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INTRODUCTION This report describes a feasibility study conducted between October 2012 and September 2013, its findings, and recommendations for a leadership development curriculum. The purpose of the study was to clarify the priority action and scope of capacity building needed to “develop the capacity for FBOs to advocate for improved healthcare for all citizens and hold governments accountable.” The mandate for this endeavor came from a PEPFAR consultation held in Kenya in May 2012 on The Role of Faith-based Organizations in Sustaining Community and Country Leadership in the Response to HIV/AIDS. This study and its leadership development goals are one of several commitments generated by participants at this consultation aimed at leveraging and strengthening the role of FBOs in HIV/AIDS prevention, treatment, and community care.
The Interfaith Health Program Public Private Partnership (IHP PPP) at Emory University collaborated on this project with the firm, Okaalet and Associates, led by Dr. Peter Okaalet. Dr. Okaalet was chosen by IHP PPP in consultation with the Division of Global HIV/AIDS at the US Centers for Disease Control and Prevention because of his long- standing leadership working with religious leaders to address HIV/AIDS, not only in Kenya but across many of part of sub-Saharan Africa. Dr. Okaalet directed the work in Kenya, both the design and implementation, taking a key role in conducting the key informant interviews. Emory IHP PPP staff worked closely with Dr. Okaalet in the development of the interview questions and jointly on the analysis of the interview data. For a 2-month period, Emory IHP PP provided on-the-ground support with a graduate student from Emory University enrolled in the Masters in Development Practices Program who supported the benchmark survey activities.
The report concludes with a set of recommendations to advance the planning for leadership capacity to achieve strong country leadership responses to HIV/AIDS in Kenya.
METHODOLOGY In this study we employed a two-pronged approach to learn from key leaders in the field and to map the field of leadership development related to the goals of this initiative. One approach was in-depth key informant interviews and the other was a search for related models. The final list of key informants and interview questions are provided as attachments. The interview questions aim to understand views on pressing HIV issues, religious leadership roles in meeting those, knowledge and capacities necessary to address them, and the features of an optimum learning environment.
An initial list of 53 leaders was developed with the potential key informants organized in the following groups: 1. policy decision makers (government, civil society, and religious organizations) 2. religious leaders (faith-based program implementers) 3. health (medical and health professionals with faith-based health responsibilities) 4. development (program implementers – NGO, CSO, CBO, FBO, and private sector) ELI Feasibility Study Final Report November 2013 Page 2
5. education (university and theological training institutions).
We set an initial goal of 12 to 20 interviews and identified priority leaders from each of the five categories. Over a 2-month time period, efforts were made to contact these leaders and conduct in-person interviews, keeping in mind a representative distribution across the five groups. A set of interview questions was sent ahead via email in most cases and some of the responses were obtained in writing when an interview was not feasible.
Twelve leaders participated as key informants, the majority in interviews conducted by Okaalet and Associates. Extensive notes were taken by a second person during the interviews and compiled into one document for analysis. Parallel analyses were conducted by Okaalet & Associates and by Emory IHP PPP staff to identify common themes across the interviews. Agreement between the two analyses was achieved by document reviews and exchange followed by conference call deliberation. A document that contains the final list of consensus common themes is attached to this report and key highlights are described in the next section.
Okaalet and Associates by virtue of their standing and reputation across the network of key informants provided a very valuable opening to the time and perspectives shared by those interviewed. It is important to note that there is likely some bias given the history and visibility within these relationships. Access to these relationships is a priority given the need for high-level engagement in this project. We expect that collaboration with Emory IHP PPP staff in the analysis reduced some of the bias. Twelve key informants should provide a range of perspectives. However, their extent to which their positions represent the full field of voices and views should be considered in a final interpretation of the interviews and vetting of a recommended curriculum.
The identification of relevant models was accomplished through online searches, a review by Okaalet, and referrals made during key informant interviews. The purpose of this component of the study was to identify existing educational resources, potential partners, and expert faculty in the field. Criteria used to select the models are as follows: 1. leadership development focus 2. African context (preferably East Africa) 3. existence of a policy or advocacy learning component 4. presence of a religious or faith-based orientation and/or a health/HIV/AIDS focus.
SUMMARY OF KEY FINDINGS This section contains key findings from the analysis of the interview notes. The lines of inquiry and overarching topics are noted in bold. The themes most commonly cited corresponding to these overarching topics are presented in italics and described in more detail when there is congruence across the three lines of inquiry most pertinent to the goal of the study – perceptions of religious leader roles, needed knowledge and skills, and recommendations for learning or capacity building experiences.
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The first part of the key informant interviews set the tone and context for later questions about religious leaders’ roles and capacities by asking interviewees the most pressing needs in Kenya and their community associated with HIV/AIDS. The three most frequently cited pressing issues are financing of prevention and treatment services, stigma, and the need for a national forum and framework. Less frequently mentioned but of significance is the socioeconomic factors that drive the disease and issues related to children – treatment and support of OVCs. In the development of the curriculum, these additional issues should also be included as feasible when selecting content as well as formulating the intended impact that is important to these leaders.
There are three themes or characteristics most frequently cited by respondents of religious leadership roles. To address the most pressing needs and challenges associated with HIV/AIDS, leaders need to -- assure that relevant and accurate information is provided to their constituents; be advocates and policy influencers; and facilitate congregational involvement and responses to community needs.
Dissemination of accurate information about HIV/AIDS is thought to be important for reducing stigma, prevention of further spread, demystifying HIV, preventing harmful “moralizing,” and assuring compassionate care. Further along in the interviews when asked about the knowledge and capacities leaders need to have an impact, the two themes that capture the most commonly reported capacities are knowledge on HIV and communication or messaging. The knowledge deemed necessary includes HIV transmission, prevention, treatment literacy, and the “broader social/political/economic environments within which it exists and spreads.” Communication and messaging are also important knowledge and skills that are necessary to have an impact. This is congruent as well with the role of religious leader to provide relevant and accurate information.
Further in the interview, key informants were asked to provide advice on learning experiences that would be most useful and feasible for religious leaders. The common themes found in these responses align with what emerged when asked about roles, knowledge and skills. Many of the key informants said that factual information on HIV/AIDS should be included. Additionally several responded that this should be accompanied with religious and theological content. Related to this as well is the theme of contextualizing the content to their realities – that it be culturally and religiously appropriate and draw from real experiences from the field.
Religious Leader Role Knowledge & Skills Optimum Learning (Theme 1) Experiences Assure relevant and Knowledge on HIV Factual information on accurate information is Communication, HIV provided to constituents messaging that Accompanied by religious creates change & theological content Contextualized to their realities
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When asked about exemplars in the field, participants cited a number of relevant common characteristics regarding the role of religious leaders. Two in particular stood out. The first was “those who are personally affected” become “agents of change through testimonies and positive living.” The second was “those active at the local, “grassroots, and middle levels” are thought to have the greatest impact.
The second of the three most cited aspects of the religious leader’s role is as advocate and policy influencer (internal and/or governmental). Several spoke of the need for advocacy on relevant policies. Of those some cited a need for advocacy “at all levels (national and community)” and for “ensuring the rights of the people” and “for those most affected.” One spoke of the need to be vocal and that “the relation between Church and the State is important.” This same theme showed up again as the third most frequently cited kinds of knowledge and skills needed by religious leaders to have an impact – policy and advocacy. In response to this question individual key informants cited the need for “advocacy skills,” “political savvy,” “policy analytical skills and formulation processes,” holding government accountable, and Church State relationships.
Role of Religious Leader (Theme 2) Knowledge and Skills Needed Advocates and policy “Advocacy skills,” “political savvy,” influencers(internal and/or “policy analytical skills and governmental) formulation processes,” holding Advocacy on relevant policies – “at all government accountable, and levels (national and community),” for Church State relationships ensuring the rights of the people” and “for those most affected.”
Two contributions associated with advocacy are worth noting that are responses to the question about useful and feasible learning experiences. Keep in mind that these do not represent clustered themes and from the twelve interviewed these may be statements made by the same individuals who raised these issues referenced above. They are included here because of the language and frame specific to advocacy that had not been raised by others. “How do you merge your pastoral role and your prophetic role? ‘Advocacy’ is more like combat, but instead we should be using Prophet Nathan’s approach.” “FBOs should take a supportive role in relating to the State leaders but also empowering the people to hold leaders to account.” Another key informant said that the learning experience should “demonstrate the critical importance of linkages between policy, programmes, health facilities, and community-based response initiatives.”
The third of the three most cited views of the respondents on the role of religious leaders is that they should facilitate an increase in congregational responses to community needs. This included providing VCT and “ongoing care and support,” “counseling members and encouraging those affected,” and “guiding their congregations in playing a more positive and transformative role in ELI Feasibility Study Final Report November 2013 Page 5
their communities.” Though this theme did not show up again directly when asked about knowledge, skills, and learning experiences, it can be assumed that the ones that did, knowledge on HIV, communication skills, and policy and advocacy skills, would indeed support the role of facilitating congregational responses.
Role of Religious Leaders (Theme 3) Facilitate an increase in congregational responses to community needs - Providing VCT and “ongoing care and support,” “counseling members and encouraging those affected,” and “guiding their congregations in playing a more positive and transformative role in their communities.”
Interestingly an important theme that emerged is knowledge and skills for program and organizational management. Among the 12 key informants there were seven references to the need for program management and governance knowledge. This certainly reinforces the need for the work of NGOTI and others such as FANIKISHA whose main focus is to build this kind of organizational capacity. And finally another knowledge and skill theme worth noting is counseling – to “address gender based violence,” “relationship skills,” “conflict resolution,” with “HIV testing,” and for “those affected.” One interviewee highlighted the now widely-noted concern regarding the huge increase in prevalence among married couples. This is an issue which has great implication for the role of FBOs as they are strategically placed for pre-wedding and in- marriage HIV-preventative interventions. As a curriculum is finalized and vetted with key stakeholders, along with advocacy and policy influencing, it will be important to further clarify counseling as an area of knowledge development.
CURRICULUM DESIGN AND STRUCTURE
1. Content and Pedagogy As reported in the previous section, the three most important knowledge and skills content areas are knowledge on HIV, communication, and advocacy/policy influencing. When asked directly about the most useful and feasible learning experiences for religious leaders, the interviewees thought it would be important to link the science and technical content to relevant scripture and religious teachings. For this same question, many respondents said it would be necessary to contextualize the learning to the realities of the religious leaders’ role and environment. Some of these realities included: “HIV prevalence rates in their locale”; “the Church’s particular voice on these issues”; “adding value to their core work (ministry, pressing needs of survival, etc.)”; and “making use of experiences from the field”, at the “personal level;” and include “life experiences of PLHIV.”
Those interviewed were quite thoughtful and provided considerable input into how the learning experience could be designed. A common theme that emerged is it should have a participatory and applied focus. This included: “involve them in the design;” “personal process oriented,” “employ methodology for self discovery;” and these from ELI Feasibility Study Final Report November 2013 Page 6 one interviewee – “group discussions based on readings or case scenarios; role plays, music, drama and other traditional forms of community awareness and education; field trips and site visits to ‘best practices’ programs; interviews with PLHIV, support group leaders and others with experience in AIDS related ministries; and development of various practical skills under the supervision of experienced mentors.” Another respondent said, “Must be about provoking discussions and solution-seeking, must be goaded to action.”
2. Structure - Length The clear message from those interviewed on the length of the learning experience was “short.” The range cited is from 1 ½ days to a week, all considered “short.” The most common was - “should be short, not longer than a week.” One suggested that higher level religious leaders should be “invited to ‘consultations’ not ‘to be trained’.” Another recommended – “Informal training programs which may range from a) one day seminars to week-long conferences to b) a series of weekend-long training modules for the benefit of congregations, leaders engaged in active ministry and for leaders of impoverished congregations.”
In the final design, it will be very important to align the content with the pressing issues identified by these and other key stakeholders as well as learners. This means that the content selected for the curriculum should give the participants knowledge and skills for action that impacts and creates change relative to the issues of financing, stigma, and a national forum and framework.
BENCHMARK EXEMPLARS AND MODELS In order to obtain a full picture of the capacity building field pertaining to the purpose of this study, two efforts were made to identify relevant training models and exemplar individual leaders. This informs the project on several fronts by providing information about curricula models upon which to draw; identifying potential partners to connect with for greater success; and identifying content or individuals to use as faculty and case study examples. Two questions were included in the interviews that asked about exemplars and models. An additional internet-based search was undertaken to identify relevant training models. The findings from this search and the models recommended by the key informants make up the accompanying benchmark survey table (see Appendix IV, pp. 22- 30).
One of the questions in the interview asked if there are exemplars that are particularly effective in meeting challenges and having an impact employing the knowledge and capacities deemed important by the respondent. These persons may be engaged as instructors or presenters and their work may become case studies used in the learning event. Engaging them in this way would aid in accomplishing the guidance to contextualize the learning in order to represent the realities of the commitments and issues that demand religious leaders’ attention. There is a comprehensive list of the 20 individuals referred to by the key informants in the summary of the interview data (see Appendix III, pp. ELI Feasibility Study Final Report November 2013 Page 7
18-19). Three of those were mentioned by more than one interviewee: Archbishop Benjamin Nzimbi of ACK, Bishop James Okombo of INERELA, and Professor Mohamed Karama.
An assessment was conducted through an internet search and key informant inquiry to identify existing educational resources, potential partners, and expert faculty in the field. Criteria used to select the models are as follows: leadership development focus; African context (preferably East Africa); has a policy or advocacy learning component; and, though not essential, it was a plus if it had either or both a religious or faith-based orientation and health/HIV/AIDS focus. The composite of these is organized into an accompanying table that includes degree or diploma programs, trainings, and resources and tools table (see Appendix IV, pp. 22-30). Reference to how this information can be used to support an educational event is made in the recommendations.
SUMMARY AND RECOMMENDATIONS Across those interviewed there is consistent support for and recognition of the need for religious leaders to take an active role in providing accurate information to their constituents that reduces stigma and discrimination as well as for being an advocate for “ensuring the rights of the people” and caring “for those most affected.” Recommendations based on the feasibility study findings are organized in three areas-- one is a proposed curriculum model with additional curriculum resource