The Japan Trust Fund Providing services to young vendors at Malawi’s Mitundu Market
Foundations of sustainability
Our Vision IPPF envisages a world in which all women, men and young people have access to the information and services they need; a world in which sexuality is recognized both as a natural and precious aspect of life and as a fundamental human right; a world in which choices are fully respected and where stigma and discrimination have no place.
International Planned Parenthood Federation The Japan Trust Fund
Our Mission IPPF aims to improve the quality of life of individuals by campaigning for sexual and reproductive health and rights through advocacy and services, especially for poor and vulnerable people. We defend the right of all young people to enjoy their sexual lives free from ill-health, unwanted pregnancy, violence and discrimination. We support a woman’s right to choose to terminate her pregnancy legally and safely. We strive to eliminate STIs and reduce the spread and impact of HIV/AIDS.
Our Core Values IPPF believes that sexual and reproductive rights should be guaranteed for everyone because they are internationally recognized basic human rights. We are committed to gender equality, and to eliminating the discrimination which threatens individual wellbeing and leads to the widespread violation of health and human rights, particularly those of young women. We value diversity and especially emphasize the participation of young people and people living with HIV/ AIDS in our governance and in our programmes. We consider the spirit of volunteerism to be central to achieving our mandate and advancing our cause. We are committed to working in partnership with communities, governments, other organizations and donors.
The current situation in Mitundu market Mitundu market, situated 38 kms from Malawi’s capital city of Lilongwe, is one of the busiest markets in the district. Twice a week approximately 8,000 vendors arrive at the market to sell their goods. Carrying with them agricultural products, foodstuffs, second hand fabric, shoes and groceries, they come from as far afield as neighbouring country Mozambique. Most of the vendors and the buyers visiting the market spend their nights in the rest houses surrounding the market. Apart from selling or buying their wares, some young female vendors are known to exchange sex for service favours like lower prices, tax exemptions, free transport and accommodation. Likewise, some young male vendors, upon making a small profit are known to spend their evenings drinking and buying sex from young women in the market place. The market place thus creates an environment in which young male and female vendors are placed at particular risk of HIV infection. A baseline assessment, conducted with 161 young vendors to assess their current level of knowledge about HIV/AIDS and STIs and related sexual risk behaviour, confirmed the existence of multiple sexual partnerships and inconsistent safe sex behaviour. For example: æ 20 per cent of the vendors had contracted an STI and 50 per cent of them had had sex without a condom at one point in their life æ of the 30 per cent of vendors who indicated that they had had sex with a sex worker, only 13 per cent of these had used a condom The absence of appropriate HIV/AIDS and STI prevention, or treatment services that can accommodate the particular needs and lifestyle of this young and mobile group of vendors, did little to improve this situation. For example: æ despite having positive attitudes towards VCT (Voluntary Counselling and Testing) only 30 per cent of the vendors had accessed VCT services æ many of the vendors (23 per cent) had limited or incorrect knowledge about where they could access VCT should they require it Negative attitudes of service providers and long waiting times were cited as the key factors that discouraged young people from utilizing the SRH (Sexual and Reproductive Health) services offered by Mitundu Hospital, which is located adjacent to the market. In turn, the health care workers, although aware that the young vendors were not fully utilizing the hospital services, felt they were unable to change this situation due to staff shortages. The delivery of effective HIV prevention services to young Malawians is essential given that the prevalence of HIV is estimated to be 15 per cent amongst those between 15–49 years.
Recognizing the gap in service delivery, the Family Planning Association of Malawi (FPAM) - under the auspices of the Japan Trust Fund for HIV/AIDS, established a service delivery point for HIV prevention in Mitundu market by offering mobile VCT and STI services to young vendors in close proximity to their stalls. In developing such an intervention, The Family Planning Association of Malawi laid down four critical foundations which secured the success of the project. Firstly, a baseline assessment conducted with 161 youth vendors and 10 key informants assessed both the current HIV/AIDS-related knowledge and sexual practices of the vendors and the level of acceptability of the proposed project to the vendors and the local authorities. This provided valuable formative input into the design of the market project. Secondly, key representatives from the District and City Assembly Authorities were introduced to the project concept through a series of meetings, a workshop and an advocacy brochure. They included people who were responsible for the management of public markets, local politicians such as the Traditional Chiefs and Members of Parliament for the area, and representatives from the vendors and the District Health Office. After this introduction their endorsement of the introduction of HIV/AIDS and STI information and services at Mitundu market was obtained. Thirdly, ten members of the Vendors Working Committee (a committee that works with the market authorities to supervise the various activities in the market) were trained to provide HIV/AIDS and STI information to their peers. Fourthly, innovative ways of conveying and
distributing HIV/AIDS and STI preventative messages, condoms and curative services were considered by the project team. These would then reduce the time that the vendors needed to spend away from their stalls whilst accessing these health services.
Getting connected
for their peers and mobilized their friends and fellow colleagues to access the new VCT and STI treatment services. They also became community-based distributors for condoms. A FPAM-supported theatre group, performing traditional songs and dances, was used to inform and encourage young vendors and buyers to attend the mobile clinic services offered by FPAM, and to provide the audience with basic knowledge about HIV/ AIDS and STIs. It is estimated that over the project period the FPAM outreach workers provided HIV/AIDS awareness raising opportunities to approximately 30,000 people.
The Mitundu Tree FPAM illustrates the project using a picture of a tree. “The ground is harbouring roots with a lot of problems which require care and treatment of the soil. Once the soil is cared for it will provide a fertile ground for the tree to grow and have a strong stem representing a good and strong partnership. The branches of the tree represent services that will be provided at the market. The branches transport food through the tree to produce healthy leaves and fruits. When all this takes place Mitundu market will have good, healthy and strong trees (the youthful vendors) who will contribute to a better sexual and reproductive health environment (like the leaves on a tree provide oxygen to the human population). Everyone in the Mitundu community will like this tree.” “For this to happen, FPAM has put together its tools in the form of competent staff and services (represented by a panga and hoe to till the soil and care for it). However, FPAM requires financial and some technical assistance from JTF (USD 15,000) to buy some inputs to care for ‘the tree’. It also requires some support from stakeholders and partner agencies to make the whole exercise a success.”
Weathering storms The seasonal downpours in January to April and November to December proved to be one of the major challenges in this project. Negotiating the movement of the mobile clinic through the muddy roads of Mitundu market proved to be a challenge for the outreach team. These seasonal downpours also reduced the number of clients from accessing services as the rain prevented many of the vendors from venturing out beyond their stalls.
Learning curves The FPAM noted that they had learnt a couple of important lessons in
implementing this project. These included: Linking practice and people: An understanding that it is possible to provide HIV/AIDS related services to communities engaged in busy economic activity if the services are designed in such a way as to acknowledge the constraints placed on vendors’ time and availability to seek health care Building local partnerships and links: Building consensus and links with the district authorities and other organizations operating within the community around the market is essential for providing a continuity of service delivery
International Planned Parenthood Federation The Japan Trust Fund
The market project, which ran from February to December 2004, provided direct HIV/AIDS and STI clinical and counselling outreach services to approximately 1,000 vendors at Mitundu market every Wednesday and Saturday. These activities included: æ providing VCT to 956 clients æ providing 112 clients with STI treatment In addition, 60 peer group discussions focusing on issues related to HIV/AIDS (including the need for community mobilization and support for those living with HIV/AIDS) were held, which reached an estimated 3,200 vendors. The project was also able to distribute 14,000 condoms to market vendors during the period it was running. The 10 members of the Vendors Working Committee, having been trained as peer educators, became on-site HIV/AIDS resource persons
MAURITANIA
Involvement of beneficiaries: Involving the target audience in the development of the project from the very beginning, through the implementation of a baseline assessment, allows for the establishment of a collaborative partnership from the outset and nurtures the sustainability of project activities
IPPF and Japan Trust Fund The Japan Trust Fund for HIV/ AIDS (JTF) was established by the International Planned Parenthood Federation (IPPF) to support the HIV prevention programmes of its Member Associations in Asia and Africa. It is funded entirely by the Government of Japan and has made funding available throughout Africa for the prevention of HIV/AIDS. Since JTF’s inception in 2000, a total of 43 projects in 23 countries have been funded in this region.
Our sincere thanks goes to the Government of Japan, the IPPF Africa Regional Office and the Family Planning Association of Malawi (FPAM)
MALI SENEGAL GAMBIA
11
GUINEA BISSAU
GUINEA
SIERRA LEONE
ERITREA
8
BURKINA FASO
20
COTE D'IVOIRE
6
12
7
TOGO
10
NIGERIA
13
CENTRAL AFRICAN REPUBLIC
CAMEROON
4
LIBERIA
Where is JTF working?
DJIBOUTI
27
BENIN
GHANA
5
35 36 37 UGANDA
GABON
SOMALIA
ETHIOPIA
EQUATORIAL GUINEA SAO TOME & PRINCIPE
9
28 29
CONGO
41 42 43
RWANDA
DEM. REP. OF CONGO
KENYA 14 15 16 17 18
BURUNDI
3
ANGOLA
32 33 34 TANZANIA
JTF is active throughout Asia and Africa
22 23 24 38 39
ANGOLA
MALAWI
30 Seychelles
ZAMBIA 40
1 Botswana Botshelo Ke Mpho (Life is a gift) Video production for IEC materials 2 Botswana: Advocacy directed towards education authorities and community leaders for incorporating HIV/AIDS prevention activities in schools in Kanye, Bostwana 3 Burundi: Reduction of transmission of HIV and STIs in Bujumbura, Gitaga and Ngozi 4 Cameroon: Youth AIDS Media (the YAM project) 5 Cameroon: Youth Aids Positive Behaviour (YAPoB Project) 6 Cote D’Ivoire: Fidel and Abstinia: Fidelity and Abstinence among the youth 7 Cote D’Ivoire: Advocacy for STI/HIV/AIDS prevention among taxi drivers in Abobo communes 8 Eritrea: Advocacy for HIV/AIDS prevention for Ground Force Commanders at the Sawa National Service Training Center 9 Eritrea: Reduce barriers to condom use 10 Ethiopia: Advocacy for HIV/AIDS prevention among factory workers in Nazareth 11 Gambia: Advocacy for HIV/AIDS prevention for bank employees 12 Ghana: Strengthening HIV/AIDS Voluntary Counselling and Testing (VCT) Services within PPAG 13 Ghana: Advocacy for STI/HIV/AIDS prevention among prison inmates in Kumasi central 14 Kenya: Promotion of Positive Behaviour Change among the youth 15 Kenya: Expansion of VCT and STI services 16 Kenya: Advocacy directed towards Ministry of Education Officials and parents to support peer youth education on HIV/AIDS in Upper Primary Schools in Nakuru 17 Kenya: Promoting youth friendly VCT services 18 Kenya: Voluntary Counselling and testing for the ‘Jua Kali’ Community
26 NAMIBIA
ZIMBABWE
25 MOZAMBIQUE
BOTSWANA
21 MADAGASCAR
SWAZILAND
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LESOTHO
SOUTH AFRICA
19 Lesotho: Women fighting HIV/AIDS: Promoting the female condom 20 Liberia: Advocacy Initiative for Policy Makers and Opinion Leaders on HIV/ AIDS Prevention and Control in Liberia 21 Madascagar: Prevention and treatment of STIs and reduction of stigma and discrimination against PLWHA 22 Malawi: Preventing HIV and STIs among the youth in Lilongwe city, Ta Chiseka and Ta Tsabango 23 Malawi: Reaching out to the youth in the market place 24 Malawi: Promoting STI treatment seeking behaviour amongst young people aged 15-24 25 Mozambique: Reduction of stigma and discrimination against PLWHA amongst miners and households 26 Namibia: Prevention of HIV/AIDS/STIs among youth in and out of school and women of childbearing age in Amusati Region 27 Nigeria: Private sector initiative for HIV/AIDS prevention in Nigeria 28 Rwanda: Prevention of HIV/AIDS/STIs in the main prisons of Rwanda in relation with GACACA Jurisdictions 29 Rwanda: HIV/AIDS prevention for Rwanda prisoners 30 Seychelles: HIV/AIDS and STI Prevention and Control among the Youth in Mahe 31 South Africa: Implementation and advocacy plan for small, medium and microenterprises (SMMEs) in the Gauteng and Kwa Zulu Natal provinces 32 Tanzania: Behaviour Change Communication for HIV/AIDS prevention among young people
4 Newhams Row, London, SE1 3UZ United Kingdom telephone facsimile email web
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Family Planning Association of Malawi Private Bag B 424, Area 14 House No 96 Lilongwe 3, Malawi
Published in November 2005 by International Planned Parenthood Federation
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+44 (0)20 7939 8200 +44 (0)20 7939 8300 info@ippf.org www.ippf.org
33 Tanzania: Fighting against STI/HIV/AIDS social stigma through strengthening prevention and care 34 Tanzania: Advocacy for youth HIV/AIDS Voluntary and Counselling 35 Uganda: Care and support for HIV/AIDS and STIs infected and affected youths involved in transient trade in Mbarara Municipality 36 Uganda: Bridging the gap: HIV/AIDS prevention for at risk and hard to reach young people in Iganga district 37 Uganda: Advocacy for supportive attitudes towards condom use for STD and HIV/AIDS prevention amongst religious leader in Mityana sub-district Uganda 38 Zambia: Advocacy for HIV/AIDS prevention among Zambian young people in Lusaka and Kabwe 39 Zambia: HIV/AIDS prevention among Zambian Youth 40 Zimbabwe: Sphilhaus Clinic: Voluntary Counselling and Testing centre 41 RO: Regional capacity building for improved service delivery by selected Member Associations 42 RO: Capacity building for effective response to HIV/AIDS pandemic 43 RO: Competency development and capacity building on HIV/AIDS advocacy within IPPF Africa region
telephone (265) 773915 facsimile (265) 771032 email fpam@malawi.net
The International Planned Parenthood Federation (IPPF) is a global network of 149 Member Associations working in 183 countries, and the world’s foremost voluntary, nongovernmental provider and advocate of sexual and reproductive health and rights. UK Registered Charity No. 229476