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This report comprehensively summarizes the FHI/AIDSCAP program in Senegal (1993-1997). The report includes a discussion of accomplishments, outcomes, implementation and management issues, as well as a series of lessons learned and recommendations.
Table of Contents I. Country Program Description C. Accomplishments and Outcomes D. Implementation and Management Issues II. Lessons Learned and Recommendations III. Subproject Highlights I. Country Program Description (continued) C. Accomplishments and Outcomes Capacity Building Introduction The purpose of AIDSCAP was to strengthen the capacity of local institutions to increase HIV risk reduction behaviors (e.g. using condoms, decreasing the number of sexual partners and seeking early and effective treatment of STIs) within specific target groups, with the overall goal of reducing the sexual transmission of HIV/AIDS. Within this context, the term "capacity building" is defined as "the process of enhancing local organizations (and the individuals within these organizations) and coalitions to design, implement and evaluate HIV/AIDS prevention programs and initiatives." The objective of capacity building is to provide local organizations with the necessary skills to implement sustainable AIDS prevention programs independently of AIDSCAP. The two main activities involved in capacity building are: strengthening organizations (organizational development) and increasing the effectiveness of coalitions (institutional development). In order to evaluate the results of the capacity building activities of the Senegal program, data was collected using three methodologies:
The CKIIQ was administered to representatives of 35 organizations having executed projects under AIDSCAP in the four AIDSCAP regions of Senegal. The data collected in the CKIIQ were processed to produce a quantitative measurement of the change in capacity of organizations to implement sustainable AIDS prevention and control projects and interventions before and after AIDSCAP. The responses collected during the focus group interviews were analyzed using several methodologies:
The results of the analyses were used in the development of the global Lessons Learned for AIDSCAP/Senegal. Technical Skill Building AIDSCAP/Senegal provided a wide range of technical assistance and training throughout the life of the project. Training was provided in BCC education and training, materials development, evaluation, communication strategies, STI management, condom promotion and logistics, sentinel and behavioral surveillance research, and policy dialogue. Technical assistance was given in all technical areas by Country Office (CO), Regional Office (RO) and Headquarters (HQ) staff, and national and international consultants. In addition, implementing agencies participated in national and international conferences on STI/HIV/AIDS increasing the knowledge and technical skills of agency staff. Prior to AIDSCAP, 77 percent of the organizations had initiated projects on their own (mostly in the health sector), however the remaining 23 percent had never previously managed a project. AIDSCAP provided the opportunity for small local organizations and associations to obtain training and experience in project execution, sometimes for the first time. For many organizations, this experience enabled them to "validate" their organization in the eyes of their community lending credibility to their organizations and paving the way for future activities. Questionnaire respondents were asked to evaluate their level of expertise and capacity in the various technical areas before and after AIDSCAP. They reported their levels as very good, good, average, weak or not applicable. It is important to note that this survey analyzes the perceptions of the respondents at the end of the project retrospectively. Due to the lack of baseline information, data should be viewed as an indicator of change, taking into account biases that may occur. Behavioral Change Communication In BCC, organizations were surveyed in the areas of intervention design, mass media strategies, counseling, training and development of IEC materials. Organizations reported an increase in their capacity in all areas. The greatest increase was seen in the area of BCC training where 26 percent of the organizations felt they were weak in this area before AIDSCAP, however only 3 percent stated they were weak in BCC training at the end of the project. In the areas of counseling and development of IEC materials the improvement in capacity was not as successful, however, some improvement was reported. This low level of increase in capacity was due to the fact that not all organizations implemented activities in these two areas and therefore did not benefit from technical assistance or training in this regard.
STIs The domain of STIs covered STI services, syndromic management, laboratory methods and STI clinic management. Only three agencies executed subprojects in STI management, however all three reported improvements in all four areas. Capacity building activities in this area involved the training of personnel in STI syndromic management, training of laboratory staff, and the provision of material supports and equipment to various health structures. By the end of the project, none of the three agencies reported weak capacity in the area of STI services. Research In the domain of research, organizations were questioned about their capacity in the following areas: focus groups, KABP studies, interview techniques, data collection and data analysis. Organizations which conducted research under AIDSCAP (approximately 30 percent of AIDSCAP/Senegal partners) reported an increase in their capacity in all areas at the end of the project. The largest improvement was seen in interviewing techniques and the collection of data. AIDSCAP provided technical assistance in the area of sentinel surveillance by way of assistance in the recruitment and training of personnel to conduct the surveys and assistance in the collection and analysis of information, as well as the provision of material support. The material assistance and training provided at the national level resulted in an improved system of data management and monthly monitoring. In addition, with AIDSCAP support, the "Epidemiology Bulletin" was published monthly with updated information. Condoms Following BCC, condom promotion was the most common activity implemented by AIDSCAP partners in Senegal. Although 37 percent of the subprojects did not include condom distribution, either due to the nature of the activity (for example, sentinel surveillance), the majority of subprojects did involve providing information on where to obtain condoms and/or referral to other health structures where information on condoms was available. In condom promotion and distribution, 42 percent of organizations reported a weak capacity at the beginning of the project, in comparison to only 16 percent at the end. Policy Dialogue Policy dialogue is an area which was not explicitly taken into account in the development of the majority of subprojects at the beginning of AIDSCAP, however, as the project developed, policy dialogue became a very important component in AIDSCAP/Senegal's overall strategy. By the end of the project, only 6 percent of organizations reported a weak capacity in policy dialogue, as opposed to 51 percent at the start of the project. Organizational competence in this domain was reinforced through direct collaboration with other partner agencies and government structures, as well as through BCC and training activities with religious, political, community and traditional leaders. The reinforcement of technical capacity can also be measured in the field by qualitative analyses of improvements in the strategies used by organizations in the types of interventions chosen for implementation, communication techniques used, the level of implication of leaders and the recognition of peer educators by their communities and target populations. The impact of these activities can also be measured in terms of increased demand for condoms, increased usage of health structures by STI patients, and reported changes in sexual behavior, not only by target populations, but also by peer educators and project personnel. Organizational and Management Skill Building The capacity of organizations to manage projects also improved through the execution of AIDSCAP subprojects. Organizations reporting a weak ability to manage a project before AIDSCAP was 33 percent, compared to only 10 percent after the project. Particularly in the areas of project planning, financial management, accounting and creating a budget, capacities increased substantially by the end of the project. However, organizations reported little improvement in the area of fundraising. Only 14 percent reported any progress in this regard. Partners reported increased recognition of their organizations, not only by their communities, but also by other organizations working in AIDS prevention, as a result of AIDSCAP. In addition, some organizations, have since established contracts with other donors. |
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