, but can also support others with similar missions.
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Success Stories in capacity building for HIV and AIDS response
REGIONAL AIDS TRAINING NETWORK
For more information please contact: The Executive Director, Regional AIDS Training Network, The Navigators Building, 3rd Floor, Kindaruma Rd, Off Ngong Rd P.O. Box 16035, 00100 GPO, Nairobi, Kenya Tel: +254-20-3871016, 3872201, 3872129, 3872235 Mobile (Office): +254 734 999975, 724 255849 Fax: +254-20-3872270 Email: ratn@ratn.org
http://www.ratn.org