Measuring Hiv Competence


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  • No commitment to community indicators in our log frames, proposals etc.
  • Link with dreams all over the world. Still is generated from dreams. Process is important to generate tools. Level 5 is the dream as described on day 1.
  • Focus is not on showing external parties the validity of the approach. It’s for the community’s motivation.
  • Measuring Hiv Competence

    1. 1. Measuring AIDS Competence Our experiences The Constellation – 14 Oct 2009 Nairobi 14-10-2009 The Constellation for AIDS Competence
    2. 2. 3 opening questions <ul><li>What did we learn until today about measuring HIV competence? </li></ul><ul><li>How does your own congregation measure its progress? </li></ul><ul><li>Who should measure and what should they measure? </li></ul>14-10-2009 The Constellation
    3. 3. Our starting point <ul><li>Every community has the capacity to envision, assess its situation, measure its progress and adapt. </li></ul><ul><li>2. We do not set indicators for other people </li></ul>14-10-2009 The Constellation
    4. 4. Levels of measuring competence <ul><li>Community level </li></ul><ul><li>Facilitation team level </li></ul><ul><li>Organization and partner </li></ul><ul><li>level </li></ul><ul><li>Related issues: </li></ul><ul><li>A. Cost-effectiveness </li></ul><ul><li>B. Linking results to global frameworks & indicators </li></ul>14-10-2009 The Constellation for AIDS Competence
    5. 5. Community We share Building the dream Initial SALT visit Facilitate self-assessment Action plan SALT visit Self- measure change Self-measure change After-Action-Review Knowledge Fair Knowledge assets Peer assist Community Facilitators SALT 14-10-2009 The Constellation for AIDS Competence we care we assess our situation we act we hope we measure change we learn & adapt
    6. 6. Level 1 – Community level Assessing our AIDS Competence 14-10-2009 The Constellation for AIDS Competence   Level 1. Indicators that show us we are aware Level 2. We react Level 3. We act Level 4. Continuous action, systematizing what we do Level 5. The practice is part of our life-style 1. Acknowledgement and Recognition We know that HIV and AIDS exist. We know enough about HIV/AIDS to respond when something happens. We publicly recognize that HIV/AIDS is affecting us as a group/community and take occasional action We regularly discuss AIDS, and have a common program of action to respond. Our response to AIDS is part of our daily life. We know our own HIV status and act from strength. 2. Inclusion We are aware of the importance of involving others. - those affected and infected We co-operate with some people to resolve common issues. We in our separate groups meet to resolve common issues (e.g. PLWA, youth, women). Various groups share common goals and define each member’s contribution. Because we work together on HIV/AIDS we can address and resolve other challenges facing us. 3. Linking care and prevention We have the basic knowledge for prevention and care. We understand the link between care and prevention. some of our actions link care and prevention We systematically link care and prevention activities. Care strengthens our relationships and helps us to change our behaviour 4. Access to Treatment We access basic medicines We have access to simple treatment. We access treatment for more opportunistic infections, but not ARV. Some of us are using ARVs regularly. All those in need of ARV drugs are using them effectively. 5. Identify and address vulnerability We know who is most vulnerable within our community We help those more vulnerable to HIV than ourselves. Our response includes some specific actions to address our own vulnerability to HIV. We systematically address our own factors of vulnerability Our actions to address vulnerability to HIV strengthens us in addressing other challenges.
    7. 7. Level 1 – Community level Assessing our AIDS Competence 14-10-2009 The Constellation for AIDS Competence   Level 1. Indicators that show us we are aware Level 2. We react Level 3. We act Level 4. Continuous action, systematizing what we do Level 5. The practice is part of our life-style 6. Gender We are aware of gender issues and how they are related to HIV/AIDS We notice gender issues in our HIV/AIDS work and respond to them We have started to address gender issues in some of our AIDS work We regularly consider gender in our HIV/AIDS prevention, care and support We have mainstreamed gender issues in all our HIV/AIDS work. 7. Learning and transfer We want to learn and share with others We adopt good practice from outside. We sometimes share our points of view to draw lessons from our actions. We learn, share and apply what we learn regularly, and seek people with relevant experience to help us. We continuously learn how we can respond better to HIV/AIDS and share our experiences with others. 8. Measuring change and adapting our response We are aware of the importance of measuring change and adapting our response. We begin consciously to self measure but we do not yet adapt the result for improvement. We adapt our response and occasionally measure the improvement We systematically adapt and can demonstrate measurable improvement We see implications for the future and continuously adapt to meet them while measuring the change process 9. Ways of working We are aware that AIDS challenges our ways of working. We focus on our own strengths to respond. We work as teams to use our collective strengths and resolve problems as we recognize them We regularly find our own solutions to access experiences and lessons learnt from others. We continuously seek to improve our ways of working and share our experience with others. 10. Mobilizing resources We wait for resources from others who tell us how to use them. We act when resources are provided to us. We take some initiatives based on our own resources. We regularly identify and access additional sources of support to complement our own strengths. We continuously use our own resources and access other resources to achieve more, and have plans for the future.
    8. 8. The self-assessment framework <ul><li>gives back a voice to the communities </li></ul><ul><li>stimulates dialogue and surfaces local reality </li></ul><ul><li>defines priorities and actions adapted to context </li></ul><ul><li>leads to the formulation of lessons learned which can then be shared </li></ul><ul><li>forms a baseline for the community and facilitates its own measurement of progress </li></ul>14-10-2009 The Constellation for AIDS Competence
    9. 9. Level 1 – Community level Self-measurement of progress <ul><li>Principle : It’s the community’s progress, not our progress </li></ul><ul><li>Key question : As a community, how do we know if we make progress? </li></ul><ul><li>Why important? Awareness of change drives further action and sharing </li></ul><ul><li>Indicator: Measurable and verifiable progress on 1 or more practices of self-assessment </li></ul><ul><li>Means of Verification: </li></ul><ul><li>Documented (repeated) self-assessments </li></ul><ul><li>Documented action plans and self-defined indicators </li></ul><ul><li>Surveillance of service uptake (VCT, ART, STI treatment etc) </li></ul><ul><li>Story-telling through audio, video, blogging by communities </li></ul><ul><li>Participatory Action Research (PAR) incl mapping, timeline etc </li></ul>14-10-2009 The Constellation for AIDS Competence
    10. 10. Example 1 – repeated self-assessment on AIDS Competence &quot;We have done the Self Assessment several times. Each time we did the current level and the target for the future.  So what we did was to take the results of last time and looked at what the targets were for last year and we looked at whether we had met those targets. Our concern was about the practices that did not make the target. And here we talked about what happened, why did we did not meet the target that we had set last year and how we could improve themselves more in that regard.“ Ms. Charkaporn Pandontong, Ta Tum Sub-district, Lamphun, Thailand 14-10-2009 The Constellation for AIDS Competence
    11. 11. Example 2 – repeated self-assessment on vulnerability Street children in the cities of Bacolod and Iloilo self-assess quarterly their risk behaviour with young peer educators and sex workers. &quot;The children now openly discuss about sexuality. They first do their self-assessment individually and then share it with their peer group. They are proud to measure their own progress.&quot; &quot;I would say that about 90% of them are changing. They go for STI screening and are going to school again instead of roaming around in the streets. They stop or reduce sex work and earn money by creating arts and selling them during fund-raising campaigns,” John-Piermont Montilla, Founder KGPP NGO, The Philippines 14-10-2009 The Constellation for AIDS Competence
    12. 12. Level Acknowledgment and recognition Inclusion Care and prevention Identify and address vulnerability Level Level Level C omparison of AIDS competence indicators pre- and post-community self assessment in 5 Bangkok districts Example 3 – comparing progress of districts with SA 14-10-2009 The Constellation for AIDS Competence Pre-intervention Post-intervention year 1 Post-intervention year 2
    13. 13. Example 4 – story-telling to show improvement in a practice 14-10-2009 The Constellation for AIDS Competence <ul><li>In a WHO/ UNICEF supported process in Papua New Guinea, people in settlements got the opportunity to share their change in the community for two reasons: </li></ul><ul><li>To share it with other communities </li></ul><ul><li>To appreciate their change </li></ul><ul><li>Networks of PLHIV and truck drivers in GLIA received cameras with video option and training to capture progress themselves. </li></ul>
    14. 14. Example 5 – Verifying service uptake with control group 14-10-2009 The Constellation for AIDS Competence
    15. 15. Example 6 –Self-assessment results including baseline 14-10-2009 The Constellation for AIDS Competence
    16. 16. Level 2 – Facilitation team level <ul><li>Principle : We set indicators for our team, not for the community </li></ul><ul><li>Key question : How can we measure our progress as a facilitation team and improve? </li></ul><ul><li>Why important? To ensure quality of facilitation and enable scale, we must learn & improve continuously </li></ul><ul><li>Indicator: Measurable progress in technical and managerial capacity to facilitate the AIDS Competence process </li></ul><ul><li>Means of Verification: </li></ul><ul><li>Documented (repeated) facilitators’ self-assessment </li></ul><ul><li>Documented After Action Review (AAR) after each visit/ meeting </li></ul><ul><li>Self-assessment on SALT </li></ul><ul><li>% of response to invitations or % of follow up after 1 st visit </li></ul>14-10-2009 The Constellation for AIDS Competence
    17. 17. Example 1 – facilitators’ self-assessment <ul><li>Facilitators belonging to networks of PLHIV and networks of truck drivers assessed themselves on 20 practices covering both facilitation skills, attitudes and managerial capacity. </li></ul><ul><li>The exercise is done in teams, so that discussion leads to deeper analysis. </li></ul><ul><li>Comparing results in a ‘river diagram’ shows potential to learn within and between facilitation teams </li></ul>14-10-2009 The Constellation for AIDS Competence
    18. 18. Example 2 – After Action Review <ul><li>Facilitation teams in DR-Congo conduct after each community visit an After Action Review (AAR) asking themselves four questions: </li></ul><ul><li>What strengths did we see? </li></ul><ul><li>How did we work as a SALT team? </li></ul><ul><li>What did we learn? </li></ul><ul><li>What can we improve next time? </li></ul><ul><li>The AAR ensures continuous learning and improvement as a facilitation team </li></ul>RDCCompetence – the National facilitation team in DR-Congo 14-10-2009 The Constellation for AIDS Competence
    19. 19. <ul><li>Norwegian Church Aid (NCA) in Thailand with Global Fund support established over 300 interfaith facilitation teams that use SALT during home visits. </li></ul><ul><li>After each home visit, they conduct their own self-assessment to see if they applied SALT. </li></ul><ul><li>S – Stimulate, Support </li></ul><ul><li>A – Appreciate </li></ul><ul><li>L – Listen, Learn, Link </li></ul><ul><li>T – Transfer, Team </li></ul>Example 3 – After Action Review on SALT A SALT team of NCA facilitates HIV Competence among Muslim communities 14-10-2009 The Constellation for AIDS Competence
    20. 20. <ul><li>At what stage are we now? </li></ul>Example 4 – Check progress in local response progression 14-10-2009 The Constellation for AIDS Competence
    21. 21. Level 3 –organization and partners <ul><li>Principle : As an organization, we need to change as well </li></ul><ul><li>Key question : What action do we take based on our experience and knowledge derived from local responses? </li></ul><ul><li>Why important? To move from being ‘experts’ to ‘facilitators’, we need to shift our mindset and adapt policies, budgets and communications. </li></ul><ul><li>Indicator: Number of actions taken to adapt attitudes, policies, budgets, communications etc. </li></ul><ul><li>Means of Verification: </li></ul><ul><li>Verify adaptations that support local responses/ HIV Competence </li></ul><ul><li>Stories on personal change of staff via video, audio, blogs </li></ul><ul><li>Number of strategic areas that support concept of HIV Competence. </li></ul><ul><li>Number of self-assessments done by staff </li></ul>14-10-2009 The Constellation for AIDS Competence
    22. 22. <ul><li>The Aga Khan Development Network (AKDN) consists of institutions as diverse as Banks, Hotels, Insurance Companies, Hospitals, Social services, Schools and Madrasas. </li></ul><ul><li>The Network Facilitation Team facilitates the AIDS Competence Process in 16 institutions.  </li></ul><ul><li>The AIDS Competence Process has now been integrated into the work policy of AKDN. Benefits range from a common purpose, large increases in the number of staff volunteering to go for testing to sharing information on access to ARVs </li></ul>Example 1 – Aga Khan Development Network Mary Gitau from the Nairobi AKDN hospital shares on their own self-assessment 14-10-2009 The Constellation for AIDS Competence
    23. 23. <ul><li>UNFPA Indonesia staff, together with Indonesian policy makers joined on a week of SALT visits in Northern Thailand </li></ul><ul><li>It changed their organization. Their strategy supports local responses and they recruited an ACP person to support Indonesian facilitation teams. </li></ul><ul><li>Staff together does their self-assessment on HIV Competence every 3 months and they introduced Reproductive Health Competence. </li></ul>Example 2 – UNFPA Indonesia 14-10-2009 The Constellation for AIDS Competence
    24. 24. Cost-effectiveness <ul><li>Key question : Compared to other interventions, what is performance of the process at given levels of program expenditures? </li></ul><ul><li>Why important? Policy makers and donors have limited funds. What is the ‘best buy’? </li></ul><ul><li>Indicator: the cost/ ‘change in end user’ or the cost/ ‘incremental increase in outcome for HIV Competence’? </li></ul><ul><li>Means of Verification: </li></ul><ul><li>Choose appropriate type of study </li></ul><ul><li>Define and calculate direct and support costs </li></ul><ul><li>Define and assess outcomes that are comparable to other interventions </li></ul><ul><li>Calculate relevant ratios and define assumptions </li></ul>14-10-2009 The Constellation for AIDS Competence
    25. 25. <ul><li>“ Based primarily on reach, the AIDS Competence Programme was found to be highly cost-effective when compared to other programmes since it has extended to many sites in nearly 30 countries at relatively minimal costs and is spreading without additional funding. </li></ul><ul><li>Efficiency varies from US$ 0.10 to US$ 2.00 per person reached (>1 Million). Costs/reach may become negligible as AIDS Competence Programme methods and knowledge spread in communities. Costs per Satisfied User likely to spread the process currently vary between US$ 1.00 to US$ 4.50.” </li></ul>Example 1 – UNAIDS 2005 evaluation 14-10-2009 The Constellation for AIDS Competence
    26. 26. Linking HIV Competence to global frameworks & indicators Outcome Framework 2009-2011 Global Fund outcome framework UNGASS Indicators Multi Sectoral AIDS Program (MAP) 14-10-2009 The Constellation for AIDS Competence
    27. 27. Level 1 – Community level <ul><li>Improvements on the 10 practices of the self-assessment contribute directly to Global indicators. For example: </li></ul><ul><li>Improvements on practice 1 (acknowledgement) and practice 4 (access to treatment) contribute to </li></ul><ul><li>UNGASS Indicator: National Programs, Indicator 7. Percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who know their results </li></ul><ul><li>UNAIDS Outcome Framework, Principal Outcome 5 , Key Output 1: Prevention of sexual transmission of HIV and STI strengthened including through sexual and reproductive health policy, programmes and service linkage . </li></ul><ul><li>Improvements on practice 5 (vulnerabilities) contribute to </li></ul><ul><li>UNGASS Indicator: Knowledge and Behaviour, </li></ul><ul><li>16. Percentage of women and men aged 15–49 who have had sexual intercourse with more than one partner in the last 12 months </li></ul><ul><li>17. Percentage of women and men aged 15–49 who had more than one sexual partner in the past 12 months reporting the use of a condom during their last sexual intercourse </li></ul>14-10-2009 The Constellation for AIDS Competence
    28. 28. Level 2 & 3 – Facilitation team/ organizational level <ul><li>Improvements in technical and managerial capacity to facilitate the process directly contribute to global indicators. For example </li></ul><ul><li>Training of competent facilitation teams contributes to: </li></ul><ul><li>UNAIDS Outcome Framework. Principal Outcome 3, Key Output 4: Community systems strengthened through capacity building and inclusion of people living with HIV, most-at-risk, affected and vulnerable groups in national responses. </li></ul><ul><li>Global Fund Outcome Framework. </li></ul><ul><li>OBJ 1.1 Strengthen behaviour change programmes, interventions and curricula for prevention. </li></ul>14-10-2009 The Constellation for AIDS Competence
    29. 29. Conclusions <ul><li>As community members ourselves, we can measure our progress in our own communities. As facilitators, organizations, FBOs, we measure our own indicators to see how WE can improve. </li></ul><ul><li>As facilitators, be rigorous in supporting a community’s capacity to measure its own progress </li></ul><ul><li>As facilitators, we are not driven by global indicators, but are aware of them. We link community-measured progress on a meta-level to show contribution to indicators </li></ul><ul><li>Contribution vs attribution </li></ul><ul><li>As facilitators, we link communities to services and resources. We don’t provide them </li></ul>14-10-2009 The Constellation for AIDS Competence
    30. 30. Connecting local responses 14-10-2009 The Constellation for AIDS Competence books full of ‘best practices & lessons learnt 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?
    31. 31. 14-10-2009 The Constellation Practice 3 - Linking care and Prevention Description of level 5 (our vision): Care and prevention are not seperated. They are used in an integrative way. Care is used in the wider sense of the word and includes emotional, spiritual and psycho-social care. Care strengthens relationships and helps to change our behaviour. Recommendations Experiences Blog link for full story & contact details Video (2 min) Existing resources If target groups take the lead in care and prevention strategies, responses will be more creative, effective and sustainable. Understand, engage and change! A NGO in San Kampaeng district in Thailand took care of children affected by HIV. Later they became teenagers with very relevant experiences and were succesfully involved in prevention efforts for the younger generation. AVERTUNAIDSNCA It's not shampoo, it’s a condom! In Bombay, the AASDHA project took advice of sexworkers and made condom packages that look like shampoo packs to avoid the stigma around it. Tuktuk drivers in Mattakkuliya give free rides to VCT centre. Through strong community invovlement and use of music events, tuktuk drivers (amongst many others) cared for their passengers, provided prevention messages and referred people to VCT