AIDSTAR-One Case Study: Jane Goodall Institute in Tanzania


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AIDSTAR-One Case Study: Jane Goodall Institute in Tanzania

  1. 1. AIDSTAR-One | CASE STUDY SERIES August 2012The Jane Goodall Institutein TanzaniaMainstreaming HIV Programming into Natural ResourceManagement and Economic Growth Activities E manueli and his family live in Kasuku village in the far western area of Tanzania, near Gombe National Park, which is famous worldwide as a haven for the endangered chimpanzee. All three members of the family are HIV-positive and are on antiretroviral therapy. Emanueli’s 22-year-old stepdaughter, Bukiwa, Victoria Rossi felt so healthy after taking her antiretroviral drugs that she assumed she was cured and stopped taking them.With support from JGI, Emanueli Before long, she became very sick again and developed(center) and his family with a new symptom: a bad cough. She was taken to theJumanne (second from right), helpHIV-affected households in Kasuku closest bus stop on the back of a bike and, with donatedvillage, western Tanzania. funds, put on a bus to Kigoma Regional Hospital. There, tests for tuberculosis were negative, her condition was stabilized, and she was sent home with instructions to take her medicine every day, no matter how she feels. Today, Bukiwa is doing much better; she has gained back most of her strength and her cough has improved. Jumanne, who also lives in Kasuku, was the one who pedaled Bukiwa to the bus so she could get life-saving care—but that’s hardly the first service he has rendered this family. Jumanne works as a home-based care provider (HBCP) for the Jane Goodall Institute (JGI), which serves communities near the park where the famous primatologist has studiedBy Victoria Rossi, chimpanzees for more than a half century. He has been involved withGrace Lusiola, and Emanueli and his family for several years, since they were diagnosedAysa Saleh-Ramirez with HIV, supporting them to live positively and adhere to treatment while also counseling them on family planning options. Jumanne worksAIDSTAR-OneJohn Snow, Inc.1616 North Ft. Myer Drive, 16th Floor This publication was made possible through the support of the U.S. Agency for InternationalArlington, VA 22209 USA Development under contract number GHH-I-00-07-00059-00, AIDS Support and Technical Assistance Resources (AIDSTAR-One) Project, Sector I, Task Order 1, funded January 31, 2008,Tel.: +1 703-528-7474 and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).Fax: +1 703-528-7480 Disclaimer: The author’s views expressed in this publication do not necessarily reflect the views of the United States for International Development or the United States Government.
  2. 2. AIDSTAR-One | CASE STUDY SERIES a rapid assessment of local needs to verify these anecdotal findings and found that health, education, safe water, and access to capital were community priorities (JGI 2011). From the early days, JGI has recognized and fostered synergies between these priorities and the organization’s core mandate of natural resource management by designing a community-centered model of conservation that addresses local socioeconomic development needs. HIV, Conservation, and Economic Growth HIV has had a significant effect on conservation in sub-Saharan Africa. As a result of morbidity and mortality associated with HIV, government agencies, nongovernmental organizations, research institutions, and the private sector have lost human Victoria Rossi capacity. National park and wildlife conservation staff are especially vulnerable to HIV because many people work away from their families for “Only if the people living around the extended periods in remote areas where they are great wilderness areas like Gombe more likely to engage in high-risk sexual behavior. become our partners can we hope Loss of staff adversely impacts institutional memory and continuity of operations and can reduce an to save habitat and animals who organization’s ability to achieve program objectives. live there.” Precious conservation funds are diverted to pay – Dr. Jane Goodall for HIV- and AIDS-related staff costs such as sick leave, medical expenses, terminal benefits, funerals, and training of replacement staff. Also,with Emanueli to help Bukiwa maintain her health experiencing continuous bereavement canby monitoring her pills to make sure she adheres to adversely impact staff morale and can decreaseher treatment. productivity (Oglethorpe and Gelman 2007).JGI was founded in 1977 to protect the Increased use of natural resources is another strainchimpanzees and their habitat at Gombe and on conservation. As HIV-affected households loseto continue Goodall’s research. As JGI began wage earners and capacity for heavy agriculturalpartnering closely with the local communities labor, they turn increasingly to natural resourcessurrounding the park, they quickly learned that as a safety net. Activities such as hunting, fishing,environmental degradation was not the primary and charcoal making increase as families seekconcern of these communities. JGI staff conducted alternative livelihoods. Households caring for sick2 AIDSTAR-One | August 2012
  3. 3. AIDSTAR-One | CASE STUDY SERIESfamily members use more water, firewood, and -affected people within the community, whereasmedicinal plants, while timber consumption for internal mainstreaming seeks to achieve the samecoffins and charcoal production increases, leading goal internally among an organization’s staffto deforestation (Africa Biodiversity Collaborative members and their families (UNAIDS, World Bank,Group 2002; Barany et al. 2005). These United Nations Development Program 2005).unsustainable practices erode the natural resourcebase for the future. Protected conservation land The U.S. President’s Emergency Plan for AIDSbecomes increasingly threatened as people seek Relief (PEPFAR) provides support to variedaccess to natural resources that are no longer “wraparound” programs that mainstream HIVavailable in their communities. Additionally, programs within other sectors to improve qualitytraditional knowledge of sustainable natural of life and strengthen development efforts overall.resource management is lost when parents die PEPFAR-supported wraparound activities arebefore passing it on to their children (Oglethorpe carried out within programs funded by the U.S.and Gelman 2007). Government; the Global Fund to Fight AIDS, Tuberculosis and Malaria; United Nations agencies;HIV also leads to changes in land use. When the private sector; and other partners. Wraparoundagricultural labor capacity is diminished and programs leverage resources, both human andhousehold income declines, households farm financial, from entities with different fundingwith fewer resources, lacking inputs such as sources to increase access to HIV services and tohighly responsive seeds, fertilizer, pest control maximize PEPFAR’s effectiveness (PEPFAR 2008).agents, and irrigation. Without them, more land In addition to increasing access to HIV servicesis required to maintain crop yields, which leads to among hard-to-reach or marginalized populations,environmental degradation. the wraparound programming approach enhances the quality of development programs. Most wraparound activities are supported with a mix ofMainstreaming HIV funds, primarily from sources other than PEPFAR.Programming In many cases, the other funding sources provide the platform, whereas PEPFAR funds supportMainstreaming of HIV programming is defined by activities for high-priority HIV-affected populationsthe Joint United Nations Programme on HIV/AIDS (PEPFAR 2011). JGI’s mainstreaming of HIV(UNAIDS) and other international health agencies programming into natural resource managementas “a process that enables development actors and economic growth (NRM/EG) activities isto address the causes and effects of AIDS in an supported by funding from a wraparound programeffective and sustained manner, both through their between the PEPFAR-supported health team andusual work and within their workplace…address[ing] the NRM/EG sector of USAID/Tanzania.both the direct and indirect aspects of HIV andAIDS within the context of the normal functions ofan organization or community” (UNAIDS, World The History of JGIBank, United Nations Development Program Programming2005, p. 11). Mainstreaming has two interlinkeddimensions: internal and external. External Since JGI began mainstreaming HIV programsmainstreaming seeks to reduce vulnerability to more than 15 years ago, the organization hasnew HIV infections and support HIV-infected and implemented four NRM/EG projects in western The Jane Goodall Institute in Tanzania: Mainstreaming HIV Programming into Natural Resource Management and Economic Growth Activities 3
  4. 4. AIDSTAR-One | CASE STUDY SERIESTanzania, beginning with the Lake Tanganyika • Agriculture: developing and distributing improvedCatchment, Reforestation and Education (TACARE) palm seedlings, promoting cash crops, andProject in 1994. training in agro-forestry • Health: establishing family planning, water andTACARE recognized the fundamental link between environmental sanitation programs, as well asthe loss of the area’s forests and the socioeconomic education, care, and support programming for HIVdevelopment needs of the local community. The and other sexually transmitted infectionsproject integrated the protection of high-value • Youth education: the Roots & Shootsbiodiversity and sustainable natural resource environmental and humanitarian educationuse through a community-centered conservation program for in-school youth.approach that built local capacity and empowered After TACARE ended in 2005, JGI refined andrural underserved communities. The project was expanded its work through the implementationdivided into five primary technical areas (JGI 2009): of two large programs in western Tanzania: the Greater Gombe Ecosystem and the Masito-• Community development: supporting community- Ugalla Ecosystem Programs. These programs run savings and credit programs, creating were designed to use TACARE as a platform village development funds, and promoting fuel- for community-centered conservation. In 2010, efficient stoves JGI launched the Gombe-Masito-Ugalla (GMU)• Forestry: setting up tree nurseries, planting trees Program, which built upon and expanded these around villages, and establishing forestry reserves two programs (JGI 2009). The mission statement protected by village bylaws of GMU is to “ensure survival of the native habitats VOICES FROM THE COMMUNITY: Emanueli was inspired by Jumanne’s support and his own family’s experiences to start Kasuku’s People Living with AIDS (KIPLAPlus), a network of PLHIV in Kasuku village, which now numbers 20 members. Members of the village who are affected by HIV come to Emanueli for guidance; even health workers from the dispensary have asked him for support with village members who need help accepting their HIV status. KIPLAPlus members meet regularly to discuss how to manage their lives in a healthy way, and they grow vegetables together to eat for good nutrition and to sell to generate income. They talk through their problems, discuss how to take care of themselves if they are sick, and encourage other HIV-infected village members to join the group and be open about their status. Using a small Victoria Rossi microcredit loan, they also started a palm seed business to generate income for the group. They give palm seeds to a big farmer in Kigoma town to make oil, and he pays them on a Palm oil entrepreneur and beneficiary of the JGI- monthly basis as a percentage of the income he makes from supported microenterprise/credit group in Mwakizega oil sales. village, western Tanzania.4 AIDSTAR-One | August 2012
  5. 5. AIDSTAR-One | CASE STUDY SERIESand wildlife and other natural resources of the GMUecosystem by improving the standard of living of VOICES FROM THE COMMUNITY:local communities” (JGI 2011). Through GMU, JGI Aziza lives in Kasuku village and has worked withis currently mainstreaming HIV programming into its Jumanne as a CBDA/HBCP since 2006. She is 35NRM/EG activities in 46 villages in Kigoma District, years old and married with five children. She lovesand is expanding these services to the Mpanda her job and feels very close to the community. SheDistrict in the Rukwa Region. says community members trust and respect her because she has “kept the secret of those that areImplementation of JGI HIV-infected.” She gets “blessings from God by doing this job” and would like to do her job “until death doProgramming [her] part.”The HIV-related services that JGI externallymainstreams into its NRM/EG activities includehome-based care for HIV-affected households;microenterprise/credit for people living withHIV (PLHIV); fuel-efficient stoves to decreaseindoor air pollution for PLHIV; forestry reserves,woodlots, and agro-forestry to decrease dailylabor requirements for PLHIV; and HIV education. Victoria RossiJGI also mainstreams broader health initiativesinto its NRM/EG activities and implementsinternal mainstreaming among JGI staff and theirfamily members. Jumanne (far left) and Aziza (far right) with two other community-based distribution agents/home-based care providers from Kasuku village, western Tanzania.Expansion of community health workersprogram: JGI has long supported voluntarycommunity health workers, also called community- CBDAs to double as HBCPs. JGI partnered with thebased distribution agents (CBDAs), who provide Ministry of Health and Social Welfare (MOHSW) tofamily planning services in 46 villages in the train these CBDAs to provide HIV-related servicesKigoma District. The CBDAs provide family planning to affected households, thus becoming HBCPs aseducation, dispense birth control pills and condoms, well. JGI provides its CBDAs/HBCPs with basicand refer women of child-bearing age to the supplies to facilitate movement throughout thedispensary and rural health centers for injectable villages, including bags, bicycles, umbrellas, andcontraceptives, intrauterine contraceptive devices, boots for the rainy season. JGI supports refresherimplants, and surgical interventions. JGI currently training for the CBDAs/HBCPs every six monthssupports 170 CBDAs (86 male and 84 female) who using MOHSW trainers. The HBCPs have reachedhave reached close to 200,000 people with family over 737 people (351 male and 386 female) withplanning messaging, which has led to the adoptionof a family planning method by over 9,000 women. messaging on HIV prevention and provided home- based care and support to over 307 people (126As the impact of HIV in the Kigoma District became male and 181 female), including 42 PLHIV (20 maleincreasingly evident, JGI decided to leverage its and 22 female). The Jane Goodall Institute in Tanzania: Mainstreaming HIV Programming into Natural Resource Management and Economic Growth Activities 5
  6. 6. AIDSTAR-One | CASE STUDY SERIES VOICES FROM THE COMMUNITY: Mwamgongo is a remote village next to Gombe National Park, only accessible by a 16-mile boat ride from the town of Kigoma along Lake Tanganyika. JGI helped Mwamgongo establish a microenterprise group that has grown to include 64 members. Mwainadi and his wife, Hemed, are HIV-positive members who received seed money from JGI as part of its HIV mainstreaming efforts. Both Mwainadi and Hemed received 200,000 Tanzanian shillings (about U.S.$133); Victoria Rossi Mwainadi opened a sardine business, while Hemed launched a palm oil and soap-making business. Both loans were granted under an 11-month repayment scheme at an interest rate of 15 percent, and both paid back their loans in full by the end of the 11th month. Mwainadi dries sardines for his fish-trading Mwainadi used his profit of 258,000 shillings (U.S.$172) to pay microenterprise. for school fees for his five HIV-uninfected children, annual health insurance coverage for his family, and construction of a water tap and shower in his backyard. Thanks to the water tap, Mwainadi and Hemed no longer have to exhaust themselves by carrying heavy buckets of water from the lake. The shower has helped protect their weakened immune systems by improving household hygiene.Kasuku village currently has four CBDAs/HBCPs 46 villages in the Kigoma District to encouragewho began their work by sensitizing the village establishment of microenterprise groups thatgovernment and introduced themselves to the distribute and oversee microcredit loans to villagecommunity at a public meeting. The CBDAs/ members. These self-governing groups elect aHBCPs explained they would be offering home- board and vote on such organizational mattersbased services to HIV-affected families and family as membership fees, loan repayment schemes,planning services to all interested households. As interest rates, and penalties. As part of JGI’s effortspart of their ongoing responsibilities, they promote to mainstream HIV into its NRM/EG activities, JGIcondom use as an effective way to prevent HIV began providing seed money to PLHIV so theytransmission and encourage anyone who feels sick could join these microenterprise groups and accessto go to the dispensary for HIV testing. HIV-related small loans. A total of 2,443,001 Tanzanian shillingsservices include teaching families how to care for (about U.S.$1,630) was provided to 42 PLHIV (22their sick family members, to wear gloves, to use female and 20 male) from nine villages to coverdisinfectants, to make home-based remedies such fees, deposits, and initial savings needed for themas boiled water and salt to treat mouth sores, and to join the microenterprise groups. Involving PLHIVto eat a healthy diet of fruits and vegetables. HIV- in microenterprise has also been shown to reduceinfected women who are pregnant are referred to stigma against them, leading to greater acceptancethe dispensary for antenatal care, prevention of by the community. The various microenterprisesmother-to-child transmission, and counseling on the that have been established with support from JGIbenefits of exclusive breastfeeding. include palm seedling nurseries, production of palm oil and soap, sustainable charcoal-making, poultryMicroenterprise/credit for PLHIV: JGI farming, sustainable vegetable and fruit farming,provides education on income generation to fish trading, and beekeeping.6 AIDSTAR-One | August 2012
  7. 7. AIDSTAR-One | CASE STUDY SERIES agro-forestry plots are distinct land designations that JGI supports for inclusion in village land-use management plans. Forestry reserves are protected wooded areas, often on the outskirts of a village, inside which trees cannot be cut down for firewood or used for home construction. Conversely, woodlots are small plots of trees planted exclusively to serve as firewood. Woodlots are usually located within a village and directly adjacent to people’s Victoria Rossi homes. This minimizes the distance traveled for firewood collection, thus decreasing daily labor requirements, which is especially helpful for PLHIV.A family in Mwakizega village benefiting from a JGI also trains villages to practice agro-forestry,fuel-efficient stove designed by JGI. which is the combined use of land to cultivateFuel-efficient stoves: JGI has designed a both crops for human consumption and treeslow-cost, fuel-efficient stove for inside the home for reforestation. The training focuses on PLHIVthat consumes significantly less firewood or and encourages them to cultivate trees whilecharcoal. This produces much less smoke and simultaneously growing vegetables to supportsoot and improves indoor air quality. PLHIV are good nutrition, which can improve tolerance ofmore susceptible to respiratory infections and HIV medications.benefit significantly from decreased smoke andsoot inside the home. The stove is made of locally HIV education: In 2005, JGI began contractingavailable materials and has a raised, enclosed base with a local organization called the Kigoma Vijanathat is vented to the outside. The enclosed base Development Association (KIVIDEA) to supportencapsulates heat, enabling food to cook twice as the integration of HIV education into JGI’s Rootsfast as with an open-flame fire, which loses up to 80 & Shoots program, which supports youth clubs inpercent of its heat to the surroundings. The more primary and secondary schools. Roots & Shootsefficient use of firewood means that fewer trees teaches youths primarily about conservation, whileare cut, mitigating environmental degradation and using life skills training as the entry point for HIVlessening the daily labor requirements for PLHIV. education. The life skills training includes teachingThe stoves also decrease daily labor requirements decision making and critical thinking skills, conflictfor a household because pots and pans sit above resolution and negotiation of peer pressure,the flame and not inside it, thus collecting less soot relationship management, self-control, andto scrub off. These stoves—beneficial for both understanding the physical changes in one’s body.the environment and PLHIV—are a quintessential The Roots & Shoots program’s messaging aroundrepresentation of JGI’s effective integration of HIV HIV is age dependent, employing “abstinenceand NRM/EG activities. and being faithful” messaging in primary schools and “abstinence, being faithful, and condoms”Forestry reserves, woodlots, and agro- messaging in secondary schools. KIVIDEA hasforestry: JGI works closely with the district council adapted the United Nations Children’s Fund’sand village governments to develop land-use plans life skills training curriculum to the local context,that designate certain areas of land to be used for and currently supports 32 schools and 70 Rootsspecific purposes. Forestry reserves, woodlots, and & Shoots clubs throughout the Kigoma District. The Jane Goodall Institute in Tanzania: Mainstreaming HIV Programming into Natural Resource Management and Economic Growth Activities 7
  8. 8. AIDSTAR-One | CASE STUDY SERIESJGI also integrates HIV education into its natural JGI has also mainstreamed water and sanitationresource management training for the district activities into its NRM/EG activities to providecouncil and village governments, village fire crews, clean drinking water for rural villages to reduceand forest monitors. JGI screens village films the transmission of waterborne diseases. Theon wildfire management, leaving time at the end organization’s water and sanitation activities includeto show an MOHSW-endorsed film on HIV and providing education and training on hygiene andfacilitate a community-level discussion on the topic. sanitation in communities and schools, protecting water springs, and constructing rainwaterBroader health initiatives: In addition to HIV harvesting tanks and ventilated, improved pitactivities, JGI is also successfully mainstreaming latrines. The latter not only improves sanitationbroader health issues into its NRM/EG activities, for schools but also ensures that young girls canincluding family planning, child survival, cervical stay in school once they begin menstruating,cancer screening, and water and sanitation which reduces their vulnerability to HIV. Water andprojects; the organization is also renovating five sanitation initiatives also benefit PLHIV by helpingdispensaries in the Kigoma District. JGI’s CBDAs to reduce the incidence of diarrheal diseaseseducate women and men about their reproductive caused by contaminated, the benefits of child spacing, and the Internal mainstreaming: In addition to JGI’savailability of family planning services and methods, external mainstreaming of HIV activities intoand also provides some family planning methods, community NRM/EG activities, the organization hasincluding oral contraceptives and condoms. JGI also internally mainstreamed HIV into operations forhas integrated child survival interventions into JGI staff and family members. JGI has incorporatedits family planning activities to take advantage HIV education into general staff meetings and madeof the credibility and linkages that CBDAs condoms available in bathrooms, the receptionhave already established. The CBDAs educate area, and the staff clinic in Gombe National Park.families about child survival issues, including JGI partners with the MOHSW and the Tanzanianthe importance of accessing early treatment for National Park Association to conduct educationalsuch childhood diseases as malaria, pneumonia,diarrhea, and upper respiratory infections.They also promote integrated management ofchildhood illnesses services at the village leveland work closely with dispensary staff to ensureprompt treatment of sick children. Additionally,JGI has partnered with Grounds for Health, aninternational nongovernmental organization thatworks with coffee-growing communities to establishsustainable cervical cancer prevention programs, Victoria Rossito bring its cervical cancer screening techniquesto the Kigoma District. JGI facilitates Grounds forHealth’s efforts to educate and sensitize women in KIVIDEA, a JGI subgrantee, supports mainstreaming of HIVthe villages about cervical cancer and to encourage education into JGI’s Roots and Shoots program in primarythem to go for screening. and secondary schools.8 AIDSTAR-One | August 2012
  9. 9. AIDSTAR-One | CASE STUDY SERIESsessions on HIV and provide HIV testing andcounseling for its ape researchers who live within VOICES FROM THE COMMUNITY:Gombe and away from their families for extendedperiods of time. In Mwakizega village, JGI trained and supported Aisha and her brother, Sauda, to launch an organic honey business. The siblings maintain several beeWhat Works Well huts in a secluded, wooded area of the village that they have cleared of brush and dried leaves toAdapting the organizational mission to protect the bee huts from wildfires. They do not useaddress community needs: JGI recognized pesticides to maintain the hives, which yields organicvery early on that achieving its mandate of honey that fetches“conserving biodiversity and protecting and a higher price thanrestoring wildlife habitat in critical ecosystems in regular honey. Whenwestern Tanzania” required expanding its scope some of their hivesof work. First, JGI empowered the communities in were threatened bywhich it works to identify their own priorities, and destructive ants,then enabled enough organizational flexibility to JGI trained them toadapt its mission statement and design effective lay ash—a naturalstrategies to address those priorities. JGI has fully repellent—at theintegrated health promotion and socioeconomic base of the bee huts.development of the local communities into natural Aisha and Saudaresource management, which is evident in the harvest 5 to 10 litersmission statement of the current GMU program: of organic honey Victoria Rossi“To ensure the survival of the native habitats and every three months,wildlife and other natural resources of the GMU which they sell atecosystem through improving the standard of living 3,000 Tanzanianof local communities” (JGI 2011). shillings per 0.5 liters Aisha is an organic beekeeping for a total of 30,000 entrepreneur in Mwakizega village as a result of aLeveraging the NRM/EG platform for to 60,000 shillings microcredit loan and trainingmaximum health impact: For JGI to achieve (U.S.$20 to $40). made possible by JGI support.its organizational objectives in the KigomaDistrict, it must design and implement NRM/EG interventions that reach down to the village, JGI is able to invest the majority of its PEPFARhamlet, and even household level, which is a major wraparound funds in direct HIV activities.challenge in the global health field. Implementingcommunity-based health interventions can be Committed, multidisciplinary staff: JGIhighly resource intensive, especially for remote, works in a remote part of western Tanzaniaunderserved populations. JGI’s community- and is the only nongovernmental organizationbased NRM/EG activities are well established working on population, health, and environmentat the grassroots level, creating a cost-effective issues in that region. JGI’s staff members areplatform for implementing community-based health multidisciplinary, with expertise in a broad rangeinterventions. By leveraging an already existing of technical areas, including primatology, botany,platform that was established using NRM/EG funds, conservation, microenterprise, health, governance, The Jane Goodall Institute in Tanzania: Mainstreaming HIV Programming into Natural Resource Management and Economic Growth Activities 9
  10. 10. AIDSTAR-One | CASE STUDY SERIESand community development. JGI employs afull-time health specialist to coordinate its HIVmainstreaming work and to build the capacityof the organization on broader health issues.JGI’s staff share a deep sense of commitmentand responsibility to the communities they serve,and understand the intimate linkages betweenthe socioeconomic status of the people andconservation of the land. On a daily basis, they Victoria Rossiare the key players creating the time and space toeffectively mainstream HIV into their work, whilesimultaneously fulfilling JGI’s core mandate ofprotecting chimps and their natural habitat. JGI staff with home-based care provider trainers from the Ministry of Health and Social Welfare in the Kigoma District.Partnering with local government: At thecenter of JGI’s work in the Kigoma District are De-stigmatization of HIV: It has beenstrong partnerships with the district councils, anecdotally reported by JGI staff, MOHSW trainers,village-level government, and the MOHSW. JGI CBDAs/HBCPs, and community beneficiaries thatsupports MOHSW trainers to train the CBDAs/ JGI’s work in the Kigoma District has significantlyHBCPs. It also works directly with the district reduced the stigma associated with HIV.councils and village-level government to develop Community sensitization and education about HIVland use management plans, implement water demystifies the disease and dispels inaccurate localand sanitation projects, roll out cervical cancer beliefs about its cause, transmission, and treatment.screening, set up microenterprise groups, conduct Mainstreaming HIV into family planning/childHIV educational campaigns, and establish HIV survival home-based services and broad, village-committees within the village-level government wide NRM/EG activities decreases the stigmastructure. This level of collaboration with the local attached to the disease and increases participationgovernment ensures that program design is locally in JGI-supported activities.appropriate, and it also fosters political buy-in thatproves critical for successful implementation andfuture program sustainability. ChallengesUse of community-based health workers: Weak HIV capacity and lack of clarity onThe CBDAs/HBCPs provide a critical linkage mainstreaming: Mainstreaming HIV into NRM/between clients and the health system. They act as EG activities is traditionally done by organizationsa conduit for rural and remote populations to access that do not have significant experience with HIVfacility-based health services and serve as effective or health expertise in general. Definitions ofhealth educators and mentors to improve the mainstreaming are somewhat vague and provideuptake of health messages. Reaching beyond the little guidance for operationalization. In this context,dispensary down to the hamlet level, they support concerns can arise that the mainstreaming of HIVpatients throughout the full continuum of care to will detract from an organization’s core area ofpromote adherence and to improve retention. expertise and will divert resources. Staff of NRM/10 AIDSTAR-One | August 2012
  11. 11. AIDSTAR-One | CASE STUDY SERIESEG organizations can perceive the mainstreaming the high-level PEPFAR indicators for treatment,of HIV as a burdensome addition to their daily work care, and support. JGI has grown accustomed toand may be reluctant to prioritize these activities. USAID’s NRM/EG reporting requirements, which allow for selection of customized indicators toFunding from different USAID offices accurately represent its work. USAID/Tanzaniawith different reporting requirements: has encouraged JGI to take full advantage ofUnder the current GMU project, JGI receives both the comments section of its PEPFAR reports toPEPFAR wraparound funds and NRM/EG funding qualitatively document its achievements, but JGIthrough USAID/Tanzania. From a mainstreaming has expressed concern that funding levels may beperspective, JGI takes the ideal approach of adversely impacted if they do not report against thedeveloping one single, integrated workplan by full set of PEPFAR indicators.adding the PEPFAR wraparound funds to theoverall budget and incorporating all HIV activities Resource limitations: In several villages,as part of its NRM/EG workplan. However, having the CBDAs’ bags, umbrellas, and rain bootsone workplan that incorporates both NRM/EG and need replacing, and the bicycles that JGIHIV activities presents challenges for tracking provided in 2007 need repair. Additionally, asspending from the two different funding sources. the microenterprise/microcredit groups haveThis is especially true for fully integrated HIV and flourished, more PLHIV have become interestedNRM/EG activities, such as for HIV sensitization in participating. With increased funding, JGI wouldand the education of beekeepers who receive be able to provide additional services, includingmicroenterprise support from JGI. In order to clearly replenishment of village-based supplies andarticulate activities and expenditures from each equipment, bicycle repairs, seed money for PLHIVfunding source, JGI had to artificially separate to join microenterprise/credit groups, and logisticalNRM/EG and HIV activities in the previously support for the MOHSW’s mobile outreach services,integrated workplan and budget. including family planning, antiretroviral therapy, and HIV testing and counseling.Additionally, distinct reporting templates are usedfor NRM/EG and HIV reporting. On a quarterlybasis, JGI completes NRM/EG reports that Recommendationsdocument in a specific wraparound section howPEPFAR wraparound funds have been used to Key lessons can be drawn from JGI’s successfulimplement HIV mainstreaming activities. These work in mainstreaming HIV services into NRM/EGNRM/EG reports are shared with the PEPFAR activities in western Tanzania.wraparound team. On a semi-annual basis,JGI completes PEPFAR reports using a distinct Practice internal mainstreaming to fostertemplate to report against a set of standard staff’s understanding and commitment:PEPFAR indicators. For staff to effectively mainstream HIV into their daily work, they must be well-educated aboutFitting into PEPFAR indicators: JGI has found HIV infection and understand its impact on theit challenging to accurately and fully capture its communities they serve. Internal mainstreaming,work within PEPFAR’s standard set of indicators. including training during staff meetings and supportJGI’s mainstreamed HIV activities are primarily for staff members and their families affected byprevention related, falling outside the purview of HIV, fosters a sense of well-being that will extend The Jane Goodall Institute in Tanzania: Mainstreaming HIV Programming into Natural Resource Management and Economic Growth Activities 11
  12. 12. AIDSTAR-One | CASE STUDY SERIESto their work in the communities. If staff do not how it has mainstreamed HIV activities into itsfeel adequately educated about HIV or enabled core work during that quarter. Furthermore,to confront it within their own personal lives, they PEPFAR recently added an indicator to its reportingwill be ill equipped to mainstream HIV education templates that captures economic strengtheningand support services into NRM/EG activities at work for vulnerable families in order to address thethe community level. One recommendation worth broader development work that partners are doing.strong consideration is the recruitment of a full-time This indicator should better capture the community-staff member with health expertise to coordinate the based economic strengthening activities that mostmainstreaming of HIV into an organization’s NRM/ NRM/EG organizations will implement in the future.EG activities and to build staff capacity. Coordinate provision of technicalMaintain effective communication assistance to support mainstreaming:between recipient and donors: PEPFAR As mentioned previously, mainstreaming HIVwraparound funds link HIV programs with other into NRM/EG activities is traditionally done bynon-health sectors that may not have strong organizations without significant experience withtechnical knowledge of HIV; similarly, HIV program HIV and that may have insufficient guidance.staff may lack an understanding of NRM/EG. Organizations specializing in HIV, such asTo minimize confusion, regular communication AIDSTAR-One, can be contracted to providebetween the donors (in this case, USAID/Tanzania targeted technical assistance on the effectivestaff from the Health and NRM/EG teams) and mainstreaming of HIV into annual workplans,the wraparound funding recipient is imperative. implementation plans, and budgets.Although quarterly reports are a form of regularcommunication, as discussed previously, they have Promote sustainable, country-ledsome inherent challenges. A schedule of regular programming: Strong partnerships with thecheck-ins—including in-person meetings and field government are critical, beginning at the nationalvisits—might help improve the implementation of level and continuing down to the regional, district,wraparound programming. and village levels. These partnerships ensure that programming is locally appropriate and thatTake full advantage of both NRM/EG and governments have the technical capacity andPEPFAR reports: As mentioned previously, political commitment to sustain programming inthere is a section in the NRM/EG quarterly reports the future.where the organization thoroughly documents itsHIV mainstreaming activities. These NRM/EG Mainstream broader health issues:reports are shared with the PEPFAR wraparound Mainstreaming should extend beyond HIV toteam. However, it can be challenging to accurately broader health issues such as maternal andand fully capture HIV mainstreaming work within child health, water and sanitation, malaria, andPEPFAR’s standard indicators. PEPFAR recognizes nutrition. The benefits of such an approach includethis fact and encourages partners to qualitatively the mitigation of HIV stigma, improved cost-document their achievements in the comments effectiveness, and better attention to communitysection of the PEPFAR reports. If an NRM/EG health needs overall, not just the relatively smallorganization is not able to report on any of the number of households affected by HIV. ThisPEPFAR indicators, it can still submit a satisfactory approach is also consistent with future fundingreport by fully describing in the comments section trends as determined by the U.S. Global Health12 AIDSTAR-One | August 2012
  13. 13. AIDSTAR-One | CASE STUDY SERIESInitiative (GHI), which calls for increased integration 16, 2005. Available at such health concerns as HIV, tuberculosis, 088e4b8cdc0c6bd4b67eaa81e6427a705.pdfmalaria, nutrition, maternal and child health, (accessed February 2012).neglected tropical diseases, safe water, sanitation,and hygiene (U.S. GHI 2011). Jane Goodall Institute. 2009. Landscape Scale Community-Centered Ecosystem Conservation in Western Tanzania. Technical Application inConclusion Response to USAID/Tanzania 09-003-APS.JGI’s work in the Kigoma District provides an Jane Goodall Institute. 2011. Landscape-Scaleexample of successful implementation of PEPFAR Community-Centered Ecosystem Conservationwraparound funding to mainstream HIV and in Western Tanzania: Gombe-Masito-Ugallabroader health issues into NRM/EG activities. JGI Ecosystem, Historical Background and Progress.has designed a community-centered model ofconservation that addresses the socioeconomic Joint United Nations Programme on HIV/AIDS,development priorities of the local people, including World Bank, and United Nations Developmenthealth, education, safe water, and access to capital. Program. 2005. Mainstreaming HIV and AIDSThrough thoughtful leveraging of the NRM/EG in Sectors and Programmes: An Implementationplatform, JGI has effectively balanced community Guide for National Responses. Available atpriorities and adherence to its core mandate of chimpanzees and their habitat. Lessons en/publications/hiv-aids/mainstreaming-hiv-and-that have emerged during JGI’s work in the Kigoma aids-in-sectors-and-programmes--guide/19.pdfDistrict could help other organizations, program (accessed June 2012).managers, policymakers, donors, and countrygovernments to more effectively mainstream HIV Oglethorpe, Judy, and Nancy Gelman. 2007. HIV/and broader health issues into NRM/EG activities AIDS and the Environment: Impacts of AIDSwithin their own contexts. g and Ways to Reduce Them: Fact Sheet for the Conservation Community. Washington, DC: WorldREFERENCES Wildlife Fund, Inc., reproduced from UNAIDS. Available at Biodiversity Collaborative Group. 2002. communityaction/people/phe/WWFBinaryitem7051.“Proceedings on HIV/AIDS and Natural Resource pdf (accessed February 2012).Management Linkages.” Proceedings presentedat the Nairobi Workshop, Mweka, Tanzania, President’s Emergency Plan for AIDS Relief. 2008.September 2002. “Connecting the Dots of International Development.” Available at, Marc, Christine Holding-Anyonge, (accessed November 2011).Dennis Kayambazinthu, and Almeida Sitoe. 2005.“Firewood, Food and Medicine: Interactions President’s Emergency Plan for AIDS Relief. 2011.Between Forests, Vulnerability and Rural FY 2012 Country Operational Plan GuidanceResponses to HIV/AIDS.” Proceedings from Appendices. Available at IFPRI Conference: HIV/AIDS and Food and documents/organization/169695.pdf (accessedNutrition Security, Durban, South Africa, April 14– November 2011). The Jane Goodall Institute in Tanzania: Mainstreaming HIV Programming into Natural Resource Management and Economic Growth Activities 13
  14. 14. AIDSTAR-One | CASE STUDY SERIESU.S. Global Health Initiative. 2011. “U.S. Global RECOMMENDED CITATIONHealth Initiative. Saving Lives and PromotingSecurity.” Available at Rossi, Victoria, Grace Lusiola, and Aysa Saleh-factsheets/2011/161412.htm (accessed Ramirez. 2012. The Jane Goodall Institute inNovember 2011). Tanzania: Mainstreaming HIV Programming into Natural Resource Management and Economic Growth Activities. Case Study Series. Arlington, VA:ACKNOWLEDGMENTS USAID’s AIDS Support and Technical Assistance Resources, AIDSTAR-One, Task Order 1.The authors would like to thank the followingagencies for providing input and guidance for thedevelopment of this case study: the U.S. Agency for Please visit forInternational Development (USAID)/Tanzania, the additional AIDSTAR-One case studies and otherJane Goodall Institute (JGI) Kigoma, the Kigoma HIV- and AIDS-related resources.Vijana Development Association, JGI Washington,USAID/Washington, and the United Republic ofTanzania Ministry of Health and Social Welfare.Special thanks go to Grey Saga (USAID/Tanzania),Emmanuel Mtiti (JGI Kigoma), Alice Macharia (JGIWashington), and all the community members of theKigoma District who shared their perspectives andexperiences.14 AIDSTAR-One | August 2012
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