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Final Report for the
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8. Capacity Building AIDSCAP's overall approach to capacity building has been described in the Country Program Description section of this report. Detailed descriptions of specific sub-projects that built capacity in particular technical areas have also been provided in the relevant sections. Examples are the subproject with PATH to train NGOs in materials development (see BCC section above), the training for STD providers (see STD section) and training for KANCO members in policy development (see Policy section). Most sub-projects, however, resulted in capacity-building, either through their direct training components, AIDSCAP technical assistance, or ongoing Country Office review of their financial and program monitoring capabilities. The following projects were specifically designed to provide technical assistance to build the capacity of organizations and so are included in this section. Technical Assistance to the Kenya AIDS NGOs Consortium Resource Centre FCO 36473 and 56572
Background In 1994, AHRTAG a UK-based NGO, was invited by the Kenya AIDS NGOs Consortium (KANCO) and FHI/AIDSCAP to provide technical support and training for a project to develop a Resource Centre and practical HIV/AIDS/STI information services in Kenya. This was administered under two Letters of Agreement (LOA), the second of which was basically a cost extension for provision of end of project evaluation support. The first LOA was budgeted at $32,640 and the second at $18,105. Objectives Overall, the technical assistance was to be provided with a view to:
Accomplishments Over the course of the project, AHRTAG's AIDS Program and Information Systems Unit staff visited KANCO during five separate trips. Additionally, the KANCO coordinator was able to work with AHRTAG in London in August 1996. The Information Coordinator made specific inputs on the original assessment, strategic planning, project management, monitoring and evaluation, and narrative and financial reporting to FHI/AIDSCAP. He made three visits in October 1994, December 1995, and February 1997. A documentalist provided support on the development of a classification scheme, information management, quality control, Resource Centre policy, training in computer database use and maintenance, space design, and monitoring forms. Her site visit was made in March 1995. The Program Officer provided assistance in information support, review of information packages and other KANCO information products. She worked with KANCO on the field review of resource packs on materials for youth and youth-serving organizations. She also helped in project planning, implementation, and evaluation. She visited KANCO in December 1995. An AHRTAG documentalist worked with KANCO staff and the evaluation committee to determine key issues for evaluation, during a site visit in December 1996. This included issues for the desk review project and those to be verified in the interviews and focus group discussion with users. During her visit, she assisted in the development of the data structure of the AIDS information system, which the KANCO staff are currently using to revise the AIDS information system. With the KANCO team, she was able to revise the monitoring form and design data bases to hold monitoring data to reduce data processing at the end of the year. She also helped in the design of internal procedures to ease the flow of data from users to staff and amongst staff themselves. AHRTAG's Design and Production Officer reviewed KANCO Resource Centre's information products, and recommended suggestions to strengthen the design of the KANCO newsletter. Through their network system, AHRTAG was instrumental in supporting an exchange and training visit whereby KANCO's Resource Centre Officer co-facilitated a workshop in Botswana hosted by the Southern African Network of AIDS Service Organizations (SANASO) in 1996. Country Office Assessment AHRTAG has enjoyed an open and constructive relationship with KANCO staff, volunteers, and members, as well as with FHI/AIDSCAP. This has facilitated the fulfillment of AHRTAG's terms of reference. AHRTAG has been involved in developing a new plan and proposal for the next three years of the project, and is committed to continuing its participation in such an important, dynamic, and successful initiative. AHRTAG's results and achievements can be inferred from the Resource Centre's activities which they actively supported through the life of the project, from initiating a needs assessment to conducting a final project evaluation. The lessons learned and recommendations are equally relevant to AHRTAG (see report on KANCO Resource Centre above). This technical assistance from AHRTAG was a well thought out and executed project. It is important that when highly technical projects such as the Resource Centre are initiated, linkages with leading groups in the specialty be established from the onset. Not only did it help in setting up an internationally acceptable resource base, but it also helped to create standards within the country . The Resource Centre has established itself as a focal reference point and information source for both non-governmental and government institutions. This was confirmed during the end of project evaluation which affirmed that KANCO's Resource Centre was one of the two major primary sources of information on AIDS/HIV, the other being the National AIDS/STD Control Programme. AHRTAG used a team approach, hence ensuring that technical support tied directly into the Resource Centre's outcomes. Thus separating the Resource Centre's achievement from the support provided would be a misrepresentation of AHRTAG's contribution.
Technical Assistance to the Kenya National AIDS/STD Control Programme FCO 20481, 40475, 56488
The Letter of Agreement and consultancy agreements listed above are treated as one activity for the purposes of this report, since they were all administrative mechanisms to provide technical assistance by Paul Newton to the National AIDS/STD Control Programme. The purpose of the TA was to upgrade and monitor the national HIV sentinel surveillance system. Background In 1991, the Kenya National AIDS Control Program requested assistance from AIDSTECH to support and link sentinel surveillance data collected from antenatal and STD clinics with AIDS reporting and blood donor screening systems. At that time, the inputs to the surveillance system were based on a combination of manually completed reports and data on dBase compatible files, with duplication of entry sometimes occurring when the same data were sent in both forms. Additionally, reports were not received on a timely basis and were not consistently complete and accurate. There was a lack of system integration, lack of flexibility in interfacing between systems, and thus a lack of flexibility in reporting. Once the system was in place, it was realized that networking of computers at NASCOP would enhance the flexibility of the system and eventual decentralization of the system would help to involve and motivate those officers at the remote sites responsible for original collection of the data. In order to enhance the system, NASCOP needed enhanced computer capability, staff training, and ongoing monitoring and support for systems problems. This was provided by AIDSCAP through several linked interventions: technical assistance through the three agreements listed above and enhanced computer capability and training through a separate agreement with NASCOP (see below). From 1991, AIDSTECH worked with Paul Newton of Braeburn Limited, to design software for an expanded sentinel surveillance system and carry out preliminary work on a Project Tracking System. This assistance was continued through the technical assistance described below. Objectives The overall objectives of the interventions were to:
Accomplishments In 1993, a Letter of Agreement, Technical Assistance for Project Tracking System and Sentinel Surveillance for the Kenya National AIDS Control Program, was signed with Braeburn Limited, to enable Paul Newton to continue to upgrade the system. At that time, four sites were computerized, while the rest were still using manual data entry. The objectives were to modify the software for the Project Tracking System and the Sentinel Surveillance/Case Reporting/Donor Screening Systems; to link selected computers at the NACP; and to upgrade training in use of the software program. Under this agreement, Paul Newton:
Under a follow-up consultancy agreement (June 26, 1995 to August 26, 1996), Paul Newton provided ongoing support for the surveillance system, through funding two days' technical assistance per month. The work carried out included minor enhancements to the system, such as adding the new variables used in the 1993-94 sentinel surveillance survey, and providing ongoing training to staff at the central NASCOP office. In January 1996, a further consultancy agreement was concluded to support a Letter of Agreement with NASCOP to upgrade the sentinel surveillance system (see the following project description). By early 1996, the original 13 sentinel surveillance sites, based in urban areas, had been increased to 19, six being peri-urban sites. At this point, with a well established software system in place, it was realized that decentralization of the system, including the data entry and analysis process, would increase the motivation and technical skills of those officers responsible for collecting the data at the remote sites. System hardware also needed to be reviewed and upgraded at both central and site levels. Paul Newton was therefore hired to supervise the technical aspects of upgrading the surveillance system, and provide training in data entry and analysis. In late 1996, the sites were further expanded to 24, with the addition of 5 rural sites. The objectives of this consultancy were to streamline and modernize the sentinel surveillance system through installing computer hardware and software at eight sentinel sites (to replace manual entry of data); to network the computer system; and to provide training and on-site supervision to sentinel site officers. Technical assistance was given by Paul Newton to:
Constraints Difficulties in communication between the remote sites and the central NASCOP office meant that the site visit teams sometimes found unexpected system problems (for example, hardware problems) that delayed the work of the team. Some of the hardware is now so old as to be virtually obsolescent. Procurement of consumable supplies (diskettes, paper, ink) by the remote sites was often a problem. This was due to one or more of the following: lack of funds, lack of transport, exorbitant prices (especially outside Nairobi/Mombasa), lack of availability. For similar reasons, maintenance and repair of equipment was a particular problem, especially for the remote sites. Lessons Learned New computer systems and software for handling multi-level and varied information require many changes in the field and should be installed in stages and modified over time. Input and involvement in a data management system from users at all levels provides motivation for all concerned, down to the district level, to use the system and to work with greater interest and accuracy. Provision needs to be made for maintenance and eventual replacement of the computers at the remote sites. Better provision is also needed to ensure continuous availability of consumable supplies (paper, ink cartridges, printer ribbons and diskettes) for the remote sites. Country Office Assessment Since 1991, when the first surveillance data were obtained on a regular basis, Kenya has had one of the best HIV sentinel surveillance systems in the Sub-Saharan region. AIDSCAP assumed the role of supporting the system at the time when the WHO/Global Programme on AIDS was withdrawing its technical staff and funding support from the NACP. The technical assistance provided by Paul Newton through AIDSCAP was an essential component of creating a sustainable national HIV sentinel surveillance system. Decentralizing the system will contribute to the new policy emphasis on a district focus, and will enhance the role of local District AIDS/STD Control Programs. As noted above, it will be important to ensure that site monitoring continues, that new staff are properly trained in data collection, analysis and reporting procedures, and that computer hardware is well serviced and maintained. Without these inputs, the system is liable to degenerate or to provide incomplete data.
Strengthening NASCOP Epidemiology and Sentinel Surveillance System FCO 56488
Background The National AIDS/STD Control Programme is the main custodian of national data on AIDS/STDs, which includes the sentinel surveillance system. Technical assistance to develop and maintain this system had originally been provided to NASCOP under the AIDSTECH program, and this was continued under AIDSCAP (see above: FCO 20481: Technical Assistance from Paul Newton to NASCOP). By 1995, it was evident that the data analysis facilities and computer hardware were no longer adequate to handle the storage capacity and speed required for the sentinel surveillance system. In addition, it was considered desirable to enhance the system's flexibility by decentralizing data entry to the sites and enhancing system interface between site and central level. Objective The purpose of this agreement was to provide additional hardware to NASCOP, to institute regular servicing for the system, to provide initial and follow-up training to sentinel site officers in data entry and analysis procedures, and to supervise the new system through one site visit. This agreement covered the purchase of the equipment and training costs: technical assistance and training expertise was provided through a parallel consultancy agreement with Paul Newton (described above). Accomplishments Three computers and printers were bought and installed at NASCOP. The FoxPro surveillance system was installed at 8 sentinel surveillance sites (5 already had computer data entry facilities), so that all 13 original sites were now entering data at source. 19 officers from these sites received a refresher training in basic computer skills, training in the FoxPro surveillance system in one three-day workshop, and follow-up training in a later three-day workshop. Each site received one follow-up supervision visit, which was carried out by the technical assistance consultant and one representative from NASCOP. (Note: these are the same activities described above, under FCO 20481 et al.). Lessons Learned and Country Office Assessment The project constraints, lessons learned, and recommendations were described above, under FCO 20481 et al. Also see FCO 20481 et al. for country office assessment. Process Indicator Summary
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