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 with high HIV prevalence : Zimbabwe South Africa Botswana with low HIV prevalence: Madagascar Mali Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision . 1950– 1955 1955- 1960 1960- 1965 1965- 1970 1970- 1975 1975- 1980 1980- 1985 1985- 1990 1990- 1995 1995- 2000 2000- 2005 Senegal 30 35 40 45 50 55 60 65 Life expectancy (years)
<ul><li>There is another way! </li></ul>Photo: Georgia Roessler
Phayao, Thailand HIV seroprevalence among 21 year old men 1991 1992 1993 1994 1995 1996 0 2 4 6 8 10 12 14 16 18 HIV Seroprevalence, % 2002 2000 1998
Uganda: trends in antenatal HIV prevalence at selected sentinel sites
what have we learnt? <ul><li>effective responses to HIV/AIDS are people-driven, not commodity driven </li></ul><ul><li>service provision is required, but is no substitute to people driven responses </li></ul><ul><li>progress hinges on local partnerships </li></ul>
we are the subjects of the response to HIV/AIDS people work policy community personal family
Local Partnerships to HIV/AIDS – The Key for AIDS Competence LF: Local Facilitation Civil society LF Youth Clubs Traditional Leaders Women Groups Local Religious Leaders Teachers Nurses and doctors People living with HIV/AIDS Families Providers of services People of influence
country-wide AIDS progress <ul><li>horizontal sharing of AIDS-competence from community to community </li></ul><ul><li>scaling-up of locally available services and financial resources </li></ul><ul><li>facilitative, catalytic leadership </li></ul>
LFT Knowledge-sharing UN CBOs Churches Business Government sectors NGOs Persons living with HIV/AIDS Civil society DFT DFT: District Facilitation Team. LFT LFT LFT LFT LFT
Regional Partnerships National Partnerships Local Partnerships NFT Global Partnerships DFT GFT LFT LFT LFT DFT RFT District Partnerships GFT: Global Facilitation Team NGOs Foundations Business Religious leaders Persons living with HIV/AIDS Governments UN Donors
The Constellation for AIDS Competence <ul><li>Connecting local responses around the world </li></ul><ul><li>Committed to the goal of AIDS Competence and </li></ul><ul><li>Committed to HCD as a strategy </li></ul><ul><li>Founded on December 8, 2004 </li></ul>
Our vision and mission <ul><li>We envision a global society in which each element is pursuing AIDS competence. </li></ul><ul><li>Our mission is to connect people involved in local responses to AIDS around the world for mutual support, learning and transformation. </li></ul><ul><li>We are made of learning communities whose members support and learn from each other in their own journey towards AIDS competence. </li></ul><ul><li>We cooperate with any other organisation which pursues a similar vision and approach to the resolution of global development challenges. </li></ul>
What makes us different? <ul><li>We see people primarily as the subjects of the response to AIDS, not as the targets of interventions. </li></ul><ul><li>We connect people for learning; we do not seek to organise resources. </li></ul><ul><li>Each of us is linked to local responses and is inspired by the experience. </li></ul><ul><li>We start from within: ourselves, and the organisations we belong to. </li></ul>
Our Goal: AIDS Competence <ul><li>In an AIDS Competent society, we – as we relate to families, to communities, to our work and to policy– act from strength to: </li></ul><ul><ul><li>acknowledge the reality of HIV and AIDS, </li></ul></ul><ul><ul><li>build our capacity to respond, </li></ul></ul><ul><ul><li>reduce our vulnerability and risk, </li></ul></ul><ul><ul><li>allow everyone to live out their full potential, and </li></ul></ul><ul><ul><li>share our experience with others. </li></ul></ul>
Our Approach Human Capacity for Response <ul><li>We care </li></ul><ul><li>We change </li></ul><ul><li>We learn </li></ul><ul><li>We belong </li></ul><ul><li>We transfer </li></ul>
the challenge to the true leader <ul><li>appreciates local strengths and assets </li></ul><ul><li>seeks to understand rather than to judge </li></ul><ul><li>stimulates interaction among various partners </li></ul><ul><li>values listening over talking </li></ul><ul><li>prefers asking questions over providing answers </li></ul><ul><li>chooses learning over teaching </li></ul>
organisations: shifting attitudes Together, you and we have solutions You have a problem We reveal strength We respond to need We facilitate responses We control a disease We believe in people’s strengths to respond We believe in our own expertise to provide solutions
facilitation teams: goals <ul><li>members assist each other to: </li></ul><ul><li>learn from local responses </li></ul><ul><li>stimulate knowledge creation and sharing </li></ul><ul><li>embed lessons learnt into organisations </li></ul><ul><li>participate in knowledge sharing worldwide </li></ul>
Ways of Working <ul><li>participation is voluntary </li></ul><ul><li>responds to invitations </li></ul><ul><li>any community can invite </li></ul><ul><li>no internal hierarchy </li></ul><ul><li>one organisation serves as host </li></ul>
Self-Assessment of AIDS competence We invite others to help measure our change and share learning/results with others. We measure our change systematically and can demonstrate measurable improvement. We measure our own progress and set targets for improvement. We begin consciously to self measure. Our change is evaluated by others. Measuring change We see an improvement in local responses as a result of our learning and sharing. We learn, share and apply what we learn systematically, and seek people with relevant experience to help us. We have processes for learning and sharing which we use sometimes. We seek people of experience when necessary. We share learning from our successes but not our mistakes. We learn by what we do rather than what we learn from and share with others. Learning and transfer We are addressing vulnerability in all aspects of the life of our group, all are aware and involved in responding. Our strategy is based on good practices. We have a clear strategy to address vulnerability and risk. We have mapped vulnerability and risk. We aware of the general factors of vulnerability and the risks affecting us. Identify and address vulnerability We address and resolve all challenges facing us (not only HIV/AIDS.) Our partnerships share common goals, and define each partner’s contribution. Religious and community leaders get involved. We (individuals, families, communities, service providers and policy makers) work together to respond to HIV/AIDS. We get together with some people who are crucial to resolve common issues. We don’t involve those affected by the problem. Inclusion We intentionally link care and change of behaviours and work practices in ourselves and with others . We change because we care. Our care and prevention activities are separate and dependent on external stimulus. We adapt and communicate externally provided messages about care and prevention. We communicate externally provided messages about care and prevention. Care and change of behaviour We recognise our own strength to deal with the challenges and seek others for mutual support and learning. We acknowledge openly with others our concerns about HIV/AIDS and the challenges it represents for us. We recognise that HIV/AIDS is a problem for us and we discuss it amongst ourselves We recognise that HIV is a problem. We know the basic facts about HIV/AIDS. Acknowledgement and Recognition 5 HIGH 4 3 2 1 BASIC
Self assessment <ul><li>People: </li></ul><ul><ul><li>talk </li></ul></ul><ul><ul><li>exchange perspectives </li></ul></ul><ul><ul><li>get to grasp the local reality </li></ul></ul><ul><ul><li>define priorities and actions adapted to context </li></ul></ul><ul><ul><li>follow up </li></ul></ul><ul><ul><li>formulate lessons learned </li></ul></ul><ul><ul><li>identify what experience to share and what to experience to seek </li></ul></ul>
Follow up: One Example Cinq Districts in Bangkok
Comparison of AIDS Competence Indicators Pre- and Post-Community Self Assessment in 5 Bangkok Districts Level Acknowledgment and recognition Inclusion Care and prevention Identify and address vulnerability Level Level Level Pre-intervention Post-intervention year 1 Post-intervention year 2
Comparison of AIDS Competence Indicators Pre- and Post-Community Self Assessment in 5 Bangkok Districts Learning and transfer Adapting Way s of working Mobilizing resources Level Level Level Level Pre-intervention Post-intervention year 1 Post-intervention year 2
Comparison of AIDS Competence Indicators Pre- and Post-Community Self Assessment in 5 Bangkok Districts Access to treatment Measuring change Level Level Pre-intervention Post-intervention year 1 Post-intervention year 2
Current levels for Mae Chan community Mae Chan 1 2 3 4 5 Acknowledgement Care and Change Inclusion Vulnerable groups Learning and transfer Measuring change Adapting Ways of working Mobilising resources Level
Levels for other communities too Mae Chan 1 2 3 4 5 Acknowledgement Care and Change Inclusion Vulnerable groups Learning and transfer Measuring change Adapting Ways of working Mobilising resources Level
Mae Chan 1 2 3 4 5 Acknowledgement Care and Change Inclusion Vulnerable groups Learning and transfer Measuring change Adapting Ways of working Mobilising resources Level Ecart entre les niveaux actuels
Mae Chan 1 2 3 4 5 Acknowledgement Care and Change Inclusion Vulnerable groups Learning and transfer Measuring change Adapting Ways of working Mobilising resources Level Le niveau de Mae Chan – “la rivière”
Mae Chan 1 2 3 4 5 Acknowledgement Care and Change Inclusion Vulnerable groups Learning and transfer Measuring change Adapting Ways of working Mobilising resources Level
Something to learn, something to share <ul><li>Match making to put those with something to learn in touch with those with something to share via a Peer Assist meeting or an electronic forum. </li></ul>Something to share Something to learn Progress Acknowledgement & Recognition Improvement Objective Current level +4 +3 +2 +1 0 Moroto 1 Arua Rakai 2 Kibaale Pallisa Busia 3 4 Mbarara 5
A few more 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? Even more Still More More Lessons More Lessons Lessons Learned Knowledge Assets
"...the politics accompanying hierarchies hampers the free exchange of knowledge. People are much more open with their peers. They are much more willing to share and to listen.” Lord John Browne Peer Assists – Learning before doing Action What you know in your context What I know in my context What we both know What’s possible?
Context and detail – where and when you need it… “ “ “ “ “ “
A Knowledge Asset AFCN process Hope World-wide/Enda Sante/SA partnership Team leadership development is done through attaching people to teams with more experienced facilitators, allowing people to practise with support of a team, and then handing over team leadership to others…. Work as a team: co-facilitating and mentoring new team members in every process HCD Concept Paper Action Research (SA) Capacity for care, change, leadership and hope as transferable concepts which have been seen and documented in multiple countries Believe that people/communities have capacity, experience and knowledge to share Resources (Documents, Policies, People) Experience which leads to the principle Principles (or advice)
Two ideas <ul><li>The Constellation for AIDS Competence </li></ul><ul><li>Friends for Life </li></ul>
Managing Knowledge? <ul><li>“ 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 </li></ul>Capturing Connecting
The “ Stairs ” Diagram Cooper River Bulwer Island Lavera Chemicals Feluy Texas City Kwinana Coryton Feluy Joliet Grangemouth Geel Netherlands Decatur Hull FPS Trinidad Oil High desire to improve High performance 5 4 3 2 1 0 1 2 3 4 Gap between current and target Performance Manage Corrosion