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Rapid Assessment of District and Community HIV and AIDS Response

Rapid Assessment of District and Community HIV and AIDS Response. Challenges, Constraints and Prospects Technical Review 2008. Objectives. To generate community-based experiences regarding the implementation of NMSF in terms of what worked well and what needs to be improved

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Rapid Assessment of District and Community HIV and AIDS Response

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  1. Rapid Assessment of District and Community HIV and AIDS Response Challenges, Constraints and Prospects Technical Review 2008

  2. Objectives • To generate community-based experiences regarding the implementation of NMSF in terms of what worked well and what needs to be improved • To assess progress in community and district responses for HIV & AIDS and the key issues

  3. Sharing the tool with Stakeholders To assess prospects and challenges for district and community response to HIV and AIDS To share findings with Key Stakeholders

  4. DISTRICT AND COMMUNITY HIV and AIDS RESPONSE Coverage of Assessment 6 teams (1 or 2 consultant(s) + 1 LGA staff per team): • Lake Zone (Muleba, Ukerewe, Tarime) • Central Zone (Iramba, Kondoa and Kahama) • Southern Zone (Rungwe, Makete and Tunduru) • Western Zone (Kibondo, Nkasi, Nzega) • Northern Zone (Kiteto, Rombo and Monduli) • Eastern Zone (Mkuranga, Temeke and Ulanga) Plus: • Regional level • National level

  5. Methodology Qualitative in-depth interviews were administered to respondents from: • Households, • Umbrella Civil Society Organisations including the Private and Informal sector where applicable; • Council Multisectoral Committees, • Districts, • Regions and • National levels

  6. Findings Household / community

  7. Findings:Community / House hold - Perception Challenges and Gaps: • Inadequate food supply for the PLHIV • Lack of sustainable development projects for supporting PLHIV – need of community initiated owned IGAs • Apart from free ARVs, other prescribed drugs for Opportunistic Infections are not adequate and they are asked to purchase the drugs

  8. Findings:Community / House hold - Perception Challenges and Gaps: • Most of the community in the villages lack adequate knowledge on HIV and AIDS • Inadequate funds to the Community Based Organizations dealing with HIV and AIDS activities • Limited sensitization on HIV and AIDS activities • The PLHIV come from long distance (fare costs up to 4,000) which they cannot afford to pay for each visit (out of pocket expenditures)

  9. Findings:Community / House hold - Perception Challenges and Gaps Disabled in Ukerewe • Limited number of Home Based Care Providers to meet the demand at the community level • No specific HIV and AIDS activities for the Disabled • Poverty level is very high in rural areas – then adherence to ARVs becomes difficulty

  10. Findings:Community / House hold Challenges and Gaps PLHIV – amputated due gangrene – using her eating utensils • Overdependence fuels stigma and discrimination • Existence of social cultural practices that fuel the spread of HIV and AIDS

  11. Community / House hold • Long distance to access services – CTCs, VCTs, and HBCs, • Where Mobile CTCs are available they are good but irregular • Poor accessibility to services in general for HIV and AIDS activities

  12. Findings:Community / House hold- Participation in Planning Challenges and Gaps • Limited involvement of community in planning process • Unaware of the current council / CSOs HIV and AIDS plans • Most of the communities in the villages lack adequate knowledge on HIV and AIDS • Lack of adequate funds to the Community Based Organizations dealing with HIV and AIDS activities • Limited sensitization on HIV and AIDS activities

  13. Community / House hold - Access to resources / sources of funding Challenges and Gaps • Inadequate understanding by the community • Unequal distribution of resources favouring those closer to service delivery locations – No food No Strength to Dig the Farm • Lack of support to Disabled PLHIV (Wheel Chairs / Artificial Limbs)

  14. Community / House hold - Perception on THs and TBAs Challenges and Gaps • THs and TBAs - Limited knowledge on HIV and AIDS • No clients records kept on their respective local areas of the operation

  15. Community / House hold - Perception on THs and TBAs Challenges and Gaps PLHIV – MVC - Guardian • THs and TBAs - Limited knowledge on HIV and AIDS • No clients records kept on their respective local areas of the operation

  16. Community / House hold - Leadership on HIV and AIDS activities at community level Challenges and Gaps • Inadequate understanding of H/H on structures / roles and responsibilities of WMACs / VMACs / CSOs though they mentioned Councillors, WEOs, VEOs as leading the response • Lack of bylaws to fight on HIV and AIDS

  17. CSOs , Private and Informal Sector

  18. Findings: Civil Society organization- Response to HIV and AIDS Challenges and Gaps • Some of the members do not have skills or capacity to implement HIV and AIDS activities • What reported as done has not been done!

  19. Civil Society organization - Added Value to district response • Inadequate quality and quantity of the services needed as compared to the demand • Missed opportunities e.g. umbrella organisations having inadequate skills regarding roles and responsibilities (capacity building, financial management and resource tracking, M&E, Proposal development and Report Writing) therefore unable to support members and add value to Council HIV&AIDS plan

  20. Civil Society organization - Capacity to implement Challenges and Gaps • Limited support / capacity to carry out their campaign for HIV and AIDS prevention activities in the community • Lack of transport facilities for implementation of HIV and AIDS activities in their respective areas

  21. Civil Society organization - Sources of funding Challenges and Gaps • Lack of adequate of funds • Limited community contributions (in kind and cash) • Delay release of funds for the approved HIV and AIDS planned activities • Bureaucratic procedures by the funding agencies • No feedback provided on the altered or unfunded HIV and AIDS activities by funding agencies

  22. Civil Society organization - Good Governance on HIV and AIDS Challenges and Gaps CSO - SHUUWVVUTA • Lack of transparency , information flow and cooperation – CSOs do not report on the funds received from different Partners • Red tape in getting support from higher levels

  23. Council Multisectoral AIDS Committees

  24. Findings: Council Multisectoral AIDS Committees (CMAC) Challenges and Gaps • Inadequate capacity building of CMACs, WMACs and VMACs members due to inadequate funds • Limited support of the PLHIV (food, drugs and transport ) • Long waiting time for getting the services in the Health Facilities

  25. Findings: Council Multisectoral AIDS Committees (CMAC) Challenges and Gaps • Community still not well educated on HIV and AIDS / Mind set – BCC and some of the community members are not yet reached • Lack of transport: Bicycles, Motorbikes , Boats (hard to reach) due to long distances travelled to reach the clients • Lack of sense of urgency: Political will at the district level

  26. Findings: Council Multisectoral AIDS Committees (CMAC) Challenges and Gaps • Inadequate budgets for HIV and AIDS • Increased number of OVCs/ MVC (burden) • Change of CMAC members affected the performance of the committee • The PLHIV come from long distance (fare costs up to 4,000) which they cannot afford to pay for each visit • Shortage of staff

  27. Findings: Council Multisectoral AIDS Committees (CMAC) Challenges and Gaps • Overload / overcrowd of the CTC clinic in the hospital as some of the clients also refuse to go to other clinics! • The clients are living under very hard conditions • Some of the clients cannot understand our language, need for an interpreter, implying a cultural barrier • CSOs working under difficult conditions without transport support

  28. Findings: Council Multisectoral AIDS Committees (CMAC) Challenges and Gaps Feedback meeting at Muleba Challenges and Gaps • Few centres for measuring CD4 and in addition need for more training on the use of the methodology • Get less funds as it had been promised • Most of thefundsprovidedfortheimplementation of HIV and AIDS are fortheseminars only and notforthe target audiences

  29. Findings: Council Multisectoral AIDS Committees (CMAC) Challenges and Gaps • Some CSOs had paid fees for secondary school students but now, with RFA not working, the students are going to suffer. • Limited support from the council to facilitate CHAC and DACC HIV and AIDS activities

  30. Findings: Council Multisectoral AIDS Committees (CMAC) Challenges and Gaps • Function of CMACs is constraints by limited resources • Guidelines alone are not enough but unless followed and further training is provided • Lack of understanding of the HIV and AIDS Act

  31. Local Government Authorities (LGAs)

  32. Findings:District - Local Government Authorities – Planning and Guidelines Challenges and Gaps: • Lack of accurate data (TOMSHA not yet in function) • Inadequate capacity building of LGAs in the planning process. • Too many and confusing planning guidelines, e.g. CHAC has NMSF, DACC has the Basket fund Guidelines, the Treasury has PBG. The Planning Rep and O&OD) • Most the LGAs are unaware of various planning guidelines related to HIV and AIDS

  33. Findings:District - Local Government Authorities – Planning and Guidelines Challenges and Gaps: • Low community mobilisation in the implementation of HIV and AIDS activities • Lack of law for the citizens regarding HIV and AIDS • Increased number of clients • Lack of working tools, like the computers and other facilities

  34. District - Local Government Authorities Coordination Challenges and Gaps • Difficulty to send reports or feedback in the villages • There was inadequate information flow regarding type and sources of support from Regional and National levels among LGA Actors • Late release of funds for the approved HIV and AIDS Interventions

  35. District - Local Government Authorities Overall implementation Challenges and Gaps • Target groups are not well reached in the hard to reach areas (OVC, PLHIV, MVC, Widows / Widowers, Youths and Disabled) • Counsellors at the Ward level not well supported in terms of resource to undertake their tasks • WMACs and VMACs : lack awareness on their roles and responsibilities as Key Implementers • Limited involvement of CBOs in educating the community of HIV and AIDS • Implementers are not well informed as they do not have adequate skills in HIV and AIDS.

  36. District - Local Government Authorities - Services delivery Challenges and Gaps • Inadequate VCTs and CTCs in council ( closer to the clients) • Shortage of Staff (Human resources constraints) • Stigma among the service delivery providers. • Long distances travelled to get the services.

  37. District - Local Government Authorities - Funding Challenges and Gaps • Delay in the release of funds for approved HIV and AIDS interventions as a result the planned activities are not realized due to price changes. • Inadequate / limited funds for HIV and AIDS activities.

  38. District - Local Government Authorities - Monitoring and Evaluation Challenges and Gaps • Local Government Monitoring Database (LGDM) and TOMSHA are not well known to most of the members • Mixed reaction but almost all of them were ‘not sure’ of receiving feedbacks of the reports • Variations of reporting procedures in the councils. • M&E activities are not budgeted in the LGAs planned activities.

  39. Findings from Regional level

  40. FindingsRegional- Planning, Technical support to LGA, Coordination and M&E Challenges and Gaps • Human resource constraints • Lack of transport! / difficult to reach remote areas (hard to reach) • Limited follow up of HBC / PMCTC at the family level • Mindset of the community – resistant to change! (Behaviour Change Communication) • Sometimes difficult to track resources because the resources are sent directly to council. • Lack of linkages between regional level and district levels as far as monitoring and evaluations systems are concerned.

  41. Findings from National level

  42. Findings National- Technical Assistance Policies, Planning, Strategies and Guidelines Challenges and Gaps • Lack of clear Guidelines for LGAs and CSOs on best practise • Councils do not seem to involve partners or communities much in their planning processes

  43. National- Coordination mechanisms Challenges and Gaps • At Ministerial level, the Technical AIDS Committees do not seem particularly active. In some Ministries, such as MOFEA, the Committee has even not been established yet. • At district level, LGA do not coordinate with partner agencies and do not share information.

  44. National- Coordination mechanisms • At district level, CSOs feel that CMACs provide only a partial opportunity for coordination: there is currently no mechanism for feedback from CMAC members to CSOs or vice-versa. Most Councils seem to appoint CMAC members rather than allowing CSOs to elect a representative from amongst themselves.

  45. National- Coordination mechanisms, resources • TACAIDS informed CSOs that the CMAC Guidelines would be revised but so far CSOs have not seen the revised CMAC Guidelines nor had an opportunity to contribute to their revision. • Current budget guidelines limit the amount of funding which Ministries can request for the annual MTEF for HIV and AIDS activities

  46. National- Monitoring and Evaluation Challenges and Gaps • There is no operational plan for the NMSF. • At LGA level the Three Ones principle is not implemented and there is still confusion over who is responsible for monitoring of HIV and AIDS • The monitoring system within the health sector is very strong. However monitoring system for HIV and AIDS implemented outside of the health sector needs to be strengthened.

  47. National- Monitoring and Evaluation • TOMSHA is not operational. None of CSOs interviewed had received TOMSHA forms. • LGAs do not monitor regularly the activities implemented by non-state actors (such as CSOs). • Partners provide reports to LGAs and to national level authorities, including TACAIDS, but LGAs and TACAIDS do not provide feedback.

  48. Thank you very much for listening

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