Appendix 3 ARUMERU: Project and Evaluation Edited from an evaluation report by Tamara Kwarteng, Tim O’Shaughnessy and Florence Ghamuga September 1999 Précis Arumeru is a “classic” HIV/AIDS prevention project in the best sense of the word. Prevention is the chief intervention and largely relies on counselling and education activities carried out by community volunteers. Dependence on volunteers, when combined with fervent community acceptance and participation, gives the Arumeru Project a high probability that it will be sustainable. Strong governmental approval of the project’s performance adds to the likelihood that HIV/AIDS prevention measures will continue after World Vision funding stops. Arumeru is more than prevention, however. The project also engaged communities in ways to care for AIDS orphans and people living with AIDS (PLWA). While not the main thrust of the Arumeru Project, care became an important intervention, as did ways to improve people’s livelihoods. Enterprise development grew out of a concern that poor women have few assets to sell except their bodies, a risky endeavour where HIV is epidemic. Loans to start businesses were also extended to youth in an effort to turn “loitering” into something more productive. Contents Summary 128 Introduction 129 Arumeru District HIV/AIDS Project 129 Evaluation Process and Methods 131 Planning the evaluation 131 Arumeru Project Activities and Coverage 133 Project coverage 133 Project Impact 135 Knowledge about HIV/AIDS 135 Behavioural changes 139 Strengths and Challenges of the Project 142 Sustainability Issues 145 Assessment of project sustainability 145 Recommendations and Planning Issues 146 127 Learning from the past, hope for the future Summary There was a high level of community ownership of the Arumeru Project as indicated by the significant The Arumeru HIV/AIDS Prevention and Control participation of community members in Project Project (Arumeru Project) began in October 1995 and activities and the dedication of Community Counsellors serves about 211,837 people living in four divisions, who conduct HIV education seminars. Overall, the Poli, King’ori, Mbuguni and Moshono. This report evaluation team rated the Arumeru Project high in terms describes the findings of an evaluation of the Arumeru of sustainability because it: Project conducted in September 1999. The purpose of the evaluation was to review progress against the Project Was socially viable as its theory, content, such as HIV objectives and assess the impact to date. The evaluation education curriculum, and methods were congruent would also seek to understand the process by which with the local mainstream understanding and culture. achievements have been attained, draw conclusions and Was also in line with government strategies and identify recommendations for enhancement of future policies, such as encouraging industrious attitudes performance. and practices. An evaluation team of 25 people, included the major Worked through government structures. The stakeholders, such as Project staff, Project committee Arumeru Project was more difficult than members, community representatives and counsellors, conventional projects to tell where the Project began district and central government representatives and and ended as it formed an integrated, seamless web of World Vision staff conducted the evaluation. The HIV prevention and care with its partners, evaluation process was used as an opportunity to build government, village leaders, religious leaders and the community in general. the capacity of a variety of Project stakeholders in evaluation methodologies. Through the use of The evaluation team made a number of participatory processes, the stakeholders gained recommendations pertaining to the continuation and experience in all aspects of evaluation including coverage of the Project; the approaches used by the developing key evaluation questions, interviewing Project; and specific HIV prevention and care strategies. techniques and data analysis. Key recommendations that relate to Project planning in the future are: The evaluation revealed that the Arumeru Project had a significant impact on HIV/AIDS awareness in the Project continuation and coverage Project areas. 1. Project partners did an excellent job in raising In the Poli Division, although the level of awareness awareness about HIV in the Arumeru District. about HIV was already high before the current HIV was firmly on the agenda in the Project began, the depth of understanding about HIV communities. Nevertheless, the epidemic remains transmission and risk of infection has increased and continues to expand. Given that the Arumeru significantly during the period of Project Project is the major response to HIV/AIDS in implementation. Arumeru District, it is imperative that it be continued. The length of time that the Arumeru Project took place in a community affects the knowledge of HIV. 2. The Arumeru Project area should be expanded to Comparing data from Poli Division with other include Mukulat and Enaboishu divisions and Arumeru Project areas revealed higher levels of HIV/ Mirerani mining village. AIDS knowledge in Poli than King’ori. The major Project approach difference between the two divisions was that the 1. The Arumeru Project supported an approach that Project had been implemented for longer time in Poli targeted some of the associated causes of HIV, than King’ori. such as loitering and alcoholism. Perhaps this Through the stimulus of regular seminars and other assistance is best done through community information sessions, HIV was firmly on the agenda of development. It is important that this strategy not the community from villages to local governments. only continues but that it be expanded to include Community members identified a number of changes in issues not currently addressed. Examples include behaviour that occurred since the Project began. These women’s marginalised position, negotiated safe sex included reduction in alcohol consumption in bars and or abstinence, and the socio-economic programs reduction in adultery. that address wider contextual factors. 128 Appendix 3 2. There is a need for constant dialogue between estimates that 12,000 people have developed AIDS in religious leaders and other Project partners in Arusha region since the epidemic began in 1986. An order to derive a common stand on the use of estimated 120,000 people are infected with the virus but condom as one of the main measures in the do not yet have AIDS. Of the eight districts in Arusha prevention and control of HIV/AIDS. The region, Arumeru has the second highest number of project approach to HIV prevention should HIV/AIDS cases. Over half (54%) of the people with include vigorous promotion of condom use as one HIV/AIDS are women. of the methods for preventing infection. Information from non-governmental organisations HIV/AIDS education (NGOs) in Arusha region indicated that 730 children were orphaned by the epidemic. Arumeru district had The evaluation team recommended that the nearly 200 orphans. Arumeru Project adopt a peer education approach to instruct various community members about Responses to the epidemic in the HIV. This allows for better opportunities to teach Arumeru District skills for behaviour change and will require the The responsibility for co-ordinating the HIV/AIDS identification and training of a range of educators response at the district level rests with the District AIDS such as young men and women. Control Co-ordinator (DACC). In reality, there has Community counsellors and trainer-of-trainers been little funding from the government for HIV/AIDS prevention and care activities in Arumeru District. The The evaluation team recommended that the Arumeru DACC estimated that in 1999, only15% of Arumeru Project expand the role of Community spending on AIDS prevention activities was provided by Counsellor from HIV educators to Primary Health the government. The remainder of the funding for HIV/ Care Volunteers. This will require additional AIDS activities was done through NGOs and churches: training for them, but it will address an area of 65% by World Vision through the Arumeru Project, expanding need by providing home-based care 15% by the Evangelical Lutheran Church of Tanzania close to where people live. (ELCT), and 10% by Oxfam. Care and support for people living with AIDS (PLWA) The Arumeru HIV/AIDS Project 1. To reduce the fear and stigma associated with Background and coverage. The Arumeru Project began in HIV/AIDS and change community attitudes October 1995. It was an expansion of the former about PLWHA, the Project should develop new Nkoaranga HIV/AIDS Prevention and Control Project HIV/AIDS education messages which do not that was implemented in Poli Division from 1990 to promote fear of people infected with the virus. 1995. Community members from three other divisions 2. The project should take a leadership role in in the Arumeru district, King’ori, Mbuguni and showing that PLWHA are employable, even when Moshono, invited World Vision Tanzania to include their HIV status is known to the employer, by them in the HIV/AIDS prevention program underway employing the PLWHA community educators in Poli Division. The total population served by the who have been volunteers for a number of years. project was 211,837 (1988 census) and consisted of 83,038 men, 86,427 women and 42,366 children. The Introduction area covered was 1,654 square kilometres, consisting of HIV/AIDS in Arumeru 85 villages in the 23 wards of the four divisions.