|
Programs |
||
|
|
||
|
This report comprehensively summarizes the FHI/AIDSCAP program in West Africa (February to July 1997). In addition to a program description, the report lists accomplishments and lessons learned.
Table of Contents I. Program Description (See Below) II. Lessons Learned and Recommendations I. Program Description A. Introduction West Africa, a 3.1 million square mile portion of the African continent stretching from Senegal to Cameroon, consists of 19 countries and is inhabited by over 206 million people. Although the region shows considerable diversity in virtually every geographic, social, and cultural dimension imaginable, the countries constituting West Africa share similar, transnational concerns and constraints in providing reproductive health services, including AIDS/STI prevention. In 1996, in recognition of the potential effectiveness and efficiency of developing regional approaches to the delivery of reproductive health services, USAID/REDSO in collaboration with numerous American and African NGOs having extensive experience in reproductive health in West Africa, initiated the five-year Family Health and AIDS (FHA) project in West and Central Africa. AIDSCAP assisted in the development and startup of this project's AIDS/STI component, targeting five West African nations -- Benin, Burkina Faso, Cameroon, Côte d'Ivoire, and Togo, and focusing on five primary program areas: HIV counseling and testing, AIDS prevention among migrants, STI case management, gender-sensitive prevention programming, and NGO capacity building. In general, AIDSCAP's efforts built upon the experience and expertise of NGOs in the regions and strengthened collaborative linkages among AIDS/STI prevention and family planning programs in both public and private sectors. FHI/AIDSCAP's implementation and strategic plan for support to the FHA project was implemented by select NGO partners in collaboration with REDSO/WCA. A Unified Management Team (UMT), consisting of representatives from John Snow, Inc./Research and Training Institute (JSI), Johns Hopkins Program for International Education and Training in Reproductive Health (JHPIEGO), Johns Hopkins Center for Communication Programs (JH/CCP), Tulane University School of Public Health and Tropical Medicine, Population Services International, and Academy for Educational Development (AED), was created to oversee the management of the FHA project. B. Country Context AIDSCAP technical assistance was provided in five target countries -- Benin, Burkina Faso, Cameroon, Côte d'Ivoire, and Togo. These countries, with a combined population of approximately 48 million, have over 22,000 cases of AIDS. Moreover, HIV prevalence among the countries' general sexually active populations ranges from 3.1 percent in Benin to 10 percent in Côte d'Ivoire and parts of Burkina Faso. Côte d'Ivoire has the highest AIDS/HIV prevalence in West Africa. Certain social factors have contributed to the spread of the epidemic. Migration across international borders to trade or to find employment occurs on a massive scale and probably plays a major role. Millions of persons travel among West African countries each year. An estimated 300,000 persons travel yearly on the Ouagadougou, Burkina Faso - Abidjan, Côte d'Ivoire route alone. Migrant workers stay in "host" countries for five to nine months a year, and often engage in sex with multiple, casual partners or commercial sex workers while away from their families. Other migrant workers resort to commercial sex to survive and support their families. Adding to the problem, social and cultural norms throughout West Africa generally relegate little decision-making power to women concerning sexual behavior. As a result, women and girls are particularly vulnerable to the threat of HIV/AIDS as they have limited social or cultural support to protect themselves. Finally, for most West Africans, access to reproductive health services, including treatment for STIs, is usually limited. Thus, these social factors -- migration, sex with multiple partners, lack of decision-making power in sexual relationships, and untreated STIs -- have exacerbated the HIV/AIDS situation in West Africa. C. Accomplishments Counseling and Testing (C&T) The objective of AIDSCAP's activities in the C&T component was to strengthen the counseling and testing capabilities of the Côte d'Ivoire based NGO, ESPOIR-CIPS, to be a resource training center for C&T in the region. Technical assistance was to be provided from AIDSCAP to assess the existing HIV counseling and testing services in Benin, Burkina Faso, Cameroon and Togo, identify areas of improvement for collaborating NGOs in target countries, conduct technical training for AIDS counselors and hands-on management training for managers of the select counseling and testing centers in the target countries, review and update counseling and testing strategies in collaboration with specialists from AIDSCAP and UMT in the select countries, and conduct reassessment of counseling and testing capacity at the upgraded centers before the end of the project period. JSI was the main partner in implementing this component. The assessment team met with officials of the National AIDS Programs in the four target countries, other donors in the C&T sector, and heads of national and international NGOs to review the status of the HIV/AIDS epidemic in each country, the organization of C&T services in the public and private sectors in each of the countries, the quality of C&T services provided, the level of knowledge of counselors (C&T service providers), and the demand for C&T services by the population. Following the country visits, recommendations were made by the assessment team and a proposed plan of action for future C&T activities was designed to strengthen C&T services in each country. Although not part of the mandate, the ESPOIR/CIPS report included Côte d'Ivoire in the assessment despite its progress C&T services relative to other countries in the region. The team recommended that C&T service providers in the target countries be trained through a series of workshops by the ESPOIR/CIPS staff in Côte d'Ivoire and that they organize a consensus conference for the stakeholders of C&T services in the region. Institutional difficulties within ESPOIR/CIPS as well as the brief time for implementation precluded undertaking planned technical support to in-country C&T program managers under AIDSCAP. It is expected, however, that these activities will be continued under the REDSO West Africa project. AIDS and Migration The objective of the AIDS and Migration component of the FHA project was to address the reproductive health needs of migrants in the region. This cross-border activity was implemented by the Ivorian NGO ECODEV and the Burkina Faso NGOs AFAFSI/BF and URBLS. Under this component, FHI/AIDSCAP used its expertise in behavior change communication (BCC) to upgrade the skills of local NGO staff to manage targeted interventions and to develop appropriate IEC materials. AIDSCAP provided technical assistance and financial support for projects of ECODEV, URBLS and AFAFSI/BF. By strengthening the capacity of these three local NGOs, AIDSCAP laid the groundwork for continued implementation of AIDS/STI prevention activities targeting migrant workers. Activities included the recruiting and training of outreach peer educators to work with migrant populations, developing BCC materials based upon identified regional needs, and developing a radio soap-opera and television spots. AIDSCAP supported the development of training curricula and assisted with the training of 102 peer educators among truckers, commercial sex workers and migrant plantation workers across the project who reached over 2,550 persons in the first three months of their program. Using participatory methodologies, AIDSCAP trained program staff in materials development and supported the design and distribution of several BCC materials including radio soap operas, television spots, billboards and several booklets and promotional items in local languages. The migrants project is complex due to the critical coordination of multisite, multicountry programming, the multiple local languages of its target audiences, and the many implementing agencies participating in the program. In recognition of this, AIDSCAP also assisted in conducting supervisory training for the NGO staff managing this ongoing effort. The intervention launched with AIDSCAP's assistance is continuing with support from PSI and AFRICARE. HIV/AIDS/STI Management The objective of the HIV/AIDS/STI management component was to strengthen STI/AIDS programs in the private sector and to promote links to the public sector. AIDSCAP assisted JHPIEGO and Morehouse University in conducting a needs assessment in Côte d'Ivoire in order to identify sites for STI service provision and sites to train clinicians. In addition, assistance was provided in collaboration with the National AIDS Program (NACP), the Association Ivoirienne pour le Bien-Etre Familial (AIBEF), and the Ministry of Health (MOH) in the development of a technical assistance strategy in STIs and in the development of a national strategy for the syndromic treatment of STIs. JHPIEGO and Morehouse School of Medicine were the main collaborating partners in implementing this component. Following the assessment, a plan for technical assistance that integrates STI treatment within family planning services was developed and sites were identified for the provision of STI services and for the training of clinicians. Subsequently, a one week STI case management course for 16 family planning service providers from selected clinics was conducted. Women and AIDS (Sensitivity to Gender Training) The Women and AIDS component of the FHA project sought to increase the efficiency and impact of HIV/AIDS prevention activities in the region by making them more sensitive to the needs of women and girls. As gender inequality within sexual relationships is perhaps one of the most significant barriers to preventing HIV infections, there is a central and critical need to address gender issues in AIDS programs in Africa. Although knowledge about modes of transmission and methods of prevention is now widespread, traditions of male dominance and female submission reduce women's ability to practice methods of prevention. AIDSCAP provided assistance to a local NGO, AFAFSI/BF, to design, plan and conduct a gender training workshop targeting high-level policy makers, project planners, and project implementers working in reproductive health and HIV/AIDS. Johns Hopkins University (JHU) and the Women In Development (WID) unit at REDSO/WCA were the main partners in implementing this component. The Gender and AIDS Workshop was held in Ouagadougou, Burkina Faso with the participation of representatives of the MOH of each of the five countries, a representative from an NGO working in collaboration with the FHA project, members of the Society for Women in AIDS in Africa (SWAA) from each of the five participating countries, and representatives of AFAFSI/BF. As part of the workshop, participants designed women's initiatives to incorporate a gender strategy into ongoing AIDS prevention programs as well as guidelines for the use of a rapid response funding mechanism to implement initiatives. NGO Capacity Strengthening The objective of the NGO capacity strengthening component was to increase the capacity of key African institutions to design and implement training, service delivery, IEC, and operations research components in HIV/AIDS prevention programs, with minimal reliance on external technical assistance. To help achieve this objective, AIDSCAP used the knowledge and experience gained from its existing country programs to provide hands-on training for managerial and key technical staff from selected local NGOs. Training was conducted during the NGOs' implementation of AIDS prevention activities targeting migrant workers. AIDSCAP provided financial support to the Cameroon Health Program (CHP) to monitor and oversee this activity. AIDSCAP, through CHP, laid the groundwork for AFAFSI/BF, URBLS and ECODEV's IEC/BCC activities by providing preliminary guidance and the technical assistance needed to implement the migrant workers project in Burkina Faso and Côte d'Ivoire. Specifically, CHP assisted with IEC/BCC training for peer educators from the target populations (CSWs, migrant workers, truckers); developed monitoring tools to track completion of activities; coordinated AIDSCAP input into the FHA project, insuring that that appropriate technical assistance was provided to programs and activities as described in the implementation plan; participated in the design of project activities (including the preparation of budgets, implementation of schedules, and the establishment of evaluation criteria); monitored AIDSCAP-financed projects to ensure that they met financial, administrative, and programmatic goals; and assisted implementing agencies in preparing and submitting required financial and narrative reports to FHI/AIDSCAP. |
|||
 |
|||
