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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 (See Below) III. Subproject Highlights II. Lessons Learned and Recommendations Introduction AIDSCAP/Senegal held its Lessons Learned Workshop in May 1997 with the participation of 35 organizations which received AIDSCAP support over the life of the project. The objective of the workshop was to share experiences of the various organizations and associations in the implementation of AIDSCAP and elaborate elements which influenced positively or negatively the final results of the project. These "lessons learned" can then be used as guidelines for future HIV/AIDS projects in order to make the next phase of AIDS prevention programming in Senegal more effective. Since it's inception, AIDSCAP encouraged partnership with local institutions involved in health and non-health related activities. The majority of these institutions were those with a common interest such as women's groups, professional and commercial associations, youth groups, religions groups and associations of people living with HIV/AIDS. One of the objectives of AIDSCAP was to create a partnership with local non-governmental organizations (NGOs) and community based organizations (CBOs) in order to transfer knowledge and technology and to reinforce the capacity of these organizations to design, implement and evaluate sustainable HIV/AIDS prevention programs. The following lessons were learned through this initiative: The partnership with these local organizations allowed for community participation in the fight against HIV/AIDS, as well as allowing AIDSCAP to target individuals and implicate them as actors capable of taking decisions relating to their behavior and to influence others to do the same. This partnership also allowed for innovative approaches to HIV/AIDS prevention to succeed. The NGOs and CBOs as partners enabled AIDSCAP to surmount some of the cultural barriers which could have posed formidable obstacles in reaching certain populations with appropriate prevention messages. These accomplishments can also be attributed to a sense of ownership of the program that local organizations acquired through the partnership with AIDSCAP. Women & AIDS In 1994, AIDSCAP launched the women's initiatives in the fight against AIDS. Following this launch, AIDSCAP/SENEGAL financed a study on the needs of select women's associations in the regions of Kaolack and Dakar. The results of this study demonstrated the extent of the market women's exposure to STI/HIV/AIDS due to their migratory nature and limited financial means. The study resulted in an HIV/AIDS prevention program targeting the Serere market women, the objective of which was to allow these women to take decisions on matters relating to sexuality. This small intervention demonstrated women's fundamental preoccupation with their financial situation and economic activities. It became evident that a stand alone program on HIV/AIDS would not reach this group of women unless it was combined with a credit program responding to these women's primary concern: some sort of financial autonomy. An integrated program that encompasses income generating activities and training information on HIV/AIDS prevention would be advantageous as it would allow women to improve their economic situations and thereby allow for increased time to participate in such activities in addition to other advantages of economic empowerment. A program targeting women alone is not sufficient. Although the level of knowledge and means of protection was demonstrated to have gone up, discussions relating to their partners remained taboo. Given that women, in the African context, are rarely at liberty to take decisions relating to their bodies, it is important to elaborate interventions specific to men and women in order to incite the participation of men and to reduce the transmission of HIV to women. Use of visual training and education materials can be beneficial and are effective with such groups of women who not only do not have time to read but in most cases are of low literacy level. Policy Dialogue Political, opinion, traditional and religious leaders have shown to be invaluable support persons in the fight against AIDS. Gaining the support of such leaders helps to create a positive environment which supports AIDS prevention efforts as well as bringing the issues of AIDS to public attention. Political leaders have the power to create policies, such as adopting national STI guidelines or laws to protect the rights of persons living with AIDS, which are essential to AIDS programs. Religious leaders have great influence over their communities, particularly in a country like Senegal where 95 percent of the population practices an established religion (90 percent Muslim and 5 percent Christian). As religious and traditional leaders are generally highly respected and their views trusted, with their support, AIDS prevention messages are more likely to be believed and acted upon. The following lessons were learned in regard to the implication of leaders in the fight against AIDS in Senegal:
Other lessons learned in the area of policy include:
STI Service Delivery Syndromic Management of STIs has been found to be an effective approach to STI treatment, as well as considered time-efficient by health care providers who are generally overworked. This approach has also reduced the necessity of laboratories, which are often not well equipped, for diagnosis. However, there remains the issue of availability of recommended or equivalent drugs within the Bamako initiative which remains to be sorted out between the government of Senegal and donors. The question remains, should donors invest in training health care providers in the syndromic approach, while those seeking treatment for STIs have no access to the treatment? Although great improvements were made in the area of quality STI services, partner notification still remains a problem due to various cultural beliefs and practices which are often linked with the position of women in Senegalese society. In order to achieve greater success with partner notification, and thereby decrease the negative effects of STIs, health agents and peer educators should receive more training in an IEC approach directed at couples. In addition, AIDS topics should be integrated to a higher degree in the prevention of STIs. Behavior Change Communication The following lessons learned were identified in the area of Behavior Change Communication:
Mass Media Through Radio Within the framework of mass communication, AIDSCAP/SENEGAL implemented sensitization and information programs through Radio Kaolack and Radio Ziguinchor, both state radio stations serving the two different regions, as well as a private radio station, Sud-Fm, serving the regions of Dakar and Thies. Mass media through radio was found to be more efficient than posters or brochures in information campaigns against AIDS. However, its was noted that radio messages were not appropriate for all the targeted populations. Each locality has its sensitivities and specific preferences in the area of mass communication and other IEC support materials. Radio messages, as with other IEC materials, need to be adapted appropriately to the target audiences. In addition, as listeners can become saturated with information, messages should vary in content and format in order to avoid listener "burnout". Project Management The most common constraint cited by implementing agencies in the area of program management was the AIDSCAP administrative procedures which were seen by many implementing agencies as complicated and lengthy. The signing of agreements and reimbursement of funds was often delayed and in some cases caused not only delays, but also the cancellation of some project activities. Future projects should consider ways to decentralize the signing of agreements and/or disbursement of funds to field country offices in order to avoid lengthy complicated procedures. In addition, subagreements could be translated where possible into local languages in order to implicate to a greater extent small associations and local organizations in the administration, planning and design of their projects. Another management constraint experienced by the AIDSCAP/Senegal program was a lack of adequate staff. A program of this size and complexity requires an adequate staffing structure with appropriately trained staff to effectively monitor and evaluate field activities, particularly in the area of finance and management both at the national and regional levels. |
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