Partner NGO Initiative: Sustaining Local Capacity to Slow the Spread of AIDS

To sustain USAID's investment in capacity building for HIV/AIDS prevention, FHI/AIDSCAP's Partner NGO Initiative helps AIDSCAP offices throughout the world become independent, indigenous nongovernmental organizations.

Alexis Boupda Kuate ended his seven-year career as an employee of Family Health International September 30, 1996. The U.S. Agency for International Development mission in Cameroon had closed, and with it the USAID-funded AIDS Control and Prevention (AIDSCAP) Project managed by FHI.

But Kuate did not just walk away. Determined that his office's pioneering work against HIV/AIDS will not end with the AIDSCAP Project, he is writing proposals and meeting with donors to solicit the funds he needs to maintain and expand prevention projects.

"We have learned so much during the past seven years," said Kuate, who was a resident advisor for AIDSCAP and the USAID-supported AIDSTECH Project that preceded it. "Now we want to use these skills to continue the progress we have made against the AIDS epidemic here in Cameroon."

With help from the Cameroon Ministry of Health and AIDSCAP, Kuate and his staff have registered as an indigenous nongovernmental organization (NGO), the Cameroon Health Program, to continue supporting HIV/AIDS prevention efforts by community-based groups and to integrate these efforts into health and family planning programs.

AIDSCAP Director of Program Management Sheila Mitchell, who joined Kuate in meetings with representatives from international donors and with the U.S. ambassador to Cameroon, was pleased with the response. Everyone they met with agreed on the need for an NGO with the experience and credibility of AIDSCAP/Cameroon.

Partner NGOs

In Cameroon, India, Haiti and other countries where AIDSCAP has worked for the past five years, dedicated professionals like Alexis Boupda Kuate are now fighting to ensure that the expertise and experience of their staffs will not be lost when the project ends in September 1997. FHI/AIDSCAP's Partner NGO Initiative is designed to help these fledgling NGOs identify their niche and attract the financial support they need to survive.

"USAID has really built up a tremendous resource in our country offices," said Mitchell. "In many cases AIDSCAP's offices are recognized as the expertise in a country to provide technical assistance for and management of AIDS prevention programs.

"What we want to do is to leave behind this capability once AIDSCAP ends," she added. "But what we need to do is both diversify and expand the funding base for these NGOs so that they can continue AIDS prevention work in their countries."

The country offices will be registered as indigenous, independent NGOs, which will enable them to seek funding from any international or local donor and from the private sector. These local NGOs will be valuable partners for FHI and other international organizations in the future.

Along with AIDSCAP/Cameroon, country offices in Haiti, the Dominican Republic, Brazil and India were chosen to participate in the pilot phase of the Partner NGO Initiative. Mitchell explained that the criteria for selection were timing, opportunity and demand.

Like Cameroon, the Haiti office was about to close. Three of the offices -- Haiti, Brazil and the Dominican Republic -- had already registered or were in the process of registering as indigenous NGOs. And in India, where as many as 5 million people may have been infected with HIV and few NGOs have experience in HIV/AIDS prevention, the need is great.

FHI/AIDSCAP hopes to help many of its 18 country offices become NGOs by the end of the AIDSCAP Project in September 1997. AIDSCAP has already begun to work with its staff to register local NGOs in Ethiopia, Tanzania, Zimbabwe and Honduras, where the resident advisors and USAID mission officials have expressed strong support for the Partner NGO Initiative.

"AIDSCAP has built up a strong, indigenous country office...seen by the Government of Tanzania National AIDS Control Program as an important partner in the fight against AIDS," Mission Deputy Director Bill Anderson of USAID/Tanzania wrote in a cable to the Agency HIV/AIDS Division in Washington. "We hope that the local office will survive even after the end of AIDSCAP."

Sustaining an Investment

Demand for the services of AIDSCAP country offices in many countries spurred the drive to transform them into local NGOs. During the past five years, AIDSCAP resident advisors have fielded requests for technical assistance from international organizations and national AIDS control programs. "The problem is that AIDSCAP as a USAID project cannot accept money from other donors," Mitchell explained.

Having to turn down funds from international donors and the private sector was what motivated Dr. Martha Butler de Lister, AIDSCAP's resident advisor in the Dominican Republic, to form Foundation Genesis. "It was frustrating knowing that there was a lot of international money for AIDS that our country was not accessing and having to live every day with the dire need for more funds," she said.

In Brazil, the NGO Associação Saúde de Família was created in 1992 to support the AIDSCAP program. In addition to implementing the AIDSCAP program, this NGO has received grants for HIV/AIDS prevention activities from donors such as the Levi Strauss Foundation, the Ford Foundation and the Overseas Development Authority. In August it launched a campaign to raise funds from the private sector in collaboration with an AIDS foundation established by the international fashion industry.

Dr. Eddy Génécé, former AIDSCAP resident advisor in Haiti and a founder of the Haitian NGO Promoteurs l'Objectif ZeroSIDA (POZ), also has been able to solicit support for his new organization. The World Health Organization and UNICEF donated equipment and educational materials, and POZ recently received a grant from Plan International to incorporate HIV/AIDS prevention into Plan projects in four areas of the country.

Despite these early successes, the resident advisors know that raising sufficient funds to maintain an independent NGO is an enormous challenge. To help them make the transition to independence, FHI is seeking funding from various donors to support seed grants to the new NGOs.

AIDSCAP staff are also assisting the NGOs with local fund raising, working with them to develop business plans and providing technical assistance in proposal writing and resource development.

This assistance is one way of achieving USAID's objective of strengthening indigenous capacity to prevent HIV/AIDS, according to Victor Barnes, acting chief of USAID's HIV/AIDS Division.

"What it does is build upon the USAID investment in a number of countries and allows us to turn a USAID-funded project office into a resource for the indigenous population," he said.

Support for the new NGOs is also a potential response to the need for HIV/AIDS prevention assistance in countries where USAID no longer has a mission, Barnes noted. USAID Administrator Brian Atwood has appointed a working group to study the possibilities for NGOs to implement USAID programs in these "non-presence" countries.

Identifying Needs

Under its Partner NGO Initiative, FHI/AIDSCAP will offer the new NGOs training and guidance documents on proposal writing, fund raising, business planning and financial management. Each NGO will develop a business plan.

"We're treating them as small businesses in the U.S. model," Mitchell said. "They're going to be responding to demand, but they're going to have a plan, based on the needs in the country and the strengths of the NGO."

FHI/AIDSCAP begins by helping each country office conduct a detailed demand analysis to determine whether a new NGO is needed and to identify the demand for specific services. The analysis includes an assessment of the services already available from other NGOs in a country.

The analyses showed that AIDSCAP country offices' experience in supporting and monitoring prevention programs that are actually implemented by community-based organizations is rare.

"Most of the countries have NGOs that can do the community-based work, but there are few who have the strength to manage international funding at a large-scale programmatic level," Mitchell said. "That's the demand that we see in most of these countries."

To meet this demand, the new NGOs are likely to operate much as they did under AIDSCAP, providing financial, technical and management support to other local NGOs.

"We really see them as umbrella NGOs that will help to attract a much broader funding base and still grant money back out to the NGOs that have been our partners all along," Mitchell said.

In Brazil, local NGOs seem to like the idea of working with such an umbrella NGO. "They see it in a positive way because we are not competing with them, but we are giving them more support," Dr. Fernandes said. "This kind of NGO did not exist before."

The executive director of one of AIDSCAP's implementing partners in the Dominican Republic believes that donors' confidence in the technical leadership and financial management of Foundation Genesis will increase the funding available to NGOs like his for HIV/AIDS prevention. "This large NGO with a good reputation could make it easier for us, "said Dr. Bayardo Gómez of the Comité de Vigilancia y Control de SIDA (COVICOSIDA).

Foundation Genesis will help ensure that the quality of NGO AIDS prevention activities does not diminish, according to Dr. Francisco Gomez of the Dominican Ministry of Health. Before AIDSCAP, he said, "agencies came and went and nobody monitored the spending of monies or whether plans were followed and objectives were achieved."

The demand analysis in India revealed a different situation: many experienced NGOs, but few with strong expertise in HIV/AIDS prevention. This finding is echoed by Dr. Cornelia Davis, team leader for the Joint United Nations Programme on AIDS in India.

"There are many good health and developmental NGOs in India in practically every state," she said, "but few have the necessary experience or technical capacity in AIDS prevention."

New Directions

The new NGOs are evolving in different directions to meet the needs of people and organizations in their countries. In Cameroon, for example, the Cameroon Health Program will support a more integrated approach to HIV/AIDS, as it did in an AIDSCAP pilot project implemented by Save the Children in Fanou province, where HIV/AIDS services were provided along with family planning and maternal and child health care.

Associação Saúde de Família in Brazil has also discovered a broader mandate. "We work with reproductive health, self-esteem, human rights, violence -- issues that the marginalized populations we work with, day to day, bring to us," Dr. Fernandes said. "You need to address those issues. Otherwise the program will not work because you cannot answer to the specific needs of your target population."

Dr. Butler agrees that it is impossible to work in HIV/AIDS prevention without addressing the underlying problems of poverty and discrimination that make people vulnerable to infection. "If you're going to be working in a poor neighborhood or where women don't have decent jobs, AIDS prevention work needs to be based on economic empowerment of the people," she said.

Through Foundation Genesis, Dr. Butler hopes to link organizations that specialize in micro-enterprise credit programs with NGOs helping women protect themselves and their children from HIV/AIDS in the Dominican Republic. The Haitian NGO will use its experience with several AIDSCAP pilot projects to expand activities in counseling, care and support for people living with HIV/AIDS and their families. So far it has opened one AIDS counseling and support center in Port-au-Prince.

Advocacy and information are other important areas for POZ. The NGO will disseminate information to government and NGO officials to ensure that HIV/AIDS policies and prevention strategies are based on the lessons learned from local and international HIV/AIDS prevention programs.

"Some small organizations are trying to do what we did five years ago because they haven't taken into account the five years of experience of AIDSCAP's implementing partners," Dr. Génécé explained. "We want to make sure what they did is not lost."

An understanding of state-of-the-art HIV/AIDS strategies and methods is sorely needed in India, where many NGOs approach HIV/AIDS prevention as they would traditional family health and welfare issues, according to Dr. Thomas Philip, AIDSCAP's resident advisor in Madras. "What the NGOs are trying to do is cover the whole community in the same way -- they don't understand the need to target people who engage in high-risk behavior and their sexual networks.

"It's a big vacuum which will probably get filled in five, ten or 15 years, but which we can facilitate by passing on quickly the information available from other countries and from the AIDSCAP Project," he added.

The USAID Mission has asked AIDSCAP to explore the possibility of strengthening an existing NGO in India. So far, however, it has not been possible to find an organization with the necessary skills and experience.

Unlike the other resident advisors, Dr. Philip does not have a technical staff because AIDSCAP has played a small, supportive role in the USAID-funded HIV/AIDS prevention project in India. What he does have is a strong network of local and international consultants who have helped AIDSCAP grantees during the past four years. He hopes to use this network to provide training and technical assistance to Indian NGOs that are beginning to incorporate HIV/AIDS prevention into their programs.

"Without this kind of assistance, I am afraid that the NGO sector in India will lose quite a bit of time -- probably three or four years," he said. "But if there is a concerted, focused effort to reach NGOs and give them a good idea about what has worked in other parts of the world, they will develop effective interventions."

-- Kathleen Henry