Participatory, strategic policy development processes and concerted efforts to build the capacity of NGOs to influence HIV/AIDS policy are beginning to yield tangible results in Kenya.
In early 1994, when a senior official in the Kenya Ministry of Health voiced hope for greater public debate on HIV/AIDS policy issues, he held only limited expectations that such discussion would occur. Despite widespread public awareness about the epidemic, most policy makers in government and other sectors chose not to consider policy responses that could help control the epidemic and moderate its impact on society and the economy.
Two and a half years later, however, the HIV/AIDS policy situation in Kenya has changed in many ways. Now the same official says he is hopeful that practical policies will be adopted and implemented as a result of the policy development processes that have occurred. For example, the government is preparing a national HIV/AIDS policy and has sought input from a broad range of technical, legal, ethical and policy opinion makers. With support from AIDSCAP, MAP International facilitated policy-oriented discussions among church leaders, while the Kenya AIDS NGOs Consortium solicited the experiences and views of local constituents during a series of district and provincial policy workshops. The results of these and other efforts to shape HIV/AIDS policy include improvements in the policy climate in Kenya, better mechanisms for strengthening HIV/AIDS prevention and care, and some specific changes in policy.
Policy Development
In response to the expressed need of Kenyans for greater debate on HIV/AIDS policy issues, AIDSCAP provided support to two nongovernmental organizations (NGOs), the Kenya AIDS NGOs Consortium and MAP International. Their approach was similar: to influence national policies through a process of collecting issues identified by field-based workers, program managers and civil servants and refining the issues for presentation to policy makers. AIDSCAP provided technical assistance on the policy development process, but avoided involvement in policy formulation.
Through a series of skill-building and problem-identification workshops, representatives from district-based NGOs, government and religious groups prioritized HIV/AIDS issues they face regularly. Their problems and concerns were expressed as issues, making them more adaptable to policy responses. For example, a concern about individual rights to privacy of the results of HIV tests was expressed as a policy issue that included options for shared confidentiality.
Results of the local workshops were discussed at national workshops. Participants in the MAP-sponsored national workshop in February 1996 included leaders of Kenya's major Christian denominations and religious umbrella organizations. Research results were presented showing a high level of sexuality among religious youth, the desire of these young people for more sex education, and field-level clergy and laity support for stronger denominational leadership on HIV/AIDS. Church leaders responded with a commitment -- subsequently published in one of Kenya's daily newspapers -- to formulate policies within their religious groups on 14 issues identified by participants.
The process followed by the Kenya AIDS NGOs Consortium was designed to develop consensus on priority HIV/AIDS issues among diverse groups. Drawing upon the lists of priority issues developed at the provincial workshops, participants at a national workshop selected seven issues that consortium staff will develop into policy recommendations. The recommendations will be directed toward appropriate national authorities or shared with partners (such as a business association) better placed to pursue them in the policy arena.
The Kenyan government has been engaged in a two-year process of soliciting expert opinion, drafting and re-drafting, and consensus building to produce a national policy. In 1996, a comprehensive policy will be made public that addresses legal and ethical, social and cultural, economic and service delivery dimensions of the HIV/AIDS epidemic.
The Policy Climate
During the early 1990s, HIV/AIDS issues primarily concerned health authorities. In the years that followed, however, large segments of the Kenyan population became informed and actively involved in what are essentially policy issues. For example, politicians, religious leaders, and the media have pointed out that various traditional cultural practices (such as the sexual "cleansing" of widows) may contribute to HIV transmission and have urged adaptation of such practices to reduce risk.
National leaders are more willing to discuss HIV/AIDS than in years past. Part of the reason is that HIV/AIDS is now seen as a development issue. An entire chapter of the 1994-96 Kenya national development plan was devoted to HIV/AIDS and its impact on social well-being and economic growth. In a country where AIDS was rarely mentioned in public discourse a few years ago, it is common to hear political leaders refer to the socioeconomic impact of HIV/AIDS and to cite specific examples of such impact on their constituents.
To back up its policy development, the Kenyan government has committed substantial resources to HIV/AIDS prevention. A loan from the World Bank is being used to expand prevention interventions and improve STD treatment and care services.
Another indication of changes in the policy climate is the growing confidence and willingness of people at all levels to speak out on critical HIV/AIDS issues. A prime example is the recent challenge to Pearl Omega, a locally developed drug initially said to cure AIDS. Legal, scientific and HIV/AIDS program specialists immediately questioned the claim and called for stronger regulatory oversight to prevent such claims in the future. The specialist and HIV/AIDS prevention communities' response to the initial reports was much faster and more public than in years past, when unsubstantiated claims for AIDS "cures" were rarely publicly challenged.
Improved Mechanisms
The means to formulate policy questions and to influence the direction of debate on HIV/AIDS issues in Kenya has been strengthened in recent years. Existing networks have become stronger and new coalitions have emerged.
The Kenya AIDS NGOs Consortium, for example, grew from about 20 members in the early 1990s to over 200 in 1996. The consortium has overcome government suspicion of NGOs and is now given credit for its coordinating role, for supporting and strengthening cooperation between the government and NGOs, and for its technical contributions to prevention and care discussions and plans. The strong working relationship between the consortium and the National AIDS and STD Control Programme is evident in their regular collaboration at workshops and public meetings.
The consortium's resource center, which existed only on paper a few years ago, is now recognized as a central source for information in Nairobi. During debate on legislation to assist children orphaned by the death of parents to AIDS, members of parliament visited the center for information.
Other networks that have emerged include the Kenya Churches AIDS Network and Women Fighting AIDS in Kenya, which provides support for HIV-positive women and women vulnerable to infection. Also, non-health organizations have begun to take on HIV/AIDS as an issue for advocacy. The churches are major examples, but the list extends to women's and development organizations and legal societies.
Policy Change
Improvements in the policy climate and in mechanisms for strengthening HIV/AIDS prevention are beginning to have an impact on policy in Kenya. Existing national guidelines on home-based care and counseling are being reviewed and revised by the National AIDS and STD Control and Prevention Programme. A number of businesses and NGOs have adopted or are considering adoption of policies related to HIV/AIDS in the workplace, and religious denominations have made a public commitment to adopting policies to guide clergy, laity and parishioners.
Legal issues are also receiving attention. Gaps and ambiguities in Kenyan laws related to HIV/AIDS, such as the inheritance rights of women, have been identified by legal experts. Legislation has been introduced and debated in parliament to provide support to destitute youth, including AIDS orphans.
While much has changed in the policy area in Kenya in recent years, many outstanding policy issues remain. Sex education for youth has been widely debated, but religious and secular groups have been unable to reach consensus on curriculum content. Radio advertising of condoms was banned in 1995, and some newspapers occasionally report statements that condoms are ineffective or lead to immorality. However, sales of condoms continue to increase. Legal precedents relating to widow inheritance, pre-employment HIV testing, confidentiality and similar issues remain to be established.
In Kenya and throughout Africa, the rapid pace at which the epidemic moves through society and the growing number of AIDS-related deaths provide impetus for policy change. As Kenya's experience demonstrates, those changes can be shaped by well-planned strategies to engage people at all levels in issue identification and advocacy.
-- Bill Rau
Bill Rau, PhD, is AIDSCAP's associate director for policy.
