Every time we speak about HIV and AIDS, it is our duty to remind ourselves of the reality that is in front of us. A reality of tremendous loss of life, of tremendous loss of opportunity.
Presentations on HIV/AIDS often start with figures. So, I will give you figures. To me, the most telling is the one now on the screen. The three lines that are going straight up represent the increase of life expectancy in African countries with low HIV prevalence. But look at Zimbabwe, Botswana and the Republic of South Africa. In Botswana, a country that has had the greatest economic development per capita in the world for several consecutive years, sees its development threatened at the base, its people. Ten years ago, life expectancy at birth was about 60 years. Today, it is less than 40 years. In 10 years, life expectancy have been reduced by more than 20 years in Botswana. There is no other way we can comprehend the full extent of the loss of life and loss of opportunity which those countries have to deal with.
However, there is another reality about AIDS. It is a reality of hope and of competence to effectively deal with the problem. It is a reality of communities that are making sure that AIDS would not affect for ever the quality of their life.
This is the evolution of the level of HIV sero-prevalence among young males age 21 in a province of Northern Thailand, Phayao. Five hundred thousand people are living there, near Laos and Myanmar. The HIV prevalence level among young males was 18% just 10 years ago. Today, the prevalence among young males is less than 2%.
And progress is not confined to a particular country. You can now see on the screen that progress is also registered in Uganda where prevalence levels of HIV in pregnant women have gone down in some sites from 30% to about 10%. What can we learn from those places where focus is being made.
What are the lessons can we learn from that progress? We have learned that effective responses to AIDS are people-driven, not commodity driven. We have learned that service provision is required, but is no substitute for people driven responses. And we have learned that local partnerships feature in all effective local responses to HIV/AIDS I will in particular dwell on the first, and on the last points.
To deal effectively with HIV and AIDS, we have to realize that we, and not someone else out there, are the subjects of the response to AIDS. AIDS is affecting my life as an individual, as a father, as a member of my community. It is affecting my work as well as the stands I am taking in society. The picture Dr. Nesbit showed us of a AIDS Day Care Center in Northern Thailand that made me think of the story of Khun Nongkran, the head of such a Center in Dokkamtai.. Khun Nongkran and other many others nurses were suffering of burn out. There were so many cases of AIDS coming to them. And the head of the Provincial health office of the province noticed the situation. She took everyone on a retreat for a week. She said: “I don’t care what your solution is but I want you to think about what AIDS does for your life”. Nongkran told us that after that week, she was at peace with the issue, Now that she understood herself, she could understand others. That process is absolutely central to effective responses to AIDS.
You might say: this is all good and well, but you are talking of micro level responses. How can you imagine that thousands of local partnerships required for an effective national response flourish countrywide? With the increasing confidence, we can state that there are three concurrent processes at work. The first one is horizontal sharing of AIDS competence from community to community; the second one is scaling-up of locally available services and financial resources; and third, facilitative, catalytic leadership. Please note that generally one focuses on the second process. I will therefore rather focus on the first and the third one.
Country-wide responses require facilitative leaders. You need leadership, but not any kind of leadership. You need a leader who is able to appreciate strengths. In the development business, we go and look for needs so that we can respond to those needs. Of course, its clear that there are needs out there. At the same time, how much do we appreciate strength? Are we seriously attempting to learn from what people really do in response to major development challenges such as AIDS? How much do we seek to understand rather than judge? How much do we try to understand the situation of a sex worker who has HIV rather to judge him or her. How much do we try to understand the woman who is at home who has only has her husband who happens to have HIV? How much do we try to understand instead of judge? This is absolutely critical if we want to launch an effective response to AIDS. Our values must be clear. They must consist of listening, of participation, of learning. If we want to support strengthening of local responses on AIDS, we have to become the learners from those experiences. By validating what people do, they will have the strength to do a better job and to share with others what they are learning from what they do.
AIDS is not only challenging sexual behavior. It is also challenging institutional behavior. Organizations accepting the reality of HIV and AIDS need to review their own style of management, their own style in doing business. We use to rely in our own expertise to provide solutions; we now need to appreciate people’s strengths to respond. We used to picture ourselves in control of a disease; we now realize that we only can influence other people’s responses. We used to see our job as primarily consisting in responding to needs; in responding to these needs, let us start with what people are already doing. If we thought that the right approach consists in telling people that they have a problem, let us think twice. We have the problem together. And together we might find the solution.
Of course, that style of management is not an easy one to take on. That is why we propose the establishment of the facilitation teams. Those teams stimulate local ownership of the problem and of its solution; stimulate the creation and sharing of knowledge; maintain the facilitation “spirit” and apply lessons learned to organizations.
Our Journey towards AIDS Competence
Changes in life expectancy in selected African countries with high and low HIV prevalence: 1950 - 2005 65 60 with high HIV prevalence: Zimbabwe 55 South Africa Life expectancy (years) Botswana 50 45 with low HIV prevalence: 40 Madagascar Senegal Mali 35 30 1950–1955- 1960- 1965- 1970- 1975- 1980- 1985- 1990- 1995- 2000- 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision.
what have we learnt? effective responses to HIV/AIDS are people-driven, not commodity driven service provision is required, but is no substitute to people driven responses progress hinges on local partnerships
we are the subjects of the response to HIV/AIDS community family personal people work policy
Local Partnerships to HIV/AIDS – The Key for AIDS Competence People of influence Providers of services Teachers Local Religious Leaders Nurses and doctors LF People living Traditional Leaders with HIV/AIDS Families Women Groups Youth Clubs Civil societyLF: Local Facilitation
country-wide AIDS progress horizontal sharing of AIDS- competence from community to community scaling-up of locally available services and financial resources facilitative, catalytic leadership
Knowledge-sharing LFT LFT Churches UN Business LFT LFT Civil society DFT Government sectors CBOs NGOs Persons living with LFT HIV/AIDS LFTDFT: District Facilitation Team.
Regional Partnerships Religious leaders Governments UN RFT National Partnerships GFT Donors NGOs NFT Foundations Business District Persons living withPartnerships HIV/AIDS Global Partnerships DFT DFT LFT Local LFT LFT Partnerships GFT: Global Facilitation Team
The Constellation for AIDSCompetence Connecting local responses around the world Committed to the goal of AIDS Competence and Committed to HCD as a strategy Founded on December 8, 2004
Our vision and mission We envision a global society in which each element is pursuing AIDS competence. Our mission is to connect people involved in local responses to AIDS around the world for mutual support, learning and transformation. We are made of learning communities whose members support and learn from each other in their own journey towards AIDS competence. We cooperate with any other organisation which pursues a similar vision and approach to the resolution of global development challenges.
What makes us different? We see people primarily as the subjects of the response to AIDS, not as the targets of interventions. We connect people for learning; we do not seek to organise resources. Each of us is linked to local responses and is inspired by the experience. We start from within: ourselves, and the organisations we belong to.
Our Goal: AIDS Competence In an AIDS Competent society, we – as we relate to families, to communities, to our work and to policy– act from strength to: acknowledge the reality of HIV and AIDS, build our capacity to respond, reduce our vulnerability and risk, allow everyone to live out their full potential, and share our experience with others.
Our ApproachHuman Capacity for Response We care We change We learn We belong We transfer
the challenge to the true leader appreciates local strengths and assets seeks to understand rather than to judge stimulates interaction among various partners values listening over talking prefers asking questions over providing answers chooses learning over teaching
organisations: shifting attitudesWe believe in our own We believe in people’sexpertise to provide strengths to respondsolutionsWe control a disease We facilitate responsesWe respond to need We reveal strengthYou have a problem Together, you and we have solutions
facilitation teams: goalsmembers assist each other to: learn from local responses stimulate knowledge creation and sharing embed lessons learnt into organisations participate in knowledge sharing worldwide
Ways of Working participation is voluntary responds to invitations any community can invite no internal hierarchy one organisation serves as host
Self-Assessment of AIDS competence 1 5 2 3 4 BASIC HIGH We acknowledge openly We recognise our own We recognise that with others our concerns strength to deal with theAcknowledgement We know the basic facts We recognise that HIV is a HIV/AIDS is a problem for about HIV/AIDS and the challenges and seek and Recognition about HIV/AIDS. problem. us and we discuss it challenges it represents others for mutual support amongst ourselves for us. and learning. We communicate We adapt and Our care and prevention We intentionally link careCare and change of externally provided communicate externally activities are separate and We change because we and change of behaviours behaviour messages about care and provided messages about dependent on external care. and work practices in prevention. care and prevention. stimulus. ourselves and with others. Our partnerships share We (individuals, families, We get together with common goals, and define communities, service We address and resolve all We don’t involve those some people who are each partner’s Inclusion affected by the problem. crucial to resolve common providers and policy contribution. Religious challenges facing us (not makers) work together to only HIV/AIDS.) issues. and community leaders respond to HIV/AIDS. get involved. We are addressing Identify and We aware of the general We have a clear strategy vulnerability in all aspects We have mapped Our strategy is based on address factors of vulnerability vulnerability and risk. to address vulnerability good practices. of the life of our group, vulnerability and the risks affecting us. and risk. all are aware and involved in responding. We have processes for We learn, share and apply We learn by what we do We see an improvement in We share learning from learning and sharing which what we learn Learning and rather than what we learn local responses as a result our successes but not our we use sometimes. We systematically, and seek transfer from and share with of our learning and mistakes. seek people of experience people with relevant others. sharing. when necessary. experience to help us. We measure our change We invite others to help We measure our own Our change is evaluated We begin consciously to systematically and can measure our change andMeasuring change by others. self measure. progress and set targets demonstrate measurable share learning/results for improvement. improvement. with others.
Self assessment People: talk exchange perspectives get to grasp the local reality define priorities and actions adapted to context follow up formulate lessons learned identify what experience to share and what to experience to seek
Follow up: One Example Cinq Districts in Bangkok
Comparison of AIDS Competence Indicators Pre- and Post-Community Self Assessment in 5 Bangkok DistrictsLevel 5 Level Acknowledgment and 5 Inclusion 4 recognition 4 3 3 2 2 1 1 0 0 Ladkrabang Klongsan Nonchok Bangkae Nongkham Ladkrabang Klongsan Nongchok Bangkae NongkhamLevel Level5 Care and prevention 5 Identify and address4 vulnerability 43 32 21 10 0 Ladkrabang Klongsan Nongchok Bangkae Nongkham Ladkrabang Klongsan Nongchok Bangkae Nongkham Pre-intervention Post-intervention Post-intervention year 1 year 2
Comparison of AIDS Competence Indicators Pre- and Post-Community Self Assessment in 5 Bangkok DistrictsLevel Level Learning and transfer Adapting 5 5 4 4 3 3 2 2 1 1 0 0 Ladkrabang Klongsan Nongchok Bangkae Nongkham Ladkrabang Klongsan Nongchok Bangkae NongkhamLevel 5 Level Ways of working 5 Mobilizing resources 4 4 3 3 2 2 1 1 0 0 Ladkrabang Klongsan Nongchok Bangkae Nongkham Ladkrabang Klongsan Nongchok Bangkae Nongkham Pre-intervention Post-intervention Post-intervention year 1 year 2
Comparison of AIDS Competence Indicators Pre- and Post-Community Self Assessment in 5 Bangkok DistrictsLevel Level 5 Access to 5 Measuring treatment change 4 4 3 3 2 2 1 1 0 0 Ladkrabang Klongsan Nongchok Bangkae Nongkham Ladkrabang Klongsan Nongchok Bangkae Nongkham Pre-intervention Post-intervention Post-intervention year 1 year 2
Ac kn ow Level le dg em en t 1 2 3 4 5 C ar e an d C ha ng e In cl us i on Vu ln er a bl e gr ou psLe ar ni n g an d tra ns fe r Mae Chan M ea su rin g ch an ge Ad ap ti n g W ay s of w or Current levels for Mae Chan community ki ngM ob ilis in g re so ur ce s
Ac kn ow Level le dg em en t 1 2 3 4 5 C ar e an d C ha ng e In cl us i on Vu ln er a bl e gr ou psLe ar ni n g an d tra ns fe r Mae Chan M ea su rin g ch an ge Levels for other communities too Ad ap ti n g W ay s of w or ki ngM ob ilis in g re so ur ce s
Ac kn ow Level le dg em en t 1 2 3 4 5 C ar e an d C ha ng e In cl us io n Vu ln er ab le gr ou psLe ar ni ng an d tra ns fe r Mae Chan M ea su rin g ch a ng e Ecart entre les niveaux actuels Ad ap tin g W ay s of w or ki ngM ob ilis in g re so ur ce s
Ac kn ow Level le dg em en t 1 2 3 4 5 C ar e an d C ha ng e In cl us i on Vu ln er a bl e gr ou psLe ar ni n g an d tra ns fe r Mae Chan M ea su rin g ch an ge Ad ap ti n g Le niveau de Mae Chan – “la rivière” W ay s of w or ki ngM ob ilis in g re so ur ce s
Ac kn o Level w le dg em en t 1 2 3 4 5 C ar e an d C ha ng e In cl u si on Vu ln er ab le gr ou psLe ar ni ng an d tra ns fe r Mae Chan M ea su rin g ch an ge Ad ap ti n g W ay s of w or ki ngM ob ilis in g re so ur ce s
Something to learn, something to shareCurrent level Something Acknowledgement to share 5 Mbarara & Recognition 4 Match making to put those with something to learn in touch with Pallisa 3 Busia Kibaale 2 Rakai Arua Something to learn those with something to share via a Peer 1 Moroto Assist meeting or an Progress electronic forum. 0 +1 +2 +3 +4 Improvement Objective
Knowledge Assets What are the top ten things I need to know? Where can I get more detail? What can I re-use? Who can I talk to? A few Even more Still more More More More Lessons Lessons Lessons Learned
Peer Assists – Learning before doing Action What you know "...the politics What’s in your context accompanying possible? hierarchies hampers the free exchange of knowledge. People are much more open with What we What I know their peers. They are both know in my context much more willing to share and to listen.” Lord John Browne
Context and detail – where andwhen you need it… • • “ • • “ “ • • “ “ “
A Knowledge AssetPrinciples (or advice) Experience which leads to the principle Resources (Documents, Policies, People)Believe that Capacity for care, change, leadership and hope HCD Concept Paper people/commun as transferable concepts which have Action Research ities have been seen and documented in multiple (SA) capacity, countries experience and knowledge to shareWork as a team: co- Team leadership development is done through AFCN process facilitating and attaching people to teams with more Hope World- mentoring new experienced facilitators, allowing people wide/Enda team members to practise with support of a team, and Sante/SA in every process then handing over team leadership to partnership others….
Two ideas• The Constellation for AIDS Competence• Friends for Life
Managing Knowledge? “The idea is not to create an encyclopaedia of everything that everybody knows, but to keep track of people who ‘know the recipe’, and nurture the technology and culture that will get them talking” Arian Ward, Hughes Space & Communications Capturing Connecting
The “Stairs” Diagram Performance Manage Corrosion Cooper5 River High performance Bulwer4 Island Feluy High desire to improve Lavera Grangemouth3 Chemicals Texas City Geel Coryton Joliet Kwinana2 Feluy Decatur FPS Netherlands Trinidad Oil1 Hull Gap between 0 1 2 3 4 current and target