Anchoring Awareness in the Community - Handicap International
Anchoring Awareness in the Community - Handicap International
Anchoring Awareness in the Community - Handicap International
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LESSONS FROM EXPERIENCE:<br />
KNOW-HOW ANALYSIS<br />
October 2009<br />
<strong>Anchor<strong>in</strong>g</strong> <strong>Awareness</strong><br />
<strong>in</strong> <strong>the</strong> <strong>Community</strong><br />
Issu<strong>in</strong>g from an learn<strong>in</strong>g-from-experience process on <strong>the</strong> project<br />
“Improvement of HIV/AIDS prevention and treatment <strong>in</strong> <strong>the</strong> cross-border<br />
regions of Djibouti, <strong>in</strong> Ethiopia and <strong>in</strong> Somaliland”
Author: Julie de Lamarzelle<br />
(Capitalization Support for <strong>the</strong> HI Ethiopia Program)<br />
Contributions: <strong>Handicap</strong> <strong>International</strong> Team <strong>in</strong> Ethiopia and Partners<br />
Methodological support and edit<strong>in</strong>g: <strong>Handicap</strong> <strong>International</strong> – Professional Publications Center<br />
Graphic creation and layout: Webcastor<br />
Contact: cdixon@handicap-<strong>in</strong>ternational.org<br />
Cover photo: © Julie de Lamarzelle for <strong>Handicap</strong> <strong>International</strong><br />
This document may be used or reproduced only if <strong>the</strong> source is cited and only for non-commercial purposes.
Contents<br />
Introduction 04<br />
P a r t<br />
1<br />
P a r t<br />
2<br />
Context and Methodology 05<br />
d THE HIV/AIDS REGIONAL CONTEXT 06<br />
d AN AMBITIOUS PROJECT 07<br />
d LEARNING-FROM-EXPERIENCE PROCESS 10<br />
Implement<strong>in</strong>g Know-How 13<br />
d DARING AN ORIGINAL AWARENESS PROGRAM 14<br />
d BRINGING LONG-LASTING CHANGE 22<br />
d CREATING AN AWARENESS ENVIRONMENT 31<br />
d CARRYING OUT MORE PRECISELY TARGETED ACTIONS 39<br />
To learn more… 43<br />
3
Introduction<br />
This document provides an analysiss of <strong>the</strong> know-how implemented <strong>in</strong> <strong>the</strong> framework of a<br />
community awareness program aim<strong>in</strong>g to decrease denial and stigmatization of HIV/AIDS and to<br />
<strong>in</strong>form communities of ways to prevent <strong>the</strong> disease.<br />
Its purpose is to serve as a source of <strong>in</strong>spiration for o<strong>the</strong>r current or future projects <strong>in</strong>volv<strong>in</strong>g<br />
awareness actions. Most of <strong>the</strong> know-how presented below can be transposed or adapted<br />
and reused <strong>in</strong> a different context. Some of this know-how can be directly generalized; <strong>in</strong> o<strong>the</strong>r<br />
cases, it is more specific to our project and <strong>the</strong> project context. This latter know-how can<br />
none<strong>the</strong>less <strong>in</strong>spire o<strong>the</strong>r awareness projects on o<strong>the</strong>r <strong>the</strong>mes.<br />
This document thus addresses both persons wish<strong>in</strong>g to design a project <strong>in</strong>volv<strong>in</strong>g development<br />
of awareness and on-site teams implement<strong>in</strong>g awareness activities.<br />
Us<strong>in</strong>g <strong>the</strong> experience of <strong>Handicap</strong> <strong>International</strong>, this document was put toge<strong>the</strong>r dur<strong>in</strong>g <strong>the</strong><br />
learn<strong>in</strong>g-from-experience process of a project for improv<strong>in</strong>g HIV/AIDS prevention and treatment<br />
<strong>in</strong> <strong>the</strong> Djibouti-Ethiopia-Somaliland cross-border region between 2006 and 2009.<br />
It <strong>in</strong>cludes two ma<strong>in</strong> parts:<br />
d A first part present<strong>in</strong>g <strong>the</strong> context of <strong>in</strong>tervention, <strong>the</strong> project and <strong>the</strong> learn<strong>in</strong>gfrom-experience<br />
process (also called “capitalization”);<br />
d A second part present<strong>in</strong>g <strong>the</strong> know-how employed dur<strong>in</strong>g <strong>the</strong> project.<br />
This document is <strong>in</strong>cluded on a DVD-ROM conta<strong>in</strong><strong>in</strong>g:<br />
d A film present<strong>in</strong>g <strong>the</strong> project<br />
d Learn<strong>in</strong>g-from-experience documents (<strong>the</strong> present document, as well as two sheets<br />
identify<strong>in</strong>g different types of know-how: “Facilitat<strong>in</strong>g <strong>the</strong> establishment of Long-Last<strong>in</strong>g<br />
Cross-Border L<strong>in</strong>ks” and “Streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong> Health System”)<br />
d A toolbox with <strong>the</strong> ma<strong>in</strong> documents and tools used dur<strong>in</strong>g <strong>the</strong> project.<br />
4
Context and Methodology Part<br />
1<br />
This first part of <strong>the</strong> document presents <strong>the</strong> context <strong>in</strong> which <strong>the</strong> different<br />
types of know-how described later were developed.<br />
We will first discuss <strong>the</strong> HIV/AIDS regional context, <strong>the</strong>n <strong>the</strong> project and its<br />
different components and, f<strong>in</strong>ally <strong>the</strong> methodology used for <strong>the</strong> learn<strong>in</strong>g-fromexperience<br />
process.<br />
1. The HIV/AIDS regional context 06<br />
Mobile populations and a denial of <strong>the</strong> disease 08<br />
Alarm<strong>in</strong>g rates of prevalence 08<br />
2. An ambitious project 07<br />
Ma<strong>in</strong> projects elements 07<br />
A strong awareness component 08<br />
3. Learn<strong>in</strong>g-from-experience process 10<br />
Multiple learn<strong>in</strong>g-from-experience goals 10<br />
Choice of a ma<strong>in</strong> <strong>the</strong>me for learn<strong>in</strong>g-from-experience 10<br />
A variety of learn<strong>in</strong>g-from-experience products 11<br />
Hybrid learn<strong>in</strong>g-from-experience methodology 11<br />
5
1. The HIV/AIDS regional context<br />
Part<br />
1<br />
MOBILE POPULATIONS AND A DENIAL OF THE DISEASE<br />
The border area shared by Djibouti with<br />
Ethiopia and Somaliland is characterized by<br />
highly mobile local populations who are<br />
traditionally nomads, and a well-developed,<br />
cross-border commercial activity. Along <strong>the</strong><br />
railway and road corridors that connect <strong>the</strong><br />
city of Djibouti to <strong>the</strong> major cities of Ethiopia<br />
and Somaliland, <strong>the</strong>re is a concentrated<br />
population of truck drivers, prostitutes and<br />
merchants. A lack of <strong>in</strong>formation, risky sexual<br />
behavior and poverty are determ<strong>in</strong>ant factors<br />
<strong>in</strong> <strong>the</strong> propagation of HIV/AIDS. The strong<br />
stigmatization and denial of <strong>the</strong> disease<br />
among <strong>the</strong> Somali and Afar populations of<br />
<strong>the</strong>se regions is an aggravat<strong>in</strong>g factor.<br />
© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />
ALARMING RATES OF PREVALENCE<br />
In Djibouti, <strong>the</strong> rate of prevalence for HIV/<br />
AIDS is 2.9% for <strong>the</strong> overall adult population<br />
and is over 5% <strong>in</strong> <strong>the</strong> 20-35 year age group.<br />
In Ethiopia, <strong>the</strong> latest estimates show a<br />
prevalence of 2.2% 1 for <strong>the</strong> adult population,<br />
but at Dire Dawa, sent<strong>in</strong>el surveillance<br />
data show a seroprevalence of 12.6%. In<br />
Somaliland, prevalence is 1.4% 2 .<br />
Because of demographic and geographical<br />
characteristics, <strong>the</strong> situation of <strong>the</strong> entire subregion,<br />
which is strongly exposed to HIV/AIDS<br />
propagation, is alarm<strong>in</strong>g. An average rate of<br />
prevalence of 5% for <strong>the</strong> overall population,<br />
which is <strong>the</strong> critical threshold from which<br />
epidemic growth rate is exponential, could be<br />
rapidly atta<strong>in</strong>ed <strong>in</strong> <strong>the</strong> region.<br />
1. Prevalence for <strong>the</strong> 15-49 age group - Source: S<strong>in</strong>gle Po<strong>in</strong>t HIV Prevalence Estimate, Federal HIV/AIDS Prevention and Control Office, June 2007<br />
2. 2005 data<br />
6
2. An ambitious project<br />
Part<br />
1<br />
Although <strong>in</strong> this document we will specifically<br />
discuss <strong>the</strong> community awareness aspect, <strong>the</strong><br />
project for improv<strong>in</strong>g HIV/AIDS prevention<br />
and treatment <strong>in</strong> <strong>the</strong> Djibouti-Ethiopia-<br />
Somaliland cross-border region, which this<br />
awareness program is part of, is extremely<br />
vast. Here, we will merely summarize details<br />
available from <strong>the</strong> different six-month activity<br />
reports 3 .<br />
MAIN PROJECT ELEMENTS<br />
In spite of <strong>the</strong> context of populations that are<br />
highly mobile between <strong>the</strong> three countries, <strong>the</strong><br />
public health authorities of Djibouti, Ethiopia<br />
and Somaliland have not yet developed a<br />
cooperative action plan to fight <strong>the</strong> epidemic.<br />
Implemented by <strong>Handicap</strong> <strong>International</strong> <strong>in</strong><br />
Ethiopia and Somaliland, this project thus<br />
complements ano<strong>the</strong>r project: “Support for<br />
<strong>the</strong> Fight aga<strong>in</strong>st HIV/AIDS <strong>in</strong> Djibouti,” which is<br />
f<strong>in</strong>anced by <strong>the</strong> French Agency for Development<br />
and implemented by <strong>the</strong> Health M<strong>in</strong>istry of<br />
Djibouti. It aims to implement cooperative<br />
actions between <strong>the</strong> three countries <strong>in</strong> order<br />
to mitigate HIV/AIDS propagation and<br />
encourage long-term patient care and<br />
follow-up of <strong>in</strong>fected <strong>in</strong>dividuals on both<br />
sides of <strong>the</strong> border. In addition, awareness<br />
actions and <strong>the</strong> re<strong>in</strong>forcement of counsel<strong>in</strong>g<br />
and voluntary test<strong>in</strong>g are be<strong>in</strong>g implemented<br />
<strong>in</strong> each country along <strong>the</strong> traffic corridors.<br />
Area of <strong>in</strong>tervention:<br />
d Ethiopia (Dire Dawa, Somalia region, Afar<br />
region)<br />
d Somaliland (western area, between Hargeisa<br />
and Togwajaale)<br />
Targets:<br />
d The adult population (over 15 years old) of<br />
<strong>the</strong> regions concerned: this group benefited<br />
from awareness activities and an improvement<br />
<strong>in</strong> <strong>the</strong> availability of counsel<strong>in</strong>g and test<strong>in</strong>g<br />
services.<br />
d Persons diagnosed with HIV/AIDS: <strong>the</strong>y<br />
benefited from an improvement <strong>in</strong> <strong>the</strong> extent<br />
and quality of treatment, <strong>in</strong>clud<strong>in</strong>g cont<strong>in</strong>ued<br />
access to treatment <strong>in</strong> <strong>the</strong> areas covered by<br />
<strong>the</strong> project.<br />
d Local partners: community organizations,<br />
religious and community leaders and<br />
associations of persons liv<strong>in</strong>g with HIV<br />
were tra<strong>in</strong>ed <strong>in</strong> <strong>the</strong> techniques of <strong>in</strong>creas<strong>in</strong>g<br />
community awareness of HIV/AIDS and how<br />
to communicate about <strong>the</strong> disease. Health<br />
workers were tra<strong>in</strong>ed <strong>in</strong> counsel<strong>in</strong>g and test<strong>in</strong>g<br />
techniques, as well as <strong>in</strong> how to treat persons<br />
<strong>in</strong>fected with HIV.<br />
3. General project documents (reason<strong>in</strong>g, activity reports, etc.) are available <strong>in</strong> <strong>the</strong> Project Documents directory of <strong>the</strong> Toolbox on <strong>the</strong> Capitalization<br />
DVD-ROM.<br />
7
Project goals<br />
General goal<br />
Contribute to reduc<strong>in</strong>g HIV/AIDS transmission<br />
and improv<strong>in</strong>g <strong>the</strong> quality of life of persons<br />
liv<strong>in</strong>g with HIV/AIDS <strong>in</strong> <strong>the</strong> northwest region of<br />
Somalia and <strong>the</strong> nor<strong>the</strong>ast region of Ethiopia.<br />
Specific goal<br />
Re<strong>in</strong>force HIV prevention and provide access<br />
to cont<strong>in</strong>ued, comprehensive treatment for<br />
persons liv<strong>in</strong>g with HIV <strong>in</strong> <strong>the</strong> neighborhood of<br />
<strong>the</strong> Hargeisa – Jijiga / Dire Dawa – Djibouti /<br />
Djibouti – Loggia corridors.<br />
Expected results<br />
1. Availability of and access to objective and<br />
culturally appropriate <strong>in</strong>formation for <strong>the</strong><br />
migratory and sedentary populations of <strong>the</strong><br />
target areas.<br />
2. Availability of voluntary counsel<strong>in</strong>g and<br />
test<strong>in</strong>g services <strong>in</strong> four secondary health<br />
structures and re<strong>in</strong>forcement of <strong>the</strong>se services<br />
<strong>in</strong> three reference centers.<br />
3. Improvement <strong>in</strong> and better performance of<br />
comprehensive care services, <strong>in</strong> particular<br />
treatment services, <strong>in</strong> <strong>the</strong> reference hospitals.<br />
4. Effective implementation of skill exchanges<br />
on <strong>the</strong> regional scale and promotion of<br />
experience capitalization.<br />
<strong>Handicap</strong> <strong>International</strong> is <strong>in</strong> charge of<br />
<strong>the</strong> implementation of <strong>the</strong> project <strong>in</strong> <strong>the</strong><br />
two countries: Ethiopia and Somaliland.<br />
The <strong>in</strong>tervention logic is ma<strong>in</strong>ly based on<br />
partnership through <strong>the</strong> coord<strong>in</strong>ation and<br />
re<strong>in</strong>forcement of local <strong>in</strong>itiatives.<br />
A STRONG AWARENESS COMPONENT<br />
At <strong>the</strong> different sites of project <strong>in</strong>tervention,<br />
development of awareness represented a<br />
fundamental aspect of <strong>the</strong> project, with its<br />
implementation entrusted to local partner<br />
associations.<br />
“House-to-house” awareness action<br />
In each community concerned, awareness<br />
was developed at different levels, <strong>in</strong> different<br />
contexts and through target<strong>in</strong>g different<br />
groups. First, a “house-to-house” awareness<br />
action, implemented daily, enabled contact<br />
with persons present <strong>in</strong> <strong>the</strong> home dur<strong>in</strong>g <strong>the</strong><br />
day, ma<strong>in</strong>ly women. This method consisted<br />
<strong>in</strong> mak<strong>in</strong>g <strong>the</strong> contact aware of <strong>the</strong> HIV/AIDS<br />
problem by provid<strong>in</strong>g <strong>in</strong>formation and creat<strong>in</strong>g<br />
a discussion on <strong>the</strong> topic with<strong>in</strong> <strong>the</strong> <strong>in</strong>timacy<br />
of <strong>the</strong> home. To do this, animator would make<br />
several visits to a home; dur<strong>in</strong>g <strong>the</strong>se visits, <strong>the</strong><br />
animator would talk about different subjects<br />
that enabled know<strong>in</strong>g <strong>the</strong> disease better<br />
and how to prevent it. At each <strong>in</strong>tervention<br />
site, a team of five animators was <strong>in</strong> charge<br />
of a daily program of awareness development<br />
throughout <strong>the</strong> three project years.<br />
Involv<strong>in</strong>g community leaders<br />
In parallel to this “house-to-house” program,<br />
extensive collaborative work with <strong>the</strong><br />
community was carried out to make <strong>the</strong><br />
project possible. Religious and community<br />
leaders were actively <strong>in</strong>volved <strong>in</strong> <strong>the</strong> project<br />
through <strong>the</strong> creation of “Project Advisory<br />
Committees” responsible for promot<strong>in</strong>g <strong>the</strong><br />
project with<strong>in</strong> <strong>the</strong> community, giv<strong>in</strong>g advice<br />
on project orientations and resolv<strong>in</strong>g <strong>the</strong><br />
conflicts encountered by <strong>the</strong> organizers.<br />
Without <strong>the</strong> support of <strong>the</strong>se leaders, project<br />
acceptation with<strong>in</strong> <strong>the</strong> community would have<br />
been difficult.<br />
Creat<strong>in</strong>g an environment<br />
of comprehensive awareness<br />
In addition to develop<strong>in</strong>g awareness <strong>in</strong><br />
8
homes and imply<strong>in</strong>g community leaders, an<br />
environment of comprehensive awareness was<br />
implemented <strong>in</strong> <strong>the</strong> community us<strong>in</strong>g different<br />
communication tools: from stickers to a film<br />
on prevention, by way of pa<strong>in</strong>ted walls, posters,<br />
T-shirts, etc. Also, <strong>in</strong> some regions where<br />
collective exchanges are part of <strong>the</strong> everyday<br />
culture (community conversations, coffee<br />
ceremonies), <strong>the</strong>se exchanges were used<br />
to present <strong>the</strong> topic of HIV/AIDS prevention.<br />
In <strong>the</strong> same way, collective awareness was<br />
developed through <strong>the</strong> organization of festive<br />
events (circus, concert, etc.) dur<strong>in</strong>g which<br />
awareness messages were communicated.<br />
Specific actions for groups at risk<br />
F<strong>in</strong>ally, some groups considered to be at<br />
greater risk (prostitutes, truck drivers, young<br />
men, etc.) were particularly targeted by<br />
specific activities, such as educational<br />
programs, sem<strong>in</strong>ars, and even condom<br />
distribution, but only where it was culturally<br />
acceptable.<br />
The object of this document is to list pert<strong>in</strong>ent<br />
know-how identified dur<strong>in</strong>g <strong>the</strong> learn<strong>in</strong>g-fromexperience<br />
process for all <strong>the</strong>se different<br />
methods of develop<strong>in</strong>g awareness, which<br />
are complementary to each o<strong>the</strong>r.<br />
© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />
9
3. Learn<strong>in</strong>g-from-experience process<br />
Part<br />
1<br />
MULTIPLE LEARNING-FROME-EXPERIENCE GOALS<br />
The learn<strong>in</strong>g-from-experience process<br />
(sometimes called “capitalization”) took<br />
place over three months dur<strong>in</strong>g <strong>the</strong> last six<br />
months of this three-year project with <strong>the</strong> help<br />
of an outside person act<strong>in</strong>g as a facilitator.<br />
We def<strong>in</strong>ed three goals for this learn<strong>in</strong>g-fromexperience<br />
process:<br />
d Provide knowledge of <strong>the</strong> overall project<br />
d Describe <strong>the</strong> activities implemented and<br />
<strong>the</strong> tools used<br />
d Provide reusable elements for <strong>the</strong> def<strong>in</strong>ition<br />
and implementation of future projects<br />
CHOICE OF A MAIN THEME FOR LEARNING-FROME-EXPERIENCE<br />
Given <strong>the</strong> scope of <strong>the</strong> project, both <strong>in</strong><br />
geographical terms and concern<strong>in</strong>g <strong>the</strong><br />
diversity of actions undertaken, we thought it<br />
best to limit our choices and to concentrate on<br />
some aspects of <strong>the</strong> project where <strong>in</strong>terest<strong>in</strong>g<br />
know-how had been developed.<br />
Also, s<strong>in</strong>ce <strong>the</strong> goal of learn<strong>in</strong>g-fromexperience<br />
process is to share experience,<br />
<strong>the</strong> topics chosen should allow produc<strong>in</strong>g<br />
reusable know-how for o<strong>the</strong>r projects.<br />
In consequence, <strong>the</strong> choice of capitaliz<strong>in</strong>g on<br />
<strong>the</strong> know-how developed for implement<strong>in</strong>g<br />
community awareness activities was a logical<br />
choice. The development of awareness for this<br />
project was considerable and <strong>the</strong>re is thus<br />
a large amount of know-how to capitalize.<br />
Above all, develop<strong>in</strong>g awareness is a central<br />
aspect of numerous projects <strong>in</strong> different fields,<br />
<strong>in</strong>clud<strong>in</strong>g topics that are far removed from HIV.<br />
Thus, <strong>the</strong> production of knowledge on this<br />
topic can serve as a source of <strong>in</strong>spiration for<br />
many o<strong>the</strong>r development projects.<br />
In addition, we have created two summary<br />
sheets (just a few pages for each) to identify<br />
know-how on two o<strong>the</strong>r aspects of <strong>the</strong><br />
project: establishment of long-last<strong>in</strong>g<br />
cross-border l<strong>in</strong>ks and re<strong>in</strong>forcement of <strong>the</strong><br />
health system. These sheets are also meant<br />
to be sources of <strong>in</strong>spiration for future regional<br />
or cross-border projects or for o<strong>the</strong>r health<br />
projects.<br />
10
A VARIETY OF LEARNING-FROM-EXPERIENCE PRODUCTS<br />
Learn<strong>in</strong>g-from-experience products are varied<br />
and are all found on <strong>the</strong> DVD-ROM, where<br />
<strong>the</strong>y are classified <strong>in</strong> three parts:<br />
d A film present<strong>in</strong>g <strong>the</strong> project to fulfill <strong>the</strong><br />
goal of knowledge<br />
d Learn<strong>in</strong>g-from-experience documents:<br />
- A document analyz<strong>in</strong>g <strong>the</strong> know-how<br />
implemented on <strong>the</strong> topic of “<strong>Anchor<strong>in</strong>g</strong><br />
<strong>Awareness</strong> <strong>in</strong> <strong>the</strong> <strong>Community</strong>” (<strong>the</strong> present<br />
document)<br />
- Learn<strong>in</strong>g-from-experience sheet provid<strong>in</strong>g<br />
know-how on <strong>the</strong> topic of “Facilitat<strong>in</strong>g <strong>the</strong><br />
establishment of long-last<strong>in</strong>g, cross-border<br />
l<strong>in</strong>ks”<br />
- Learn<strong>in</strong>g-from-expere<strong>in</strong>ce sheet provid<strong>in</strong>g<br />
know-how on <strong>the</strong> topic of “Streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong><br />
health system”<br />
d A “Toolbox” conta<strong>in</strong><strong>in</strong>g <strong>the</strong> ma<strong>in</strong> documents<br />
and tools used for <strong>the</strong> project (rationale,<br />
activity reports, communication tools, followup<br />
formats, photos, etc.).<br />
HYBRID LEARNING-FROM-EXPERIENCE METHODOLOGY<br />
Most of <strong>the</strong> work of learn<strong>in</strong>g-from-experience<br />
process was dedicated to analyz<strong>in</strong>g<br />
community awareness activity know-how,<br />
which is presented <strong>in</strong> this document. For this<br />
analysis, <strong>the</strong> methodology chosen <strong>in</strong>cluded<br />
three phases, which sometimes occurred <strong>in</strong><br />
parallel.<br />
Observation, documentary research and<br />
collection of useful tools:<br />
This phase consisted <strong>in</strong> read<strong>in</strong>g different<br />
project documents, which were produced<br />
both at <strong>the</strong> moment of project design (logical<br />
framework and associated narrative) and<br />
dur<strong>in</strong>g project implementation (activity reports,<br />
reference terms and o<strong>the</strong>r reports, mid term<br />
evaluation, etc.).<br />
In addition, for more knowledge of <strong>the</strong> project<br />
and to feed <strong>the</strong> “Toolbox,” <strong>the</strong> different tools<br />
used and produced were reviewed, selected<br />
and classified.<br />
In parallel, observation of activities was<br />
carried out.<br />
On-site activities<br />
This phase consisted <strong>in</strong> collaborat<strong>in</strong>g with<br />
animators on <strong>the</strong> field to provide support<br />
for identification of <strong>the</strong> know-how <strong>the</strong>y used<br />
for <strong>the</strong> project. To do this, we used different<br />
methods:<br />
d Learn<strong>in</strong>g-from-experience workshops,<br />
ei<strong>the</strong>r with animatoranimators teams or with<br />
project advisory committees. The goal of<br />
<strong>the</strong>se workshops was to identify <strong>the</strong> different<br />
© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />
11
types of know-how by fill<strong>in</strong>g out toge<strong>the</strong>r a<br />
simple learn<strong>in</strong>g-from-experience process<br />
file (<strong>in</strong>clud<strong>in</strong>g four parts: context specificity,<br />
<strong>in</strong>itial conditions required and success factors,<br />
know-how implemented and lessons learned).<br />
d Topical discussions with members of <strong>the</strong> HI<br />
teams and partner associations (for example,<br />
on partnership with <strong>in</strong>stitutional participants,<br />
on partnership with associations, design of<br />
awareness tools, monitor<strong>in</strong>g of activities, etc.).<br />
d Individual <strong>in</strong>terviews with key persons, <strong>in</strong><br />
particular <strong>in</strong>stitutional partners of <strong>the</strong> project<br />
or health professionals who had undergone<br />
tra<strong>in</strong><strong>in</strong>g.<br />
Analysis and preparation<br />
The phase of analysis and writ<strong>in</strong>g, which was<br />
begun <strong>in</strong> parallel with on-site activities, ended<br />
with a series of discussions with persons<br />
outside <strong>the</strong> project. This enabled enrich<strong>in</strong>g our<br />
th<strong>in</strong>k<strong>in</strong>g and led to preparation of collective<br />
know-how materials to enable reuse by<br />
o<strong>the</strong>rs <strong>in</strong> o<strong>the</strong>r contexts.<br />
12
Implement<strong>in</strong>g Know-How Part<br />
2<br />
1. Dar<strong>in</strong>g an orig<strong>in</strong>al awareness program 14<br />
Adapted awareness method 15<br />
A new method 16<br />
Appropriate messengers 17<br />
<strong>Community</strong> leaders as facilitators 19<br />
2. Br<strong>in</strong>g long-last<strong>in</strong>g chance 22<br />
Acceptance of <strong>the</strong> animators 23<br />
Animators and awareness development know-how 25<br />
Invaluable double support for animators 27<br />
Involv<strong>in</strong>g local stakeholders for long-last<strong>in</strong>g change 28<br />
Streng<strong>the</strong>n<strong>in</strong>g partner associations 29<br />
3. Creat<strong>in</strong>g an awarenness environment 31<br />
Varied visual communication tools 32<br />
Popular radio broadcasts 34<br />
Use of traditional group exchange 36<br />
Festive events to convey <strong>the</strong> messages 37<br />
4. Carry<strong>in</strong>g out more precisely targeted actions 39<br />
Special target<strong>in</strong>g of populations at risk 40<br />
Promot<strong>in</strong>g condoms… where it is acceptable to do so 41<br />
13
Part<br />
2<br />
1. Dar<strong>in</strong>g an orig<strong>in</strong>al awareness program<br />
1. Adapted awareness<br />
d Know <strong>the</strong> context very well to chose<br />
<strong>the</strong> appropriate awareness method<br />
d Delimit awareness<br />
d Rely on exist<strong>in</strong>g bases<br />
d Adapt prevention to <strong>the</strong> context<br />
2. A new method<br />
d Become a daily presence<br />
d Promote private di<br />
d Provide complete <strong>in</strong>formation<br />
d Adapt session rhythm<br />
d Measure what is acceptable<br />
3. Appropriate messengers<br />
d Us<strong>in</strong>g pioneers for an <strong>in</strong>novative approach<br />
d Facilitate acceptance by <strong>the</strong> community<br />
d Use <strong>the</strong> expertise of <strong>the</strong> sick as a base<br />
d Demonstrate that this is not just someth<strong>in</strong>g<br />
that happens to o<strong>the</strong>rs<br />
d Tell how a positive life is possible<br />
d Show will<strong>in</strong>gness to discuss<br />
d Social status for HIV + animators<br />
4. <strong>Community</strong> leaders as facilitators<br />
d Respond to a perceived problem<br />
d Conv<strong>in</strong>ce leaders to support <strong>the</strong> project<br />
d Rely on local authorities<br />
d Make <strong>the</strong> project accepted through<br />
<strong>the</strong> leaders<br />
d Call on <strong>the</strong> advisory committee <strong>in</strong> case<br />
of conflict<br />
d Decrease stigmatization us<strong>in</strong>g <strong>the</strong> behavior<br />
of leaders<br />
d Communicate on a large scale through<br />
<strong>the</strong> leaders<br />
d Let <strong>the</strong> project advisory committee<br />
def<strong>in</strong>e priorities<br />
Us<strong>in</strong>g prelim<strong>in</strong>ary studies as a basis for<br />
decision, we chose to carry out an awareness<br />
program with<strong>in</strong> <strong>the</strong> community by means of<br />
an orig<strong>in</strong>al <strong>in</strong>tervention method: “house-tohouse”.<br />
This method is based on <strong>the</strong> activity of<br />
animators who go from house to house, often<br />
spontaneously, to discuss <strong>the</strong> <strong>the</strong>me of HIV<br />
with family members. <strong>Awareness</strong> is thus very<br />
personalized s<strong>in</strong>ce it is encouraged with<strong>in</strong> <strong>the</strong><br />
<strong>in</strong>timate context of <strong>the</strong> home and targets only<br />
a few persons. It enables reach<strong>in</strong>g persons<br />
who are not normally covered by traditional<br />
awareness campaigns, such as young girls<br />
and housewives.<br />
The animators visit each home often, from three<br />
to n<strong>in</strong>e times, depend<strong>in</strong>g on cultural contexts,<br />
<strong>in</strong> order to furnish <strong>in</strong>-depth <strong>in</strong>formation<br />
on <strong>the</strong> disease and ways to prevent it. The<br />
different subjects to be discussed are listed<br />
<strong>in</strong> <strong>the</strong> detailed guide used as a support by<br />
animators.<br />
To carry out this awareness program, animators<br />
were chosen as nearly as possible from with<strong>in</strong><br />
<strong>the</strong> community. In Ethiopia, animators are<br />
<strong>the</strong>mselves HIV +, which was not possible <strong>in</strong><br />
<strong>the</strong> Afar region (Ethiopia) or Somaliland, where<br />
stigmatization is too strong for people liv<strong>in</strong>g<br />
with HIV (PLWHIV) to reveal <strong>the</strong>ir status.<br />
To enable this awareness program to function<br />
at <strong>the</strong> sites chosen, community leaders<br />
served as facilitators for <strong>the</strong>ir communities.<br />
14
ADAPTED AWARENESS METHOD<br />
The choice of this <strong>in</strong>novative method of rais<strong>in</strong>g<br />
awareness by go<strong>in</strong>g from house to house was<br />
based on <strong>in</strong>-depth prelim<strong>in</strong>ary studies. In<br />
addition, subjects targeted by <strong>the</strong> awareness<br />
program were carefully selected. F<strong>in</strong>ally, before<br />
start<strong>in</strong>g <strong>the</strong> program, a guide giv<strong>in</strong>g details on<br />
<strong>the</strong> messages to be delivered for each subject<br />
was drawn up <strong>in</strong> order to serve as a basis for<br />
<strong>the</strong> animators.<br />
Know <strong>the</strong> context very well to chose<br />
<strong>the</strong> appropriate awareness method<br />
Before <strong>the</strong> start of <strong>the</strong> project, we took <strong>the</strong><br />
time to carry out prelim<strong>in</strong>ary studies <strong>in</strong> order<br />
to precisely def<strong>in</strong>e needs, elaborate an<br />
appropriate <strong>in</strong>tervention strategy and collect<br />
data enabl<strong>in</strong>g us to measure project impact.<br />
These studies concerned <strong>the</strong> knowledge,<br />
attitudes, practices and behaviors related<br />
to HIV/AIDS and reproductive and sexual<br />
health, an analysis of prevention and<br />
tra<strong>in</strong><strong>in</strong>g tools, tra<strong>in</strong><strong>in</strong>g needs <strong>in</strong> <strong>the</strong> HIV/AIDS<br />
area <strong>in</strong> health structures and, f<strong>in</strong>ally, HIV/TB<br />
(tuberculosis) co-<strong>in</strong>fection <strong>in</strong> Somaliland.<br />
Thus, <strong>the</strong> choice of carry<strong>in</strong>g out a “house-tohouse”<br />
awareness program rested on solid<br />
knowledge of <strong>the</strong> context and was <strong>in</strong>spired<br />
by recommendations from <strong>the</strong>se studies.<br />
Delimit awareness boundaries<br />
Once <strong>the</strong> awareness strategy was chosen and<br />
before actually start<strong>in</strong>g <strong>the</strong> activities, we carried<br />
out extensive work to choose <strong>the</strong> topics<br />
that would be concerned by <strong>the</strong> awareness<br />
program. In this way, some subjects related<br />
to HIV were withdrawn for cultural reasons,<br />
because <strong>the</strong>y were not pert<strong>in</strong>ent <strong>in</strong> <strong>the</strong> chosen<br />
context or because <strong>the</strong>y were not socially<br />
acceptable.<br />
Once <strong>the</strong> subjects were chosen, a manual was<br />
put toge<strong>the</strong>r to precisely def<strong>in</strong>e <strong>the</strong> notions<br />
to be taught and <strong>the</strong> level of detail required<br />
for each topic.<br />
This manual <strong>the</strong>n served as <strong>the</strong> basis for all<br />
community awareness activities and for tool<br />
production and communication on HIV/AIDS.<br />
Rely on exist<strong>in</strong>g bases<br />
The manual was written at <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />
of <strong>the</strong> project <strong>in</strong> Ethiopia by a project team<br />
committee. For its preparation, group<br />
members chose to use already exist<strong>in</strong>g<br />
analyses and documents written by experts on<br />
<strong>the</strong> subject. To beg<strong>in</strong> with, <strong>the</strong>y were <strong>in</strong>spired<br />
by Ethiopian specifications for <strong>the</strong> tra<strong>in</strong><strong>in</strong>g<br />
of peer educators on <strong>the</strong> topic of HIV. After<br />
select<strong>in</strong>g n<strong>in</strong>e priority awareness topics, <strong>the</strong><br />
writ<strong>in</strong>g committee turned aga<strong>in</strong> to exist<strong>in</strong>g<br />
documents, such as communication<br />
supports collected from different stakeholders<br />
<strong>in</strong> <strong>the</strong> fight aga<strong>in</strong>st AIDS, <strong>in</strong> order to describe<br />
each topic <strong>in</strong> detail for <strong>the</strong> manual.<br />
Adapt prevention to <strong>the</strong> context<br />
To create a tra<strong>in</strong><strong>in</strong>g manual for animators<br />
that was adapted to Somaliland, it was<br />
necessary to use <strong>the</strong> orig<strong>in</strong>al manual<br />
written <strong>in</strong> Ethiopia. But for this manual to be<br />
accepted <strong>in</strong> Somaliland, it was necessary<br />
to withdraw some topics that would not<br />
have been accepted <strong>in</strong> <strong>the</strong> country’s cultural<br />
context (promotion of condom use, mentions<br />
of homosexuality, etc.). In addition, so that <strong>the</strong><br />
© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />
15
animators and <strong>in</strong>habitants of <strong>the</strong> region would<br />
feel concerned by <strong>the</strong> <strong>in</strong>formation delivered,<br />
a number of case studies were <strong>in</strong>vented to<br />
illustrate <strong>the</strong> manual, us<strong>in</strong>g local place names<br />
and Somali first names that are common <strong>in</strong> <strong>the</strong><br />
region concerned.<br />
A NEW METHOD<br />
Become a daily presence<br />
By do<strong>in</strong>g this house-to-house work <strong>in</strong> an<br />
everyday environment, with animators present<br />
three times a week for three years, not only did<br />
<strong>the</strong> awareness program become accepted,<br />
it even came to be considered as a normal<br />
activity <strong>in</strong> <strong>the</strong> community.<br />
Promote private discussion<br />
In contrast to <strong>the</strong> methods of mass awareness<br />
programs, this house-to-house work enables<br />
meet<strong>in</strong>g with people <strong>in</strong> <strong>the</strong>ir homes, <strong>in</strong> a<br />
context where <strong>the</strong>y are at ease and surrounded<br />
by close relatives <strong>in</strong> front of whom <strong>the</strong>y can<br />
talk freely and ask <strong>the</strong> questions <strong>the</strong>y want to<br />
ask.<br />
“When people are at home, <strong>the</strong>y speak more<br />
openly and dare to ask questions; <strong>the</strong>y dare<br />
to confide <strong>in</strong> <strong>the</strong> animatoranimator. They have<br />
noth<strong>in</strong>g to hide.” 4<br />
Provide complete <strong>in</strong>formation<br />
We decided to provide <strong>in</strong>-depth <strong>in</strong>formation<br />
that was as complete as possible on <strong>the</strong><br />
topics chosen to persons who were be<strong>in</strong>g<br />
made aware. Rais<strong>in</strong>g awareness <strong>in</strong> a home<br />
was done <strong>in</strong> various sessions <strong>in</strong> order to cover<br />
<strong>the</strong> n<strong>in</strong>e chapters on <strong>the</strong> disease (<strong>the</strong> bases of<br />
HIV/AIDS, ways of transmission, how <strong>the</strong> virus<br />
cannot be transmitted, ways of prevention,<br />
etc.). Br<strong>in</strong>g<strong>in</strong>g complete <strong>in</strong>formation on <strong>the</strong><br />
disease enabled people to feel truly <strong>in</strong>formed<br />
and to have enough knowledge to choose<br />
<strong>the</strong>ir prevention method by <strong>the</strong>mselves,<br />
request test<strong>in</strong>g, etc.<br />
SUCCESS STORY:<br />
THE COMMUNITY DEMANDED<br />
ANIMATORS WHEN THEY WERE<br />
ABSENT!<br />
When <strong>Handicap</strong> <strong>International</strong> changed<br />
its partner association <strong>in</strong> <strong>the</strong> Somali<br />
region, animators were <strong>in</strong>active for a<br />
period of three months. At Ayesha,<br />
a small village near Dire Dawa, <strong>the</strong><br />
animators were scolded by everyone:<br />
“Well, where have you been? Why<br />
aren’t you work<strong>in</strong>g any more? You must<br />
cont<strong>in</strong>ue to act for <strong>the</strong> community!”<br />
The community obviously missed<br />
<strong>the</strong>m and had become accustomed to<br />
<strong>the</strong>ir presence!<br />
Adapt session rhythm<br />
Depend<strong>in</strong>g on <strong>the</strong> area, house-to-house<br />
awareness strategies differed accord<strong>in</strong>g to<br />
cultural habits. For example, at Dire Dawa <strong>the</strong><br />
animators went n<strong>in</strong>e times to each house but<br />
stayed no longer than 20 m<strong>in</strong>utes. O<strong>the</strong>rwise,<br />
people became bored. In contrast, <strong>in</strong> <strong>the</strong> Afar<br />
region animators went no more than three<br />
times to each home, often rema<strong>in</strong><strong>in</strong>g for<br />
more than an hour. In part of this region, it<br />
is difficult to set up appo<strong>in</strong>tments because <strong>the</strong><br />
people are very mobile (nomad culture, need<br />
to travel some distance to obta<strong>in</strong> water, etc.).<br />
In addition, Afar residents are very culturally<br />
attuned to receiv<strong>in</strong>g <strong>in</strong>formation; <strong>the</strong>y can<br />
rema<strong>in</strong> for hours listen<strong>in</strong>g to a animator who<br />
4. Legesse Mulisa, member of <strong>the</strong> Dire Dawa Project Advisory Committee with <strong>the</strong> status of village elder.<br />
16
has come as a “dagou” (mean<strong>in</strong>g “bearer<br />
of <strong>in</strong>formation” <strong>in</strong> <strong>the</strong> Afar language). This is<br />
<strong>the</strong> opposite of Dire Dawa residents, who tire<br />
easily if a conversation takes too long.<br />
Measure what is acceptable<br />
In Somaliland, <strong>the</strong> house-to-house awareness<br />
program was supported by community<br />
elders, who accepted HIV/AIDS to be spoken<br />
about because <strong>the</strong>y knew it was a problem<br />
for <strong>the</strong> community. They strongly supported<br />
awareness, on <strong>the</strong> condition that <strong>the</strong>re would<br />
be no promotion of condom use. Contrary<br />
to what was done <strong>in</strong> Ethiopia, <strong>the</strong>re was<br />
no mention or promotion of condoms <strong>in</strong><br />
Somaliland, s<strong>in</strong>ce this was not considered as<br />
socially acceptable.<br />
APPROPRIATE MESSENGERS<br />
Once <strong>the</strong> outl<strong>in</strong>es of <strong>the</strong> awareness effort were<br />
well def<strong>in</strong>ed, it was necessary to choose <strong>the</strong><br />
most pert<strong>in</strong>ent animators for this task. At all<br />
<strong>in</strong>tervention sites, <strong>the</strong>y were selected as nearly<br />
as possible from with<strong>in</strong> <strong>the</strong> community itself.<br />
However, <strong>the</strong>ir profile could vary accord<strong>in</strong>g<br />
to <strong>the</strong> context. For example, <strong>in</strong> Ethiopia,<br />
animators were all HIV + and often older than<br />
forty. But <strong>in</strong> Somaliland <strong>the</strong> disease rema<strong>in</strong>s<br />
highly stigmatized and very few persons reveal<br />
<strong>the</strong>ir status; it was thus difficult to f<strong>in</strong>d HIV +<br />
animators. In consequence, leaders were<br />
chosen from young people <strong>in</strong> <strong>the</strong> community.<br />
In all countries and regions, animators carried<br />
out <strong>the</strong>ir activity part-time for a few days a week<br />
and received a salary. At all sites, it was decided<br />
to encourage an almost daily presence of <strong>the</strong><br />
animators. Thus, <strong>in</strong> Somaliland new animators<br />
were recruited from with<strong>in</strong> <strong>the</strong> community<br />
after <strong>the</strong> program had started to streng<strong>the</strong>n<br />
<strong>the</strong> exist<strong>in</strong>g team, who were too few to ensure<br />
daily awareness <strong>in</strong>itiatives simultaneously at all<br />
sites.<br />
Us<strong>in</strong>g pioneers for an <strong>in</strong>novative approach<br />
In Ethiopia, animators were often among <strong>the</strong><br />
first <strong>in</strong> <strong>the</strong>ir community to declare <strong>the</strong>ir HIV<br />
status and take responsibility for <strong>the</strong>ir status.<br />
For <strong>the</strong> <strong>in</strong>novative house-to-house approach,<br />
we could thus count on <strong>the</strong>se brave people,<br />
who were pioneers <strong>in</strong> declar<strong>in</strong>g <strong>the</strong>ir HIV<br />
status. In Somaliland, where <strong>the</strong> PLWHIV do<br />
not reveal <strong>the</strong>ir status, young people were<br />
chosen because <strong>the</strong>y accepted to talk about<br />
AIDS, which was still taboo for <strong>the</strong>ir elders.<br />
Facilitate acceptance by <strong>the</strong> community<br />
The fact that <strong>the</strong> animators were <strong>the</strong>mselves<br />
members of <strong>the</strong> community where <strong>the</strong>y<br />
worked greatly facilitated <strong>the</strong>ir acceptance<br />
by families for carry<strong>in</strong>g out <strong>the</strong> awareness<br />
program, s<strong>in</strong>ce <strong>the</strong>y came “as neighbors”. In<br />
Somaliland, for example, <strong>the</strong> community had a<br />
benevolent view of this project, which allowed<br />
some of <strong>the</strong> younger members to work. It was<br />
thus well received, whereas <strong>the</strong> community<br />
would probably have refused to listen to<br />
strangers speak<strong>in</strong>g on <strong>the</strong> subject of HIV.<br />
Use <strong>the</strong> expertise of <strong>the</strong> sick as a base<br />
In Ethiopia, persons liv<strong>in</strong>g with HIV were <strong>the</strong><br />
ones who educated <strong>the</strong> community. Be<strong>in</strong>g<br />
HIV + made it legitimate for <strong>the</strong>m to speak<br />
about <strong>the</strong> disease, its consequences and <strong>the</strong><br />
ways it is treated, s<strong>in</strong>ce <strong>the</strong>y live with it every<br />
day. Animators were thus liv<strong>in</strong>g witnesses<br />
and for this reason were listened to very<br />
attentively. Their experience was a conv<strong>in</strong>c<strong>in</strong>g<br />
17
SUCCESS STORY:<br />
AWARENESS THAT ALLOWED A REAL DROP IN STIGMATIZATION<br />
Before, people <strong>in</strong> <strong>the</strong> village rejected us, especially on market days when a lot of<br />
people who knew noth<strong>in</strong>g about <strong>the</strong> disease came <strong>in</strong> from <strong>the</strong> country. They refused<br />
to come near us and threw stones at us. People were afraid to get AIDS just by<br />
look<strong>in</strong>g at us! But now that people know about how <strong>the</strong> disease is transmitted, <strong>the</strong>y<br />
are no longer afraid of us and even shake our hand without a problem.<br />
testimony to <strong>the</strong> reality of <strong>the</strong> disease and<br />
<strong>the</strong> effectiveness of treatment, and thus of<br />
<strong>the</strong> importance of know<strong>in</strong>g one’s status.<br />
“It’s my own experience, <strong>the</strong> fact that <strong>the</strong>y saw<br />
me very sick and that now I am healed thanks to<br />
<strong>the</strong> medic<strong>in</strong>es: this is what opens <strong>the</strong>ir doors.<br />
It’s one of <strong>the</strong> ma<strong>in</strong> reasons <strong>the</strong>y believe me.” 5<br />
Demonstrate that this is not just someth<strong>in</strong>g<br />
that happens to o<strong>the</strong>rs<br />
In a context of strong denial of <strong>the</strong> disease,<br />
enabl<strong>in</strong>g community members to talk about<br />
<strong>the</strong>ir HIV status has demonstrated that<br />
everyone can be affected, <strong>in</strong>dependently of<br />
religion, sex or physical appearance:<br />
“By hav<strong>in</strong>g <strong>the</strong> fat, <strong>the</strong> young and <strong>the</strong> old,<br />
Muslim or not, tell about <strong>the</strong>ir experience,<br />
we showed to what extent everyone can be<br />
affected and conv<strong>in</strong>ced accord<strong>in</strong>gly.” 6<br />
Tell how a positive life is possible<br />
The animators <strong>in</strong>fected with <strong>the</strong> virus told<br />
about <strong>the</strong>ir own lifestyle and how it is possible<br />
to live with <strong>the</strong> virus <strong>in</strong> a positive way, to be<br />
<strong>in</strong> good health, active and self-esteemed,<br />
with a satisfy<strong>in</strong>g trade. These personal stories<br />
allowed strongly decreas<strong>in</strong>g <strong>the</strong> fear of be<strong>in</strong>g<br />
tested and of discover<strong>in</strong>g that one carries<br />
<strong>the</strong> virus, because persons who were made<br />
aware no longer saw HIV status as <strong>the</strong> end of<br />
everyth<strong>in</strong>g.<br />
“People realize that you can live with HIV. When<br />
<strong>the</strong>y listen to us tell about our disease, about<br />
our life, <strong>the</strong>y learn many th<strong>in</strong>gs from us. Some<br />
will follow up by be<strong>in</strong>g tested, <strong>the</strong>n reveal <strong>the</strong>ir<br />
status and take antiretroviral medic<strong>in</strong>es.” 7<br />
Show will<strong>in</strong>gness to discuss<br />
Dur<strong>in</strong>g <strong>the</strong>ir house-to-house work, <strong>the</strong><br />
animators must also be available to talk about<br />
<strong>the</strong> disease with anyone who wants to. For<br />
this reason, <strong>the</strong>y wear a T-shirt stat<strong>in</strong>g: “I am<br />
a animator: if you have questions about AIDS,<br />
just ask me!”<br />
Social status for HIV + animators<br />
Because of <strong>the</strong>ir participation <strong>in</strong> <strong>the</strong> awareness<br />
program, animators enjoyed a new social<br />
status. In Ethiopia, most of <strong>the</strong> leaders had been<br />
rejected by <strong>the</strong> community when <strong>the</strong>y revealed<br />
<strong>the</strong>ir HIV status. Through <strong>the</strong>ir work, <strong>the</strong>y were<br />
recognized for <strong>the</strong>ir role as educators who<br />
provided <strong>in</strong>-depth knowledge of <strong>the</strong> disease.<br />
In addition, be<strong>in</strong>g a leader meant earn<strong>in</strong>g a<br />
salary and be<strong>in</strong>g able to support a family.<br />
5. Aynaiem Tamirat, animator at Dire Dawa, Kebele 05<br />
6. Hassen Duale, animator at Ayesha<br />
7. Hana Mamo, , member of <strong>the</strong> partner association of persons liv<strong>in</strong>g with HIV and of <strong>the</strong> Dire Dawa project advisory committee<br />
18
COMMUNITY LEADERS AS FACILITATORS<br />
To be able to talk about such a sensitive<br />
subject <strong>in</strong> a cultural context of denial<br />
and stigmatization, we needed to rely on<br />
community leaders to support <strong>the</strong> animators.<br />
To do this, community leaders were called<br />
on to form “project advisory committees”<br />
at each <strong>in</strong>tervention site. Composed of<br />
<strong>in</strong>fluential members of <strong>the</strong> community, <strong>the</strong>se<br />
committees were responsible for help<strong>in</strong>g to<br />
def<strong>in</strong>e <strong>the</strong> <strong>in</strong>tervention strategy that was<br />
most appropriate locally, <strong>in</strong>form<strong>in</strong>g <strong>the</strong><br />
community about <strong>the</strong> project and its activities<br />
and support<strong>in</strong>g animators <strong>in</strong> case of conflict.<br />
In Ethiopia, <strong>the</strong>se committees were made up<br />
of a dozen members designated by a local<br />
authority (<strong>the</strong> “kebele”), who was careful<br />
to <strong>in</strong>clude representatives of each religion,<br />
women’s associations, young people, and<br />
local political personalities. In Somaliland,<br />
<strong>the</strong>se advisory committees were made up of<br />
<strong>the</strong> two most <strong>in</strong>fluential community leaders.<br />
Whatever <strong>the</strong>ir form, <strong>the</strong>se committees enabled<br />
project acceptance by <strong>the</strong> community and<br />
made possible <strong>the</strong> daily house-to-house<br />
activity of <strong>the</strong> animators.<br />
Respond to a perceived problem<br />
The different community leaders had become<br />
<strong>in</strong>creas<strong>in</strong>gly aware that it was necessary to fight<br />
aga<strong>in</strong>st AIDS; however, <strong>the</strong>y found <strong>the</strong>mselves<br />
powerless to do so s<strong>in</strong>ce <strong>the</strong>y did not know<br />
how to make <strong>the</strong> community aware. Thus,<br />
<strong>the</strong>y received this project very favorably<br />
and were happy that it enabled gett<strong>in</strong>g rid<br />
of <strong>the</strong> taboo and <strong>the</strong> silence surround<strong>in</strong>g <strong>the</strong><br />
disease. In addition, <strong>the</strong> project allowed <strong>the</strong>m<br />
to participate without be<strong>in</strong>g on <strong>the</strong> front l<strong>in</strong>e,<br />
s<strong>in</strong>ce <strong>the</strong> animators were responsible for<br />
awareness <strong>in</strong> <strong>the</strong> field. For <strong>the</strong>se reasons,<br />
community leaders became actively <strong>in</strong>volved <strong>in</strong><br />
support<strong>in</strong>g <strong>the</strong> project and mak<strong>in</strong>g it accepted<br />
by <strong>the</strong> community.<br />
Conv<strong>in</strong>ce leaders to support <strong>the</strong> project<br />
In Somaliland, tra<strong>in</strong><strong>in</strong>g was proposed to motivate<br />
community leaders who were designated to<br />
become part of an advisory committee. Dur<strong>in</strong>g<br />
two days, <strong>the</strong>y acquired basic knowledge of<br />
HIV/AIDS and of <strong>the</strong> project itself; this was<br />
followed by a period of discussion on <strong>the</strong><br />
topic, “What can you do for your community<br />
concern<strong>in</strong>g <strong>the</strong> HIV/AIDS problem?” Next, we<br />
proposed that <strong>the</strong>y play a support<strong>in</strong>g role for<br />
animators <strong>in</strong> <strong>the</strong>ir community by form<strong>in</strong>g a<br />
project advisory committee. All participat<strong>in</strong>g<br />
leaders accepted do<strong>in</strong>g this and proved to be<br />
effective channels for promot<strong>in</strong>g awareness<br />
with<strong>in</strong> <strong>the</strong> community.<br />
Rely on local authorities<br />
In Ethiopia, we called on <strong>the</strong> “kebele,” <strong>the</strong><br />
local authority at <strong>the</strong> neighborhood level, to<br />
select community leaders to make up <strong>the</strong><br />
project advisory committee. We advised him<br />
to choose <strong>the</strong>m so that different segments of<br />
<strong>the</strong> population would be represented: women,<br />
young people, each religious community,<br />
elders, etc. However, <strong>the</strong> f<strong>in</strong>al decision<br />
concern<strong>in</strong>g <strong>the</strong> composition of <strong>the</strong> project<br />
advisory committee would be up to <strong>the</strong> kebele<br />
himself.<br />
© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />
19
SUCCESS STORY:<br />
LEADERS THAT LET THEMSELVES BE CONVINCED<br />
At <strong>the</strong> start of <strong>the</strong> workshop with community leaders, one of <strong>the</strong> Muslim leaders<br />
affirmed that <strong>the</strong> disease could not affect Muslims by say<strong>in</strong>g to <strong>the</strong> o<strong>the</strong>rs, “This<br />
disease is your problem; you are <strong>the</strong> ones who are <strong>in</strong>fect<strong>in</strong>g yourselves. You need<br />
only dr<strong>in</strong>k camel’s milk to keep it away.” Then, at <strong>the</strong> end of <strong>the</strong> day, conv<strong>in</strong>ced by <strong>the</strong><br />
different <strong>in</strong>terventions, testimonials and discussions, he asked <strong>the</strong> group’s forgiveness<br />
for his reaction dur<strong>in</strong>g <strong>the</strong> morn<strong>in</strong>g. In addition, after this awareness workshop, six of<br />
<strong>the</strong> leaders present went to be tested over <strong>the</strong> follow<strong>in</strong>g days.<br />
Make <strong>the</strong> project accepted<br />
through <strong>the</strong> leaders<br />
Even <strong>in</strong> <strong>the</strong> presence of strong denial, people<br />
will accept <strong>the</strong> awareness program because of<br />
<strong>the</strong> presence of <strong>the</strong> project advisory committee.<br />
S<strong>in</strong>ce <strong>the</strong> members of this committee are<br />
leaders, <strong>the</strong>ir arguments are listened to and<br />
respected.<br />
To ensure project acceptance, project<br />
advisory committee members sometimes<br />
accompanied <strong>the</strong> animators on <strong>the</strong>ir houseto-house<br />
visits, ei<strong>the</strong>r to conv<strong>in</strong>ce <strong>the</strong> family to<br />
welcome <strong>the</strong> animator or to provide translation<br />
services at <strong>the</strong> start, if necessary, or simply to<br />
express <strong>the</strong>ir support of <strong>the</strong> project.<br />
In addition, project advisory committee<br />
members prepared communities for <strong>the</strong><br />
project by speak<strong>in</strong>g to <strong>the</strong>m, <strong>in</strong> particular<br />
when animators wished to visit a “hostile”<br />
area, where stigmatization was very strong or<br />
where people refused to open <strong>the</strong>ir doors to<br />
HIV + animators.<br />
“Now that we have conv<strong>in</strong>ced <strong>the</strong>m, people say<br />
<strong>the</strong> animators can come any time, whenever<br />
<strong>the</strong>y want to.” 8<br />
Call on <strong>the</strong> advisory committee<br />
<strong>in</strong> case of conflict<br />
As <strong>in</strong>fluential persons <strong>in</strong> <strong>the</strong> community,<br />
advisory committee members were very useful<br />
for resolv<strong>in</strong>g conflicts encountered by <strong>the</strong><br />
animators. If a person at home was reluctant<br />
to speak with a animator, <strong>the</strong> conflict was<br />
generally resolved through <strong>the</strong> <strong>in</strong>tervention of<br />
one of <strong>the</strong>se leaders, who accompanied <strong>the</strong><br />
animator to <strong>the</strong> home to discuss <strong>the</strong> importance<br />
of awareness and to provide support.<br />
“When <strong>the</strong> project advisory committee was<br />
created and signed an agreement with HI, all<br />
doors were opened.” 9<br />
Decrease stigmatization us<strong>in</strong>g<br />
<strong>the</strong> behavior of leaders<br />
Daily behavior of leaders around PLWHIV<br />
persons served as an example and was enough<br />
to lower <strong>the</strong> rate of fear and stigmatization.<br />
For example, <strong>the</strong> fact that community leaders<br />
accompanied animators or shook <strong>the</strong>ir hand<br />
was enough to demonstrate that <strong>the</strong>se<br />
animators were not dangerous to be around<br />
and that say<strong>in</strong>g hello to <strong>the</strong>m would not cause<br />
<strong>in</strong>fection with AIDS.<br />
Communicate on a large scale<br />
through <strong>the</strong> leaders<br />
The leaders communicated on <strong>the</strong> project<br />
as part of <strong>the</strong>ir activities: dur<strong>in</strong>g religious<br />
services for religious leaders or dur<strong>in</strong>g<br />
associational or social activities for <strong>the</strong> o<strong>the</strong>r<br />
leaders. For example, at project launch, <strong>the</strong><br />
religious leaders spoke about <strong>the</strong> project to<br />
<strong>the</strong>ir different congregations and encouraged<br />
8. Yusuf Hassen, Dire Dawa Project Advisory Committee member and mosque representative<br />
9. Hiwot Taddess, animator at Dire Dawa, Kebele 06<br />
20
people to receive <strong>the</strong> animators by expla<strong>in</strong><strong>in</strong>g:<br />
“Five animators tra<strong>in</strong>ed by <strong>Handicap</strong><br />
<strong>International</strong> will be com<strong>in</strong>g to visit your homes;<br />
dp not close <strong>the</strong> door to <strong>the</strong>m.” 10<br />
In a similar manner, dur<strong>in</strong>g public events <strong>the</strong><br />
leaders relayed <strong>in</strong>formation on program<br />
dates, location and reasons for participat<strong>in</strong>g <strong>in</strong><br />
order to motivate <strong>the</strong> people present.<br />
Let <strong>the</strong> project advisory committee<br />
def<strong>in</strong>e priorities<br />
At some sites, leaders carefully monitored <strong>the</strong><br />
areas covered by <strong>the</strong> awareness program.<br />
Three morn<strong>in</strong>gs a week, advisory committee<br />
members met with <strong>the</strong> animators and <strong>in</strong>dicated<br />
<strong>the</strong> neighborhoods to cover, preferably<br />
choos<strong>in</strong>g risky areas (with lots of hotels, bars<br />
and bus<strong>in</strong>esses).<br />
10. Hiwot Taddess, animator at Dire Dawa, Kebele 06<br />
21
2. Br<strong>in</strong>g<strong>in</strong>g long-last<strong>in</strong>g change<br />
Part<br />
2<br />
1. Acceptance of <strong>the</strong> animators<br />
d Be patient<br />
d Do not become discouraged<br />
about contact<strong>in</strong>g people<br />
d Discourage criticism by stay<strong>in</strong>g<br />
d Encourage identification of <strong>the</strong> animator<br />
as a “peer”<br />
d Negotiate without forc<strong>in</strong>g<br />
d Rely on community leaders<br />
<strong>in</strong> case of conflict<br />
d Ma<strong>in</strong>ta<strong>in</strong> an on-go<strong>in</strong>g relationship<br />
with leaders<br />
2. Animators and awareness development<br />
know-how<br />
d Smooth <strong>the</strong> approach and <strong>the</strong> first moments<br />
of discussion<br />
d Choose ears that are ready to hear<br />
d Choose <strong>the</strong> best time for develop<strong>in</strong>g<br />
awareness<br />
d Conv<strong>in</strong>ce at least one person<br />
d Separate men and women to speak<br />
with more freedom<br />
d Listen well and discuss without be<strong>in</strong>g<br />
d Adapt <strong>the</strong> level of <strong>in</strong>formation to <strong>the</strong> level<br />
of exist<strong>in</strong>g knowledge<br />
d Use <strong>the</strong> guide and adapt it as needed<br />
d Be sure each word is understood<br />
d Use chance encounters to identify<br />
persons at risk<br />
3. Invaluable double support for animators<br />
d Ma<strong>in</strong>ta<strong>in</strong> regularity and coherence<br />
with double monitor<strong>in</strong>g<br />
d Get an overall view of neighborhood<br />
awareness<br />
d Be an available partner<br />
d Support animators with regular shar<strong>in</strong>g<br />
d Use experienced animators to tra<strong>in</strong><br />
new ones<br />
4. Involv<strong>in</strong>g local stakeholders<br />
for long-last<strong>in</strong>g change<br />
d Encourage adoption of <strong>the</strong> cause<br />
by community leaders<br />
d Anchor <strong>the</strong> topic permanently<br />
by <strong>in</strong>volv<strong>in</strong>g community members<br />
d Streng<strong>the</strong>n community<br />
d Reach o<strong>the</strong>r social areas through <strong>the</strong> leaders<br />
5. Streng<strong>the</strong>n<strong>in</strong>g partner associations<br />
d Use partner knowledge<br />
d Provide partners with reusable tools<br />
d Provide tra<strong>in</strong><strong>in</strong>g adapted to needs<br />
d Tra<strong>in</strong> by do<strong>in</strong>g<br />
d Know how to say what’s wrong<br />
d Delegate more or less<br />
d F<strong>in</strong>d regular occasions for discussion<br />
d Jo<strong>in</strong> forces to enable ambitious action<br />
22
Through house-to-house awareness<br />
development, as it was done on this project,<br />
<strong>the</strong> number of persons contacted could seem<br />
ra<strong>the</strong>r low. However, after three years of <strong>the</strong><br />
awareness program, change <strong>in</strong> <strong>the</strong> community<br />
was palpable: stigmatization and denial of <strong>the</strong><br />
disease had strongly decreased, knowledge<br />
of <strong>the</strong> disease had become generalized and<br />
PLWHIV had rega<strong>in</strong>ed a social status.<br />
The daily activity of <strong>the</strong> animators allowed<br />
contact<strong>in</strong>g a large number of persons <strong>in</strong> an<br />
efficient way, thanks to <strong>the</strong> know-how <strong>the</strong>y<br />
had developed throughout <strong>the</strong> project.<br />
In addition, <strong>the</strong> effectiveness of <strong>the</strong>ir work<br />
was <strong>in</strong>creased as <strong>the</strong>y were followed and<br />
supported by <strong>the</strong> association of PLWHIV , a<br />
local partner of <strong>Handicap</strong> <strong>International</strong>, as well<br />
as <strong>the</strong> project advisory committee of <strong>the</strong><br />
village where <strong>the</strong>y <strong>in</strong>tervened.<br />
This double implication also had <strong>the</strong> great<br />
advantage of rais<strong>in</strong>g <strong>the</strong> awareness of and<br />
implicat<strong>in</strong>g community resource persons,<br />
<strong>the</strong>reby creat<strong>in</strong>g long-last<strong>in</strong>g change for<br />
<strong>the</strong>se persons concern<strong>in</strong>g <strong>the</strong> disease and its<br />
portrayal.<br />
© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />
ACCEPTANCE OF THE ANIMATORS<br />
In a context of disease denial, mak<strong>in</strong>g multiple<br />
visits to each home to speak of HIV/AIDS was<br />
not easy, particularly <strong>in</strong> Ethiopia, where <strong>the</strong><br />
animators were <strong>the</strong>mselves HIV +. Thus, one<br />
of <strong>the</strong> biggest difficulties encountered by <strong>the</strong><br />
animators was to succeed <strong>in</strong> be<strong>in</strong>g accepted<br />
<strong>in</strong>side <strong>the</strong> homes.<br />
Be patient<br />
Project acceptation was not easy. Very often,<br />
<strong>in</strong>habitants did not want to talk about <strong>the</strong><br />
subject; some of <strong>the</strong>m refused to even get<br />
close to or talk to <strong>the</strong> HIV + animators. In many<br />
homes, <strong>the</strong> animators were obliged to return<br />
patiently a number of times before be<strong>in</strong>g<br />
able to start a discussion.<br />
“At <strong>the</strong> start of <strong>the</strong> awareness program <strong>in</strong> <strong>the</strong><br />
village, it was hard, but we stayed with it. Little<br />
by little, we were accepted. No one chases us<br />
away any more, and <strong>the</strong>y accept open<strong>in</strong>g <strong>the</strong>ir<br />
doors to us and listen<strong>in</strong>g to us.” 11<br />
Do not become discouraged<br />
about contact<strong>in</strong>g people<br />
To establish contact with a home, it was<br />
sometimes necessary to be very persever<strong>in</strong>g,<br />
because people were not necessarily available<br />
at <strong>the</strong> proper time.<br />
“If we set up an appo<strong>in</strong>tment, <strong>the</strong>y didn’t keep<br />
it because we weren’t a priority for <strong>the</strong>m. So,<br />
we went by from time to time unannounced<br />
and didn’t become discouraged if <strong>the</strong>y were<br />
absent or busy. We went as often as we had to<br />
until we were able to contact <strong>the</strong>m.” 12<br />
Discourage criticism by stay<strong>in</strong>g calm<br />
At <strong>the</strong> start, animators were accused of<br />
participat<strong>in</strong>g <strong>in</strong> <strong>the</strong> program for <strong>the</strong> money<br />
only, but <strong>the</strong>y chose to ignore <strong>the</strong>se dismissive<br />
remarks. They cont<strong>in</strong>ued to carry out <strong>the</strong><br />
program for <strong>the</strong>se persons as if <strong>the</strong>y had made<br />
no comments. By stay<strong>in</strong>g calm and strongly<br />
committ<strong>in</strong>g to <strong>the</strong> program, <strong>the</strong>y managed to<br />
11. Bezuye Shiferaw, animator at Sh<strong>in</strong>ile<br />
12. Aynalem Bekele, animator at Togochale<br />
23
w<strong>in</strong> <strong>the</strong> trust of <strong>the</strong> skeptics.<br />
“Before, nobody would come close. We were<br />
even rejected because of our HIV status. But<br />
<strong>the</strong>y realized how brave we were <strong>in</strong> reveal<strong>in</strong>g<br />
our status and work<strong>in</strong>g on <strong>the</strong> program. This<br />
gives us <strong>the</strong> right to be part of <strong>the</strong> community<br />
aga<strong>in</strong>.” 13<br />
Encourage identification<br />
of <strong>the</strong> animator as a “peer”<br />
So that animators would be well perceived and<br />
thus listened to <strong>in</strong> <strong>the</strong> home, <strong>the</strong> team tried to<br />
ensure that a animator would be of <strong>the</strong> same<br />
orig<strong>in</strong>, or, if necessary, be accompanied by<br />
a person from <strong>the</strong> same region as <strong>the</strong> family.<br />
Thus, <strong>the</strong> animators held sessions as frequently<br />
as possible <strong>in</strong> <strong>the</strong> language of <strong>the</strong> home.<br />
Negotiate without forc<strong>in</strong>g<br />
If a home refused to meet with <strong>the</strong>m to<br />
talk about <strong>the</strong> disease, <strong>the</strong> animators<br />
attempted negotiat<strong>in</strong>g to conv<strong>in</strong>ce <strong>the</strong>m, but<br />
without <strong>in</strong>sist<strong>in</strong>g too much <strong>in</strong> order to avoid<br />
confrontation. In <strong>the</strong> case of a refusal, <strong>the</strong>y were<br />
sometimes led to term<strong>in</strong>ate <strong>the</strong> discussion to<br />
avoid aggravat<strong>in</strong>g <strong>the</strong> relationship or produc<strong>in</strong>g<br />
total rejection on <strong>the</strong> part of <strong>the</strong>ir contacts.<br />
Animators <strong>the</strong>n <strong>in</strong>formed <strong>the</strong> contacts that <strong>the</strong>y<br />
would come by <strong>the</strong> follow<strong>in</strong>g day to talk about<br />
<strong>the</strong> subject. Little by little and thanks to calm<br />
discussions, most homes f<strong>in</strong>ally accepted to<br />
meet with <strong>the</strong> animators.<br />
Rely on community leaders<br />
<strong>in</strong> case of conflict<br />
In <strong>the</strong> case of total refusal or conflict with<br />
a family <strong>in</strong> spite of negotiation efforts, <strong>the</strong><br />
animators would call on members of <strong>the</strong><br />
project advisory committee. As community<br />
leaders, <strong>the</strong>se persons often found a way to<br />
lessen reluctance on <strong>the</strong> part of <strong>the</strong> family,<br />
for example by act<strong>in</strong>g as mediators and<br />
accompany<strong>in</strong>g <strong>the</strong> animator on visits and by<br />
expla<strong>in</strong><strong>in</strong>g to <strong>the</strong> family <strong>the</strong> importance of<br />
awareness.<br />
Ma<strong>in</strong>ta<strong>in</strong> an on-go<strong>in</strong>g relationship<br />
with leaders<br />
The support of <strong>the</strong> project advisory committee<br />
was fundamental <strong>in</strong> mak<strong>in</strong>g <strong>the</strong> project accepted<br />
<strong>in</strong> <strong>the</strong> community and <strong>in</strong> resolv<strong>in</strong>g conflicts<br />
encountered by <strong>the</strong> animators. For <strong>the</strong>se<br />
animators it was thus important to ma<strong>in</strong>ta<strong>in</strong><br />
an on-go<strong>in</strong>g relationship with community<br />
leaders on <strong>the</strong> committee. Depend<strong>in</strong>g on <strong>the</strong><br />
site, this relationship was more or less formal<br />
and ma<strong>in</strong>ta<strong>in</strong>ed ei<strong>the</strong>r by regularly scheduled<br />
weekly meet<strong>in</strong>gs or by unplanned encounters.<br />
But <strong>in</strong> all cases, <strong>the</strong>se exchanges between<br />
animators and <strong>the</strong> advisory committee were<br />
frequent and enabled ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g strong<br />
commitment from <strong>the</strong> leaders.<br />
13. Emebet Yosef, animator at Hurso<br />
24
ANIMATORS AND AWARENESS DEVELOPMENT KNOW-HOW<br />
We have seen that <strong>the</strong> animators were selected<br />
accord<strong>in</strong>g to educational level atta<strong>in</strong>ed, with<br />
PLWHIV <strong>in</strong> regions where it was possible.<br />
These animators were <strong>the</strong>n tra<strong>in</strong>ed to acquire<br />
<strong>in</strong>-depth knowledge of <strong>the</strong> disease, as well as<br />
on how to monitor <strong>the</strong>ir activities. But it is most<br />
certa<strong>in</strong>ly through <strong>the</strong>ir work experience that<br />
<strong>the</strong>y acquired <strong>the</strong>ir awareness development<br />
know-how. In this chapter, we will have a<br />
closer look at this know-how.<br />
Smooth <strong>the</strong> approach<br />
and <strong>the</strong> first moments of discussion<br />
To put people at ease, <strong>the</strong> animators were<br />
careful to adopt <strong>the</strong> same cultural codes<br />
as those <strong>the</strong>y visited and greet <strong>the</strong>m <strong>in</strong> an<br />
appropriate manner. For example, <strong>the</strong>y would<br />
say “salamalekum” when address<strong>in</strong>g a Muslim<br />
family. Then <strong>the</strong>y would present <strong>the</strong>mselves<br />
and wait to be <strong>in</strong>vited <strong>in</strong>side <strong>the</strong> home.<br />
Next, to gradually start <strong>the</strong> discussion, <strong>the</strong><br />
animators first talked about <strong>the</strong>mselves and<br />
<strong>the</strong>ir personal experience before beg<strong>in</strong>n<strong>in</strong>g to<br />
develop awareness.<br />
Choose ears that are ready to hear<br />
In <strong>the</strong> Somali ethnic group, it is easier to<br />
approach women than men. Thus, animators<br />
generally spoke to women. Through <strong>the</strong>m, it<br />
was eventually possible to approach <strong>the</strong> men,<br />
ei<strong>the</strong>r because <strong>the</strong>y were nearby at <strong>the</strong> moment<br />
of conversation or because <strong>the</strong>ir wives told<br />
<strong>the</strong>m what was said dur<strong>in</strong>g <strong>the</strong> conversation.<br />
Choose <strong>the</strong> best time<br />
for develop<strong>in</strong>g awareness<br />
There are times when people are more<br />
available for discussion than o<strong>the</strong>rs, when<br />
<strong>the</strong>y are ready to take time to talk. Animators<br />
must choose <strong>the</strong> moment when people are<br />
receptive to <strong>the</strong> awareness messages and<br />
ready to discuss <strong>the</strong>m.<br />
“In <strong>the</strong> morn<strong>in</strong>g, men are <strong>in</strong> a bad mood<br />
because <strong>the</strong>y chewed khat <strong>the</strong> night before.<br />
But <strong>in</strong> <strong>the</strong> afternoon, when <strong>the</strong>y start chew<strong>in</strong>g<br />
khat aga<strong>in</strong>, <strong>the</strong>y are <strong>in</strong> a good mood and we<br />
can talk to <strong>the</strong>m.” 14<br />
Conv<strong>in</strong>ce at least one person<br />
To enter <strong>in</strong> contact with a reluctant family, <strong>the</strong><br />
animator tried to conv<strong>in</strong>ce at least one family<br />
member. Then, this person ei<strong>the</strong>r conv<strong>in</strong>ced<br />
<strong>the</strong> o<strong>the</strong>r family members to participate <strong>in</strong> <strong>the</strong><br />
awareness program or participated alone. But<br />
at least one member had been made aware of<br />
HIV and was <strong>in</strong>formed about it. Consciously<br />
or not, this person later served as a relay for<br />
transmitt<strong>in</strong>g this <strong>in</strong>formation to <strong>the</strong> rest of <strong>the</strong><br />
family.<br />
Separate men and women<br />
to speak with more freedom<br />
In some families, it was easier to speak by<br />
rais<strong>in</strong>g awareness of <strong>the</strong> men on one side<br />
with a male animator, and of <strong>the</strong> women on<br />
<strong>the</strong> o<strong>the</strong>r with a female animator. Discussion<br />
was easier with a person of <strong>the</strong> same sex and<br />
everyone felt free to ask questions.<br />
Listen well and discuss<br />
without be<strong>in</strong>g didactic<br />
To encourage people to ask questions, <strong>the</strong><br />
program leaders tried above all to put <strong>the</strong>m<br />
at ease <strong>in</strong> order to facilitate talk<strong>in</strong>g. This was<br />
made possible by demonstrat<strong>in</strong>g that <strong>the</strong><br />
animator listened to each one.<br />
“We didn’t start right away by tell<strong>in</strong>g everyth<strong>in</strong>g<br />
we knew. First of all, we asked people what<br />
<strong>the</strong>y knew already. This allowed creat<strong>in</strong>g a<br />
dialog and putt<strong>in</strong>g people at ease, as well as<br />
show<strong>in</strong>g that our goal was to discuss <strong>the</strong> topic<br />
of <strong>the</strong> disease.” 15<br />
14. Wuhatem Abebe, animator at Ayesha<br />
15. Trsit Selemen, animator at Togochale<br />
25
“To be a good animator, you need above all to<br />
be a good listener. First, we ask <strong>the</strong>m what <strong>the</strong>y<br />
know about HIV because this enables see<strong>in</strong>g<br />
how much <strong>the</strong>y know. In this way, we can<br />
adapt our message accord<strong>in</strong>gly.” 16<br />
Adapt <strong>the</strong> level of <strong>in</strong>formation<br />
to <strong>the</strong> level of exist<strong>in</strong>g knowledge<br />
In <strong>the</strong> context of this personalized awareness<br />
program, animators adapted <strong>the</strong> level of<br />
<strong>in</strong>formation transmitted to <strong>the</strong>ir contacts for<br />
each home. If family members had only a few<br />
notions about <strong>the</strong> diseases, <strong>the</strong> animators<br />
supplied <strong>the</strong>m with basic <strong>in</strong>formation only. If<br />
families already had a basic knowledge of HIV/<br />
AIDS, animators would provide more complex<br />
and <strong>in</strong>-depth <strong>in</strong>formation.<br />
Use <strong>the</strong> guide and adapt it as needed<br />
All topics to be discussed and <strong>in</strong>formation to<br />
be transmitted dur<strong>in</strong>g <strong>the</strong> awareness program<br />
were described <strong>in</strong> <strong>the</strong> work guide. On <strong>the</strong><br />
night before a visit, most animators reread<br />
<strong>the</strong> <strong>in</strong>formation <strong>the</strong>y wanted to discuss on <strong>the</strong><br />
follow<strong>in</strong>g day <strong>in</strong> order to refresh <strong>the</strong>ir memory.<br />
If necessary, <strong>the</strong>y made notes <strong>in</strong> a notebook<br />
but did not read <strong>the</strong> guide dur<strong>in</strong>g an awareness<br />
session <strong>in</strong> order to promote free discussion.<br />
In addition, <strong>the</strong> animators also knew how to<br />
improvise: <strong>the</strong> guide did not specify us<strong>in</strong>g<br />
one’s personal experience, but <strong>in</strong> practice, <strong>the</strong><br />
animators used it systematically.<br />
Be sure each word is understood<br />
In surround<strong>in</strong>gs where HIV knowledge was<br />
lack<strong>in</strong>g, <strong>the</strong> fact of be<strong>in</strong>g declared HIV +,<br />
and <strong>the</strong>refore with a “positive” status, risked<br />
be<strong>in</strong>g <strong>in</strong>terpreted as someth<strong>in</strong>g positive, <strong>in</strong><br />
opposition to someth<strong>in</strong>g negative! It was thus<br />
important to expla<strong>in</strong> with simple words what<br />
it means to be “positive” (HIV +) or “negative”<br />
(seronegative) and to be sure that <strong>the</strong>se notions<br />
were properly assimilated.<br />
Use chance encounters<br />
to identify persons at risk<br />
Dur<strong>in</strong>g house-to-house awareness activities,<br />
some animators met or heard about o<strong>the</strong>r<br />
key persons to educate. For example,<br />
raiseed awareness at <strong>the</strong> home of a woman<br />
who took care of <strong>the</strong> children of women<br />
prostitutes enabled meet<strong>in</strong>g with some of<br />
<strong>the</strong>se prostitutes to make <strong>the</strong>m aware of HIV/<br />
AIDS and encourage <strong>the</strong>m to use condoms to<br />
protect <strong>the</strong>mselves.<br />
16. Ardo Adem, animator at Togochale<br />
26
INVALUABLE DOUBLE SUPPORT FOR ANIMATORS<br />
Although animators developed most of <strong>the</strong>ir<br />
know-how by participat<strong>in</strong>g <strong>in</strong> <strong>the</strong> awareness<br />
program, <strong>the</strong> effectiveness of <strong>the</strong>ir work was<br />
<strong>in</strong>creased by double monitor<strong>in</strong>g: on <strong>the</strong> one<br />
hand, by <strong>the</strong> partner association of <strong>Handicap</strong><br />
<strong>International</strong>, which <strong>the</strong>y belonged to, and on<br />
<strong>the</strong> o<strong>the</strong>r, by <strong>the</strong> project advisory committee<br />
composed of village leaders. Advice from <strong>the</strong><br />
association, which had awareness rais<strong>in</strong>g<br />
and follow-up/evaluation skills, and from <strong>the</strong><br />
committee, which had detailed knowledge<br />
of <strong>the</strong> community, were complementary,<br />
and both were <strong>in</strong>dispensable to successful<br />
completion of <strong>the</strong> project. Therefore, <strong>in</strong><br />
this chapter we will present <strong>the</strong> knowhow<br />
perta<strong>in</strong><strong>in</strong>g to community awareness<br />
activity follow-up which enabled project<br />
effectiveness.<br />
Ma<strong>in</strong>ta<strong>in</strong> regularity and coherence<br />
with double monitor<strong>in</strong>g<br />
On <strong>the</strong> one hand, double monitor<strong>in</strong>g enabled<br />
ensur<strong>in</strong>g regularity and <strong>the</strong> ma<strong>in</strong>tenance of<br />
an activity level through <strong>the</strong> monthly report<br />
supplied by <strong>the</strong> person <strong>in</strong> charge of animators.<br />
This report listed <strong>the</strong> number of homes<br />
with <strong>in</strong>creased awareness, which should<br />
correspond to <strong>the</strong> goals set <strong>in</strong> terms of number<br />
of monthly visits. On <strong>the</strong> o<strong>the</strong>r, monitor<strong>in</strong>g<br />
enabled ensur<strong>in</strong>g project coherence with<br />
needs expressed by community through<br />
regular meet<strong>in</strong>gs with <strong>the</strong> project advisory<br />
committee, which chose <strong>the</strong> areas to be<br />
covered.<br />
Get an overall view<br />
of neighborhood awareness<br />
To facilitate monitor<strong>in</strong>g and identify <strong>the</strong><br />
neighborhoods already covered by <strong>the</strong><br />
awareness program, <strong>the</strong> animator put a<br />
special mark on <strong>the</strong> outside of <strong>the</strong> house, for<br />
example a cross drawn with chalk, to <strong>in</strong>dicate<br />
that <strong>the</strong> program had been completed. In this<br />
way, it was easy to see <strong>the</strong> extent of houseto-house<br />
activity of <strong>the</strong> animators.<br />
Be an available partner<br />
To follow activities, <strong>the</strong> <strong>Handicap</strong> <strong>International</strong><br />
team planned weekly visits to <strong>in</strong>tervention<br />
sites that were geographically close, as well<br />
as unplanned visits, <strong>in</strong> such a way as to<br />
accompany animators almost daily, share <strong>the</strong>ir<br />
problems and resolve eventual conflicts. Thus,<br />
animators felt supported, <strong>the</strong> importance of<br />
<strong>the</strong>ir work was valued and <strong>the</strong>ir motivation<br />
was ma<strong>in</strong>ta<strong>in</strong>ed.<br />
Support animators with regular shar<strong>in</strong>g<br />
S<strong>in</strong>ce <strong>the</strong> activity of <strong>the</strong> animators with<strong>in</strong> <strong>the</strong><br />
community was ra<strong>the</strong>r solitary and sometimes<br />
difficult, it was important to create a spirit<br />
of mutual aid and provide <strong>the</strong>m with moral<br />
support. To do this, a follow-up meet<strong>in</strong>g was<br />
organized each month by <strong>the</strong> association<br />
of persons liv<strong>in</strong>g with HIV, which <strong>the</strong>y were<br />
members of. Dur<strong>in</strong>g <strong>the</strong> meet<strong>in</strong>g, <strong>the</strong>y were<br />
<strong>in</strong>vited to talk about problems encountered<br />
and to discuss toge<strong>the</strong>r possible ways of<br />
solv<strong>in</strong>g <strong>the</strong>m.<br />
Use experienced animators<br />
to tra<strong>in</strong> new ones<br />
When new animators were recruited for <strong>the</strong><br />
project, <strong>the</strong>y received tra<strong>in</strong><strong>in</strong>g. Dur<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g,<br />
experienced animators came to tell about<br />
<strong>the</strong>ir daily activity, share <strong>the</strong>ir experience<br />
and present future animators what <strong>the</strong>y felt<br />
to be <strong>the</strong> <strong>in</strong>dispensable know-how needed<br />
by a good animator, <strong>in</strong> particular <strong>the</strong> need for<br />
patience every s<strong>in</strong>gle day.<br />
27
INVOLVING LOCAL STAKEHOLDERS FOR LONG-LASTING CHANGE<br />
The community was doubly active <strong>in</strong> carry<strong>in</strong>g<br />
out this project: on <strong>the</strong> one hand, because <strong>the</strong><br />
project animators were <strong>the</strong>mselves members<br />
of <strong>the</strong> community, and on <strong>the</strong> o<strong>the</strong>r, because<br />
<strong>the</strong> project advisory committee was made<br />
up of community leaders.<br />
This double <strong>in</strong>volvement of local stakeholders<br />
encouraged <strong>the</strong> development of long-last<strong>in</strong>g<br />
changes with<strong>in</strong> <strong>the</strong> community.<br />
Encourage adoption<br />
of <strong>the</strong> cause by community leaders<br />
Because <strong>the</strong>y participated <strong>in</strong> <strong>the</strong> project<br />
advisory committee, <strong>the</strong> different community<br />
and religious leaders adopted <strong>the</strong> project.<br />
Hav<strong>in</strong>g to propose solutions to <strong>the</strong> problems<br />
of <strong>the</strong> animators or advis<strong>in</strong>g on project<br />
orientations favored <strong>the</strong>ir jo<strong>in</strong><strong>in</strong>g <strong>the</strong> cause.<br />
They realized <strong>the</strong> importance of develop<strong>in</strong>g<br />
HIV/AIDS awareness.<br />
Anchor <strong>the</strong> topic permanently<br />
by <strong>in</strong>volv<strong>in</strong>g community members<br />
Choos<strong>in</strong>g and tra<strong>in</strong><strong>in</strong>g local animators for<br />
rais<strong>in</strong>g awareness enabled <strong>the</strong> community<br />
to acquire knowledge of <strong>the</strong> disease and<br />
educational know-how. Even after <strong>the</strong> project<br />
is over, <strong>the</strong>se animators will still be considered<br />
as resource persons for obta<strong>in</strong><strong>in</strong>g <strong>in</strong>formation<br />
on <strong>the</strong> disease.<br />
In a similar way, <strong>the</strong> leaders <strong>in</strong>volved, who have<br />
been made aware of HIV, will cont<strong>in</strong>ue after <strong>the</strong><br />
project to have an attitude that contributes<br />
to dim<strong>in</strong>ish<strong>in</strong>g stigmatization and promot<strong>in</strong>g<br />
prevention <strong>in</strong> <strong>the</strong> different social networks<br />
where <strong>the</strong>y have an <strong>in</strong>fluence.<br />
Streng<strong>the</strong>n community capacities<br />
In <strong>the</strong> field, <strong>the</strong> awareness program was<br />
entirely implemented by community members:<br />
<strong>the</strong> animators for house-to-house education<br />
and <strong>the</strong> partner association and <strong>the</strong> leaders for<br />
SUCCESS STORY:<br />
UNEXPECTED PARTNERS JOIN IN<br />
The Dire Dawa University of Psychology<br />
called on animators to carry out a jo<strong>in</strong>t<br />
research project, where <strong>the</strong> reaction of<br />
<strong>the</strong> community to this type of houseto-house<br />
awareness development<br />
was <strong>in</strong>vestigated. Ano<strong>the</strong>r research<br />
project concerned <strong>the</strong> reaction and<br />
<strong>the</strong> feel<strong>in</strong>gs of persons who discover<br />
<strong>the</strong>ir HIV status.<br />
monitor<strong>in</strong>g <strong>the</strong> project. Thus, at <strong>the</strong> end of <strong>the</strong><br />
project <strong>the</strong> community has all <strong>the</strong> capacities<br />
for implement<strong>in</strong>g a similar project <strong>in</strong> <strong>the</strong> future<br />
on its own. Also, <strong>the</strong> choice of carry<strong>in</strong>g out an<br />
<strong>in</strong>-depth awareness program with a number<br />
of sessions per household participated <strong>in</strong> this<br />
re<strong>in</strong>forcement of community knowledge,<br />
s<strong>in</strong>ce <strong>the</strong>se households benefit from <strong>in</strong>-depth<br />
knowledge of <strong>the</strong> disease.<br />
Reach o<strong>the</strong>r social areas<br />
through <strong>the</strong> leaders<br />
The choice of creat<strong>in</strong>g <strong>the</strong> project advisory<br />
committee from <strong>in</strong>fluential leaders <strong>in</strong><br />
different doma<strong>in</strong>s (religious and political<br />
leaders, representatives of women’s<br />
associations, young people, persons liv<strong>in</strong>g<br />
with HIV, etc.) enabled strongly <strong>in</strong>volv<strong>in</strong>g<br />
respected personalities who are active <strong>in</strong><br />
different associations and different social<br />
areas. Thus, with<strong>in</strong> <strong>the</strong>ir associations, <strong>the</strong>se<br />
leaders highlighted <strong>the</strong> awareness project by<br />
promot<strong>in</strong>g it and mentionn<strong>in</strong>g it frequently as<br />
an example.<br />
28
STRENGTHENING PARTNER ASSOCIATIONS<br />
Ano<strong>the</strong>r way to permanently anchor project<br />
effects <strong>in</strong> <strong>the</strong> region was by streng<strong>the</strong>n<strong>in</strong>g<br />
<strong>the</strong> capacities of local partner associations,<br />
who acquired expertise on rais<strong>in</strong>g awareness<br />
of HIV/AIDS through <strong>the</strong> project. Throughout<br />
<strong>the</strong> project <strong>the</strong>re was also an on-go<strong>in</strong>g effort<br />
to streng<strong>the</strong>n <strong>the</strong>ir project management<br />
capacity.<br />
Use partner knowledge<br />
Partner associations, who know <strong>the</strong> context<br />
very well, enabled us to have a critical<br />
appreciation of <strong>the</strong> project. At <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />
of <strong>the</strong> project, numerous meet<strong>in</strong>gs with <strong>the</strong>m<br />
enabled us to discuss <strong>the</strong> pert<strong>in</strong>ence of<br />
actions planned and to re-def<strong>in</strong>e <strong>the</strong>m if<br />
necessary.<br />
In addition, <strong>the</strong> particular skills of <strong>the</strong> partner<br />
associations enabled enrich<strong>in</strong>g project<br />
activities. Thus, <strong>the</strong> partner association <strong>in</strong> <strong>the</strong><br />
Afar (Ethiopia) region had already organized<br />
community discussions on different topics. For<br />
<strong>the</strong> project, once <strong>the</strong> animators were tra<strong>in</strong>ed<br />
on <strong>the</strong> HIV topic, <strong>the</strong>y were able to organize<br />
community discussions on this topic.<br />
Transmit methods by work<strong>in</strong>g toge<strong>the</strong>r<br />
To streng<strong>the</strong>n <strong>the</strong> capacities of partner<br />
associations, <strong>Handicap</strong> <strong>International</strong><br />
sometimes chose to support <strong>the</strong>m by<br />
work<strong>in</strong>g daily with <strong>the</strong>m at <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />
of <strong>the</strong> partnership, until <strong>the</strong>y were able to<br />
function <strong>in</strong>dependently. In this way, <strong>Handicap</strong><br />
<strong>International</strong> was at <strong>the</strong> side of some partners<br />
for writ<strong>in</strong>g <strong>the</strong> terms of reference of some<br />
activities, plann<strong>in</strong>g, follow-up, etc. When<br />
<strong>the</strong> methods were assimilated and habits<br />
formed, <strong>the</strong> partners were able to carry out<br />
activities <strong>the</strong>y were responsible for on <strong>the</strong>ir<br />
own, while cont<strong>in</strong>u<strong>in</strong>g to ma<strong>in</strong>ta<strong>in</strong> an on-go<strong>in</strong>g<br />
<strong>in</strong>terchange with <strong>Handicap</strong> <strong>International</strong>.<br />
“With <strong>Handicap</strong> <strong>International</strong>, we had a very<br />
strong partnership. We did everyth<strong>in</strong>g toge<strong>the</strong>r,<br />
from plann<strong>in</strong>g to follow-up. In this way, we<br />
learned a lot and acquired good work<strong>in</strong>g<br />
methods.” 17<br />
Provide partners with reusable tools<br />
Because some partner associations had never<br />
developped, we proposed monitor<strong>in</strong>g tools<br />
and <strong>the</strong>n worked toge<strong>the</strong>r on <strong>the</strong>ir adaptation.<br />
Us<strong>in</strong>g <strong>the</strong>se tools, <strong>the</strong> person responsible<br />
for <strong>the</strong> animators collected daily data on <strong>the</strong><br />
activity of five team animators and ga<strong>the</strong>red it<br />
toge<strong>the</strong>r <strong>in</strong> a monthly report.<br />
Provide tra<strong>in</strong><strong>in</strong>g adapted to needs<br />
After identify<strong>in</strong>g needs for re<strong>in</strong>forcement of<br />
skills, specific tra<strong>in</strong><strong>in</strong>g was organized for <strong>the</strong><br />
partners. For example, follow<strong>in</strong>g a mid-project<br />
evaluation, gaps were noted <strong>in</strong> <strong>the</strong> monitor<strong>in</strong>g<br />
and evaluation carried out by animators<br />
and partner associations. Because of this<br />
observation, we organized a general tra<strong>in</strong><strong>in</strong>g<br />
program around monitor<strong>in</strong>g and evaluation<br />
for <strong>the</strong> animators and project managers from<br />
partner associations <strong>in</strong> <strong>the</strong> three countries.<br />
SUCCESS STORY:<br />
Ethiopian associations declared<br />
<strong>the</strong>mselves pleased to be so well<br />
“tooled” by HI, s<strong>in</strong>ce <strong>the</strong>y had felt<br />
<strong>in</strong>adequately equipped to correctly<br />
monitor projects f<strong>in</strong>anced by o<strong>the</strong>r<br />
<strong>in</strong>vestors. Some have even adapted<br />
<strong>the</strong>se follow-up tools to make <strong>the</strong>m<br />
useable for some of <strong>the</strong>ir o<strong>the</strong>r<br />
projects.<br />
17. Getahun Mekonen, project manager for <strong>the</strong> Shama Brihan Association <strong>in</strong> Ethiopia, a partner<br />
29
Tra<strong>in</strong> by do<strong>in</strong>g<br />
Dur<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g for animators <strong>in</strong> Somaliland,<br />
<strong>the</strong> goal was not to ask <strong>the</strong>m to learn by<br />
heart <strong>the</strong> contents of a thick guidebook, but<br />
to know how to use it for <strong>the</strong> house-to-house<br />
awareness program. In this way, <strong>the</strong> animators<br />
<strong>the</strong>mselves “taught <strong>the</strong> lesson”. They were<br />
divided <strong>in</strong>to small groups and each group had<br />
a subject to work on. They were given time<br />
to prepare, <strong>the</strong>n each small group presented<br />
a complete awareness session before <strong>the</strong><br />
entire assembly. The assembly was expected<br />
to react to <strong>the</strong> proposed session and discuss<br />
how to improve its contents.<br />
Know how to say what’s wrong<br />
Dur<strong>in</strong>g <strong>the</strong> project, conflicts or communication<br />
difficulties were sometimes encountered with<br />
partner associations. Discussion and listen<strong>in</strong>g<br />
allowed overcom<strong>in</strong>g <strong>the</strong>m. In particular, after a<br />
series of misunderstand<strong>in</strong>gs with <strong>the</strong> partner<br />
association <strong>in</strong> <strong>the</strong> Afar region (Ethiopia),<br />
a meet<strong>in</strong>g was organized dur<strong>in</strong>g which<br />
<strong>Handicap</strong> <strong>International</strong> was able to present<br />
all <strong>the</strong> po<strong>in</strong>ts it considered unsatisfactory<br />
<strong>in</strong> <strong>the</strong> implementation of activities and <strong>the</strong><br />
partner relationship. All remarks were <strong>the</strong>n<br />
taken <strong>in</strong>to consideration by <strong>the</strong> partner and<br />
fur<strong>the</strong>r relations with <strong>the</strong> partner were based<br />
on mutual trust and exchange.<br />
Delegate more or less<br />
L<strong>in</strong>ks with <strong>the</strong> partner association depended<br />
heavily on <strong>the</strong> context and on geographical<br />
proximity. In <strong>the</strong> regions where <strong>the</strong> <strong>Handicap</strong><br />
<strong>International</strong> team was present, it worked<br />
very closely with <strong>the</strong> partner association<br />
and supported it <strong>in</strong> daily management of<br />
activities. It was not possible to ensure <strong>the</strong><br />
same level of assistance <strong>in</strong> <strong>the</strong> Afar region<br />
(Ethiopia), located at a distance requir<strong>in</strong>g many<br />
hours to reach by car. Therefore, <strong>in</strong> this region<br />
<strong>the</strong> partner association implemented activities<br />
with a great degree of <strong>in</strong>dependence with<br />
regular visits from <strong>Handicap</strong> <strong>International</strong><br />
every quarter.<br />
F<strong>in</strong>d regular occasions for discussion<br />
Each month, <strong>the</strong> partner association sent<br />
<strong>in</strong> a monthly activity report for all animators<br />
and each quarter, a narrative and f<strong>in</strong>ancial<br />
report describ<strong>in</strong>g activities undertaken. After<br />
receiv<strong>in</strong>g <strong>the</strong> quarterly report, <strong>the</strong> <strong>Handicap</strong><br />
<strong>International</strong> project manager visited each<br />
site, even those that were far away, <strong>in</strong> order<br />
to spend time <strong>in</strong> <strong>the</strong> field with <strong>the</strong> animators<br />
and <strong>the</strong>ir managers. Each quarterly visit was<br />
<strong>the</strong> occasion for <strong>the</strong> partner association<br />
and <strong>Handicap</strong> <strong>International</strong> to discuss<br />
toge<strong>the</strong>r strategy, problems encountered and<br />
perspectives.<br />
Jo<strong>in</strong> forces to enable ambitious action<br />
At Hargeisa (Somaliland), a number of NGOs<br />
participated <strong>in</strong> <strong>the</strong> creation of a youth center,<br />
which offered a leisure area with different games<br />
(table soccer, billiards, p<strong>in</strong>g-pong, sports field,<br />
etc.). The participation of different association<br />
stakeholders, both local and <strong>in</strong>ternational,<br />
enabled <strong>in</strong>stall<strong>in</strong>g a library, a dozen computers<br />
with Internet access, education on health<br />
topics and, <strong>in</strong> particular, <strong>in</strong> <strong>the</strong> framework<br />
of a project led by <strong>Handicap</strong> <strong>International</strong>,<br />
development of awareness on <strong>the</strong> topic of<br />
AIDS, with <strong>the</strong> presence of leader-advisors.<br />
30
3. Creat<strong>in</strong>g an awareness environment<br />
Part<br />
2<br />
1. Varied visual communication tools<br />
d Use exist<strong>in</strong>g tools that have shown<br />
<strong>the</strong>ir worth<br />
d Communicate where o<strong>the</strong>rs are not already<br />
present<br />
d Choose media adapted to lifestyle<br />
d Make <strong>in</strong>formation available to all<br />
d Target priority subjects without try<strong>in</strong>g<br />
to be exhaustive<br />
d Have <strong>the</strong> tools validated<br />
by different partners<br />
d Test <strong>the</strong> process before generaliz<strong>in</strong>g it<br />
d Promote broad distribution of tools created<br />
2. Popular radio broadcasts<br />
d Test <strong>the</strong> impact of <strong>the</strong> first broadcasts<br />
before cont<strong>in</strong>u<strong>in</strong>g<br />
d Transmit messages us<strong>in</strong>g community voices<br />
d Respect gender to reach women<br />
more effectively<br />
d Vary broadcasts to avoid boredom<br />
d Make <strong>the</strong> message a “habit” by giv<strong>in</strong>g<br />
it a story l<strong>in</strong>e<br />
d Choose prime-time broadcast<strong>in</strong>g<br />
d Evaluate impact from <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />
3. Use of traditional group exchange<br />
d Use cultural habits for <strong>in</strong>creas<strong>in</strong>g awareness<br />
d Leadership techniques to make people th<strong>in</strong>k<br />
d Choose busy public places<br />
4. Festive events to convey <strong>the</strong> messages<br />
d Involve health authorities for greater impact<br />
d Announce to attract<br />
d Use <strong>the</strong> know-how of exist<strong>in</strong>g associations<br />
for animat<strong>in</strong>g <strong>the</strong> event<br />
d Mix modernity and tradition<br />
to raise awareness<br />
d Adapt awareness events to <strong>the</strong> audience<br />
d Encourage test<strong>in</strong>g through “positive life”<br />
testimonials<br />
d Use humor to raise awareness<br />
d Make realer than real by demonstrat<strong>in</strong>g<br />
d Use high-impact testimonials<br />
d Ask questions to make sure<br />
d Use powerful symbols<br />
In parallel to <strong>the</strong> house-to-house awareness<br />
program, designed to raise awareness by<br />
br<strong>in</strong>g<strong>in</strong>g <strong>in</strong>-depth knowledge of <strong>the</strong> disease<br />
to <strong>the</strong> home, an environment of collective<br />
awareness was created <strong>in</strong> <strong>the</strong> community.<br />
First, various communication tools were<br />
designed so that awareness would be visible <strong>in</strong><br />
different places and contexts. At <strong>the</strong> same time,<br />
<strong>in</strong> some regions <strong>the</strong> project took <strong>in</strong>spiration<br />
from collective traditions of exchange,<br />
which are anchored <strong>in</strong> <strong>the</strong> culture, <strong>in</strong> order to<br />
adapt <strong>the</strong>m to <strong>the</strong> awareness program. F<strong>in</strong>ally,<br />
festive events centered on musical concerts<br />
or circus shows were used to create animated<br />
ga<strong>the</strong>r<strong>in</strong>gs for attract<strong>in</strong>g crowds. These were<br />
ideal for rais<strong>in</strong>g awareness <strong>in</strong> playful, varied<br />
ways.<br />
31
VARIED VISUAL COMMUNICATION TOOLS<br />
For extend<strong>in</strong>g awareness, numerous IEC<br />
(Information Education Communication)<br />
communication tools were developed. Their<br />
elaboration was based on <strong>the</strong> analysis of IEC<br />
tools already exist<strong>in</strong>g <strong>in</strong> this area.<br />
First, tools were created to “be seen”:<br />
T-shirts for <strong>the</strong> team, animators and those<br />
who distributed Stickers were designed and<br />
widely distributed and stuck on cars and<br />
public transportation vehicles <strong>in</strong> group areas<br />
and adm<strong>in</strong>istrations. In addition, to <strong>in</strong>form<br />
by leav<strong>in</strong>g material with <strong>the</strong> <strong>in</strong>habitants,<br />
brochures and leaflets were designed <strong>in</strong><br />
different local languages and distributed.<br />
Based on a prelim<strong>in</strong>ary study, radio also proved<br />
to be a very pert<strong>in</strong>ent media. Thus, a series of<br />
40 radio programs <strong>in</strong> <strong>the</strong> Somali language<br />
were produced and broadcast on local radio<br />
as a complement to <strong>the</strong> visual tools.<br />
O<strong>the</strong>r long-term elements were created at<br />
some <strong>in</strong>tervention sites, such as <strong>in</strong>formation<br />
boards and pa<strong>in</strong>ted walls <strong>in</strong> Ethiopia and <strong>in</strong><br />
Somaliland.<br />
F<strong>in</strong>ally, audiovisual tools rounded out <strong>the</strong><br />
variety of communication tools, with <strong>the</strong><br />
elaboration of an HIV/AIDS prevention film <strong>in</strong><br />
Somaliland, <strong>the</strong> video clip of a song promot<strong>in</strong>g<br />
voluntary counsel<strong>in</strong>g and test<strong>in</strong>g <strong>in</strong> Ethiopia<br />
and a film present<strong>in</strong>g <strong>the</strong> project.<br />
Use exist<strong>in</strong>g tools<br />
that have shown <strong>the</strong>ir worth<br />
Before develop<strong>in</strong>g its own tools, <strong>the</strong> HI team<br />
met with o<strong>the</strong>r NGOs work<strong>in</strong>g on AIDS and<br />
collected <strong>the</strong>ir communication tools to<br />
use as a base. These tools were a source of<br />
<strong>in</strong>spiration for enrich<strong>in</strong>g discussions on <strong>the</strong><br />
choice of awareness messages and <strong>the</strong> way of<br />
present<strong>in</strong>g <strong>the</strong>m.<br />
O<strong>the</strong>r types of tools were <strong>in</strong>spired by tools that<br />
had shown <strong>the</strong>ir worth <strong>in</strong> o<strong>the</strong>r situations.<br />
Thus, <strong>the</strong> idea of produc<strong>in</strong>g a song with a<br />
video clip was <strong>in</strong>spired from an idea used<br />
<strong>in</strong> Ghana. In Ethiopia, this type of tool was<br />
proposed by local artists, who created a song<br />
and an associated clip <strong>in</strong> a typically Ethiopian<br />
version, with lyrics promot<strong>in</strong>g test<strong>in</strong>g.<br />
Communicate where o<strong>the</strong>rs<br />
are not already present<br />
A prelim<strong>in</strong>ary study showed that <strong>in</strong> <strong>the</strong> Somali<br />
region (Ethiopia), numerous IEC tools, which<br />
had been developed on HIV/AIDS, ma<strong>in</strong>ly<br />
brochures and leaflets, had little impact. This<br />
was primarily due to <strong>the</strong> fact that <strong>the</strong>y were<br />
almost all written <strong>in</strong> Amharic <strong>in</strong> a region where<br />
people speak ma<strong>in</strong>ly Somali! This gave rise to<br />
<strong>the</strong> idea of produc<strong>in</strong>g brochures <strong>in</strong> Amharic, as<br />
well as Somali, and leaflets <strong>in</strong> both languages.<br />
In a similar way, <strong>in</strong> Ethiopia many radio<br />
programs on AIDS had been developed <strong>in</strong><br />
Amharic. None were <strong>in</strong> Somali. For this reason,<br />
40 radio broadcasts were produced <strong>in</strong> this<br />
language.<br />
Choose media adapted to lifestyle<br />
Knowledge of <strong>the</strong> context obta<strong>in</strong>ed from<br />
prelim<strong>in</strong>ary studies on exist<strong>in</strong>g tools and<br />
practices enabled identify<strong>in</strong>g that <strong>the</strong> ma<strong>in</strong><br />
means of <strong>in</strong>formation was <strong>the</strong> radio <strong>in</strong><br />
regions where few adults are literate and<br />
where television is rare. It was thus decided<br />
to communicate on HIV/AIDS through a series<br />
© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />
32
of 40 radio programs broadcast over five<br />
months.<br />
Make <strong>in</strong>formation available to all<br />
The variety of communication tools produced<br />
for <strong>the</strong> project enabled communicat<strong>in</strong>g<br />
with different audiences and mak<strong>in</strong>g <strong>the</strong><br />
awareness messages available to everyone. In<br />
<strong>the</strong> brochures, most messages were presented<br />
as draw<strong>in</strong>gs, with a few written explanations<br />
<strong>in</strong> Amharic and Somali. In addition, <strong>the</strong> song<br />
clip promot<strong>in</strong>g test<strong>in</strong>g <strong>in</strong>cluded a simultaneous<br />
translation <strong>in</strong> sign language <strong>in</strong> order to reach<br />
hear<strong>in</strong>g-impaired <strong>in</strong>dividuals.<br />
Target priority subjects<br />
without try<strong>in</strong>g to be exhaustive<br />
Possible subjects for HIV/AIDS awareness<br />
were many. Dur<strong>in</strong>g creation of tools, it was<br />
necessary to target <strong>the</strong> message precisely,<br />
without try<strong>in</strong>g to talk about everyth<strong>in</strong>g, <strong>in</strong><br />
order to avoid drown<strong>in</strong>g <strong>the</strong> <strong>in</strong>formation. For<br />
example, one of <strong>the</strong> brochures used draw<strong>in</strong>gs<br />
to focus on decreas<strong>in</strong>g stigmatization by<br />
rais<strong>in</strong>g awareness of disease transmission<br />
modes, as well as on how <strong>the</strong> disease cannot<br />
be transmitted (by eat<strong>in</strong>g toge<strong>the</strong>r, by shak<strong>in</strong>g<br />
hands, by talk<strong>in</strong>g, etc.). Ano<strong>the</strong>r brochure<br />
highlighted positive ways of liv<strong>in</strong>g with <strong>the</strong><br />
virus by choos<strong>in</strong>g a HIV + man and woman<br />
of different religions and from different social<br />
areas.<br />
Have <strong>the</strong> tools validated<br />
by different partners<br />
Before validat<strong>in</strong>g <strong>the</strong> tools for production, we<br />
asked <strong>the</strong> different partners to give us <strong>the</strong>ir<br />
op<strong>in</strong>ion of <strong>the</strong>m. For <strong>the</strong> film on HIV/AIDS<br />
awareness produced <strong>in</strong> Somaliland, we<br />
met a number of times dur<strong>in</strong>g edit<strong>in</strong>g with<br />
government and association partners to collect<br />
<strong>the</strong>ir comments, which were <strong>in</strong>valuable for<br />
creat<strong>in</strong>g a f<strong>in</strong>al version that was coherent with<br />
Somali culture and pert<strong>in</strong>ent for all <strong>in</strong>habitants.<br />
They suggested we hide <strong>the</strong> faces of PLWHIV,<br />
moderate some topics that were too direct,<br />
<strong>in</strong>clude more well-known images of <strong>the</strong> city<br />
and country, etc.<br />
For <strong>the</strong> <strong>in</strong>formation boards, health authorities<br />
and community leaders were consulted<br />
on what <strong>the</strong>y felt to be <strong>the</strong> most effective<br />
type of contents. They suggested <strong>in</strong>clud<strong>in</strong>g<br />
photographs of <strong>in</strong>fluential people <strong>in</strong> <strong>the</strong><br />
community, accompanied by an awareness<br />
message.<br />
Test <strong>the</strong> process before generaliz<strong>in</strong>g it<br />
For pa<strong>in</strong>ted walls and radio messages, we<br />
started by produc<strong>in</strong>g “samples” <strong>in</strong> order to test<br />
<strong>the</strong> level of comprehension and satisfaction<br />
of different audiences. This enabled not only<br />
adapt<strong>in</strong>g our way of communicat<strong>in</strong>g, but also<br />
test<strong>in</strong>g <strong>the</strong> logistical organization required<br />
and improv<strong>in</strong>g it for communicat<strong>in</strong>g later on a<br />
larger scale.<br />
Promote broad distribution of tools created<br />
To enable broad and rapid distribution of<br />
stickers, half-day contracts enabled us to<br />
hire a few people to paste stickers on public<br />
build<strong>in</strong>gs or <strong>in</strong> busy places, as well as on<br />
“bajaj” taxis (<strong>the</strong>se are small, three-wheeled<br />
Ethiopian taxis) and public m<strong>in</strong>ivans. Us<strong>in</strong>g<br />
this approach, <strong>in</strong> less that two hours over half<br />
of <strong>the</strong> public transportation <strong>in</strong> mid-size cities<br />
featured a project sticker!<br />
In addition, to <strong>in</strong>crease <strong>the</strong> impact of posters<br />
and <strong>the</strong> awareness film <strong>in</strong> Somaliland, an<br />
official ceremony was held when <strong>the</strong>y were<br />
launched. This ceremony brought toge<strong>the</strong>r<br />
all local partners <strong>in</strong>volved <strong>in</strong> <strong>the</strong> fight aga<strong>in</strong>st<br />
HIV/AIDS. Next, <strong>the</strong> film and <strong>the</strong> posters<br />
were widely distributed to all <strong>in</strong>terested<br />
organizations and to hospitals. Each festive<br />
event with<strong>in</strong> <strong>the</strong> project framework presented<br />
an opportunity to show <strong>the</strong> film, which<br />
conta<strong>in</strong>ed footage of local celebrities, creat<strong>in</strong>g<br />
even greater impact <strong>in</strong> terms of awareness.<br />
33
POPULAR RADIO BROADCASTS<br />
In Ethiopia, prelim<strong>in</strong>ary studies showed<br />
that <strong>the</strong> most effective media for reach<strong>in</strong>g a<br />
large audience was <strong>the</strong> radio. However, all<br />
exist<strong>in</strong>g radio programs on awareness were<br />
<strong>in</strong> Amharic. None were <strong>in</strong> Somali, which is<br />
<strong>the</strong> ma<strong>in</strong> language of <strong>the</strong> Somali region<br />
concerned by <strong>the</strong> project. It was thus decided<br />
to produce 40 radio programs, each one<br />
last<strong>in</strong>g 20 m<strong>in</strong>utes; <strong>the</strong>se were broadcast on<br />
local radio <strong>in</strong> Dire Dawa twice a week for five<br />
months.<br />
Reach isolated <strong>in</strong>dividuals<br />
through a popular medium<br />
Radio is a medium that is very popular with<br />
families. It enables reach<strong>in</strong>g everyone at<br />
home, even housewives and mo<strong>the</strong>rs who do<br />
not often go out. In addition, s<strong>in</strong>ce FM radio<br />
<strong>in</strong> Ethiopia is very recent, it is considered<br />
“trendy” and is <strong>the</strong>refore very popular. This<br />
was thus <strong>the</strong> local radio used to broadcast <strong>the</strong><br />
40 HIV/AIDS prevention programs.<br />
Test <strong>the</strong> impact of <strong>the</strong> first broadcasts<br />
before cont<strong>in</strong>u<strong>in</strong>g<br />
After <strong>the</strong> production of five programs and<br />
before <strong>the</strong>ir broadcast, we chose to “test”<br />
<strong>the</strong>m <strong>in</strong> order to measure <strong>the</strong>ir pert<strong>in</strong>ence and<br />
<strong>the</strong> impact of <strong>the</strong>ir contents. To do this, at each<br />
site where project activities were be<strong>in</strong>g carried<br />
out, a representative group of around thirty<br />
persons was assembled <strong>in</strong> order to listen to<br />
and comment on <strong>the</strong> broadcasts. In parallel,<br />
<strong>the</strong> same process for ga<strong>the</strong>r<strong>in</strong>g comments was<br />
carried out for health authorities. All <strong>the</strong>se<br />
comments were taken <strong>in</strong>to account for <strong>the</strong><br />
production of <strong>the</strong> next 35 broadcasts.<br />
Transmit messages<br />
us<strong>in</strong>g community voices<br />
When people hear members of <strong>the</strong>ir own<br />
community speak, <strong>the</strong>y feel more concerned<br />
by <strong>the</strong> message. Thus, when <strong>the</strong> “test” groups<br />
heard <strong>the</strong> first five radio messages <strong>in</strong> <strong>the</strong><br />
Somali language but spoken by persons from<br />
a different community and thus with a different<br />
accent, <strong>the</strong>y made it known that <strong>the</strong>y wanted<br />
to hear people from <strong>the</strong>ir own community with<br />
<strong>the</strong> same accent: “People wanted to hear<br />
about <strong>the</strong>mselves.” 18<br />
Respect gender to reach<br />
women more effectively<br />
Even though <strong>in</strong> <strong>the</strong> Somali region women<br />
speak little <strong>in</strong> public, <strong>the</strong> producers made<br />
sure that <strong>in</strong> <strong>the</strong> radio broadcast contents,<br />
parity was respected. Women very positively<br />
perceived <strong>the</strong> fact that <strong>the</strong> broadcasts let<br />
women do most of <strong>the</strong> talk<strong>in</strong>g, whe<strong>the</strong>r this<br />
was personal testimony from PLWHIV women<br />
or <strong>in</strong>terventions by experts, journalists or<br />
<strong>in</strong>stitutional leaders.<br />
Vary broadcasts to avoid boredom<br />
To make <strong>the</strong> broadcast of 40 programs<br />
more attractive, it was decided to do <strong>the</strong>m<br />
<strong>in</strong> <strong>the</strong> form of a “radio magaz<strong>in</strong>e”, i.e., by<br />
<strong>in</strong>clud<strong>in</strong>g different types of contents <strong>in</strong> <strong>the</strong><br />
same program: “like a buffet, with different<br />
choices.” 19 Thus, radio messages featured<br />
<strong>in</strong>terviews with health authorities and medical<br />
experts, testimonials from PLWHIV, pop<br />
voices (a succession of different voices giv<strong>in</strong>g<br />
<strong>the</strong>ir op<strong>in</strong>ion <strong>in</strong> a few short sentences), diary<br />
extracts, short plays, etc. F<strong>in</strong>ally, songs on<br />
18. Tigist Kassa, Director of Guishen Ethiopia Radio<br />
19. Tigist Kassa, Director of Guishen Ethiopia Radio<br />
34
HIV/AIDS <strong>in</strong> Somali, which were well-known<br />
and very popular, were broadcast between<br />
pauses <strong>in</strong> speak<strong>in</strong>g.<br />
Make <strong>the</strong> message a “habit”<br />
by giv<strong>in</strong>g it a story l<strong>in</strong>e<br />
One of <strong>the</strong> keys to success of <strong>the</strong> radio<br />
messages was <strong>the</strong> use of <strong>the</strong> fictitious “diary”<br />
of a PLWHIV. With each radio message, <strong>the</strong><br />
audience discovered <strong>the</strong> daily worries of this<br />
person by “read<strong>in</strong>g” <strong>the</strong> diary: confrontation<br />
of discrim<strong>in</strong>ation, treatment, etc. In addition<br />
to mak<strong>in</strong>g <strong>the</strong> testimony more alive, this way<br />
of present<strong>in</strong>g it had <strong>the</strong> advantage of mak<strong>in</strong>g<br />
listeners want to hear <strong>the</strong> next episode of <strong>the</strong><br />
story, thus mak<strong>in</strong>g it a habit.<br />
Choose prime-time broadcast<strong>in</strong>g<br />
Around Dire Dawa, prime broadcast<strong>in</strong>g time<br />
is <strong>in</strong> <strong>the</strong> afternoon, because people are at<br />
home, chew<strong>in</strong>g khat and listen<strong>in</strong>g to <strong>the</strong> radio,<br />
especially on Saturday. Although it was first<br />
scheduled as a morn<strong>in</strong>g show, <strong>the</strong> program<br />
was changed to a later time. Arguments<br />
presented to <strong>the</strong> radio station on <strong>the</strong> fact that<br />
HIV/AIDS awareness is an important topic<br />
allowed obta<strong>in</strong><strong>in</strong>g a better broadcast time:<br />
Wednesday and Saturday at noon, right after<br />
<strong>the</strong> news.<br />
SUCCESS STORY:<br />
RADIO BROADCASTS ACCLAIMED<br />
BY HEALTH AUTHORITIES<br />
After listen<strong>in</strong>g to some of <strong>the</strong> radio<br />
broadcasts, <strong>the</strong> Somali Region Health<br />
Office, an Ethiopian government<br />
partner <strong>in</strong> <strong>the</strong> project, asked <strong>Handicap</strong><br />
<strong>International</strong> for copies of <strong>the</strong><br />
broadcasts and <strong>the</strong> right to use <strong>the</strong>m.<br />
The idea was to broadcast <strong>the</strong> set of<br />
messages at <strong>the</strong> regional level.<br />
Evaluate impact from <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />
When <strong>the</strong> project of produc<strong>in</strong>g 40 messages<br />
was be<strong>in</strong>g developed, it was decided to set<br />
aside budget for evaluat<strong>in</strong>g <strong>the</strong> impact of <strong>the</strong>se<br />
messages. This was done after <strong>the</strong> broadcast<br />
of <strong>the</strong> 40 messages at two sites <strong>in</strong> order to<br />
measure <strong>the</strong> impact of radio messages<br />
and provide recommendations for <strong>the</strong> next<br />
steps. In this context, two focus groups were<br />
organized, as well as <strong>in</strong>terviews with key<br />
persons, such as members of <strong>the</strong> <strong>Handicap</strong><br />
<strong>International</strong> team and <strong>in</strong>stitutional partners.<br />
People from <strong>the</strong> village were also questioned at<br />
random at <strong>the</strong> two sites. From this evaluation, it<br />
was clear that <strong>the</strong>re was a unanimous desire,<br />
expressed by both <strong>in</strong>habitants and authorities,<br />
that <strong>the</strong> program should cont<strong>in</strong>ue!<br />
35
USE OF TRADITIONAL GROUP EXCHANGE<br />
In certa<strong>in</strong> regions, group meet<strong>in</strong>gs or<br />
<strong>in</strong>formation exchanges are cultural traditions.<br />
We thought it would be <strong>in</strong>terest<strong>in</strong>g to use<br />
<strong>the</strong>se to promote awareness actions. Thus, <strong>in</strong><br />
Ethiopia, coffee ceremonies were organized<br />
on <strong>the</strong> HIV/AIDS topic. In <strong>the</strong> Afar region,<br />
community conversations were <strong>in</strong>spired<br />
from liv<strong>in</strong>g tradition, and <strong>the</strong> “dagou” culture<br />
<strong>in</strong>spired awareness activities.<br />
Use cultural habits<br />
for <strong>in</strong>creas<strong>in</strong>g awareness<br />
In <strong>the</strong> Afar tradition, a cultural habit known<br />
as “dagou” exists; <strong>the</strong> word means “transmit<br />
<strong>in</strong>formation.” Before even say<strong>in</strong>g hello,<br />
someone will ask: “Do you have dagou?” In<br />
o<strong>the</strong>r words, “Do you have any <strong>in</strong>formation to<br />
transmit?” <strong>Community</strong> conversations <strong>in</strong> <strong>the</strong><br />
framework of <strong>the</strong> project were designed us<strong>in</strong>g<br />
this culture. Animators went to a busy public<br />
place and shouted, “I have dagou!” People<br />
came immediately to ga<strong>the</strong>r around and listen.<br />
Dur<strong>in</strong>g <strong>the</strong> conversation, which could last up<br />
to two hours, <strong>the</strong>y participated actively, s<strong>in</strong>ce<br />
debate is also a cultural habit. At <strong>the</strong> end of<br />
<strong>the</strong> conversation when people returned to <strong>the</strong>ir<br />
homes, <strong>the</strong>y transmitted <strong>the</strong> <strong>in</strong>formation<br />
<strong>the</strong>y had received to <strong>the</strong>ir families. In this<br />
case, <strong>the</strong> “dagou” concerned HIV/AIDS.<br />
In a similar way, <strong>the</strong> coffee ceremony <strong>in</strong><br />
Ethiopia was used to organize a group<br />
exchange on awareness. Coffee ceremonies<br />
were organized right on <strong>the</strong> street <strong>in</strong> order to be<br />
available to all passers-by. As usage requires,<br />
while <strong>the</strong> coffee was be<strong>in</strong>g roasted and ground<br />
before be<strong>in</strong>g prepared, different PLWHIV<br />
talked about <strong>the</strong>ir condition and, above all,<br />
discussion and debate took place. Once <strong>the</strong><br />
coffee was drunk, <strong>the</strong> group dispersed.<br />
Leadership techniques<br />
to make people th<strong>in</strong>k<br />
Dur<strong>in</strong>g community conversations <strong>in</strong> <strong>the</strong> Afar<br />
region, group leaders use techniques to<br />
<strong>in</strong>cite participants to th<strong>in</strong>k personally about<br />
<strong>the</strong> subject under discussion. They do not<br />
give f<strong>in</strong>al <strong>in</strong>formation; ra<strong>the</strong>r, <strong>the</strong>y question<br />
<strong>the</strong> audience about how to solve a problem,<br />
s<strong>in</strong>ce <strong>the</strong>y feel that <strong>the</strong> solution should come<br />
from <strong>the</strong> community. By tradition, people<br />
participate easily <strong>in</strong> debates <strong>in</strong> this region and<br />
thus easily share <strong>the</strong>ir ideas to f<strong>in</strong>d a solution<br />
to <strong>the</strong> issue presented.<br />
Choose busy public places<br />
To carry out awareness activities <strong>in</strong> public<br />
places, <strong>the</strong>se places should be carefully<br />
chosen to attract as many people as possible.<br />
For example, for community conversations,<br />
animators chose <strong>the</strong> market area, water<br />
supply po<strong>in</strong>ts or places <strong>in</strong> <strong>the</strong> city where coffee<br />
ceremonies are popular <strong>in</strong> <strong>the</strong> even<strong>in</strong>g.<br />
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36
FESTIVE EVENTS TO CONVEY THE MESSAGES<br />
Festive events were regularly organized<br />
dur<strong>in</strong>g <strong>the</strong> project at all <strong>in</strong>tervention sites. Their<br />
contents were adapted to <strong>the</strong> local cultural<br />
context, but <strong>in</strong> all cases, <strong>the</strong> pr<strong>in</strong>ciple was <strong>the</strong><br />
same: attract an audience with festive shows,<br />
musical concerts or circuses and <strong>in</strong>clude HIV/<br />
AIDS awareness activities <strong>in</strong> <strong>the</strong>se spectacles<br />
us<strong>in</strong>g skits, quizzes or personal testimony.<br />
When possible, a mobile VCT (Voluntary<br />
Counsel<strong>in</strong>g and Test<strong>in</strong>g) center was set up<br />
near <strong>the</strong> show.<br />
Involve health authorities<br />
for greater impact<br />
Before each public event, health authorities<br />
were notified of <strong>the</strong> date and place and asked<br />
to send a representative to give <strong>the</strong> open<strong>in</strong>g<br />
speech for <strong>the</strong> event. In addition, when a<br />
mobile VCT center was planned for, authorities<br />
provided a counselor and a laboratory<br />
technician to ensure test<strong>in</strong>g.<br />
Announce to attract<br />
To ensure a large audience, festive events were<br />
announced beforehand. This announcement<br />
was made by community leaders from <strong>the</strong><br />
project advisory committee <strong>in</strong> <strong>the</strong>ir respective<br />
areas of <strong>in</strong>fluence. In parallel, on <strong>the</strong> day of<br />
<strong>the</strong> event, professional announcers passed<br />
through <strong>the</strong> streets to advertise <strong>the</strong> com<strong>in</strong>g<br />
event. F<strong>in</strong>ally, a banner announc<strong>in</strong>g <strong>the</strong> event<br />
was hung at <strong>the</strong> place where <strong>the</strong> event was to<br />
take place.<br />
Use <strong>the</strong> know-how of exist<strong>in</strong>g associations<br />
for animat<strong>in</strong>g <strong>the</strong> event<br />
For public events, o<strong>the</strong>r local associations<br />
with specific know-how provided valuable<br />
assistance, especially for creat<strong>in</strong>g and<br />
present<strong>in</strong>g skits on <strong>the</strong> HIV/AIDS topic or for<br />
musical animation.<br />
Mix modernity and tradition<br />
to raise awareness<br />
In <strong>the</strong> Afar region of Ethiopia, festive events rely<br />
on an important cultural specificity, “kasso”.<br />
This is traditional music featur<strong>in</strong>g respected<br />
elders who s<strong>in</strong>g about different subjects.<br />
People play close attention to messages<br />
transmitted <strong>in</strong> this way. Dur<strong>in</strong>g concerts,<br />
modern music for danc<strong>in</strong>g alternates with<br />
calm periods and attentive listen<strong>in</strong>g to kasso<br />
s<strong>in</strong>gers, who conveyed awareness messages<br />
<strong>in</strong> <strong>the</strong>ir songs.<br />
Adapt awareness events to <strong>the</strong> audience<br />
Festive awareness events were adapted to<br />
<strong>the</strong> context of each region, as well as with<strong>in</strong><br />
a given country. At Dire Dawa (Ethiopia),<br />
festive events <strong>in</strong>cluded testimony of persons<br />
liv<strong>in</strong>g with <strong>the</strong> virus, quizzes and mobile VCT<br />
centers, whereas <strong>in</strong> <strong>the</strong> Afar region (Ethiopia),<br />
only traditional kasso music was used to<br />
transmit awareness messages.<br />
In Somaliland, public events did not <strong>in</strong>clude<br />
testimony by PLWHIV and, above all,<br />
condoms were not mentioned, s<strong>in</strong>ce <strong>the</strong><br />
authorities preferred to <strong>in</strong>form about <strong>the</strong><br />
disease only. Accord<strong>in</strong>g to <strong>the</strong>se authorities,<br />
denial is so strong that <strong>the</strong> population risked<br />
© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />
37
throw<strong>in</strong>g stones if condoms were mentioned.<br />
Because of denial and stigmatization, test<strong>in</strong>g<br />
was not offered.<br />
Encourage test<strong>in</strong>g through “positive life”<br />
testimonials<br />
In Ethiopia, each time test<strong>in</strong>g was offered<br />
dur<strong>in</strong>g a festive event, a number of<br />
persons volunteered to be tested. Personal<br />
testimonials by PLWHIV who cont<strong>in</strong>ue to live<br />
a full and healthy life thanks to antiretroviral<br />
medic<strong>in</strong>es, allowed <strong>the</strong>m to dare to be tested.<br />
Hear<strong>in</strong>g <strong>the</strong>se stories decreased <strong>the</strong> fear of<br />
discover<strong>in</strong>g HIV status and showed why it is<br />
necessary to know one’s status <strong>in</strong> order to be<br />
treated.<br />
Use humor to raise awareness<br />
In Somaliland, circus acts and small skits<br />
on <strong>the</strong> subject of HIV/AIDS were designed<br />
to make people laugh, enabl<strong>in</strong>g awareness<br />
of some topics. Subjects were varied:<br />
prenuptial test<strong>in</strong>g with a couple about to<br />
marry, stigmatization with a person who<br />
doesn’t want to shake hands with a HIV +<br />
friend, risky sexual activity with a man who<br />
gets drunk <strong>in</strong> a bar and <strong>the</strong>n goes to see a<br />
prostitute, etc.<br />
Make realer than real by demonstrat<strong>in</strong>g<br />
It is not enough to promote condom use;<br />
men must know how to use it! Thus, dur<strong>in</strong>g a<br />
public event organized <strong>in</strong> a military camp, <strong>the</strong><br />
animators brought along a replica of a penis <strong>in</strong><br />
wood to demonstrate condom application.<br />
that a very attractive and healthy-look<strong>in</strong>g<br />
young woman could carry <strong>the</strong> virus!<br />
Ask questions to make sure<br />
Dur<strong>in</strong>g festive events, a quiz (questionnaire)<br />
enabled show<strong>in</strong>g people that <strong>in</strong> spite of<br />
th<strong>in</strong>k<strong>in</strong>g <strong>the</strong>mselves well <strong>in</strong>formed on HIV,<br />
<strong>the</strong>y were often unable to answer <strong>the</strong> questions<br />
asked. The quiz thus made <strong>the</strong>m attentive to<br />
awareness messages that followed it.<br />
“At <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g of <strong>the</strong> event, young people<br />
were bored because <strong>the</strong>y had heard talk<br />
about HIV <strong>in</strong> <strong>the</strong> media and thought <strong>the</strong>y knew<br />
everyth<strong>in</strong>g about it. But dur<strong>in</strong>g <strong>the</strong> quiz, <strong>the</strong>y<br />
realized that <strong>the</strong>y couldn’t answer <strong>the</strong> questions<br />
and <strong>the</strong>refore didn’t know everyth<strong>in</strong>g. This<br />
made <strong>the</strong>m pay attention to what <strong>the</strong>y were<br />
told later.” 20<br />
Use powerful symbols<br />
For rais<strong>in</strong>g awareness, us<strong>in</strong>g symbols was<br />
effective for re<strong>in</strong>forc<strong>in</strong>g messages. World<br />
AIDS Day on December 1 was, for example, an<br />
excellent occasion for organiz<strong>in</strong>g festive vents<br />
<strong>in</strong> partnership with o<strong>the</strong>r stakeholders work<strong>in</strong>g<br />
on <strong>the</strong> same topic. In <strong>the</strong> same way, dur<strong>in</strong>g<br />
<strong>the</strong> project a festive event was organized<br />
on <strong>the</strong> strip of land separat<strong>in</strong>g Ethiopia and<br />
Somaliland, us<strong>in</strong>g <strong>the</strong> symbol of <strong>the</strong> border<br />
to <strong>in</strong>sist on <strong>the</strong> fact that “HIV/AIDS knows no<br />
borders”, which is <strong>the</strong> major message of <strong>the</strong><br />
project.<br />
Use high-impact testimonials<br />
For an audience made up of young Ethiopian<br />
soldiers, a pretty young woman came to tell<br />
about <strong>the</strong> fact that she was liv<strong>in</strong>g with <strong>the</strong><br />
AIDS virus and that she used condoms dur<strong>in</strong>g<br />
sex to avoid contam<strong>in</strong>at<strong>in</strong>g her partners. For<br />
<strong>the</strong>se soldiers, this woman was liv<strong>in</strong>g proof<br />
20. Tensig Gimariam, represent<strong>in</strong>g a youth organization on <strong>the</strong> Dire Dawa project advisory committee<br />
38
4. Carry<strong>in</strong>g out<br />
more precisely targeted actions<br />
Part<br />
2<br />
1. Special target<strong>in</strong>g of populations<br />
d Meet with groups at risk<br />
d Discuss with target populations<br />
dur<strong>in</strong>g workshops<br />
d Raise awareness of <strong>the</strong> young<br />
<strong>in</strong> familiar surround<strong>in</strong>gs<br />
d Create a climate of trust before talk<strong>in</strong>g<br />
about a sensitive subject<br />
d Carefully orient <strong>the</strong> conversation<br />
d F<strong>in</strong>d <strong>the</strong> proper relays<br />
2. Promot<strong>in</strong>g condoms…<br />
where it is acceptable to do so<br />
d Locate <strong>the</strong> most pert<strong>in</strong>ent places<br />
d Make condoms available daily<br />
d Go beyond skepticism to <strong>in</strong>novate<br />
d Educate young people through o<strong>the</strong>r<br />
young people<br />
d Pay attention to appearances<br />
In <strong>the</strong> geographical area covered by <strong>the</strong><br />
project, some populations were identified as<br />
be<strong>in</strong>g more vulnerable to HIV/AIDS, such<br />
as prostitutes, young men or truck drivers.<br />
For <strong>the</strong>se persons, specific awareness<br />
actions were implemented. For prostitutes,<br />
workshops on disease awareness and <strong>the</strong><br />
use of preservatives were organized. Truck<br />
drivers were approached dur<strong>in</strong>g awareness<br />
activities and condom distribution on <strong>the</strong><br />
traffic corridor. Concern<strong>in</strong>g young men,<br />
distribution of condoms was organized <strong>in</strong><br />
Ethiopia <strong>in</strong> front of some bars on weekend<br />
even<strong>in</strong>gs. In Somaliland, where it is difficult to<br />
mention condoms, young people were made<br />
aware through <strong>in</strong>terventions at schools, but<br />
also outside schools for those who were not<br />
students, and through <strong>the</strong> implementation of<br />
activities at a youth center.<br />
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39
SPECIAL TARGETING OF POPULATIONS AT RISK<br />
Meet with groups at risk<br />
For some groups at risk, go<strong>in</strong>g to meet<br />
with <strong>the</strong>m can enable develop<strong>in</strong>g collective<br />
awareness. Thus, at Jijiga (Ethiopia), festive<br />
events were organized for audiences deemed<br />
to be “concerned” by <strong>the</strong> AIDS topic: soldiers<br />
and young men. A public event was organized<br />
with<strong>in</strong> <strong>the</strong> military base at Jijiga for 1,500<br />
soldiers, with music, testimonials by PLWHIV,<br />
quizzes, etc. For students, <strong>the</strong> same type of<br />
event was organized for students of <strong>the</strong> Jijiga<br />
School of Higher Learn<strong>in</strong>g.<br />
Discuss with target populations<br />
dur<strong>in</strong>g workshops<br />
<strong>Awareness</strong> workshops were organized for<br />
discussions with ei<strong>the</strong>r populations at risk,<br />
such as prostitutes, or <strong>in</strong>fluential members<br />
of <strong>the</strong>ir community, such as political and<br />
religious leaders. Dur<strong>in</strong>g <strong>the</strong>se workshops,<br />
<strong>the</strong> goal was to provide basic knowledge of<br />
<strong>the</strong> disease and its means of transmission and<br />
prevention. Follow<strong>in</strong>g an overall presentation,<br />
workgroups were organized. Each group<br />
had time to prepare for answer<strong>in</strong>g a certa<strong>in</strong><br />
number of questions (i.e.: How is <strong>the</strong> virus<br />
transmitted? How can you protect yourself?<br />
How can you make a prostitute’s clients use<br />
a condom? How do you treat someone who is<br />
HIV +?). Then, <strong>the</strong> group representative gave<br />
<strong>the</strong> responses <strong>in</strong> front of <strong>the</strong> entire ga<strong>the</strong>r<strong>in</strong>g<br />
and all participants discussed and developed<br />
<strong>the</strong> answers.<br />
Raise awareness of <strong>the</strong> young<br />
<strong>in</strong> familiar surround<strong>in</strong>gs<br />
Build<strong>in</strong>g a center for young people at Hargeisa<br />
(Somaliland) enabled offer<strong>in</strong>g <strong>the</strong>m a place<br />
to meet with different leisure activities, such<br />
as billiards, table soccer, p<strong>in</strong>g-pong, outdoor<br />
activities, Internet connection or a collection<br />
of books. In this center where young people<br />
came regularly, two HIV/AIDS counselors<br />
were tra<strong>in</strong>ed to make young people aware of<br />
this topic and provide detailed and confidential<br />
advice to those who wanted it.<br />
Create a climate of trust<br />
before talk<strong>in</strong>g about a sensitive subject<br />
In <strong>the</strong> youth center at Hargeisa, <strong>the</strong> counselors<br />
gradually came <strong>in</strong>to contact with <strong>the</strong> young<br />
people and got to know <strong>the</strong>m <strong>in</strong> order to<br />
progressively w<strong>in</strong> <strong>the</strong>ir trust. They took<br />
advantage of daily activities and conversations<br />
to talk about VCT centers and give all <strong>the</strong><br />
basic <strong>in</strong>formation about <strong>the</strong> disease. Then, for<br />
more <strong>in</strong>-depth and personalized counsel, <strong>the</strong><br />
young people met with <strong>the</strong> counselor <strong>in</strong> <strong>the</strong><br />
counselor’s office. If <strong>the</strong>y wanted to cont<strong>in</strong>ue<br />
by be<strong>in</strong>g tested, <strong>the</strong>y were directed to a nearby<br />
hospital.<br />
Carefully orient <strong>the</strong> conversation<br />
S<strong>in</strong>ce <strong>the</strong>y wanted to reach populations at risk,<br />
<strong>the</strong> animators sometimes approached truck<br />
drivers by choos<strong>in</strong>g heavily traveled areas.<br />
The animators ei<strong>the</strong>r sat with <strong>the</strong> drivers <strong>in</strong> a<br />
restaurant or bar or went to see <strong>the</strong>m <strong>in</strong> <strong>the</strong>ir<br />
trucks. The discussion was first about o<strong>the</strong>r<br />
topics and <strong>the</strong> animators began by jok<strong>in</strong>g with<br />
<strong>the</strong> drivers before mention<strong>in</strong>g AIDS and <strong>the</strong>ir<br />
© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />
40
SUCCESS STORY:<br />
BAR OWNERS ACT AS RELAYS<br />
At Jijiga (Ethiopia), bar owners were tra<strong>in</strong>ed about HIV/AIDS and its means of<br />
transmission and prevention. After this tra<strong>in</strong><strong>in</strong>g, one of <strong>the</strong> owners was particularly<br />
militant concern<strong>in</strong>g <strong>the</strong> prostitutes who worked <strong>in</strong> her bar. She obliged <strong>the</strong> prostitutes<br />
to systematically offer condoms and, above all, supported <strong>the</strong>m when customers<br />
were reluctant to cooperate.<br />
role <strong>in</strong> prevention. Us<strong>in</strong>g humor was important<br />
to show <strong>the</strong>ir friendl<strong>in</strong>ess before <strong>in</strong>troduc<strong>in</strong>g <strong>the</strong><br />
topic. Introduc<strong>in</strong>g <strong>the</strong> subject of HIV/AIDS too<br />
rapidly <strong>in</strong> <strong>the</strong> conversation risked anger<strong>in</strong>g<br />
<strong>the</strong> drivers, who would <strong>the</strong>n say th<strong>in</strong>gs like,<br />
“Who told you I was concerned by AIDS? Who<br />
are you to talk to me like that?”<br />
F<strong>in</strong>d <strong>the</strong> proper relays<br />
Sometimes, for mak<strong>in</strong>g some persons aware,<br />
it was useful to identify those who had an<br />
<strong>in</strong>fluence over <strong>the</strong>m, whe<strong>the</strong>r for f<strong>in</strong>ancial<br />
or social reasons. Thus, mak<strong>in</strong>g prostitutes<br />
aware of <strong>the</strong> usefulness of us<strong>in</strong>g condoms for<br />
protection risked be<strong>in</strong>g <strong>in</strong>effective if <strong>the</strong> owners<br />
of <strong>the</strong> bars where <strong>the</strong>y worked required <strong>the</strong>m<br />
to refuse noth<strong>in</strong>g to customers. These owners<br />
were thus <strong>in</strong>vited to tra<strong>in</strong><strong>in</strong>g sessions and made<br />
aware of <strong>the</strong> importance for prostitutes and<br />
<strong>the</strong>ir customers to use condoms to mitigate<br />
propagation of <strong>the</strong> disease.<br />
In a similar way, a workshop for community and<br />
religious leaders enabled rais<strong>in</strong>g awareness<br />
of <strong>the</strong> topic. Afterwards, <strong>the</strong>se leaders were<br />
very active with<strong>in</strong> <strong>the</strong>ir communities as relays<br />
for <strong>the</strong> prevention messages. For example,<br />
<strong>the</strong>y repeatedly <strong>in</strong>vited PLWHIV to present<br />
<strong>the</strong>ir testimony dur<strong>in</strong>g religious ceremonies.<br />
PROMOTING CONDOMS…WHERE IT IS ACCEPTABLE TO DO SO<br />
In most areas covered by <strong>the</strong> project, it was<br />
difficult to mention condoms and even more<br />
difficult to distribute <strong>the</strong>m. Therefore, condom<br />
promotion was done <strong>in</strong> Ethiopia <strong>in</strong> urban<br />
areas only or with populations at risk, such<br />
as prostitutes or truck drivers. In Somaliland,<br />
it was culturally not possible to talk abut<br />
condoms <strong>in</strong> public or to promote <strong>the</strong>m; it was<br />
also very difficult to f<strong>in</strong>d <strong>the</strong>m, except <strong>in</strong> some<br />
pharmacies.<br />
Locate <strong>the</strong> most pert<strong>in</strong>ent places<br />
To distribute condoms to truck drivers, towns<br />
on <strong>the</strong> routes where <strong>the</strong> drivers habitually<br />
stopped were chosen. In <strong>the</strong>se towns, <strong>the</strong><br />
places where drivers most frequently went<br />
to relax or see prostitutes were identified.<br />
Condoms were left next to a lavatory <strong>in</strong> one<br />
of <strong>the</strong> restaurants most appreciated by truck<br />
drivers <strong>in</strong> one of <strong>the</strong> towns. In ano<strong>the</strong>r town, a<br />
popular store was chosen, which was next to<br />
<strong>the</strong> places where drivers got toge<strong>the</strong>r to chew<br />
khat.<br />
Make condoms available daily<br />
At <strong>Handicap</strong> <strong>International</strong> and at partner<br />
locations, <strong>in</strong> offices and more <strong>in</strong>timate places<br />
such as restrooms, condoms are available for<br />
employees and for passers-by. In addition to<br />
be<strong>in</strong>g part of <strong>the</strong> project <strong>the</strong>me, this <strong>in</strong>itiative<br />
also followed <strong>the</strong> governmental policy of<br />
fight<strong>in</strong>g AIDS <strong>in</strong> <strong>the</strong> workplace.<br />
41
Go beyond skepticism to <strong>in</strong>novate<br />
The idea of distribut<strong>in</strong>g condoms <strong>in</strong> front of<br />
bars on <strong>the</strong> weekends first had little support<br />
from partners on <strong>the</strong> project team, who were<br />
afraid that young men and bar owners would<br />
f<strong>in</strong>d it vulgar and irritat<strong>in</strong>g. But after <strong>the</strong> first<br />
weekends of distribut<strong>in</strong>g condoms, success<br />
was apparent: condoms were distributed<br />
massively. Bar owners even came to thank<br />
HI for this <strong>in</strong>itiative and express <strong>the</strong>ir wish that<br />
it cont<strong>in</strong>ue.<br />
Educate young people<br />
through o<strong>the</strong>r young people<br />
To reach young people <strong>in</strong> <strong>the</strong> bars on weekend<br />
even<strong>in</strong>gs, condom distribution was done by<br />
people of <strong>the</strong> same generation. This group<br />
of volunteers, made up mostly of young<br />
girls, was tra<strong>in</strong>ed on <strong>the</strong> topic of HIV/AIDS<br />
<strong>in</strong> order to provide <strong>in</strong>formation on <strong>the</strong> disease<br />
while ensur<strong>in</strong>g distribution. S<strong>in</strong>ce <strong>the</strong>y were<br />
both young and considered to be educated<br />
because <strong>the</strong>y were university students, <strong>the</strong>ir<br />
message had a strong impact on o<strong>the</strong>r young<br />
people.<br />
Pay attention to appearances<br />
The young condom distributors wore very<br />
identifiable smocks with <strong>the</strong> project logo<br />
and a message promot<strong>in</strong>g use of condoms.<br />
In addition, condoms were presented on a<br />
beautiful traditional tray to create a sort of<br />
“stag<strong>in</strong>g” for distribution. F<strong>in</strong>ally, a project<br />
sticker was applied to each box of condoms,<br />
on <strong>the</strong> one hand to communicate about <strong>the</strong><br />
project and on <strong>the</strong> o<strong>the</strong>r, to underl<strong>in</strong>e <strong>the</strong> fact<br />
that <strong>the</strong> condom was not offered for free by<br />
<strong>the</strong> manufacturer.<br />
42
To learn more…<br />
In this document, a number of types of know-how used for community awareness have been<br />
presented. This know-how aims to provide <strong>in</strong>spiration for o<strong>the</strong>r awareness projects and is not<br />
exhaustive.<br />
For those who would like to <strong>in</strong>vestigate fur<strong>the</strong>r, we propose o<strong>the</strong>r project references that give<br />
an overall view of <strong>the</strong> project, s<strong>in</strong>ce only its community awareness aspect has been discussed<br />
here. These references will allow compar<strong>in</strong>g what can be done <strong>in</strong> o<strong>the</strong>r contexts and will provide<br />
methodology and ideas for implementation of learn<strong>in</strong>g-from-experience process.<br />
PROJECT: “IMPROVEMENT OF THE PREVENTION AND TREATMENT OF HIV/<br />
AIDS IN THE CROSS-BORDER REGIONS OF DJIBOUTI, IN ETHIOPIA AND IN<br />
SOMALILAND”<br />
d Logical framework of <strong>the</strong> project and its narrative<br />
d Six-month reports, nos. 1, 2, 3, 4 and 5<br />
d Mid-project evaluation<br />
Learn<strong>in</strong>g-from-experience sheet: “Facilitat<strong>in</strong>g <strong>the</strong> establishment of long-last<strong>in</strong>g<br />
cross-border l<strong>in</strong>ks”<br />
Learn<strong>in</strong>g-from-experience sheet: “Streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong> health system”<br />
These documents are available on <strong>the</strong> project DVD-ROM <strong>in</strong> <strong>the</strong> Toolbox <strong>in</strong> <strong>the</strong> Project Documents<br />
directory. A number of o<strong>the</strong>r project documents are listed <strong>in</strong> <strong>the</strong> o<strong>the</strong>r Toolbox directories.<br />
COMMUNITY AWARENESS<br />
d Approche communautaire et projet d’appui au Burundi : l’expérience de la mise en place des<br />
comités de santé dans le cadre du projet d’accès aux so<strong>in</strong>s pour les personnes vulnérables dans<br />
la prov<strong>in</strong>ce sanitaire de Ngozi. DUBAND Agnès. Lyon: <strong>Handicap</strong> <strong>International</strong>, 2006, 3 p.<br />
http://www.handicap-<strong>in</strong>ternational.fr/fileadm<strong>in</strong>/documents/publications/AppCommunautaireBurundi.pdf<br />
d As It Is Research: F<strong>in</strong>d<strong>in</strong>gs on <strong>the</strong> knowledge, attitude, practice and access to HIV and AIDS<br />
<strong>in</strong>formation and services amongst persons with disability. <strong>Handicap</strong> <strong>International</strong> Kenya. Nairobi:<br />
<strong>Handicap</strong> <strong>International</strong>, 2007, 20 p.<br />
http://www.handicap-<strong>in</strong>ternational.fr/fileadm<strong>in</strong>/documents/publications/SummaryDisabilityHivKenya.pdf<br />
43
LEARNING-FROM-EXPERIENCE (”CAPITALIZATION”)<br />
d Learn<strong>in</strong>g-from-experience: a manual for organis<strong>in</strong>g, analys<strong>in</strong>g and document<strong>in</strong>g field based<br />
<strong>in</strong>formation / Du terra<strong>in</strong> au partage : manuel pour la capitalisation des expériences. CHAVEZ-<br />
TAFUR Jorge; HAMPSON Karen; INGEVALL Anita; THIJSSEN Rik. Amersfoort : ILEIA, 2007.-<br />
47 p. (Localisation 516.CHA)<br />
English: http://documentation.leisa.<strong>in</strong>fo/Documentation%20Manual.pdf<br />
Français: http://documentation.leisa.<strong>in</strong>fo/Du%20terra<strong>in</strong>%20au%20partage.pdf<br />
d Les démarches de capitalisation cont<strong>in</strong>ue dans le réseau des membres et partenaires de<br />
Coord<strong>in</strong>ation Sud, COORDINATION SUD. Coord<strong>in</strong>ation Sud, 2004, 5 p. [onl<strong>in</strong>e]<br />
http://coord<strong>in</strong>ationsud.org/IMG/doc/tab_capit_perm_reduit_02_09_04.doc<br />
d Note de synthèse du module de formation : « Introduction à la capitalisation d’expériences ».<br />
GRAUGNARD Gilbert ; QUIBLIER Véronique. Lyon: Ciedel, 2006.- 24 p.<br />
http://evaluation.francophonie.org/IMG/pdf/download.pdf<br />
d Learn<strong>in</strong>g and shar<strong>in</strong>g experience: lessons for learn<strong>in</strong>g processes <strong>in</strong> NGOs / Capitalisation<br />
d’expériences... expérience de capitalisations : comment passer de la volonté à l’action ?<br />
VILLEVAL Philippe. <strong>in</strong> Traverses, no. 15, October 2004, 46 p. (Localization: 516.VIL)<br />
English: http://www.handicap-<strong>in</strong>ternational.fr/fileadm<strong>in</strong>/documents/publications/TraversesUK.pdf<br />
Français: http://www.handicap-<strong>in</strong>ternational.fr/fileadm<strong>in</strong>/documents/publications/Traverses.pdf<br />
d Appui à la mise en œuvre et au suivi d’une démarche de capitalisation d’expériences, ZIEGLE<br />
Cécile. Coord<strong>in</strong>ation Sud, 2004, 5 p.<br />
http://www.coord<strong>in</strong>ationsud.org/IMG/pdf/demarche_capi_site_15_07.pdf<br />
44
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