|
Programs |
||||||||||||
|
|
||||||||||||
|
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 Executive Summary (See Below) I. Country Program Description C. Accomplishments and Outcomes D. Implementation and Management Issues II. Lessons Learned and Recommendations III. Subproject Highlights Executive Summary Country Program Description The HIV/AIDS epidemic in Senegal has not yet reached the catastrophic levels of many other African countries. The overall HIV prevalence remains at approximately 1 percent, with the ratio of men to women at 3:1. At present 45 percent of the population is urban, the majority of which live in the cities of Dakar, Thies and Kaolack. The capital of Senegal, Dakar, is a major port city in West Africa, making Senegal a transportation focal point with a large amount of migration and regional transit. The majority of the population is of the Wolof ethnic group and 90 percent is Muslim, with another 5 percent of the population Christian. Religion plays a strong role in the culture and beliefs of Senegalese society. AIDSCAP/Senegal sought to strengthen the capacity of Senegalese institutions to implement HIV/AIDS prevention and control programs with the goal of reducing the rate of sexually transmitted HIV infection in Senegal. The project focused on four geographic regions: Dakar, Thies, Kaolack and Ziguinchor, and primarily on urban populations. The main populations targeted were women receiving STI treatment and women with multiple partners, including commercial sex workers (CSWs), clandestine sex workers and women in the marketplace; men with multiple partners, including clients and regular partners of CSWs, truck drivers and male employees of other industries, and men with symptomatic STIs; and youth. The Senegal program supported 58 organizations and institutions (including 34 local associations through Rapid Response Funds) throughout the life of the project, in addition to providing technical assistance and training to the Government of Senegal, the Programme National de Lutte Contre le SIDA (PNLS), public and private health care structures, religious and opinion leaders and various educational facilities. AIDSCAP supported the implementation of targeted interventions consisting of different Information, Education and Communication techniques to encourage positive behavior change; projects to improve STI service delivery programs; research and surveillance (both behavioral and sentinel); policy dialogue activities to increase the awareness of religious and opinion leaders of the impact of the epidemic and to improve the support of AIDS prevention activities; condom promotion and distribution; materials development; and mass media campaigns. Project implementation spanned over five years, allowing for time to evaluate project accomplishments and results. However, the full impact of AIDSCAP's activities in strengthening the capacity of the GOS and other local organizations to continue AIDS prevention projects can only be measured in the coming years. Accomplishments Behavior Change Communication Of the 58 organizations which received AIDSCAP support, 50 conducted targeted behavior change communication (BCC) interventions, this number includes 34 small associations which received Rapid Response Fund (RRF) grants to conduct short-term activities within their local communities and among the members of their associations. These RRF's provided first-time funding for many of these associations, providing them with training and/or technical assistance to conduct BCC/IEC activities, and allowing them the opportunity to manage a project in AIDS prevention. For many of these associations, this AIDSCAP support not only provided them with first-time experience in running a project, but allowed them the opportunity to validate the work of their associations in the eyes of their communities and gain the confidence and recognition as professional organizations capable of managing future projects and funds. The BCC activities resulted in the training of 1,022 peer educators, who in turn conducted IEC sessions, involving group discussions, video and theater presentations, drama skits, games, songs and dances. Such participatory activities brought the target audiences together to learn about AIDS and hold discussions with their peers, and family and community members. A total of 186,412 materials and 963,147 free condoms were distributed and 78,8118 condoms sold during these BCC/IEC and other activities throughout the life of the project and over 790,000 people were educated. Strengthening STI Service Delivery A baseline evaluation was conducted on the STI service delivery programs in public and private health facilities in two of Senegal's ten regions which enumerated the number of clinics, health care workers, equipment, estimates of STI patients seen per week and the type of training health workers currently had. Ninety-seven percent of health care workers in six of the ten regions were subsequently trained in the use of STI treatment algorithms (PI6) and prevention education and counseling methods (PI7) and equipment was supplied to many health care facilities, both public and private. An evaluation of these process indicators (PI) from pre and post-training surveys indicate improvements in both areas as a result of the AIDSCAP training. In addition, a Targeted Intervention Research (TIR) survey was conducted to provide essential information on terminology and beliefs about STIs, as well as about the attitudes of health workers and prevailing perceptions of health services in the community. STI algorithms were tested and adopted as national guidelines and pocket booklets and posters were distributed to health facilities to support the training on the syndromic approach to STI case management which was provided to health care workers in the various public and private clinics. Policy Dialogue Advances were made in the area of policy dialogue where religious and opinion leaders were targeted for AIDS education sessions. The goal of such interventions was to increase the knowledge of religious and opinion leaders of the AIDS epidemic and increase their support of and participation in AIDS prevention activities. Six regional seminars for opinion leaders and a seventh seminar for parliamentarians were held, as well as two national seminars on AIDS and religion, involving both Muslim and Christian leaders. By the end of the project, both religious and political leaders were making public statements about the AIDS epidemic in their sermons and political activities. Project Outcomes Behavioral Surveillance Survey A Behavioral Surveillance Survey (BSS) was implemented in order to collect relevant data on behavioral outcomes in key target groups. The first round of BSS data was collected at the beginning of the fifth year of project implementation. In addition to the BSS, several baseline and post-intervention Knowledge, Attitudes, Beliefs and Practices (KABP) surveys were conducted among different target groups, as well as focus group discussions (FGDs). Data from the various surveys indicate that awareness about HIV and AIDS, as well as knowledge about HIV prevention and the use and availability of condoms, all increased during the life of AIDSCAP. For example, the 1992 Demographic Health Survey (DHS) of the general population found that only 6 percent of women aged 15-49 knew that condoms can prevent AIDS, and 29 percent of men and women combined could site two or more methods of prevention. In the 1997 BSS, more than 90 percent of respondents in all target groups (male and female) knew of two or more methods of prevention. The 1992 DHS survey also indicated that 26 percent of women (countrywide) knew where to procure a condom, while the 1997 BSS showed that between 85 percent and 99 percent of all target groups reported they could easily procure condoms. Indicators on condom usage also increased over the life of project. In the 1992 DHS survey, only 3.6 percent of women and 10 percent of men reported ever having used a condom, while in the 1995 the "Association pour la Promotion Sociale en Milieux Rural et Urbain" (APROSOR) KABP survey, 22 percent of respondents reported they had ever used a condom. Findings of the 1997 BSS indicate that many people are now using condoms during high-risk sex. Among CSWs, reported condom use during the last sex act and for "consistent use" with both regular and new clients reached between 90 and 98 percent. Capacity Building Capacity building activities were evaluated using a Comprehensive Key Informant Interview Questionnaire (CKIIQ), focus groups discussions with implementing agencies and a case study on policy dialogue. Thirty-five organizations participated in the CKIIQ, which provided quantitative data on the agencies' perceptions of changes in the capacity of their organizations at the completion of AIDSCAP. IA's reported increased capacity in all areas where technical support and training were given by AIDSCAP. Areas where particularly high increases in capacity were seen included BCC education and training, project planning, financial management and condom promotion and distribution. Agencies 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. Some organizations have since established other funding mechanisms and are continuing activities on their own after the completion of AIDSCAP. Lessons Learned and Recommendations The following lessons learned were identified by AIDSCAP and its implementing agencies as a result of the implementation of this program: Partnership with Local Organizations
Women & AIDS
Policy Dialogue
Strengthening STI Service Delivery
Behavior Change Communication
Mass Media Through Media
Project Management
Table 1: Senegal Process Indicator Data
|
|||||||||||||
 |
|||||||||||||
