Self-Assessment Checklist:
Mainstreaming HIV
Introduction
Since the mid-to-late 1990s, there has been a considerable increase in the number and range of non-government organisations (NGOs) involved in responding to the multiple challenges presented by HIV. This includes NGOs undertaking HIV/AIDS work; NGOs integrating HIVspecific interventions within other health programming, such as sexual and reproductive health and child and maternal health programmes; and NGOs mainstreaming HIV within development, human rights and humanitarian programming. In response to the growing number of NGOs implementing HIV-related programmes, the Code of Good Practice for NGOs Responding to HIV/AIDS was developed by civil society organisations to provide a shared vision of principles for good practice in programming and advocacy to help guide NGO work, and to which NGOs can commit and be held accountable. The Code outlines and builds a wider commitment to principles and practices, informed by evidence, that underscore successful NGO responses to HIV. It identifies a series of areas that are key to HIV programming and articulates fundamental principles that should be applied to HIV programmes in each of these areas. The principles provided in the Code are aspirational, setting out good practice principles that NGOs can work towards reaching over time.
Self-Assessment
The purpose of this self-assessment checklist is to help NGOs measure where their programmes stand in line with Code principles. In completing this module, you should be able to identify areas in your programmes that are already at a best practice or ‘outstanding’ level, as well as areas that can be developed and strengthened to meet the Code’s global standards. We have highlighted key, baseline questions that can help you get started in improving the mainstreaming of HIV in your programmes. Please complete the self-assessment (which will be seen only by you and your colleagues, so please be honest!). It is expected that your scoring will vary between modules depending to your area of expertise. As signatories of the Code, we challenge you to use this self-assessment to identify areas that you need to improve upon and develop an Action Plan that highlights how you will make improvements in this area over the next year.
Self-Assessment Checklist - Mainstreaming HIV
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Self-Assessment Checklist:
Mainstreaming HIV
An Action Plan template is provided at the end of this module, which we ask that you complete and submit to the Code Secretariat to receive credit as an ‘Implementing NGO’ and a full signatory of the Code. After the period of one year, we will ask you to measure your progress on your Action Plan. If you need help in moving forward, resources on mainstreaming are available on the Code website (www.hivcode.org), as well as examples of good practice projects, news, reports and topics of current discussion. For further information, please contact the Code Secretariat (info@hivcode.org).
Mainstreaming HIV
The Code defines mainstreaming as a learning process that requires development and humanitarian NGOs to understand: how HIV changes the context for their programming and affects the nature of their work; whether and how programmes may reduce or inadvertently increase vulnerability, and; how specific programmes can respond to vulnerability to HIV and its impacts, given the particular expertise of NGOs.
Mainstreaming principles outlined in the Code are: • We review our development and humanitarian programmes to assess their relevance to reducing vulnerability to HIV infection and addressing the consequences of HIV. • We work in partnerships to maximize the access of PLHIV and affected communities to an integrated range of programmes to meet their needs. • We design or adapt development programmes to reduce vulnerability to HIV infection and meet the needs of PLHIV and affected communities. • We ensure that our humanitarian programmes reduce vulnerability to HIV infection and address the needs of PLHIV and affected communities. • Our programmes for orphans and vulnerable children affected by HIV are child-centred, family- and community-focused and rights-based. • We advocate for an environment that supports effective mainstreaming of HIV. • We advocate for an enabling environment that addresses the underlying causes of vulnerability to HIV.
This module was developed by CARE USA.
Self-Assessment Checklist - Mainstreaming HIV
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Self-Assessment Checklist:
Mainstreaming HIV
A project as seen as being successfully mainstreamed if it: • Reaches its core business objectives (as an agriculture project, savings project, education project, etc.); • Removes barriers and enables PLHIV and affected people to participate in and derive benefits from project activities; • Minimizes the potential risk of HIV transmission and the impacts of HIV on beneficiary groups, staff and volunteers; • Enables or facilitates linkages to appropriate HIV services; • Builds the capacity for analysis and intervention at all levels; • Generates and uses evidence to improve our own work and influence the policy and practice environment in which we work.
Self-Assessment Instructions
This following self-assessment tool will help your organisation, program, or project assess the degree to which you have successfully mainstreamed HIV into your sectoral work. The questions themselves are designed to be thinking points / guidelines to help deepen and further mainstreaming within your work. Because mainstreaming is a cross-cutting issue and requires the application of some clear principles in different development sectors, we’ve chosen to provide specific examples of how those principles are applied in several settings. Many organisations are working in a few – not all – development and relief settings. We suggest that you respond only to those questions that are relevant for your work; we anticipate that you will then have a large number of “N/R” responses, which is simply a reflection of your organisation’s work and focus, and not on your progress toward effective mainstreaming!
The following questionnaire is divided into five sections: • • • • •
General / Organisational Risk of HIV Transmission Access and Relevance Impact Mitigation Advocacy
The questionnaire uses the following scoring framework: Y Yes, we undertake this work/activity I Insufficient, in preparation, or being considered N No, we’ve not yet tackled this work/activity N/R Not relevant to our work Don’t forget to develop an Action Plan that highlights HOW you will make improvements in this area over the next year and submit it to the Code Secretariat. As identified in the CARE SWARMU Mainstreaming Workshop Report, April 2007.
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Self-Assessment Checklist:
Checklist HIV Mainstreaming
A
Effective mainstreaming requires organisation-wide understanding of HIV, and commitment to the principles of mainstreaming. This section will help you determine whether your organisation / programme / project is taking the appropriate steps to mainstream HIV into your work:
Y
I
N
NR
Have all staff members been trained on HIV, gender and non-discrimination?
Y
I
N
NR
Have existing monitoring and evaluation tools been adapted to assess HIV risk and vulnerability?
Y
I
N
NR
Have existing monitoring and evaluation tools been adapted to capture information about the community’s response to HIV-related shocks and stresses?
Y
I
N
NR
Are changes in vulnerability tracked over time as households and communities respond and adapt to the impacts of HIV & AIDS?
Y
I
N
NR
Has your organisation/ programme/project assessed the wider effects of HIV, beyond the household, and analysed the impacts on social systems, human capital, infrastructure, environment and other community assets?
Y
I
N
NR
Has a stakeholder analysis been conducted to identify partners for mainstreaming?
If you answered YES
General - Organisational
to fewer than 5 of the above, consider greater mobilisation and learning within the organisation to ensure that mainstreaming becomes a more integral part of the way you work.
Self-Assessment Checklist - Mainstreaming HIV
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Self-Assessment Checklist:
Checklist HIV Mainstreaming
B
Risk This section will help you understand whether programmes minimise the risk of HIV transmission, create no inadvertent risks, and help protect people from HIV.
Y
I
N
NR
Have projects/services been assessed to understand the potential risks to HIV transmission that may be inherent in the design, including the creation or distribution of assets or commodities – including food parcels, agricultural inputs, etc?
Y
I
N
NR
Have interventions been modified to reduce the risks of HIV transmission for project beneficiaries/participants – for example, holding meetings before nightfall?risk and vulnerability?
Y
I
N
NR
Have services and facilities been designed to reduce the physical risks for women and girls? (By way of example, consider the points below): • Do strategies exist to ensure that promoting market activities does not expose women and girls to risk of HIV infection/sexual violence? • Do strategies exist to ensure that educational environments do not expose students HIV infection, including implementation of policies and procedures for the prevention of sexual exploitation? • Are latrines and toilets placed appropriately to reduce risk of sexual violence for women and girls?
Y
I
N
NR
Do your programmes examine and minimize the potential risk of HIV transmission faced by staff and volunteers?
Y
I
N
NR
Do your programmes examine potential interactions and power dynamics between project staff, volunteers, and beneficiaries that might increase risk of HIV transmission for any of those parties?
If you answered YES
to fewer than 3 of the above, consider a more in-depth assessment of potential risk factors (perverse incentives, long distances, opportunities for sexual exploitation, etc) and identify appropriate modifications which enable objectives to be met without inadvertently creating the risk of HIV transmission.
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Self-Assessment Checklist:
Checklist HIV Mainstreaming
C
These questions are designed to help you assess whether your programmes are accessible to all people, including PLHIV. They will also help you to assess whether your project is meaningful for people living with HIV.
Y
I
N
NR
Does the organisation partner with PLHIV in meaningful and sustained ways (e.g. involvement in project design, consideration given to the types of groups formed, their meeting times and places, key messages and behaviours encouraged by project staff, etc)?
Y
I
N
NR
Are services offered in a non-discriminatory and stigma free environment?
Y
I
N
NR
Have measures been taken to modify the project to ensure that benefits are derived by PLHIV and affected households?
Y
I
N
NR
Have you adapted work norms (including time and place of meetings) to enhance participation of PLHIV and affected households?
Y
I
N
NR
Have you adopted methods to ensure that the project does not increase stigma? (e.g. consideration given to the types of groups formed, their meeting times and places, key messages and behaviours encouraged by project staff, etc)?
Y
I
N
NR
Have vulnerable individuals been targeted, regardless of their HIV status, paying attention to female-, child- and elderly-headed households, families supporting OVC and families caring for chronically ill people?
Y
I
N
NR
Are facilities and services designed to address the vulnerability of children, especially girls and female-headed households, PLHIV and/or those with chronic health conditions?
If you answered YES
Access and Relevance
to fewer than 5 of the above, consider working with PLHIV and focus groups to more accurately determine needs and possible barriers to access so that interventions can be modified to enable greater participation and benefit of PLHIV and other vulnerable groups.
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Self-Assessment Checklist:
Checklist HIV Mainstreaming
C.1
Sectoral Questions on Access and Relevance The below are some examples of ways that your project/organisation might ensure that benefits are accessible to or derived by people vulnerable or affected by HIV. Please assess only those that are relevant, given your organisation’s core work.
In clinics Y
I
N
NR
Have referral procedures been reviewed to accommodate HIV-related referrals?
Y
I
N
NR
Are clients who test positive for HIV referred to other organisations for HIV- related services? Is there a system for tracking and uptake and the sustained engagement with HIV –related services? In Sexual & reproductive health programming:
Y
I
N
NR
• Is Voluntary counselling and testing [VCT] available and routinely offered, with referrals and access to other HIV services?
Y
I
N
NR
• Are prevention of mother-to-child transmission [PMTCT] and PMTCT+ services available and routinely offered?
Y
I
N
NR
• Are sexually transmitted infection [STI] services available, with links to VCT services?
In Sexual & reproductive health programming Y
I
N
NR
Are PLHIV recruited as peer educators?
Y
I
N
NR
Does training of peer educators include comprehensive training on HIV?
Savings and Credit
Y
I
N
NR
Is there flexibility in the savings and loan organisations and schemes that allows for breaks within the savings and credit cycle while retaining membership?
Y
I
N
NR
Have interventions been designed so that people excluded from credit schemes because they are too economically vulnerable can save money and, in time, gain access to the credit facilities of the micro-financing scheme?
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Self-Assessment Checklist:
Checklist HIV Mainstreaming Water and Sanitation Y
I
N
NR
Are PLHIV and women’s groups involved in the promotion of point-of-use safe water treatments?
Y
I
N
NR
Are safe water strategies and education in all clinic- and community-based HIV programmes ensured, including home-based care of PLHIV?
Y
I
N
NR
Is stigma reduction sensitisation conducted to ensure that PLHIV are able to access water points without encountering discrimination?
Food and Agriculture Y
I
N
NR
Has special consideration been given to ensure that food aid or other services provided to vulnerable households does not increase stigma when provided to PLHIV and affected communities?
Y
I
N
NR
Are food baskets and crops selected for cultivation available that accurately reflect the dietary and nutritional needs of PLHIV, including adequate intakes of energy, protein and micronutrients essential to coping with HIV and fighting opportunistic infections?
Y
I
N
NR
Has appropriate diversification of crop production and preservation methods been promoted, including introduction of new, appropriate technologies that match the labour and nutrition needs of affected households?
Y
I
N
NR
Are interventions modified to enable PLHIV to engage in productive activities closer to water points or the home?
Y
I
N
NR
Do you ensure that PLHIV and affected communities have access to appropriate credit, tools and knowledge, such as transfer of customary and institutional knowledge about agricultural practices and skills across generations?
Y
I
N
NR
Have you adapted ways in which the food ration can be more useful and appropriate for the needs of participant individuals and households?
Humanitarian Relief/Emergency Response
Y
I
N
NR
Does the organisation maintain strict adherence to the implementation and monitoring of guidelines to protect beneficiary groups from sexual exploitation?
Y
I
N
NR
Is appropriate HIV-related care provided for PLHIV in emergency situations?
Y
I
N
NR
Does the organisation provide, or link PLHIV to appropriate treatment and prevention services, including ART and/or PMTCT programmes?
Self-Assessment Checklist - Mainstreaming HIV
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Self-Assessment Checklist:
Checklist HIV Mainstreaming
D
Impact mitigation This section is designed to help you assess whether the design of your programmes will help to ease the burden of individuals and families affected by HIV.
Y
I
N
NR
Do you support the capacity of individuals, households and communities to be resilient in the event of ill health, including strategies such as building up assets and preserving and investing in family and community relationships?
Y
I
N
NR
Do you help to facilitate the transfer of traditional and institutional knowledge across generations?
Y
I
N
NR
Do your programmes address stigma and discrimination, as well as potential violence, exploitation, and abuse of PLHIV?
Y
I
N
NR
Do your projects enhance or positively impact traditional and existing coping mechanisms and strategies in the context of HIV?
Y
I
N
NR
Have rules been introduced to protect the savings and assets of married women and/or children, which may otherwise be acquired by relatives in the event of spousal or parental death?
Y
I
N
NR
Is it recognised that families and communities are the primary social safety net for OVC and have community-based responses been strengthened, including engaging leaders in responding to the needs of OVC and developing means of participation and benefit for child-headed or skippedgeneration households?
Y
I
N
NR
Are women’s caregiving and productive responsibilities, and the added burden of HIV and AIDS acknowledged, and programmes designed in ways that recognize these constraints and needs?
Y
I
N
NR
Has the caring capacity of families and communities to protect and care for OVC been strengthened by provision of economic, material and psychosocial support and development of life skills of children, parents and carers?
Y
I
N
NR
Are household members enabled to take on responsibility for, or take over, loans or project membership if the original member becomes ill or dies?
Self-Assessment Checklist - Mainstreaming HIV
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Self-Assessment Checklist:
Checklist HIV Mainstreaming
OVC Y
I
N
NR
Are parents living with HIV supported to fulfil their parenting role, including succession planning for children?
Y
I
N
NR
Do your programmes enable OVC to access services, including birth registration, schooling, health and nutrition services, safe water and sanitation, protection from exploitation, violence and abuse, and psychosocial support?
Y
I
N
NR
Has the capacity of children and young people been increased to meet their own needs, through access to quality education, protection from exploitation, psychosocial support, and developing the skills to care for themselves?
If you answered YES
10
to fewer than 6 of the above, consider deeper investigation into the effects of AIDS on caregivers and surviving household members, and identify possible modifications to your interventions.
Self-Assessment Checklist - Mainstreaming HIV
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Self-Assessment Checklist:
Checklist HIV Mainstreaming
E
Advocacy
Y
I
N
NR
Do all advocacy activities involve members of target groups – youth, women and men? PLHIV? Community consultation?
Y
I
N
NR
Does the programme/organisation participate in national and local AIDS forums/committees?
Y
I
N
NR
Have partnerships with governments, donors, the public sector and the full range of NGOs to coordinate responses been built and strengthened?
Y
I
N
NR
Do you generate and use evidence from the field to identify policy/ programmatic barriers to enabling PLHIV to lead full and dignified lives and influence policy/implementation change to reduce these barriers?
Do you advocate for review and reform of laws and policy to ensure
11
Y
I
N
NR
Gender equity for women in accessing credit and income-generating activities and property ownership?
Y
I
N
NR
Universal birth registration?
Y
I
N
NR
Protection of the inheritance rights of widows and orphans?
Y
I
N
NR
Protection of access to land, natural resources, services and credit for PLHIV and affected communities?
Y
I
N
NR
Protection of children against neglect and abuse (physical, sexual and emotional)?
Y
I
N
NR
Prohibition of exploitative and harmful child labour?
Y
I
N
NR
Availability and accessibility of social welfare support?
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Self-Assessment Checklist:
Checklist HIV Mainstreaming
Do you advocate for review and reform of laws and policy to ensure (continued)
12
Y
I
N
NR
Regulation of institutional facilities caring for children, including locating family and
Y
I
N
NR
Community-based care as soon as practicable?
Y
I
N
NR
Access to education for both girls and boys, especially for girls?
Y
I
N
NR
Appropriate placement and guardianship of children who lack adequate adult care?
Y
I
N
NR
A comprehensive approach to HIV, including access to nutritionally appropriate food for PLHIV
Y
I
N
NR
Appropriate budgeting for the needs of PLHIV in different line ministries (e.g. Agriculture, Education, etc)
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Self-Assessment Checklist:
Action PlanHIV Mainstreaming
Key Questions The nine Key Questions below address baseline issues that need to be considered first when mainstreaming HIV. If you answer ‘no’ to any of these questions, this would be a good starting point for improving your programmes!
13
Y
N
1. Have all staff members been trained on HIV, gender and nondiscrimination?
Y
N
2. Have projects/services been assessed to understand the potential risks to HIV transmission that may be inherent in the design?
Y
N
3. Have projects/services been assessed to remove any barriers that may prevent PLHIV and affected people from participating in and deriving benefits from project activities?
Y
N
4. Have the physical risks for women and girls been considered in when determining the services you deliver, the ways that these services are delivered and, if appropriate, the design of your facilities?
Y
N
5. Have existing monitoring and evaluation tools been adapted to assess the HIV- and AIDS- related vulnerabilities of beneficiary groups?
Y
N
6. Have existing monitoring and evaluation tools been adapted to determine the ways in which people living with and affected by HIV/AIDS are benefiting from project activities (including thought given to appropriate proxies for people living with and affected by HIV & AIDS)?
Y
N
7. Do your programmes examine and minimise the potential risk of HIV transmission faced by staff and volunteers?
Y
N
8. Does your organisation meaningfully involve PLHIV in the development of programs and services, to ensure that their needs and constraints are considered within the context of your core business?
Y
N
9. Have you considered how you may best enable or facilitate linkages to appropriate HIV and AIDS services?
Self-Assessment Checklist - Mainstreaming HIV
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Self-Assessment Checklist:
Action PlanHIV Mainstreaming
Strengths
In completing the Self-Assessment, we have identified the following strengths in our programmes:
Strengths
14
Self-Assessment Checklist - Mainstreaming HIV
Description (as needed)
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Self-Assessment Checklist:
Action PlanHIV Mainstreaming
Areas of Improvement
We have also identified some areas that need to be strengthened. We have prioritised what needs to be done first and have created an action plan for the next year.
Area of improvement
Action Plan
Please post or email a scanned, completed Action Plan to info@hivcode.org or PO Box 372, 1211 Geneva 19, Switzerland Name of Organisation
Contact Person
Signed
15
Self-Assessment Checklist - Mainstreaming HIV
Email Address
Date
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Self-Assessment Checklist:
Feedback HIV Mainstreaming
We hope this checklist was helpful to you in identifying where your programmes stand along the lines of good practice in involving PLHIV and affected communities in your HIV response. Your feedback is invaluable to help us revise and improve this tool so please answer any or all of the below questions on the implementation and usability of the checklist, and attach any additional information that you think will help us further refine the tool.
Y
N
1. Are the instructions clear and simple? Detail
Y
N
2. Is the format of the questionnaire user-friendly? Detail
Y
N
Y
N
3. Is the content of the checklist helpful for understanding what programmes that effectively address mainstreaming HIV should include? Was anything unclear? Detail
Y
N
4. Do you consider the module useful to your programming? For example, did it help you to identify strengths/weaknesses in your programmes that you did not know? Is it useful in terms of strategy development to address weaknesses? Detail
Y
N
5. Is the content of this tool relevant to you in the context of your work in your specific region? Detail
Y
N
6. Did you find the Action Plan to be helpful in documenting the results of your self-assessment and identifying your next steps in improving your program?? Detail
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Self-Assessment Checklist - Mainstreaming HIV
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