Increased Male Involvement in Home-based Care to Reduce ... - VSO

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Thandizani, ZambiaImplementation strategyThandizani is a community based HIV & AIDS prevention andcare organisation established in 1999 in Lundazi District, easternZambia bordering Malawi. Thandizani, in Nyanja, means ‘HelpEach Other’ and this is the philosophy behind Thandizani’sprogrammes. Thandizani began as a voluntary counselling andtesting (VCT) organisation. The information, education andcommunication (IEC) strategy used to mobilise the community forVCT included engagement of local authorities, relevant governmentdepartments such as Ministry of Health and traditional leaders,through public and focused group discussion, and training ongender and sexuality. Community leaders, including religiousleaders were trained in HIV & AIDS prevention, care and support.The gender awareness campaign revealed the gender relatedbarriers to accessing not only VCT but other services, as well as thecommunity’s participation in care and support.The open discussion on gender and sexuality attracted positiveresponse from the community in general. VCT uptake increasedrapidly and by 2002 nearly 4000 people had been tested for HIV,representing 4% of Lundazi district’s population. The VCT campaignbrought with it the challenges of care and support. Hence Thandizaniembarked on HBC and support. The HBC programme is builton a community franchising model where community care groups(CCGs) are established and affiliated to Thandizani. The CCGs arerun by committees selected by the communities. The communityalso selects the VCP. The requirements for membership in the CCGare that one is tested for HIV (the result is inconsequential to participationand does not necessarily have to be declared) and annualcontribution in cash or kind as determined by the community.The IEC campaign by Thandizani led the community, includingmen, to recognise the limited role men played in care in general.One female VCP reported that when she started volunteerwork in 1999, there were no men involved and that her spousediscouraged her. However, with the continued IEC campaignby Thandizani, more men, including her spouse became awarethat their contribution could significantly reduce the time andeffort that women put into HBC. A group discussion with menconfirmed the low participation of men in the early stages of theproject. The reasons cited for the low participation were cultureand lack of information. The men felt that care was for womenhence involvement in HBC led to stigmatisation by other men.The men also indicated that men did not want to be involved inactivities that took their time but did not generate income, a rolethey consider the prerogative of men. The men reported that theybecame more aware of the burden on women as their wives werespending more and more time on volunteer work, often leadingto disagreements in the household. Others believed that sincemen were more educated than females in their communities,men would more effectively support clients on antiretroviraltherapy (ARVs) by monitoring adherence. While acknowledgingthe high burden of care, women were also concerned aboutinvolving men mainly because of the perceived possibility of maledominance and hence women losing control of the programme.The mobilisation for male involvement addressed these and otherissues. In particular the engagement and active participation oftraditional leaders contributed significantly to men’s change inattitude to one that balances the needs of both men and women.Through partnership with VSO-RAISA, Thandizani went onstudy tours to Zimbabwe (2005) and the Copperbelt HealthEducation Project in Zambia 2006. On return, male involvementactivities were scaled up. Community leaders (chiefs, headmanand other influential people) were made aware of the role ofmen were playing in HBC in other organisations and countries.VSO volunteers placed in Thandizani provided technical supportin VCT, HBC, fund raising and laboratory services. Trainingworkshops were conducted separately for the community leaders,men, women and youths where culture and traditional issuesrelated to care and support were discussed. Seminars specificallyaddressing male involvement were organised for village heads andcommunity members. HBC committees and VCP were engaged indiscussion on male involvement.One female VCP reported that when shestarted volunteer work in 1999, there wereno men involved and that her spousediscouraged her. However, with the continuedIEC campaign by Thandizani, more men,including her spouse became aware that theircontribution could significantly reduce thetime and effort that women put into HBC.10
OutputsThe number of care groups increased from 15 in four chiefdomsin 2002 to over 100 in seven of the eleven chiefdoms in Lundaziby 2008. Overall about 140 volunteers were trained and severalothers yet to be trained are providing care. The proportion of maleVCP has consistently increased over the years to about 50% at thetime of this assessment. Since the beginning of HBC programme,the VCPs have provided care and support to about 8,000 clients ofwhom about 40% were males.Male and female VCPs perceived their central role as facilitatingimprovements in the care provided by primary caregivers throughthe provision of materials and the sharing of information. The maleVCPs receive similar training and provide similar services to clientsas female VCPs. The group discussion with women revealed thatfemale VCP felt that involvement of males had reduced the burdenof care, mainly the physically challenging activities related to careand support. During the home visits, the male VCPs effectively andconsistently perform duties that are within their comfort zone —i.e., those that are traditionally performed by men. These includefetching water, cleaning the environment, repairing or constructingphysical structures for clients, counselling, spiritual support andexercising the patient. Activities that are not traditionally assignedto men were less readily undertaken, including bathing, woundcare, and feeding of clients.Both male and female care providers categorically stated thatthey did not expect any remuneration. According to one male volunteer‘I derive my satisfaction and motivation seeing clients I assistedto get ARVs get up and walk and fend for themselves’. Thandizanidoes not give any incentives except bicycles and HBC kits which areconsidered ‘tools of the trade’. However this needs to be viewedfrom a rights based perspective 33 as well as the economic reasonsfor low male involvement reported by men in group discussions.The traditional leaders have organised themselves into groupswhich they call ‘Group Headmen Committees’ and conduct weeklymeetings where various issues are discussed. These includethe role of men in HIV & AIDS activities, as well as motivationand facilitation of other activities, such as income generation.A group discussion with village heads from Damso communityshowed that the traditional leaders were aware of the burden ofcare on women. The village heads had detailed statistics aboutthe population, number of households, widows, orphans andvulnerable children, HBC and VCP in their villages. The villageheads emphasised that their involvement in HBC made them rolemodels, not only for other men, but for male youths.Tutulane, MalawiIt is important to note that male involvement in HBC among theVSO-RAISA partners in Malawi only began after the partnersengaged in a RAISA facilitated exchange visit to the Zimbabwepartner PADARE.Implementation strategyTutulane is one of the largest CBOs in Chitipa district. Tutulanestarted HBC after VSO-RAISA facilitated an exchange visitto a CBO Tovwirane-Nsimba (Malawi) in 2003. 34 Using thecommunity mobilisation lessons learned from the CBO, Tutulanerecruited its first ten volunteers, all female. Through RAISAfacilitated exchange visits and conferences, and the attachmentof a VSO volunteer, Tutulane embarked on an intensive maleinvolvement programme. The programme was premised onthe lessons learned from partners, that gender and culturalnorms impede male participation in HBC. To address this,Tutulane approached traditional authorities and engaged themin discussion and information sharing. The traditional authoritiesare now at the fore front of recruitment of males. Tutulanealso formed a men’s forum called Pasaka, adopting the Padareconcept. Pasaka is a team of volunteer men who championgender equity, PPTCT and women’s rights in the community,while advocating for male involvement to reduce the burden ofcare on women. The team has 65 members of whom four aregroup village headmen. Men and traditional leaders were furthermobilised by their inclusion in village HBC committees, involvingtraditional leaders in management of Pasaka committees,offering free training to volunteers and establishment of incomegenerating projects (IGPs).OutputsThe efforts to increase male involvement in HBC have yieldedpositive results. The number of care providers has increased from10 (all female) in 2003 to 64 (20 men) in 2006. Thus the proportionof male volunteers increased from zero to 31% respectively. Theproportion of male volunteers further increased to 45% by endof 2007. The care providers work harmoniously with their femalecounterparts, conducting on average seven home visits per clientper month. The male care providers provide all aspects of care asavailable in HBC but do not bath female clients.11
Page 1 and 2: By Professor Exnevia Gomo for VSO-R
Page 3 and 4: AcronymsAIDSAcquired Immune Deficie
Page 5 and 6: Why Low MaleInvolvementin HIV & AID
Page 7 and 8: IncreasingBurden of Careon Womenand
Page 9 and 10: The MaleInvolvementProjectVSO build
Page 11: 1. ProjectImplementation andOutputs
Page 15 and 16: 2. Outcomes(All Partners)Because th
Page 17 and 18: Policy and Legal EnvironmentThe stu
Page 19 and 20: SADCBest PracticeCriteriaEffectiven
Page 21 and 22: RecommendationsThe study has descri
Page 23: ContactsVSO-RAISA Regional OfficePO

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