2. 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 2005
Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision.
4. Phayao, Thailand
HIV seroprevalence among 21 year old men
18
HIV Seroprevalence, %
16
14
12
10
8
6
4
2
0
1991 1992 1993 1994 1995 1996 1998 2000 2002
5. Uganda: trends in antenatal HIV
prevalence at selected sentinel sites
Nsambya Rubaga Mbarara Jinja Mbale Tororo Lacor
35
30
25
20
b
15
10
5
0
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
6. 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
7. we are the subjects of the response
to HIV/AIDS
community
family
personal
people
work policy
8. 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 society
LF: Local Facilitation
9. 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
10. Knowledge-sharing
LFT
LFT
Churches
UN Business
LFT
LFT
Civil society DFT
Government sectors
CBOs NGOs
Persons living with
LFT HIV/AIDS
LFT
DFT: District Facilitation Team.
11. Regional Partnerships Religious leaders
Governments
UN
RFT
National Partnerships GFT
Donors NGOs
NFT Foundations
Business
District
Persons living with
Partnerships HIV/AIDS
Global Partnerships
DFT
DFT
LFT
Local LFT LFT
Partnerships
GFT: Global Facilitation Team
12. The Constellation for AIDS
Competence
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
13. 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.
14. 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.
15. 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.
20. 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
21. organisations: shifting attitudes
We believe in our own We believe in people’s
expertise to provide strengths to respond
solutions
We control a disease We facilitate responses
We respond to need We reveal strength
You have a problem Together, you and we
have solutions
22. facilitation teams: goals
members assist each other to:
learn from local responses
stimulate knowledge creation and sharing
embed lessons learnt into organisations
participate in knowledge sharing worldwide
23. Ways of Working
participation is voluntary
responds to invitations
any community can invite
no internal hierarchy
one organisation serves as host
25. 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 the
Acknowledgement 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 care
Care 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 and
Measuring change by others. self measure.
progress and set targets
demonstrate measurable share learning/results
for improvement.
improvement. with others.
26. 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
33. 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
ps
Le
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
ng
M
ob
ilis
in
g
re
so
ur
ce
s
34. 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
ps
Le
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
ng
M
ob
ilis
in
g
re
so
ur
ce
s
35. 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
ps
Le
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
ng
M
ob
ilis
in
g
re
so
ur
ce
s
36. 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
ps
Le
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
ng
M
ob
ilis
in
g
re
so
ur
ce
s
37. 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
ps
Le
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
ng
M
ob
ilis
in
g
re
so
ur
ce
s
38. Something to learn, something to share
Current
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
41. 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
42. 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
43. Context and detail – where and
when you need it…
•
•
“
•
•
“
“
•
• “
“
“
44. A Knowledge Asset
Principles (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
share
Work 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….
49. Two ideas
• The Constellation for AIDS Competence
• Friends for Life
50. 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
51. The “Stairs” Diagram
Performance
Manage Corrosion
Cooper
5 River
High performance
Bulwer
4 Island
Feluy
High desire
to improve
Lavera Grangemouth
3 Chemicals
Texas City
Geel
Coryton
Joliet Kwinana
2 Feluy
Decatur
FPS Netherlands Trinidad Oil
1 Hull
Gap between
0 1 2 3 4 current and target
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.