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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 III. Subproject Highlights (continued) BCC Projects
Background and Scope of Intervention Created in 1990, the Kaolack division of the Association Sénégalaise pour le Bien-Etre Familial (ASBEF) works at the regional level and is involved in family planning and family life education for youth. Other main activities include the treatment of sexually transmitted infections and infertility. This project employed an outreach strategy by providing health information kiosks around the weekly rural markets of the Kaolack region. The weekly markets are a business and social attraction for out-of-school youth, men and women, many of whom arrive at the market places a day or two before market day. The health information kiosks were intended to create an interactive dialogue with the target groups by placing information stands in strategic market places to distribute information and materials on HIV/AIDS and other important public health diseases, and to refer patients to health clinics for the treatment of STIs. The kiosks worked in collaboration with the heads of transportation stations and neighborhoods where the kiosks were located, and with religious leaders, women's groups, medical personnel, EPS, chiefs of villages, schools and other NGOs working in the region. The project targeted populations known to practice high-risk sexual behavior and to be difficult to reach: clandestine commercial sex workers, out-of-school youth, illiterate men and women, students and truck drivers. The purpose of the project was to educate out-of-school, illiterate youth and clandestine CSWs about AIDS transmission and prevention, to sensitize the general population through the health information kiosks and to promote condom use among the target groups. The overall objective was to reduce high-risk sexual behavior among the targeted groups and the general population in the Kaolack region. Principal Accomplishments Training sessions were conducted for 15 peer educators covering HIV/AIDS prevention and control, counseling and condom usage. These peer educators were intended to manage the 15 health information kiosks, however as only 5 kiosks were completed (due to administrative problems), the other 10 peer educators conducted IEC sessions and informative discussions with the target populations without the structure of a kiosk. A total of 166 education sessions were held, reaching a total of 5,521 people with STI/HIV/AIDS prevention information and condom distribution. In addition, 1,178 home visits were completed educating 1,203 people. Peer educators also referred persons with suspected STIs to appropriate health structures to seek treatment. In terms of IEC materials, 164 brochures in French and 2,121 in Wolof/Arab were distributed, among other IEC materials. A total of 75,400 condoms were sold through this project. Important Constraints
Lessons Learned and Recommendations The use of health kiosks as a strategy for reaching target populations and the general population with STI/HIV/AIDS and general health information is recommended for future projects. Increased supplies of IEC materials as well as variety in the types of materials used, for example the projection of films, would also benefit future projects and increase interest among populations. The provision of a vehicle would significantly improve project supervision capacity.
Background and Scope of the Intervention The Society for Women Against AIDS in Africa (SWAA) implements activities throughout Africa in AIDS prevention. The Senegal chapter was created in 1989 and is involved in interventions at the local, regional, national and international levels. In Senegal, SWAA works in collaboration with the Programme National de Lutte Contre le SIDA (PNLS), NGOs and women and youth associations. Its principal activities are BCC, research, counseling and care and management for persons with HIV. The SWAA-Youth chapter works with youth and AIDS in peer education and behavior modification targeting youth between the ages of 14 and 25 years. AIDSCAP supported the regional chapter of SWAA in Ziguinchor in the implementation of an BCC project targeting women and clandestine commercial sex workers (CSWs) and their partners. The outreach strategy focused on health information kiosks which operated five days a week in the weekly markets in Ziguinchor where the ordinary stalls at the market places offer merchandise for sale as well as back rooms for services for CSWs. The health information kiosks were intended to create an interactive dialogue with the target groups by placing information stands in strategic places in the markets to distribute information and materials on HIV/AIDS and other important public health issues. The purpose of the project was to reduce high-risk sexual behavior among adult women and clandestine CSWs in the Ziguinchor region. The objectives for this intervention were:
Principal Accomplishments Training sessions were held for 12 members of SWAA/Ziguinchor to function as health educators. Training included STI/HIV/AIDS prevention and other health issues such as diarrhea, malaria, and family planning. Ten kiosks were established and a total of 1,205 IEC materials and 2,862 condoms were distributed. Through these kiosks 5,329 people received information about STIs/HIV/AIDS and other health issues. Important Constraints Administrative procedures to receive authorizations for the establishment of kiosks delayed the opening of all kiosks, as well as delays due to construction labor. In addition, some kiosks were placed in areas of high population and poor sanitary conditions which hindered access to the kiosks. Negotiations with local authorities to improve these conditions are in progress. Other constraints noted during project implementation were:
Lessons Learned and Recommendations High public interest in the kiosks shows the value of such an intervention strategy. The continuation and multiplication of kiosks in Ziguinchor and other regions is recommended. The need for follow-up training for health educators was also identified. As materials and condoms were in high demand, increases in supplies would allow the intervention to reach more people. It is also recommended to explore the possibility of selling condoms to contribute to the costs in running the kiosks and to provide a means for sustainability when AIDSCAP support ends.
Workplace AIDS Prevention
Background and Scope of the Intervention SANFAM is a Senegalese NGO providing health services to the private sector. It has worked with private and government companies in providing information and education on contraception, sexually transmitted infections and the treatment of sterility, vaccinations and nutrition of infants, safe motherhood and AIDS. AIDSCAP supported SANFAM in the implementation of a behavior change intervention targeting industry workers, and their families and partners with the objective of stabilizing and reducing the rate of STIs and sexually transmitted HIV in workplaces in the two regions of Dakar and Thies. The project's purpose was to reduce high-risk sexual behavior among the target population by sensitizing management staff, workers, and their families and partners on HIV/AIDS prevention and control. Several strategies were adopted for this project: 1) behavior change communication through peer educators, IEC outreach campaigns, mass media and interpersonal counseling; 2) establishment and expansion of condom promotion and distribution; and 3) development of the capacity of designated companies to design, implement, manage and evaluate HIV/AIDS prevention programs. Six SANFAM staff members attended a training course in HIV/AIDS at the beginning of the project to reinforce their technical skills. Four companies which had established health committees or clinics within the company were selected to participate in the project and meetings were held with managers and workers to ensure their commitment and active participation. Sixty-six peer educators were trained in STI/HIV/AIDS education and prevention, and subsequently held IEC sessions educating a total of 1,013 people. In addition, 5,900 IEC materials (brochures, calendars, T-shirts, etc.) were distributed during IEC sessions and special events, as well as in clinics, restaurants, bars and boutiques which are located near the companies and often frequented by the workers, their families and partners. SANFAM also began IEC activities in the tourist area of Mbour and was chosen to continue prevention activities at the university in Dakar. In addition, 13,475 condoms were distributed throughout the life of the project and a KABP study was conducted at the start of the project to assess levels of knowledge and attitudes towards STIs/HIV/AIDS. Important Constraints The management of certain companies would not permit the introduction of AIDS activities in their companies. Unfortunately, as a result some companies which were planned for interventions were not included in the project. Lessons Learned and Recommendations Marketing of this project directed at the heads of companies would help to lessen the obstacles to project activities and create a more positive environment for interventions within the work place. In addition, negotiations with company heads to increase the number of peer educators would increase the reach and impact of the project. Project staff also recommended giving certificates to peer educators after completion of training to document their participation and validate their status of peer educator among their coworkers.
AIDS Prevention and Education Materials
Background and Scope of the Intervention Education Pour la Santé (EPS) is a division of the Ministry of Health in Senegal with the overall mandate for health education and information nationwide. It is responsible for the design and implementation of health programs in all regions and districts of the country. Its past activities include training, multisectoral collaboration with the private sector to execute IEC programs, development and production of information materials in the print and electronic media, and small media production. EPS works with the Programme National de Lutte Contre le SIDA (PNLS) and other national health authorities to establish a comprehensive approach to the prevention of sexually transmitted HIV. It insures that information materials developed and produced are readily available to private and public institutions, sister organizations, and NGOs collaborating with AIDSCAP. AIDSCAP supported EPS in the implementation of a project targeting four populations -- youth, commercial sex workers, men-at-risk and women-at-risk in Dakar, Thies, Kaolack and Ziguinchor. The purpose of the project was to reduce high-risk behaviors among the target populations with the objective of stabilizing the prevalence of HIV in the four regions. Principal Accomplishments Project outputs were: the design and implementation of HIV/STI prevention activities for the target populations using peer education and community outreach methodologies; development and distribution of IEC materials to support peer education and special events activities; establishment and expansion of condom distribution; and, the strengthening of the institutional and technical capacity of EPS to implement HIV/AIDS prevention and control activities. Throughout the life of the project, 660 people were trained as peer educators, and a total of 31,881 people were educated. A variety of educational materials, such as posters, brochures, booklets, flipcharts, T-shirts, and key chains, were produced and tested, and 832,955 condoms were distributed. EPS staff members were trained in IEC techniques in AIDS prevention and in the management of IEC projects. A Training of Trainers was held for 10 managers of regional offices, and 22 EPS district managers were trained in the management of AIDS prevention programs. Important Constraints Decentralization was not completely implemented and delays in financing resulted in the non-execution of some activities. In addition, there was insufficient supervision by EPS at the national level of peer educator activities. Lessons Learned and Recommendations
Radio Interventions in AIDS Prevention in Ziguinchor
Background and Scope of the Intervention Ziguinchor Radio Station, a government radio station, reaches an estimated population of 462,000 inhabitants in the region of Ziguinchor, a crossroads between other regions of Senegal and the neighboring countries of the Gambia, Guinea Bissau and the Republic of Guinea. Its activities include the broadcasting of information, education and communication on different subjects, including health. Radio Ziguinchor uses 14 languages in its programming: three international languages (French, English and Portuguese), six national languages and five local languages. Radio was selected as the main channel for mass-communication in Senegal because of low literacy rates (approximately 80 percent of the population is illiterate) and as less than 0.05 percent of the rural population and less than 20 percent of the urban population have television sets. The project goal was to reduce high-risk behavior among the target population in the Ziguinchor region through increased awareness of STI/HIV/AIDS and methods of transmission, as well as improved perception of risk. The project covered all districts of Ziguinchor and targeted sexually active adults, youth, women at risk, men at risk and commercial sex workers. Principal Accomplishments During the life of the project 30 on-site radio emissions took place in various locations in Ziguinchor. These live broadcasts in local languages addressed issues of HIV/AIDS and were meant to bring the message directly to targeted populations. Two training sessions were conducted for a total of 15 people working in production, creative design, survey development, reporting and mini programs for radio. Besides training in skills development, these training sessions resulted in the production of 15 radio programs which were subsequently broadcast on Radio Ziguinchor. A roundtable was organized at the Ziguinchor studio to discuss issues of STI/HIV/AIDS with the participation of personnel from the regional services, including health education, community development, and social action. Two additional roundtables were organized, one led by the Regional Chief Health Officer and a third taking place as part of the World AIDS Day activities in December 1996. A total of 16 radio series were produced in 14 different languages, in addition to 4 sketches in local languages and a live radio program with telephone call-ins on World AIDS Day. 62 radio shows were developed in French and local languages (Mandigo, Wolof, Dioula and Pular). In addition, 129 scripts on different HIV/AIDS topics were developed, as well as a feedback network via 18 radio show contests. Radio Ziguinchor also covered numerous other AIDS activities and events sponsored by the Government and other AIDSCAP partners in the Ziguinchor region. As a result of this project, coupled with the interventions of other partners working in AIDS prevention, project monitors observed an increased awareness in the general population of the AIDS epidemic and the development of a mentality more open towards discussions of AIDS. Men and women appeared more apt to discuss issues of sexuality together increasing the possibility for safer sexual practices. In addition, Radio Ziguinchor is increasingly solicited by different associations and organizations to cover and animate events and activities in the region. Important Constraints Problems of social and political unrest and the ensuing deterioration of socioeconomic conditions caused the displacement of some populations towards urban centers and neighboring countries. This interrupted the execution of a coherent AIDS program targeting a specific population. Lessons Learned and Recommendations
Radio Interventions in AIDS Prevention in Kaolack
Background and Scope of the Intervention The Kaolack Radio Station, a government radio station, reaches a population of 912,632. Based in Kaolack, it covers the entire region and its surrounding areas and is responsible for all radio programs in the area. Its activities include broadcasting of information, education and communication on different subjects, including health. Radio Kaolack worked with the Programme National de Lutte Contre le SIDA (PNLS), the Regional Health Authorities and local communal AIDS authorities to establish an HIV/AIDS prevention radio program. In addition, it collaborated closely with Education Pour la Santé (EPS) which supplied IEC materials and AIDS information and reviewed programs before broadcasting. The goal of this project was to reduce high-risk behavior among the target population in the Kaolack region through increased awareness of STI/HIV/AIDS and methods of transmission, and improved risk perception. The project covered all districts of Kaolack and targeted sexually active adults, youth, women at risk, men at risk and commercial sex workers. Principal Accomplishments Six journalists were trained to communicate HIV/AIDS control and prevention messages and to conduct interviews in the villages to collect information to be used in radio programs. These interviews also provided a measure of the level of knowledge of the community and provided information as to what kind of programs would best reach the target population. Excerpts from the interviews were used during radio programs providing the audience with a greater sense of connection to the message. Project monitors observed a significant increase in the communities' level of interest and attention to the radio programs. In addition to the regular radio programs, a 2.5 hour radio magazine for young adults was created targeting youth about the issues of AIDS. Radio Kaolack also covered other AIDS events and activities implemented by other organizations and AIDSCAP partners in the region. A total of 2,563 IEC materials were distributed throughout the life of the project. Important Constraints A lack of coordination at the regional level was a handicap for the journalists who were not able to cover all of the special events of other organizations and AIDSCAP partners as requested. Lessons Learned and Recommendations
Women's Involvement in AIDS Prevention
Background and Scope of the Intervention Senegal has a population of about eight million, 52 percent of which is women. As sexual transmission of HIV has been identified as the most common method of transmission in Senegal, women are particularly vulnerable and at risk for infection. The Fédération Des Associations Féminines (FAFS) is a coalition of women's groups which are active in a variety of activities, including economic, social and community affairs. AIDSCAP supported FAFS in the implementation of a project targeting women who are members of FAFS and other women's associations affiliated with FAFS, as well as other women in the four targeted regions of Dakar, Thies, Kaolack and Ziguinchor. The purpose of the project was to reduce high-risk sexual behavior among the targeted populations with the objective of stabilizing or reducing the STI/HIV prevalence in Senegal among women aged 15-45 years. Principal Accomplishments The project began with strategic planning meetings with regional FAFS associations, local authorities and other partners to explain the project's goals, objectives, and develop a workplan. In addition, 246 peer educators were trained during these sessions on STI/HIV prevention. A training workshop was then organized for 15 members of the FAFS office in the management of IEC activities. The training covered the topics of IEC activities organization, training of peer educators, supervision of IEC training sessions, and the collection and organization of PIF data. The peer educators subsequently organized 2,486 IEC sessions throughout the 4 AIDSCAP regions. A total of 10,674 youth, 23,945 women and 8,536 men were educated during these IEC sessions, which included materials and condom distribution. FAFS also organized special events during the annual manifestation entitled "Quinzaine Nationale de la Femme" in which 9,000 women participated, as well as during the World AIDS Day, the National Youth Day. An information and documentation center on AIDS was created in Dakar to provide a permanent reference center on HIV/AIDS. The implementation of this project helped to reinforce the capacity of FAFS to manage IEC activities. Training was given to select staff in IEC project management. In addition, with the technical assistance of AIDSCAP, FAFS staff developed skills in project development, identification of project goals and objectives, establishing a workplan, strategic planning and report writing. FAFS improved its internal financial management system and its technical management of social projects, as well as increasing its experience in IEC materials development. During the life of this project, FAFS witnessed a mobilization of the community to work together in the fight against AIDS and a raised conscience of the responsibility and role of women in this fight. This was seen through the daily monitoring of IEC activities and participation in special events, as well as through informal discussions with project participants. FAFS has also initiated AIDS education and prevention activities in the other 6 regions of Senegal through their regional offices and affiliated associations. Important Constraints Two constraints were identified in the project:
Lessons Learned and Recommendations IEC sensitization has been an effective strategy for AIDS education and should be extended to the other six regions of Senegal. It is also recommended to include income-generation activities with AIDS education and prevention programs. In addition, the training of trainers in communication and counseling would greatly improve their skills as IEC trainers and educators.
Media Interventions in AIDS Prevention
Background and Scope of the Intervention The total population of Dakar is estimated at around 2 million inhabitants. Dakar is an important port on the west coast of Africa and is also a crossroads station for several landlocked countries in West Africa. SUD Communications is a region-wide radio station and daily newspaper in Dakar that also reaches other regions of Senegal. Its activities cover the broadcasting of general information, and education and communication on subjects such as health (STI/ HIV/ AIDS), agriculture and the environment. This project targeted sexually active adults, youth, women and men at risk and commercial sex workers (CSWs). These groups constitute a large segment of the listeners and readers of SUD Communications media. The goal of the project was to reduce high-risk behavior among the target populations in Dakar by improving knowledge, awareness, attitudes, and risk perception about STIs/HIV/AIDS. Principal Accomplishments Several activities were conducted under this project: the production of radio programs in French and Wolof on HIV/AIDS with audience participation, the training of journalists in media materials development, and the production of weekly newspaper articles on STIs/HIV/AIDS. By the end of the project, radio programs were produced in French and Wolof for a total of 153 broadcasts including roundtable discussions, interactive broadcasts with interviews, and special events. There were 37 radio game shows with an average participation of 250-300 people, totaling 10,800 persons. The number of listeners for these programs was estimated at 200,000. In addition, 5 skits were produced and broadcast, and several special events, seminars and other AIDS activities were covered by the Sud FM radio station. A total of 334 minutes of air time was given to coverage of 2 major special events -- the World AIDS Day and Youth AIDS Week -- and 30 minutes air time for the 2 major seminars on Religion and AIDS and other AIDSCAP conferences. Four journalists (1 for the newspaper and 3 for radio) were trained on AIDS prevention issues and 21 four-page special reports on AIDS were published in the Sud Quotidien newspaper reaching an estimated 15,000 readers, and 259 articles on AIDS were published. Important Constraints It was planned to develop a network with radio listeners through the encouragement of sending letters to the radio station concerning AIDS issues, however, due to sociocultural beliefs about sexuality, listeners did not respond in writing to AIDS programming. In addition, target populations had to have access to radios in order to participate in activities, which was sometimes a problem. The absence of baseline evaluation information made it difficult to measure the success of the project after execution. Lessons Learned and Recommendations Emphasis should be placed on the quality and variety of radio programs and not just quantity in order to avoid market saturation. Too much of the same message may make the information benign and result in listeners "tuning out" the message. In addition, programs on the motivations for behavior change can only be effective once the target audience has a high level of knowledge of AIDS.
(FCO 56065)
Background and Scope of the Intervention The Christian Reformed World Relief Committee (CRWRC) worked in collaboration with the Society for Women and AIDS in Africa (SWAA) and Femmes, Développement, Enterprise en Afrique (FDEA) in the implementation of an HIV/AIDS project in Dakar, Thies, and Kaolack targeting women working in the market place and out-of-school youth in the low-income neighborhoods of periurban areas of Dakar. As low-literate, low-income women and youth have been identified as one of the groups with the highest risk of infection in Senegal, this project sought to educate these groups on HIV/AIDS prevention in order to increase safer sexual choices and behavior, and thereby reduce the risk of HIV infection and sexually transmitted infections (STIs). The project worked intensively with 38 groups -- 29 women's groups which were members of FDEA and SWAA and 9 youth groups which were members of the neighborhood community centers or youth groups assembled by the SWAA youth trainers. The intervention consisted of participatory group training and education sessions in the local language, Wolof. The education sessions were based on a trainer's manual, participant's workbook, and a range of interactive educational materials developed during the project. Principal Accomplishments Prior to beginning educational activities, CRWRC conducted several studies to identify general attitudes and beliefs about HIV and STIs. Data on the knowledge, attitudes, beliefs and practices (KABP) was collected among a representative sample of 200 women in the target population. The study, conducted by Equation, an independent Senegalese agency, found that 41 percent of the women were in polygamous marriages, the average earning per month was about US $100, each woman was responsible for an average of 6-9 dependents, and only 29 percent had had any formal schooling. Regarding knowledge of STIs, 43 percent could recognize at least one symptom of an STI, 75 percent thought that STIs could not be cured, 77 percent believed it was possible to become infected with an STI by urinating in the same place as an infected person, 95 percent believed strict personal hygiene would prevent transmission of an STI and 86 percent believed an untreated STI could eventually turn into AIDS. The information collected showed that general knowledge of AIDS as a disease and practices which favor transmission was relatively accurate, however, perception of one's own risk for infection was inaccurate in relation to sexual practices as reported by survey participants. A baseline assessment was also conducted near the beginning of the project which confirmed the validity of the strategic approach selected for the intervention:
Formative research in the form of a rapid assessment took place during the first period of the project and again at the end of the project to assess the level of change of behaviors and the effectiveness of the project. Youth behavioral research was also conducted during the project focusing on at-risk sexual behavior among youth in Senegal. The study was carried out in eight sites in Dakar and surrounding suburbs. The findings of the study demonstrated that urban youth are at risk for HIV and STI infection through their high-risk behaviors. Throughout the life of the project, 11 trainers and 31 group facilitators were trained, and over 830 women and young people were educated in STI/HIV/AIDS prevention. Twenty-one community events involving public presentations of drama skits, poems and songs in Wolof language were held in the three targeted regions, during which group members shared their convictions about health promotion and risk reduction with their neighbors, friends, family and the general public. An estimated 23,323 persons were educated about HIV and STIs through these community events. A variety of educational materials and training supports were developed throughout the project, all of which were conceived and finalized in collaboration with the project participants and were therefore highly relevant both in sociocultural terms, and in responsiveness to identified learning needs. Materials produced include puzzles for teaching about anatomy, a photo/slide series on STIs, an illustrated flipbook on AIDS transmission and prevention, three card games, and a flannelgraph to encourage discussion of risk-reducing behavior, as well as videos of drama presentations. Outcomes During the training sessions with group members, emphasis was placed on building self-esteem, empowering participants to gain and use knowledge to improve their lives and the lives of family members. This focus on communication in the family and positively influencing environmental and societal norms was emphasized throughout the project. Results of the qualitative study carried out by the Institut Supérieur Africain pour le Développement de l'Entreprise (ISADE) at the end of this project indicate positive changes in behaviors to reduce the risk of STI/HIV infection since the implementation of the intervention. The ISADE study along with evaluatory group discussions carried out by project facilitators reveal that group members reduced their number of sexual partners and have adopted self-protecting behaviors such as negotiating for safer sex with partners considered to be at risk, condom use by male respondents and seeking medical advice when suspecting infection. The project has had a cascade effect in the communities which it has touched. Some community associations and organizations have decided to conduct AIDS education activities in addition to the AIDSCAP-supported interventions. For example, the Galle Nanondiral community center in Yeumbeul, a low-income neighborhood on the outskirts of Dakar, has established an ongoing program of AIDS education among youth attending that center, and the Scouts and Eclaireurs of Senegal have adapted portions of the CRWRC educational program on STIs and AIDS and are using this information for activities in a number of villages in the regions of Mboro and Thies. The end-of-project study by ISADE also noted that many of the facilitators have developed a role beyond their groups, being asked by other groups in the community to share their knowledge. The study noted that the group members see themselves as "change agents" among family and close friends, sharing newfound knowledge. Capacity Building On-the-job training of SWAA and FDEA staff in personnel management resulted in a gradual improvement of team effectiveness over the life of the project. CRWRC worked closely with the project assistant accountant and the FDEA accountant to put in place a rigorous financial management and reporting system. In addition, staff received training and experience in administration and resource management building upon the organizational capacity. It was recommended to give non-expendable inventory, including computer hardware and software to SWAA and FDEA to strengthen their capacity to carry out ongoing AIDS education activities. In addition, training and education materials developed during the project can be used by the organizations in future projects. Due to the high profile of this project within the NGO community and various government ministries, FDEA and SWAA have become known as organizations involved in STI and AIDS prevention and education, lending credence and credibility to both organizations. The training capacity was increased in both organizations enabling them to continue AIDS education among their member groups. Important Constraints Three main constraints were experienced during the project: 1) Personnel needed a level of training unanticipated during the project planning phase which delayed commencement of project activities. The development of an effective and functioning team took about nine months; 2) The women and youth groups were less organized than anticipated. Many extra days were spent establishing the logistics of group selection and establishing a workable relationship; and 3) The women in the target group were preoccupied with the demands of making a living and caring for their families. Time for training and education, regardless of the topic or importance, was in short supply. Lessons Learned and Recommendations The principal findings and recommendations resulting from the project are as follows:
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