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Final Report for the
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E. Non Subproject Highlights Sub-agreements were not awarded to these project activities. They were carried out through technical assistance from AIDSCAP/HQ. PIF data therefore are not applicable, as trip reports provided the means for assessing progress. Policy Assessments and AIDS in Kenya Book (1993-97) AIDSCAP's policy strategy in Kenya began with a policy assessment carried out in late 1993 and early 1994 by AIDSCAP Policy Unit staff. The major finding of the assessment was that multiple issues surrounding HIV/AIDS were of concern to many groups of people in Kenya, but there had been minimal national leadership and little public debate or involvement in addressing the epidemic. The major recommendations of the assessment were eventually incorporated into sub-project agreements or other activities, as follows:
AIDS in Kenya: Socioeconomic Impacts and Policy Implications was the first book-length study in Africa to focus on the multiple implications of the HIV/AIDS epidemic. The book featured ten chapters by Kenyan and North American specialists, including the two senior editors who were staff of AIDSCAP. Chapters ranged from the impact on households to orphans to the formal business sector to the national economy. A series of case studies which focused on women drew particularly strong attention during the national launch ceremony and in follow-up media coverage. AIDS in Kenya was published in mid-1996 and was officially launched in October 1996. Kenya's Vice President was the keynote speaker at the launch, which also featured the U.S. Ambassador, the Country Representative of WHO, and the Director of Medical Services, MOH as supporting speakers. The launch received extensive publicity in both print and electronic media. In addition, the book and various of its findings were subsequently referred to on several occasions in articles and editorials in the English-language press. For example, the Kenya Times (October 26, 1996) wrote in an editorial: Although Kenya is in many ways ahead of other countries in understanding the epidemic, the country, however, lacked a cohesive program document before the launching of the book. It is hoped that new policies coupled with recommendations from the book will be pursued in order to prevent the further spread of HIV and to mitigate its impact. An original printing of 2,000 copies of the book was quickly distributed throughout Kenya and other countries. A subsequent printing of 5,000 copies permitted wider distribution, including hundreds of copies for the National AIDS/STD Control Programme, UNFPA, and the Kenya AIDS NGOs Consortium, among others. A brief mid-term policy status statement was prepared (see "A Review of Policy Dimensions of HIV/AIDS in Kenya", AIDSCAP Policy Profiles, May 1994) and an EOP policy assessment was conducted to examine changes in the policy environment in Kenya between mid-1994 and early 1997 (see "HIV/AIDS Policy in Kenya: A Review of Changes, 1994-1997", AIDSCAP 1997). The changes that both Kenyan and expatriate informants identified over the period included:
Process Indicator Summary
Private Sector AIDS Policy Manuals and Training (1994-95) Background The Private Sector AIDS Policy (PSAP) activity was initiated under a grant from USAID's Bureau for Africa/Office of Sustainable Development. The project developed a training package designed to help managers understand the impact of HIV/AIDS on business and encourage private sector managers to establish workplace HIV prevention programs and appropriate policies. The PSAP materials are now available to business institutions and other business decision-makers worldwide. These may include private sector, parastatal and other organizational managers, business community leaders, union leaders, and others. The materials comprise four separate but related volumes:
Presentations based on this material can be made at business managers meetings and luncheons, such as Chamber of Commerce luncheons, Rotary club meetings, or management seminars. Presentations can also be made to selected companies through pre-arranged meetings with mangers and/or the board of directors. Activities and Achievements The Country Office was involved in several stages of the development of the PSAP material. In late 1993, AIDSCAP and Health Economics and Development Research Associates (HEDRA) conducted a workplace policy needs assessment in Kenya as the first phase of developing this training package. The assessment involved the collection of information on existing workplace policies and activities relating to HIV/AIDS prevention, as well as activities that large scale organization may be planning in the future (see the HEDRA subproject description above). Date resulting from this and assessments in other countries in the region was used in developing a draft PSAP training manual. In July 1995, the draft training modules were field-tested in a training of trainers course with selected staff from a USAID funded organization which undertakes family planning interventions in the Kenyan private sector, Family Planning Private Sector (FPPS). The trainers then made short presentations to two Nairobi Rotary Clubs and to a group of 21 business people representing Kenyan Companies who were invited to attend a business lunch. The presentations focused on the nature and level of the AIDS epidemic in Kenya, the potential impact on the workforce and the kinds of workplace interventions and policies which might alleviate that impact. Of the 13 companies attending the luncheon, all but one sent company representatives to a workshop held the following week which explored in greater depth the need for sound HIV/AIDS corporate policies and the costs and benefits to the companies. Participants in the workshop received the PSAP draft Manager's Guide to Workplace HIV/AIDS Policies and Prevention Programs. Through the current AIDSCAP worksite project implemented by Family Planning Sector (FPPS) and funded by USAID, FPPS has been able to implement what was learned from the TOT workshop on the use of PSAP materials. As part of the HIV/AIDS worksite prevention program FPPS makes presentations to top management on the need to have a clear policy as the core of an AIDS intervention and as backup to the educational and curative components of the program. PSAP materials are easy to use and have been found to be beneficial to managers as they grapple with issues concerning AIDS at the workplace. Lessons Learned FPPS's experience in using these materials revealed some issues of general interest: It was not envisaged how difficult it would be to create an entry point to the workplace to reach management. Many company managers did not understand how an AIDS prevention intervention would fit within their regulations, operational set-ups and financial limitations. Most of all, the expressed concern that such activities would interfere with production or expose management to criticism regarding the way their regulations responded to HIV/AIDS issues. There must be a conducive and supportive environment in the workplace where managers appreciate the impact HIV/AIDS has on the work force. Some managers in the workplace did not have a short or long term picture of how HIV/AIDS would impact on their business or production. Using the PSAP materials strengthened the opportunity provided through managers' workshops, to sensitize senior level management and personnel officers and to discuss their company's policy and position on HIV/AIDS. Without the understanding and support of management, it would have been impossible to set up an AIDS prevention education project in the workplace setting. Introductory meetings and managers' orientation workshops are essential "kick-starts" for creating this supportive environment. To create a sense of project ownership, facilitators involved managers in discussing strategies for instituting and sustaining the project within their worksites. Although it is crucial to have a policy document, it is even more vital that the policy be interpreted, adopted and implemented by all key players who need to be fully conversant with it. There is a lengthy process involved in developing and adopting and implementing a policy at the workplace. FPPS found out that all parties: managers, peer educators, and the workforce need more time and technical support to identify the human rights and financial issues involved (such as confidentiality, anonymous testing, discrimination, and health benefits) and determine how they are currently affecting each individual company's operations, personnel policies, and morale. There is a need for a national watchdog body to enforce the adoption of a national HIV/AIDS policy or set of guidelines in the workplace. Many employers are in a dilemma due to inconsistent health policies regarding such issues as hiring/firing, insurance and medical benefits and HIV testing and confidentiality. Many companies do not have policies that touch on HIV/AIDS and have commented that they feel a need for guidance on these issues from national or industry-wide policy guidelines. Process Indicator Summary
Kenya Country Office Sustainability Activities (1996-97) Background and Objective The objective of HIV/AIDS prevention sustainability activities in Kenya was to strengthen the ability of AIDSCAP's implementing agencies (IAs) to sustain prevention interventions following the reduction, end, or even withdrawal of donor financial and technical support. The original objective given in the Country Office Strategic plan had included the collection and analysis of data for performing cost-effectiveness analysis on the AIDSCAP-supported interventions. Subsequently, it was felt that a full cost-effectiveness survey was more elaborate than was necessary. An analysis of the costs of typical interventions was substituted, with the intention that such information would be more relevant to the sustainability of IA's and HIV/AIDS prevention interventions. Activities and Achievements Sustainability was defined as the process of building an organization that is well organized and managed so that it has adequate funding and skilled staff to effectively serve its clients. Emphasis was placed on the terms: process, solid organizational skills and management, adequate funding, and maintaining support of clients and decision makers. The definition incorporates the three elements of sustainability that were emphasized by AIDSCAP:
This definition is broader than that normally used by USAID, and reflects the diversity of IAs and interventions supported by AIDSCAP. To achieve the sustainability objective, AIDSCAP assisted Implementing Agencies in Kenya by:
The workshop on sustainability took place on February 27-28, 1997 in Nairobi. Participating agencies included MAP International, Miujiza Players, the Kenya AIDS/NGO Consortium, Family Planning Private Sector, Kenya Association of Professional Counselors, the Department of Reproductive Health from Moi University, Artnet Waves Communication, AMSUNAAC, Program for Appropriate Technology in Health and Kenya One World Linking Forum and Pathfinder. Pathfinder sponsored two other agencies and two cooperating agencies also participated. The workshop included sessions to expose participants to different approaches to institutional sustainability and methodologies for assessing the sustainability of institutions. The participants also received key findings from their self-assessment forms and shared some of their own lessons learned regarding the three key areas of sustainability: financial; institutional; and political. Other practical sessions included budgeting, donor perspectives, proposal writing and action planning. Findings Key findings from the IAs' self-assessment forms, which were incorporated into the individual IA summaries, included:
Findings related to costs of implementing various interventions were presented in the form of percentage distribution of costs. The following tables summarize the cost findings. Table 1: Distribution of Costs for STI, Peer Education, and Policy Interventions ()
Data is derived from six STI, three peer education, and two policy interventions. Table 2: Diversity of Costs for STI Treatment
Lessons Learned/Recommendations Among the recommendations that emerged at the training workshop for IAs were:
Process Indicator Summary
Country Office Assessment This activity probably was conceptually complex and required more time and resources to complete than originally planned. All of the IAs found the data collection component of the project onerous and without expected outcomes clearly defined by AIDSCAP early in the process. The unspoken expectation of most IAs was that the activity would yield tangible benefits for the continued funding for their interventions, although AIDSCAP was clear that it was only providing some of the tools and analyses which individual organization would then have the responsibility to use to help chart their futures. On the other hand, the process did prove fruitful, in part because of the limitations noted above. The data provided by IAs was extensive, but demonstrated that planning for sustainability required good data and information and commitments of time and human resources. The summaries prepared by AIDSCAP from the responses on the self-assessment questionnaires were insightful and provided a clear analysis to each IA of their strengthens and weaknesses, in the context of building sustainable organizations. The cost data had less immediate usefulness for IAs, but may over the longer term. The conceptual approach adopted by AIDSCAP resulted in a more balanced and realistic basis for comment about each IA. Several IAs had given little thought to building management and organizational skills or assuring that they were in touch with peer organizations, decision makers and clients. AIDSCAP's conceptual approach, combining the financial, organizational and external aspects of sustainability, offered a holistic perspective which most IAs had not fully considered to that point. In addition to the recommendations that were made by IAs during the training workshop, it is also recommended that issues of sustainability be incorporated into FHI's program management approach, including during project design. It may be possible, for example, to incorporate sustainability indicators into a PIF-like framework. AIDSCAP Women's Initiative Activities (1995-97) Background The AIDSCAP Women's Initiative was established at AIDSCAP Headquarters in 1993, in response to the increasing understanding of the role of gender issues in determining the ability to achieve the behavior change necessary for successful AIDS prevention. AWI was managed through an office at AIDSCAP Headquarters, and representatives in the Regional Offices, who were responsible for discussing how Country Offices could best address the issue of gender-focused initiatives. Gender issues are clearly relevant to the design of AIDS prevention initiatives in Kenya. Sentinel surveillance data indicate that the peak age for infection in women occurs between the age of 15-29 and that women are increasingly infected at younger ages. Traditional attitudes, cultural taboos against discussing sexual issues, and the generally dominant role of males within partner relationships hinder women's attempts at negotiating safer sex and condom use and severely limit their ability to refuse sex. In addition, studies in Kenya indicate that young girls have inadequate information and skills on how to deal with physiological changes and the emerging sexuality characteristic of adolescence, and lack skills for negotiating healthy relationships. Should a woman want to protect herself, she is limited by the fact that woman-controlled devices for protection against HIV/STDs are virtually non-existent, since the female condom is not available in Kenya. Objectives The objectives of gender-related activities in Kenya were to:
Activities and Achievements
Process Indicator Summary
Country Office Assessment Despite, or perhaps because of the fact that the need to address gender issues is an essential element in the design of successful AIDS prevention activities in Kenya, this was a difficult intervention to put in place. Some constraints arose from suspicion and resistance to "gender" projects. For example, the initial interviews with company managers to request approval to carry out the project revealed that gender issues are poorly understood by management, being perceived primarily as contentious feminist demands, rather than investigation of the gender dimensions of interpersonal, organizational, and social relationships. This type of constraint underlines the need for educational interventions that address gender issues. However, other delays arose from the tendency of the relatively small pool of gender specialists to over-commit themselves, which led to conflicting schedules. Perhaps most significantly, the gender initiative project at the worksite was a component that was added on to an existing intervention. This was not surprising, since the AWI Regional workshop took place midway through the country program, but as a result the gender modules were seen as an add-on, not an integral part of worksite peer education. The primary objective of the AIDSCAP Women's Initiative and attendance at the regional workshop was to sensitize key policymakers, implementing agency staff and Country Office staff to the need to incorporate a gender perspective into the design of all future projects. This was particularly successful in the case of FPPS staff. They reported that following the gender sensitization workshop all staff were more aware of gender issues, and incorporated them into training. Specifically, trainers became aware of how the use of language and selection of examples and case studies could reinforce stereotypes. However, much more needs to be done with implementing agencies and Country Office staff to strengthen their understanding of a gender perspective. Comments on the Female Condom Study and the Mothers and Daughters needs assessment are noted above. Both projects clearly indicated the need to continue to support both the introduction of female-controlled protection at an affordable price, and interventions to empower mothers and daughters to communicate with each other on reproductive health and healthy sexuality. |
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