CAMEROON LINK I.E.C. AND HIV OPERATIONAL RESEARCH

CAMEROON LINK I.E.C. AND HIV OPERATIONAL RESEARCH
EXECUTIVE SUMMARY
Nearly two decades after the emergence of the HIV/AIDS pandemic, biomedical, and epidemiological research has identified and described in great detail the nature of HIV infection and its modes of transmission.
These findings have been used by scientific experts to develop effective drug treatments, targeted behaviour change strategies, and sensitive surveillance and modelling tools.
Yet far less research has been devoted to basic operational issues that affect the delivery of services in prevention, care, and support.
We have learned much about which behaviours place persons at risk and have some sense of what types of interventions work to prevent HIV transmission, but we know far less about why and how these interventions work, what they cost, and where and when they can be successfully replicated on a large scale.
These questions are especially important in Cameroon in general and the Littoral or the south west provinces in particular, which are our main target populations, where more than 90 percent of HIV infected people live, because prevention, care, and support interventions remain the primary tools for dealing with the pandemic.
To successfully design and implement effective HIV/AIDS prevention and mitigation activities, we suggest that the program managers and policy makers urgently need accurate and timely information on the operational mechanisms that make these programs work in an era of scarce resources.
It is also critically important that decision makers be guided by the best and most current research evidence to determine which elements of policy and service programs are the most cost-effective in reducing new HIV infections and mitigating the effects of AIDS.
BREAKING NEW GROUND
As we apply for the frame work agreement for collaboration with the ministry of public health and international institutions in Cameroon, we would be reinforcing our strategies in the next five years (2001/2006) with focus on operational mechanisms of implementing policies and programs.
In addition to previous objectives, the focus will include:
-Identifying cutting-edge issues affecting the design and delivery of STD/HIV/AIDS programs.
-Test new approaches to prevention, care, and support programs through practical, field-based research.
-Disseminate the findings from the research.
-Recommend best practices to improve policies and programs.
Since the inception in 1992, the Cameroon Link (Human Assistance Programme) has worked with a bread group of local, regional, and international organisations to identify the key constraints to service delivery and to test viable alternatives to programs with limited effectiveness.
Focusing on some broad topic areas, Cameroon Link HAP is one of the first STD/HIV/AIDS projects in Cameroon to use operational research to identify program problems and test new solutions to overcoming these problems.
The operational research process has been employed extensively by Cameroon Link in collaboration with the ministry of public health, the German Technical Co-operation, GTZ, Care International and the Cameroon Association of Newspaper Journalists, AJPEC, over the last five years in reproductive health activities.
It has proven extremely effective in improving the quality and effectiveness of service delivery programs in large part because it has applied research that places a premium on involving key stakeholders in the entire process.
These stakeholders are many and include government ministries, local NGOs, Local community leaders, people living with STD/HIV/AIDS, research agencies, and international organisations, amongst others.
Multi-stepped Approach
Cameroon Link operations will in the next five years involve five basic steps:
-Problem identification and diagnosis.
-Strategy selection.
-Strategy experimentation and evaluation.
-Information dissemination.
-Results utilisation.
From past experiences, we have noted that this process increase the efficiency, efficacy, quality and cost-effectiveness of prevention and care services, and changes individual behaviour by making services more accessible and acceptable.
The Cameroon Link Human Assistance Project concentrates on working with local service delivery organisations and groups to design and implement three basic types of field-based studies.
EXPLORATORY STUDIES
These studies are needed whenever there is a perceived problem, but the nature and extent of the problem are not known. Such studies can identify individual behaviours, and the legal, cultural, and socio-economic factors that influence risk and vulnerability, as well as the parameters of a service delivery.
FIELD INTERVENTION STUDIES
This study is useful when the factors responsible for a problem situation is or are known (i.e., lack of finances, lack of training, inadequate involvement of local NGOs, lack of collaboration of target groups, high prevalence of risk behaviours).
The most efficient and cost-effective means of prevention have yet to be determined. Field intervention studies test new approaches to behaviour change and new modes of configuring and delivering prevention and care services.
EVALUATION STUDIES
Often the problem situation is known from earlier diagnostic studies and a range of possible solutions have been identified from earlier field intervention studies, but the effect and sustainability of implementing these solutions in the larger community, beyond the confines of a tightly controlled intervention study are not known.
Evaluative studies are a valuable approach for examining the out come or impart of interventions that are implemented through out a service delivery environment.
Regardless of the type of study, the goal is always to improve the way in which policies are designed and implemented. This goal can only be met if each activity is accompanied by a strong information dissemination and results utilisation program.
This explains the connection of the Cameroon Association of Newspaper Journalists, AJPEC, partnership in the Human Assistance Programme and the raison d’être of the revival of the Cameroon Link newspaper for the presentation of NGOs activities through the forum columns. Articles, feedback and suggestions or information will be welcome.
STD INTERVENTIONS
PUTTING NEW PREVENTION AND TREATMENT
APPROACHES TO THE TEST AS PROJECT
One of the most important prevention discoveries made about HIV is that the presence of other sexually transmitted diseases (STDs) greatly increases vulnerability to and transmission of the virus.
This has been a key factor in HIV’s virulent spread in Cameroon, where untreated STDs are also endemic. Thus, strengthening STD prevention and management and, wherever possible, incorporating these efforts into HIV prevention programs have become a key global strategy for curbing the virus that causes AIDS.
But this is not a simple matter. The stigmatisation of those with STDs, a very common problem, inhibits people from seeking treatment.
Designing effective behaviour change campaigns that address sexual behaviour is often difficult, especially if literacy is low. Several constraints on national health budgets restrict the implementation of STD prevention and treatment programs, just as poverty limits the ability of individuals to pay for their own treatment.
Access to care is also limited, particularly in rural areas isolated by weak infrastructure. Even in urban towns with more resources, STD prevention and control programs are often insufficiently funded.
Despite the growing wealth of knowledge about STDs, few large-scale prevention and treatment programs have evolved in the districts where the need is greatest.
One of the biggest challenges is how to translate important research finding into effective, affordable and real programs that can be adapted to very different settings.
A key lesson learnt from past experiences is that like the HIV and STD epidemics themselves, real solutions are complex and multi-faceted.
STI PREVENTION STRATEGIES
PERIODIC PRESUMPTION TREATMENT
This is mass treatment of individuals presumed to be infected with one or more STDs, without attempting to make an individual diagnosis. This strategy can be targeted to persons with known high-risk behaviours like sex workers or free girls.
SYNDROMIC MANAGEMENT
Treating a patient for all likely causes of a symptom or sign of STD, rather than on the basis of a specific diagnosis.
PEER EDUCATION
Training individuals in health education and counselling techniques so that they can educate others in their peer groups.
POLICY OF 100% USE IN SEX ESTABLISHMENT OF CONDOMS
An intervention that seeks to reduce transmission of HIV and other STDs to and by sex workers by ensuring that condoms are used for every act of intercourse.
I.E.C PROJECT OBJECTIVES
LONG TERM
The training of staff and production of information material and publication will enhance a greater awareness of the local communities and contribute to the process of community development by mobilising the local communities towards involvement in the prevention of STD/HIV/AIDS/TB and social welfare. Media organisations must be regularly implicated in I.E.C programs.
CONCLUSION
To back up this executive summary, we have enclosed a profile of Cameron Link, its projects plan of action from 2001 to 2006, a budget estimate, a calendar of major annual events and a list of documented projects realised.
Cameroon Link Profile
Cameroon Link (Human Assistance Programme) is a global Reproductive Health and Nutrition Operations project designed to identify effective practices and test solutions to problems in HIV/AIDS/TB prevention, promotion of family planning, breast feeding, health care support.
Communicating research results is a very important part of the work of Cameroon Link. It reads opinions and publishes information about health and environmental activities. The areas of interest covered by Cameroon Link include community mobilisation, capacity building and scaling up programs, in work place, private sector, social marketing, stigma and discrimination, sexually transmitted infections, prevention, care and management, barrier methods (condoms, etc.), youths both in and out of school, policy, integrated health services, cost-effectiveness, people living with HIV/AIDS, AIDS-affected children and orphans, sex workers, mother-to-child transmission, HIV/AIDS and breast feeding, care and support, voluntary counselling and testing.
As a national, non-profit and non-governmental institution, Cameroon Link seeks to improve the well being and reproductive health of current and future generations around the country and to help achieve a Humane, equitable, and sustainable balance between people and resources.
It conducts I.E.C. programmes and training, as well public health research and helps to build research information capacities in urban and rural areas of Cameroon.
AJPEC/CANJ handles the communication aspect of the project, within the frame work of the human assistance programme of Cameroon Link.
STI-HIV-AIDS PREVENTION
What Makes It Work
In some places, at some times, with some groups of people, prevention has worked. Senegal, Uganda and Thailand are often quoted as examples of this.
There is also evidence that rates of infection have dropped in some populations in Cambodia. Nevertheless, we know that the HIV epidemic continues to flourish globally and that we are not succeeding in preventing it.
Maintaining safe behaviour, and protecting young people who are becoming sexually active continue to be challenges. There are some real successes, though mainly limited to particular populations.
We need to learn from these and translate the lessons they illustrate into everyday work to prevent infections in the different countries where we work.
Cameroon Link and AJPEC experiences have shown that at different stages of the epidemic, different approaches are appropriate. At early stage, there may be a concentration of infection in a few especially vulnerable groups such as sex workers or injecting drug users.
This is an opportunity to prevent further spread so long as we can identity the right approaches. In stages where more than 10 %of the sexually active population is infected, approaches have to be broader and have to reach even more people.
With limited resources, this means making difficult choices about how to identity the most effective approaches. Cameroon Link and AJPEC have developed and are developing tools to help communities assess their needs in a participatory way. This is Cameroon link’s particular strength.
In our search for a framework agreement with the government through the ministry of public health, we are fostering our partnership to ensure that there are facilities for treatment of STDs, access to treatment for HIV related illnesses, and provision of condoms.
STRATEGIES FOR BEHAVIOUR CHANGE
It is now widely agreed that effective prevention needs more than information and awareness, though these are essential as a starting point. Individuals exist with the community and society and there are many factors which affect a person’s stability to change.
A prevention framework being used by Cameroon Link to guide programme design and implementation looks prevention at three levels: individual needs, social context, and access to medical commodities and services.
Another common perspective differentiates amongst: information through media campaigns, theatre and peer education, empowerment by building negotiation skills or understanding and challenges to gender roles which lead to vulnerability, change in the environment through changing laws and societal responses, or by providing access to services such as STD treatment or resources such as condoms or clean needles. Projects carried out by Cameroon Link through its partnership organisations illustrate how the above three elements can be combined effectively. The ministry of public health and GTZ has been giving financial and technical support to Cameroon Link and AJPEC since 1992. UNESCO and PAMOL started giving support to AJPEC in the year 2000.
A community needs assessment led to the decision to work with highly vulnerable groups of young people and women. At that time, condom use was almost non-existent. Cultural norms made it acceptable for young men to buy sex frequently, whilst young women were not well educated about sex.
One of the groups (Filles de Bonabéri-Douala) supervised by Cameroon Link which received technical and financial support from CARE Cameroon in the District of Bonassama.
The phase of the work in sexual health, STI and HIV/AIDS prevention with women from a rural community started in 1996. This is how we intend to reinforce our strategies in the next five years, starting from 2008 to 2012.
For more on Cameroon Link, please click on the following link,http://www.worldbreastfeedingweek.net/wbw2008/cameroon.htm

Changing Gender Roles

Changing Gender Roles
By James Achanyi-Fontem
The role of the family in sexual health, and in particular in gender socialisation, has changed tremendously due to a number of factors. The rise of the level of education among 10 million people, the change from a state- run economy to a liberal economic system and the change from a one-party to a multiparty system, which came with more freedom of speech, have all affected gender roles and socialisation from household to country level in Cameroon . More recently, large scale rural-urban migration, the HIV/AIDS pandemic, privatisation and globalisation forces have fuelled a national debate on the role of the family in sexual health and gender socialisation. While the anti-AIDS campaign calls for parents to talk openly to their children about safer sex, the free market economy requires parents to work around the clock to ensure basic family income.
Male Gender Socialisation
From a young age, boys in Cameroon are socialised according to gender norms. They are exposed to social pressure from their families, the community and institutions such as schools, companies and government offices to act according to the dominant model of accepted male behaviour. Social expectations also have a strong influence on men's later role in marriage and family life, sexuality and reproduction.
Although there is some evidence of changing male and female gender roles, the dominant features of masculinity in Cameroon continue to be economic autonomy and marriage. Most girls and women still consider it men's responsibility to provide for the family. This is the major reason for young men to migrate to urban areas, as the attempt to fulfil this rigidly defined social expectations. Economic success is also essential to meet another key socio-cultural expectation: marriage. Getting married and having a family is a central goal in life for most Cameroonian youths. However, many young men feel unable to compete with older, working men in the sexual economy; as they are unable to meet the financial demands of young women. Without financial resources a man cannot expect to marry or even satisfy a girl friend. The rising unemployment rates further decrease young men's access to financial resources and prevent them from fulfilling men's social expectations. Most of them will delay marriage until they have sufficient funds or employment. This delay has implications for their male identity and leads to much frustration among young men, as marriage is considered an essential rite of passage from adolescence to adulthood.
The position of girls and women in Cameroon
In this context where men are expected to be the breadwinner, boys are commonly regarded as an asset and an investment to parents when they get old. This is why boys get preferential treatments in many aspects of life, including education. This social preference for boys by family, community and legal system gives them more options to succeed in life than girls. Many still regard girls merely as persons who should get married with the family benefiting from dowry paid by the husband's family.
In school, girls are often assigned domestic activities, such as fetching water for teachers and cooking for the bachelors, limiting their time for study. Boys are given more time after school for sports, while girls are usually assigned household chores. A recent UNICEF report estimates that three million school-aged children are out of school, half of them girls. Among factors preventing girls from finishing school are adolescent pregnancy and forced early marriage because of economic gains for the family. Another factor is gender-biased socialisation in school, which reinforces traditional gender roles by promoting assertive behaviour for boys and passive behaviour for girls. Girls are also expected to care for the sick and young siblings, preventing them from attending school regularly.
The school period is also a time of biological changes, but access to sex education is often non-existent. Cameroon's parenthood system has changed enormously. The extended family system, which allowed grand parents to teach grand children on community values, is disappearing more and more. Many communities have abandoned the traditional training that prepared children at the age of 13 for the transition from childhood to adulthood. This training prepares them for the roles and responsibility of parenthood, and addressed issues related to sexuality, gender roles, taking care of the community, children and neighbours.
A recent survey in Cameroon revealed a rise in female headed household due to the increased death of partners, especially due to AIDS, and a wave of broken marriages, mostly caused by social havoc as a result of globalisation and structural adjustment programmes. Many men who were breadwinners face a massive lay off from their job due to privatisation. Frustrated unemployed men in cities and peasants who cannot generate enough income from their produce release their anger by victimising their wives. This in turn leads to children being raised without both parents.
These biological, cultural and socio-economic factors have an impact on gender socialisation at the household and community level, rendering girls increasingly vulnerable for sexual and reproductive health problems. Many girls are an easy prey for men who convince them to have unsafe sex for small cash. As a result, many get pregnant and are subsequently sent away from school. Also, many girls contract HIV and other STIs.
Sex Education and Sexual Health
Despite the serious HIV/AIDS situation and the many education campaigns, many parents still avoid talking to their children in-depth about sex and sexuality, which remain taboo topics. Till the late 1970s, in many parts of the country special traditional sexual health training was given to boys and girls at age 13, openly discussing sexual and reproductive issues. Girls were taught how to become good mothers and boys were taught how to become good fathers. New socio-economic patterns, urban-to-rural migration and formal education systems have led almost all 238 ethnic groups in Cameroon to abandon this sex education.
Currently big gaps in sex education exist, as the primary school system has no reproductive and sexual health curriculum. Many boys and girls enter puberty before completing their primary school. Hence at this important stage in their lives, boys and girls are forced to learn about sex and sexuality from their peers.
With the coming of HIV/AIDS in Cameroon in the early 1980s, most young men and young women were, regarded as HIV-risk-free group. During the early 1980s and early 1990s, many men turned to schoolgirls for their sexual needs. As a result, many adolescents especially girls were infected with HIV and are now dying of AIDS related illnesses. Sixty percent of new HIV infections in Cameroon occur among youths under 25 years of age, mostly between 17 and 19 years of age.
Condoms have become associated more with HIV prevention than with birth control. Both young men and women dislike them and at their best the use is irregular. After a degree of trust is established, prevention of pregnancy is diverting from condom use, to focus on knowledge of safe days. Society always views pre-marriage pregnancy as an unfortunate out comes of sexual activity, bad luck or an accident. Young men usually deny their responsibility for a pregnancy and abandon the girl for a number of reasons. The inability to take care of the expectant mother and the unborn child; the fear to be taken to court (if the girl is still in school); and the boy's doubts about this actual fatherhood, assuming the girl has had other sexual partners. Young men, particularly if they are unemployed, feel inadequately prepared to meet the demands and costs of supporting a girl through her pregnancy.
Gender Relation, Economic Power and Rape
Several studies have revealed that the expectation of some form of exchange in the relationships between young men and women plays a significant role in sexual coercion and rape. Young men make a distinction between forcing a girl or woman to have sex using violence or raping her, and forcing a woman to have sex after having incurred some expenses. The latter often referred to as date rape by most young men.
The same studies show that, although economic factors play a key role in structuring sexual relationships between man and woman, monetary gain is not only reason for women to have sexual relationships: sexual desire and satisfaction are also important. However, some young men's frustration at their lack of money is directed towards women, who supposedly only want sex for money. Rape cases are also commonly reported in the Cameroon media.
Despite this pervasive situation, most young men in contemporary Cameroon express their desire for real love, trust, respect and a monogamous relationship, reflecting the prevailing socio-cultural norms among men in the country. Although all young men have a strong desire to get married and have a family, for most of them this is out of reach in the immediate future because of inadequate financial resources.
Issues of gender and financial resources also interact to impact on sexuality. The power imbalance between men and women determines how sexuality is expressed and experienced. In this context, of gender inequity, male sexual pleasure supersedes female pleasure and men have greater control than women over when, where and how sex takes place. In a patriarchal society where men are expected to act as heads of the household but are often unable to fulfil this norm due to poverty and unemployment, sexual promiscuity becomes a means of demonstrating masculinity. At the same time, women and girls faced with even fewer opportunities for direct access to income, little access to decision-making power, as well as a socialisation process that reinforces low self-esteem, often turn to transactional sex to fulfil their daily needs. In this manner, within and outside marriage, women's bodies are often turned into a tool for negotiation and exchange.
Changing Gender Relations
The work place has been the main place for changing gender relations in Cameroon. While paid jobs (for men too) have become increasingly scarce as a result of the economic crisis and subsequent economic restructuring, women have entered the informal sector, usually as business owners to ensure their families' income. Women are also increasingly visible in paid jobs and government positions.
This change in women's position can be attributed partially to Cameroon's participation in the 1995 United Nations Fourth World Conference on women in Beijing, which stressed equal rights for men and women. Cameroon is among very few sub-Saharan African countries whose constitution refutes any kind of discrimination based on sex, and recognises gender equity and equality. However, despite all these efforts, few women have been appointed to higher government positions.
In Cameroon's current socio-economic climate brought about by globalisation, privatisation, economic liberalisation and a reduced role for the state in providing health and education, there are no easy or fast solutions to the problems of unemployment and gender imbalance among the youth. Changes will require long-term commitment from government as well as the communities to which the youth themselves belong. NGO initiatives can also play an important role in facilitating change.
Advocating for social change towards gender equity
The Cameroon Link Gender and Development Councils in Bonaberi is an NGO advocacy strategy for social transformation towards gender equality and equity, equal opportunities and equal access to, and control over resources by women, youth and other marginalised groups. In 2002, together with some 10 NGOs, Cameroon Link created the Feminising Activist Groups, a pressure group committed to facilitate social change in Bonaberi and beyond.
Research and action by Cameroon Link have shown that HIV/AIDS and many other problems related to gender imbalance and gender socialisation cannot be separated from the extreme poverty, lack of resources and the burden of work for women. Institutional settings at the national and local levels influence the socio-cultural context that shapes the ways in which men and women interact with each other, including in sexual relationships. Despite gender-equity policies, women in Cameroon continue to enjoy fewer rights and privileges than men. Their access to education and training, as well as their rights to property are constrained by existing patriarchal socio-cultural norms and values. Few women have access to positions of power and influence. This complex situation requires a gender inequity at all levels of society. Cameroon Link and its CLLS and COGESID partner organisations are committed to address the structural issue in families, communities and Cameroonian society as a whole, in its struggle for a more gender-balanced society.
Inclusion of gender perspectives in family education
Gender socialisation starts at birth, or even before. The early childhood period is often considered a "gender-politics-free" zone where children are allowed leeway in displaying behaviours and actions outside the social and cultural norms about boys and girlhood of a given society simply because they are considered too small to understand and follow. However, they learn about gender roles and characters from a very early age and are firmly rooted in a gender identity by the time they reach the age of formal schooling.
The UNESCO project "ICT-based Training in Basic Education for social Development" aims to strengthen human resources and build capacity among families, women, youth and ethnic minorities in promoting sustainable social development using the potential of information and communication technology (ICT). The project has a specific component entitled "inclusion of Gender perspectives in Family Education", which aims to generate awareness within families of gender issues related to child bearing and socialisation.
Understanding gender-socialisation processes
Family is the primary socialisation agent of young children, and particularly parents and other important care takers exert powerful influences on the formation of children's gender orientations, which are inseparable from the notion of self and relations with others. A child's early experience as a boy or girl, gained primarily at home can enhance or limit his/her subsequent development of potentials, capabilities and aspirations, and instil gender-based attitudes, views and behaviours which may be long-lasting.
Therefore it is important for parent and other family members to be aware of gender issues in the context of child bearing and socialisation of young children, and of the possible consequences of their practices that are constraining for girls and boys and to promote changes in them. Attention should be paid to the ways in which children internalise negative gender roles and stereotypes, and to the structures and mechanisms that reproduce gender inequality in education and other domains of life. Education of women and girls is proven to have enormous benefits for the family and society at large and contributes to sustainable social development. Young women who are exposed to basic education are more likely to have greater autonomy and wider life choice including the choice of a husband. They are likely to marry late and within marriage they are able to cope more appropriately with work responsibilities and family relations.
Family education programmes aim to empower parents as confident early childhood caretakers. But they do not sufficiently address and tackle the gender issues in raising children. Some of the problems not tackled include parents expectations toward girls and boys; parents as gender role models for their own children that benefits of father's involvement in child care and sharing of family tasks between the mother and the father in equal partnership.
Inclusion of gender perspectives in family education
Given this context, the UNESCO project component mentions inclusion of Gender Perspectives in family education which aims to generate awareness within families of gender issues related to child bearing and socialisation, and to promote the necessary changes in attitudes and practices. The ultimate goal is to create a family environment where young children, regardless of their sex are encouraged to broaden their range of skills and capacity to think, act and reflect on their actions and to help develop their characters fully in ways that will serve them in contemporary society.
The project component is UNESCO's contribution to the achievement of Goal 1 on Early Childhood Care and education, and Goal 5 on gender equity and equality in Education; set out in the Dakar frame work of action adopted by the international community at the world education forum in Dakar, Senegal, in 2000. In addition, it aims to contribute to the promotion of social development through mainstreaming gender in programmes and politics.
The initiative envisions the following three steps:
-Development of a prototypic module on inclusion of Gender perspective in family education for training of trainers and facilitators in family education programs ready to be adapted to different contexts, languages and ICT modes:
-Adaptation of the prototypic module to the local contexts and selected ICT module(s) of the pilot regions and
-Training sessions for the parent educators and / or community workers using the adapted module in the pilot countries. The trained educators and community workers will conduct training sessions for parents and other family members who are the ultimate beneficiary.
The long-term objectives of the training module are:
1) to create awareness among parents and other family members about gender dimensions in the context of childbearing and socialisation; and:
2) to promote attitudinal and behavioural changes within the family, so that young boys and girls are given equal opportunities to develop fully and are encouraged to perceive, value and act towards the opposite sex as equal partners in different spheres of life.
This module should eventually benefit parents and other major care givers of children aged 0 to 8.
The module will focus on a number of key themes and issues. For each theme there will be suggested activities and exercises for trainers of family education programmes, encouraging awareness self-reflection concrete actions in daily life. The module will be adapted to suit the local cultural and ICT context of the different regions.

Community Home Based Care for PLWHA

Advocacy for Community Home Based Care for PLWHA in Cameroon
By James Achanyi-Fontem, Cameroon Link
This project is designed based on the current practices of Community Home Based Care (CHBC) for people living with HIV and AIDS in Cameroon with special focus on the operational challenges and limitations.
The objective is to emphasis on local, community-driven initiatives responding to the HIV/AIDS crisis. Cameroon Link’s project aims at encompassing HIV/AIDS prevention, care and treatment activities.
Research shows that an effective and affordable CHBC for PLWHA has the potential to positively impact the health and social status of patients, families and the community as a whole.
Research also shows the CHBC area faces a multitude of challenges and limitations which not only adversely affect their ability to carry out their activities, but also have the potential to exacerbate poverty and existing gender inequalities among affected families and communities.
The Problems
1.Simple logistics and operational bottlenecks severely affect the access to and provision of ART for community based organisations (CBO).
2.Some CBOs providing CHBC including ARV drug administration face problems from inconsistent supply of drugs to inadequate logistic costs.
3.There is a lack of documented information on the root operational issues which contribute to the overall challenges and limitations.
Results awaited
This advocacy project aims to alleviate challenges and improve the current situation of CHBC programs.
Executive Summary
Cameroon is disproportionately affected by the HIV/AIDS pandemic. Data from UNAIDS/WHO Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections – 2004 update show the following about Cameroon:
•Adults (15 –49) HIV prevalence rate is 6.9 %
•Adults (15 – 49) living with HIV is 520.000
•Adults and children (0 – 49) living with HIV is 560.000
•Women (15 – 49) living with HIV is 290.000
•AIDS deaths recorded stand at 49.000
•Orphans are 240.000
Back Ground
•Undoubtedly, there is a great need for services and support provided by community home-based care (CHBC) program to persons infected and affected by HIV/AIDS.
•In Cameroon, where the HIV/AIDS epidemic is of paramount concern, the nature of the disease, weak health infrastructure, spiraling health costs, and lack of resources has made community home based care a necessity in the continuum of care.
•An effective CHBC program for PLWHA can yield major health and social benefits starting from the patients and their family and consequently to the entire community. However, this needs a continual cohesive commitment between vommunities, organisations and donors.
•Simple logistics and operational bottlenecks severely affect the access to and provision of ART for Community based organisations. There is inconsistent supply of drugs to inadequate logistic costs.
Project Justification
It is imperative to rethink exisitng community home based care models in order not to exacerbate poverty and existing gender inequalities among affected families and communities. Better communication, including advocacy, social mobilisation and programme communication, would help to solve many of the problems surrounding HIV/AIDS. Most of the current programmes do not carry the communication component, and it is still not clear how HIV/AIDS communication is embraced at the health area level.
This project lists a number of communication challenges relating to HIV/AIDS. These include : increasing case detection through public engagement; closing the time gap between the onset of symptoms and seeking of treatment; linking with broader health and development campaigns and movements; addressing HIV/AIDS/TB co-infction, and capitalising on successful AIDS communication interventions; and strengthening health systems.
Priority areas for action include involving affected communities; making creative use of the media; monitoring the effectiveness of communication; linking communication on HIV/AIDS/TB epidemiology; increasing communications capacity; and collating and simplifying communication tools.
Methodology and objectives
•Determine the implementation challenges faced by CHBC programs. To achieve this goal, we have to document current practices of CHBC by community organisations.
•Determine the various approaches including logistics, undertaken to deliver services to PLWHA with concentration on support and adherence of ART by CHBC programs.
•Determine the existing expertise and knowledge and how it is disseminated from NGO, development partners and government to CHBC programs.
Activities
•Information of community populations
•Training of Community Educators
•Material and Supplies: Provide guidelines, manuals for training, drugs, etc..
•Human Resource Support: Organise capacity building for CHBC program staff, conduct training of volunteers, refresher workshops, provide financial assistance for volunteers.
•Organise dialogue network groups for exchange of information and reports of activities.
Challenges and Limitations
•There is an inherently weak referral system between CHBC organisations and the public health sector
•There are few links between CHBC organisations and experienced NGOs in socio-economic, nutritional and OVC’s services for PLWHA.
•The human resource is a key challenge faced by CHBC programs and requires immediate attention in the areas of training, capacity building and technical expertise.
•Volunteers are essential to the sustainability of the CHBC, and they need to be encouraged and motivated.
•The CHBC programs are unable to implement and adequately deliver services to their clients due to insufficient resources, such as overhead funds, HBC kits, and educational/information materials.
•Transportation and logistics overheads are major limiting factors in the ability of CHBC programs to carry out their activities, such as ART adherence support.
Operational Solutions
Human Resources
The challenges in human resources are essential due to the operational issues in the areas of training/capacity building and social/technical expertise. The CHBC providers should be properly trained, and the number increased to carry out the activities and services effectively. These issues can be alleviated through:
a)Government: Establish and disseminate national guidelines on CHBC and increase public health sector involvement.
b)NGOs: Provide technical expertise and training.
c)CHBC Programs: Conduct baseline assessments; generate community involvement and identify local volunteers.
Referral Systems/Links
CHBC programs require a strong two way referral system and strong links to the public health sector and NGOs.
a)Government: Create a “platform” to allow CHBC to organise referral system with local public health centres.
b)CHBC Programs: Actively develop and maintain links with NGOs, especially for support of socio-economic activities.
Institutional Resources Logistics
There is a lack of institutional resources for CHBC and logistics to deliver appropriate services.
Government: Allow CHBC programs who receive funds to properly allocate funds for transportation within the budget. Provide HBC Kits and Information/Educational materials.
CHBC Programs: Adopt innovative techniques toalleviate issues in transportation, utilise local resources to create HBC Kits.
RECOMMENDATIONS
1.Effective CHBC cannot be provided without realistic financial support for transportation, overheads and logistics.
2.CHBC programs need the financial and technical support with a starting focus on “essential care” activities. These essential care activities have the potential to positively impact the health and social status of PLWHA and prolong their need for additional complex medical care.
Roles and Responsibilities
CHBC programs cannot be successful unless they receive active support and participation from NGOd and communities. The following are the roles and responsibilities each needs to assume:
•Incorporate CHBC into district health service plans.
•Train and educate health care staff in the public health facilities on their necessary active participation in CHBC with an emphasis on the reduction of stigma and discrimination.
•nvolve and encourage other public sector agencies dealing with social welfare, education, food and nutrition as key players and share responsibilities in providing CHBC.
NGOs/Donors can assist CHBC programs with technical expertise in the area of education and training the personnel, volunteer recruitment and motivation techniques, monitoring and evaluation of activities.
Community level: The level of active participation of communities will differ from community to community, as the communities needs and resources will vary. Communities should be encouraged to initiate and develop their CHBC programs, actively participate in recruitment, motivation and compensation of volunteers.
Cameroon’s Sexual and Reproductive Health Rights Bulletin
National Revenue per inhabitant (2002) U.S. $ 1.640
Human Development Indicator (2001) 0,499
Health Expenses per inhabitant (2000) U.S. $ 24
Average Number of Birth per Woman (2003) 5.2
Rate of employed women out of agricultural sector (2000) 10%
Rate of Boys’ Registration in Secondary Schools (2001/2002) 68%
Rate of Girls’ Registration in Secondary Schools (2001/2002) 32%
Number of seats occupied by women in parliament (2003) 9%
Number of women reported to have been victim of physical violence (2003) 892
Maternity Deaths out of 100.000 (2000) 730
Birth in the presence of a qualified health attendant (2001) 56%
National Policy on Abortion – For the preservation of physical health
Still-births out of 1.000 (2001) 96
Married women using contraceptives (2003) 19%
Married women not satisfied with family planning needs 19,7%
Annual birth rate out of 1.000 aged between 15 to 19 years (2003) – 142
Men/women aged between 15 to 24 who know HIV can be transmitted (2001) 63% / 54%
HIV/AIDS rate among male aged between 15 – 24 (2001) 9.8%
HIV/AIDS rate among female aged between 15 – 24 (2001) 12.7%
N.B. According to World Bank sources, these indicators are constantly on the decrease.
Acronyms
AIDS – Acquired Immune Deficiency Syndrome
ART – Anti-retroviral Therapy
CBO – Community Based Organisation
CHBC – Community Home Based Care
CHW – Community Health Worker
HIV – Human Immunodeficiency Virus
NGO – Non governmental Organisation
OI – Opportunistic Infections
OVC – Orphans and Vulnerable Children
PLWHA – People living with HIV/AIDS
PMTCT – Prevention of mother-to-child transmission
STI – Sexually Transmitted Infection
TB – Tuberculosis
VCT – Voluntary counseling and testing