What happens when the donors withdraw? Community Based Organisations for HIV/AIDS and the World Bank in Zambia Aisling Walsh 1 , C Mulambia 2 , J Hanefeld 3 , R Brugha 1 , G Walt 3 1 Royal College of Surgeons in Ireland 2 Institute of Economic and Social Research, Zambia
Community Based Organisations for HIV/AIDS and the World Bank in Zambia
Aisling Walsh1, C Mulambia2, J Hanefeld3, R Brugha1, G Walt3
1 Royal College of Surgeons in Ireland
2 Institute of Economic and Social Research, Zambia
3 London School of Hygiene and Tropical Medicine
Irish Aid DANIDA
HIV policies and structures put in place from 2000
Importance of CBOs in Zambia for provision of advocacy and support services:
30% of VCT services, 80% treatment care & support, 70% OVC
75% are local, 25% international
World Bank MAP in Zambia $42m (2003-2008)
Zambia National Response to HIV/AIDS project (ZANARA)
Community Response to AIDS - 35% of grant
Other funders – PEPFAR (62%) and Global Fund (16%) (2007)
Loan offer (2008) of $20m rejected by Zambian Govt
Studies on WBMAP in Zambia have focused on:
Predicting what would occur with closure of MAP (Siamwiza, 2007)
The wind down period and immediate aftermath (Hanefeld et al)
An internal World Bank evaluation (2009)
Need for evidence on effects 2+ years after cessation, when deeper effects likely to have emerged.
Study aim: to produce evidence on what was the current status and activities of these CBOs in Mumbwa two years following MAP/CRAIDS cessation.
What were the range and scale of their activities at district and community level?
How had these been affected by cessation of CRAIDS funds?
A - provide evidence to enable planning for future support to CBOs to deliver HIV and AIDS care and support services
B - provide a voice to CBOs, community/district stakeholders on activities and needs of CBOs for HIV and AIDS.
One district – rural Mumbwa
Consultation with NAC and DACA
Mapping – national and district level
39 in-depth interviews
- All CRAIDS funded CBOs (18)
- District/Community AIDS Task Force members (10)
- National level stakeholders (11)
Analysis: thematic approach (ongoing)
From CRAIDS to the funding gap
ALL CRAIDS funded CBOs existed prior to CRAIDS
9 CBOs had no external funding prior to CRAIDS – survived from IGAs
Funders pre-CRAIDS: PAM, HEIFER Intl, CHAZ, Millennium Change Corporation, NGOCC, CDF - reportedly no longer funding CBOs in Zambia in 2010
Overall view of CRAIDS was very positive (all stakeholders).Initial target of 350 projects – actual number funded was 1,800
Most heard about funding through DACA and most received funds between 2005-2007
Size of grants ranged from K35m to K72m – some in lump sums, others in installments
More accessible than other funders
Some CBOs unhappy with conditions on services, but necessary for even spread and availability of services throughout the district
CBOs: most clear about timing of grant from outset but some told that they may get another installment.
District and national: poor communication about CRAIDS closing (district & national)
Examples of districts where no trace of CRAIDS remains and where the DATFs no longer exist (district and national)
Current funding opportunities
Scarce and definite decrease from 2008
Most CBOs not aware of other sources
World Vision and Child Fund
CHAZ – funded 4 CBOs in past, but currently ‘on a break’
Incorrect information on ZNAN conditions– member for 3 years with audited accounts
Little knowledge of PEPFAR or their grants
MCDSS: funding scheme for OVCs
social cash transfer scheme
CBO SERVICE PROVISION
Home Based Care: nutritional support, counselling, cleaning, washing
Transport: (mainly bicycles) to clinic/hospital, HBC
Sensitisation activities: for prevention, reduce stigma and awareness campaigns
OVC Support: subsidies for nutrition support, school uniforms, school fees
Effectiveness and sustainability of IGAs?
Most CBOs engaged in IGAs such as
animals, farming, cooking, knitting, hammer mills
Enabled some CBOs to open a shop and others
used farming to generate food for HBC.
Not always sustainable, due to lack of infrastructure – roads, bridges and small local markets
Competition amongst IGAs frequently cited
Only 2 reported IGAs enabled services
levels to be maintained at CRAIDS levels
“Each time a community decided on an IGA, then it was making returns, then competition came in from new comers. The outsiders wanted to do also exactly the same thing. So they lost on the market.” (District stakeholders)
“With the hammer mill the income is very slow because we are in the midst of people who have electric hammer mills that are even more efficient… so that difference kills our business.” (CBO rep)
All CBOs funded by CRAIDS are still in existence. BUT
Reductions in service provision
Transport the biggest obstacle
Decrease in nutritional support
“For the OVCs there has been a change from when CRAIDS was funding us. There was a feeding programme. Right now we are failing to feed the children. We are also finding it very difficult to keep 100 children at school. Some of them have stopped coming to school.” (CBO rep)
Decrease in numbers supported through HBC
Report of an imbalance of emphasis on treatment and prevention services
Other schemes to improve service provision
MCDSS food security programme; women and development programme; public welfare assistance scheme (for school fees and uniforms)
MoEd: school feeding programme
capacity building of CBOs
Volunteers are at the heart of care and support services
Range in numbers from 10-100 per CBO.
Most reported a reduction in volunteer numbers
All CBOs reported capacity being built through CRAIDS
Training for psychosocial counselling, adherence support, peer education
Capacity continues to be built internally but
Some skills lost over time – changing technical/medical knowledge
Coordination and planning
DACA held in high regard by CBOs
– advises, monitors, coordinates
Importance of a local leader with in-depth local knowledge.
Office of DACA located in DHO meaning now firmly situated within government health system
Uncertainty about DACA/DATF continuation (mid 2010) and lack of funding meant more difficult to carry out functions
Funding now secured through GF for next 2 years?
Cooperation with other providers
Monitoring and Evaluation
NARFs and HMIS exist in parallel but capture different indicators
Reporting a challenge – distances and lack of fuel for DACA to collect forms
Communities more motivated when monitored
Lack of awareness of NGO Act 2009 but where CBOs were aware, general positivity
Numbers of CBOs registered with DATF increased since 2008
A.1Conduct situation analyses of community-based AIDS care and support services and needs in all districts
Map AIDS care and support service provision
Organisations: CBOs, NGOs and Government services
Services: Home Based Care, food supports, support to OVCs, Counselling, treatment adherence, Income Generating Activities
Assess community needs for services
Target group in need of services (PLWAs, OVCs) – numbers and distribution
Numbers receiving / not receiving services – coverage levels
Map existing funding sources – UNAIDS?
Assess CBOs’ capacities to deliver care & support services (+ do IGAs) – DATFs?
Map links between CBOs and district health facilities
A.2Maximise use of existing funding sources
Communicate existence and mechanisms for accessing funding sources
Funders to make funding conditions explicit to CBOs
Implement recommendations by
working through the DATF and CATF (note success of CRAIDS)
using media such as newspapers and local radio more effectively.
Options for funding and supporting AIDS Care and Support
A. Mainstream HIV care and support services within broader poverty alleviationfunding channels - however, ensure that:
The needs of PLWAs and families are prioritised
CBOs can access funds and support to carry out their activities
Continued support to DATFs and CATFs to carry out their coordination activities
OR / AND ?
B. Retain a separate funding stream for community AIDS Care and Support activities
Poverty alleviation activities can be through generic or AIDS-specific channels
AIDS-specific / specialised support activities through these channels
What are the community-support schemes run by the MCDSS and the MoEd?
Are they accessible to CBOs? To PLWAs? Do they meet their AIDS care and support needs?
Should community responses make special provision to target communities based on needs for AIDS care & support
Need for (feasibility of) conducing community situation analyses of AIDS Care and Support needs and services? Other options?
What should be in the AIDS community response package?
HBC, Food, Counselling, Treatment adherence, support to OVCs
IGAs (income generating activities) – need for lesson learning
Capacity-building (it is possible) + create enabling environments
Should funding go to CBOs to do AIDS Care and Support?
Defining what is a CBO
If so, through DATFs / district AIDS bodies or
Through Local Government bodies?
what do we mean by it?
Are there some community AIDS Care and Support activities that should be sustained through resources from the national level (Govt and Donors)?
Reporting, monitoring and evaluation?
How well is the NARF (National AIDS Reporting to the NAC) working?
Are NARF data reported, analysed and acted upon?
Would there be value in evaluating the NARF M&E reporting process?
QUESTIONS for DISCUSSION?