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Final Report for the
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6. Integrated Interventions with Churches Integrated Action against AIDS with Kenyan Churches FCO 56068
Background The church is to be found within virtually every community in Kenya, and cuts across ethnic, gender, age, economic and social lines. More than 80% of Kenyans consider themselves Christian. Yet the churches were only marginally involved in HIV/AIDS activities. Utilizing MAP's capacity to bridge denominations and its history of wide collaboration with churches, NGOs and other organizations, this project was intended to increase the number and capacity of Kenyan churches to initiate and manage effective, culturally appropriate and locally sustainable HIV/AIDS intervention programs both for their own congregations and the wider communities in which they are located. This was to be accomplished through a combination of policy formulation initiatives, use of mass media, development of educational tools and training programs. Extensive baseline research was undertaken among church leaders and youth to determine attitudes towards HIV/AIDS, to examine barriers to behavior change, to reveal key attitudes in regard to high risk behavior and practice and to identify areas of need and opportunity. The research results guided the development of church-based awareness and intervention programs as well as the development of tools used in the project. This project was begun under the AIDSCAP PVO Initiative. This supported projects from priority countries that were selected on a competitive basis. Primary funding was provided from the AIDSCAP central funds, but each selected PVO organization also contributed funds to support the country-level activity of its linked country organization. Objectives The goal of the project was to reduce high risk sexual behavior among high risk populations in Kenya. The purpose was to increase the number and capacity of Kenyan churches initiating and managing effective, culturally appropriate and locally sustainable HIV/AIDS control programs within their communities. Accomplishments A major accomplishment of the project was its facilitation, through several workshops, of the development, articulation and dissemination of two policy statements on HIV/AIDS issued by Kenya's church leadership. The first, issued in November 1994, stated that "The AIDS Challenge is the Church's Challenge." The second statement appeared in February 1996. This comprehensive policy statement identified fourteen major policy issues which each church denomination and umbrella group committed to addressing. Both statements were widely publicized through an advertisement in the national press. Signatories to the second document represented four national church umbrella groups and two international church umbrella groups, as well as nineteen denominations. Subsequently a number of church denominations have made substantial progress in developing and implementing policies relating to HIV/AIDS. Specific policy development has been undertaken in these areas by the National Council of Churches of Kenya, the Organization of African Instituted Churches, the Methodist Church in Kenya, the Presbyterian Church of East Africa, the Africa Inland Church (on the national and international councils' agenda for April, 1997), and the Church of the Province of Kenya, as well as twelve independent church denominations from Western Kenya. Through an integrated media campaign, HIV/AIDS awareness was communicated at the international, national and local levels. The national press carried a number of advertisements and articles; national television reported on several project activities, including the policy workshop, and screened a video produced by MAP, "Springs of Life," in prime time on several occasions; national radio carried advertisements and other messages; international radio broadcast several special programs; and the "Springs of Life" film was shown to nearly 3 million Kenyans in rural communities throughout the country through the auspices of traveling cinema vans. One of the most far-reaching and long-term impacts of the project is likely to be the materials produced and distributed. All materials were produced after extensive consultation, widespread input and field testing, thereby ensuring that they were culturally appropriate and relevant. Curriculum modules which examine many of the issues of HIV/AIDS were developed for Kenya's theological and pastoral training schools. A parent/youth guide to adolescence and sexuality was developed in response to the need expressed in the baseline research, and was disseminated nationwide. Community training manuals were reprinted in English, translated into Kiswahili and printed. Awareness packets and church guidelines were developed and printed in English and Kiswahili. These formed the basis of the curriculum used to train clergy and lay leaders in ten regional workshops. An important feature of the training approach was that initial workshop were followed by a refresher workshop three months later, and in the interim trainees began activities in their communities. The 105 clergy who attended both workshops disseminated the training they received throughout their communities, reaching over 56,400 people in less than three months. Finally, the capacity of Kenya's churches to design, implement, manage and evaluate HIV/AIDS programs was increased. This was achieved primarily through all of the above initiatives, but perhaps most importantly through facilitating the creation and development of the Kenya Christian AIDS Network (KCAN). KCAN has spread like a grass fire throughout the country, with more than thirty branches being ignited in the past year, largely through the initiative of project-trained local pastors and lay leaders. Findings MAP carried out baseline and end of project follow-up research (quantitative KABP survey and focus group discussions) among church leaders and church youth, aged 12-19. This research was used to measure both behavior change and to complement the Process Indicator Forms in measuring the degree to which the projects had met its stated indicators of achievement. Findings from the process indicator forms (PIFs) and research studies showed the following results:
Further findings related to knowledge, attitudes and behavior were revealed in a comparison between the baseline and EOP research, as follows:
Constraints Several constraints, or obstacles, to project implementation were experienced during the life of the project. Broadly speaking, they can be placed under the following four categories: Technical: A significant part of the project's output was in materials production. Technical difficulties relating to computer capacity and hardware serviceability significantly delayed the production of several publications. As a result and in the end, it became necessary to sub-contract some of the production to professional desk-top publishers. The emerging drought in Kenya and resultant power shortages and blackouts during business hours throughout 1996, caused a number of production delays. Scope of the Project: The project was well conceived and designed, but significantly over-ambitious. Being an integrated and collaborative project, necessitating the initiative, collaboration and agreement of churches and church denominations having fundamentally different theological, interpretive and cultural perspectives proved to be a tremendous and sometimes overwhelming challenge. Yet it must be said that while this was a constraint, the seriousness of the HIV/AIDS epidemic has provided a context in which the churches are beginning to recognize and face the enormity of the crisis. They are choosing to do so in a spirit of unprecedented unity and singleness of purpose. Process vs. Productivity: In addition, the above constraints proved to have an incremental effect on program activities and production. By early 1996, MAP noted that they were significantly behind in the production of materials. In order to complete the expected outputs, they were forced to favor productivity over process. It may be that for the first 12-15 months of the project too much emphasis was placed on process and on building relationships at the expense of productivity. The relationship between capacity building as a process and the exigencies of productivity is likely to be a struggle in any project. Lessons Learned To bring about a desired behavioral change, there is a need to address cultural issues more extensively. Changes in core values are very difficult to achieve as underlying traditional cultural and religious values continue to be the foundation upon which behavior is built. To reduce the threat of HIV/AIDS requires that people modify or dramatically change behavior based on their core values. In its "Lessons Learned" draft paper, MAP noted that "many Kenyan communities (both 'traditional' and Christian) believe that HIV/AIDS has entered their communities precisely because they have abandoned traditional cultural practices and thus the supernatural forces which are entrusted with protecting those communities are displeased." Providing current, reliable information to church leadership was an essential element in empowering them to speak out on policy issues related to AIDS. MAP's basic strategy was to use baseline research in various forums, including the policy workshops, to inform, sensitize and educate church leadership as to the nature and dynamics of the crisis. When confronted by the reality and seriousness of the situation, they began to deal decisively and with urgency, unanimity and commitment to both express their concern and to address policy issues. This was immediately and correctly perceived by local church leadership as empowerment and authorization. MAP was able to play key roles in facilitation, coordination and communication, which considerably speeded the process up. Information was the most valuable resource MAP provided to churches. As an outsider, with inside credibility, MAP could successfully play the role of a mediator. The church in Kenya is fractured along denominational, theological and in some instances, ethnic lines. MAP, As a Christian organization with credibility in health development issues, but not identified with and particular church or denomination, came to be viewed as a trusted facilitator. It was essential the success of the project that facilitation not e associated with any one particular perspective or viewpoint. Churches will respond effectively to the AIDS epidemic, with proper training, provision of materials and information, and they are important partners. Initial contacts with most local church leaders revealed that they were well aware of the magnitude of the epidemic and aware of the vulnerability of their communities, but felt powerless to act effectively. Training, provision of awareness and educational materials, facilitation a communications hub and interaction between the church representatives were needed in order to affirm their capabilities and enable them to engage in HIV/AIDS interventions more effectively. Research provided both the credibility and rationale for AIDS interventions. Research identified the directions, content and target audience for a number of interventions. This included both program design and materials development processes. Country Office Assessment MAP very effectively and successfully involved Kenyan churches in HIV/AIDS issues. Major denominations had resisted discussing such issues into the mid-1990s. Several outspoken clergy argued that people living with HIV/AIDS had only themselves to blame, and issues of sexuality were avoided. Yet by the end of this project, all major church bodies in Kenya had signed a public statement, committing themselves and their denominations to developing HIV/AIDS policies, thus conveying a positive attitude. While clergy and parishioners may still consider HIV/AIDS a curse incurred by individuals as a result of the disruption of the surrounding social and cultural order, official church positions now recognize HIV/AIDS as a major problem and challenge to parishioners and church communities and denominations themselves, whatever the origins of the disease. The project learned too that there is an important synergy between the level of policy and decision making and the local grassroots level. When effectively managed, this synergy can lead to rapid and comprehensive change in attitudes and result in rapid change. To ensure continuity of information and experience sharing, MAP has been a leading partner in the formation of the Kenya Christian Network (KCAN) at the grassroots level. Most of the 32 branches that have emerged across Kenya reflect the interest and needs of clergy and laity to address HIV/AIDS issues aggressively in their congregations and communities. As mentioned earlier, one of the most far-reaching and long-term impacts of the project is likely to be the materials produced and distributed. All materials were produced after extensive consultation, widespread input and field testing, thereby ensuring that they were culturally appropriate and relevant. MAP's ability to change their production plans in response to research findings, from a publication for teachers to a youth-parent guide demonstrates the flexibility desired in a community project such as this. Additionally, MAP operated an innovative "no-missed-opportunity" formula by linking up with a mobile national cinema van which has so far reached a record 1.5 million Kenyans in the rural areas. The activity features a five minute spot announcement and the HIV/AIDS video Springs of Life Significantly too, MAP solicited funding from other organizations to reprint and translate several materials into French and Portuguese. This initiative is demand driven and reflects the opportunity for cross-border collaboration, especially in places with similar cultures. The materials earmarked for translation include the AIDS awareness package and the counseling manuals for pastors, and posters for youth, all produced under the AIDSCAP PVO grant. Several factors contributed to the change in church involvement:
Among the additional lessons that emerge from this successful project are:
MAP responded to a need in the church and succeeded in breaking ground where most other organizations failed to respond in practical ways. This project has been able to be a catalyst and facilitator in an ongoing transformation of involvement of the Church in Kenya in HIV/AIDS awareness and intervention. Process Indicator Summary
Building Sustainability for HIV/AIDS Church-Based Involvement in Kenya FCO# 56573
Background This subproject was designed to build upon the positive response of churches to HIV/AIDS prevention and care resulting from the intensive two-year project, Integrated Action Against AIDS with Kenyan Churches (described above). The subproject sought to strengthen the capacity of the Kenya Christian AIDS Network to work effectively and encourage HIV/AIDS prevention and care at the community level. This was to be achieved by the emergence of community-based HIV/AIDS interventions that were initiated and managed by local communities, harnessing all their resources locally. Secondly, the subproject was to facilitate the development and implementation of church policy guidelines at the denominational and local church level. This was to be accomplished largely through informal networking, leading to the presentation of HIV/AIDS policy documents for consideration to the supreme organs of two large denominations and one para-church organization. The third output of the subproject was to equip the alumni of previous pastoral counseling training workshops to train other church leaders in HIV/AIDS counseling and care. Lastly, the subproject sought to develop information resource points in identified KCAN branches country wide. Accomplishments A national convention was held that brought together 38 participants from 20 of the 34 KCAN branches, with seventeen denominations being represented. At the meeting, the vision and purpose of KCAN was discussed, and participants reviewed the process for the ratification of the draft KCAN constitution. Skills in the management of community based initiatives were also reviewed. The KCAN branches continued to hold regular meetings as the local branch level, with an average of twenty-one branches meetings at least quarterly. Participants are often drawn from a radius of about 30 kilometers of the local KCAN center. The representation of the different denominations as reported in the minutes of most branch meetings has been very encouraging. Most branches have also reported attendance by the local Ministry of Health officials, Provincial administration officials and teachers, keen to learn from KCAN. The participation of these officials has especially raised the social visibility and recognition of the networks. The quality of interaction and information exchange at these meetings has been very stimulating and owed much to the presence of community health workers, including community-based HIV/AIDS counselors. During the five months of this activity, three issues with a total of 7,500 copies of the K-CAN Newsletter were produced. The newsletter tackled such varied issues as policy advocacy, home based care for PLWAs, KCAN's vision and purpose, NASCOP reports, KCAN's role as a community-based organization, parenting skills and HIV/AIDS communication through drama. The newsletter was distributed through the regional coordinators. A total of 15 resource centers were established country wide and biblically based HIV/AIDS materials delivered to these centers. It was envisioned that 5 major denominations and two major umbrella church organizations would develop policy issues for consideration at their annual meetings. To date, the subproject has informally recorded two major denominations, the Africa Inland Church and the Presbyterian Church; and one para-church organization, the Police Chaplaincy, as having attained this level of policy advocacy. The Africa Inland Church at their just-concluded Baraza Kuu, the supreme organ of the church, in the month of April, received an elaborate presentation on the challenge of HIV/AIDS to the Church. About 245 alumni of 1995/96 workshops were followed up with letters asking how they had been able to deploy their skills in their communities. Eighty-six replied, reporting activities in AIDS education, HIV/AIDS counseling, youth education and marriage enrichment seminars. Home based care, training of trainers, and orphan support are areas yet to be effectively addressed. Many of the alumni were able to identify non-financial resources available to them at the community level. The responses also indicated that policy issues have yet to percolate to the grassroots. The project's four Regional Coordinators have visited branches on a continuous basis. Their role has been one of facilitation and encouragement of the local branches. They have attended 80% of the KCAN meetings - no easy feat as they have had to crisscross Kenya's dangerous highways to meet with branch leadership in remote outposts of the country. Constraints The KCAN constitution has been the subject of protracted debate among the members of the national steering committee and is still under review by the KCAN subcommittee concerned. There are basically two models that could be adopted to provide for the legal structure and management of the network. The first is a centralized structure where the network is registered under the societies act as a national movement. The other option is to free the branches to register with the ministry of culture and social services as self-help groups. This latter model promotes a participatory, non-directive network of churches and gives the local community a mandate to enact their own constitution and manage the affairs of the network locally. Policy development is a process of dialogue and education and evolves when members from within are deeply convicted of need. Ultimately, the respective denomination regulates the speed with which to implement policy decisions. Since the area of policy development did not significantly evolve during the short time frame of this subproject, no model policies were distributed to other church bodies. Recommendations While the concept of training trainers is effective, a system that both evaluates and monitors the amount of activity undertaken after the training and the quality of training that takes place at the second and third levels of training needs to be devised. The system should hold the alumni of TOT workshops accountable to the communities they come from. There is need to invest more resources in education workshops on the financial and institutional sustainability of HIV/AIDS interventions at the community level. The materials produced under the Integrated Action Against AIDS with Kenyan Churches have proven practical, relevant and effective. A system whereby they can be offered at cost should be developed to ensure that they will always be available. It would be desirable to pursue informal networks with specific church denominations to encourage and equip them to develop and implement HIV/AIDS policy issues. MAP?s experience has shown that most churches lack the vision and encouragement to work on these issues. Formal programs should focus once again at socio-cultural and spiritual misconceptions that promote HIV/AIDS prevalence in the Church. These may include condom use within marriage, the AIDS-as-a-curse debate and the Churches' response to PLWA's. Continuation of the KCAN newsletter would provide a cost effective medium of interaction among the KCAN branches. Process Indicator Summary
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