A Case Study Integrated AIDS Program Thika, Kenya MEASURE Evaluation With Support from Integrated AIDS Program-Thika and Pathfi nder International in Kenya A Case Study Integrated AIDS Program Thika, Kenya Prepared by MEASURE Evaluation Tonya Renee Thurman and Kristin Neudorf With Support from Integrated AIDS Program-Thika and Pathfi nder International in Kenya This case study was made possible by support from the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief under the terms of Cooperative Agreement GPO-A-00-03-00003-00. The opinions expressed are those of the authors and do not necessarily refl ect the views of USAID or the United States government.May 2008 SR-08-41 Integrated AIDS Program 5 Contents Acknowledgements Acknowledgements ................................................................................5 This case study could not have been completed without the assistance of the Integrated AIDS Program (IAP-Thika) staff in Thika district, who were List of Acronymns..................................................................................6 very generous in giving their time to explain the details of their program. Executive Summary ...............................................................................7 In particular, Sister Emmah Karanja, the program manager, contributed a Introduction ........................................................................................10 great deal to this case study, and was instrumental in making the necessary arrangements with other staff and the benefi ciaries. A big thank you also goes Orphans and Vulnerable Children in Kenya ........................................12 out to Sister Helen, the voluntary counseling and testing center counselors, Methodology .......................................................................................14 and the Education for Life team members, who made it possible to see the Information Gathering .......................................................................14 program “in action.” We are extremely appreciative of the many IAP-Thika Focal Site ............................................................................................14 staff who took time from their busy schedules to arrange meetings with community members and provided enormous insight in to the workings of Program Model ....................................................................................16 the project at the community level. Overview and Framework .................................................................. 16 Key Program Activities ....................................................................... 17 Cover photo by Felix Masi/Voiceless Children, courtesy of Photoshare. Benefi ciaries ....................................................................................... 25 Services Provided ................................................................................26 Unmet Needs ..................................................................................... 28 Community Ownership ..................................................................... 29 Resources .............................................................................................32 Donors ...............................................................................................32 Program Staff ..................................................................................... 32 Volunteers .......................................................................................... 33 Community In-Kind Contributions ...................................................34 Lessons Learned ...................................................................................35 Program Challenges ............................................................................35 Program Innovations and Successes .................................................... 36 The Way Forward ................................................................................39 References ............................................................................................41 6 Integrated AIDS Program Integrated AIDS Program 7 Acronyms Executive Summary AIDS acquired immune defi ciency syndrome The global HIV and AIDS epidemic has affected sub-Saharan Africa more than any other region in the world. AIDS deaths in sub-Saharan Africa account for APHIA II NC AIDS, Population, and Health Integrated Assistance 72% of AIDS deaths worldwide (UNAIDS, 2006a). As a result, the number Program in Nairobi and Central Province of children who have been orphaned or otherwise made vulnerable by HIV ARV antiretroviral and AIDS is also highest in this region. Despite the infl ux of programs and CBO community-based organization policies in the last decade to address this crisis, very little evidence is available CHW community health worker as to the impact and effectiveness of these programs. In an attempt to fi ll this COPHIA Community Based HIV and AIDS Prevention, Care knowledge gap, MEASURE Evaluation is undertaking a targeted evaluation and Support Program of four programs for orphaned and vulnerable children (OVC) in four unique settings in Kenya and Tanzania. The targeted evaluation includes household ECD early childhood development surveys, focus group discussions, a costing analysis and in-depth case studies EFL education for life of the selected programs. Emergency Plan The U.S. President’s Emergency Plan for AIDS Relief FBO faith-based organization The purpose of this case study is to gain a better understanding of one of the HBC home-based care programs selected for the evaluation — Integrated AIDS Program-Thika (IAP- Thika) supported by Pathfi nder International — as well as identify lessons HIV human immunodefi ciency virus learned that could be applied to other initiatives. The case study is based IAP-Thika Integrated AIDS Program-Thika upon program document review; program site visits, including discussions IGA income generating activities with local staff, volunteers, benefi ciaries, and community members; and K-REP Kenya Rural Enterprise Program observations of program activities. The primary audience for this case study includes OVC program implementers in Kenya and elsewhere in Africa, as NGO nongovernmental organization well as relevant policy makers, funding agencies addressing OVC needs, and RAAAPP rapid country assessment, analysis, and action planning other local and international stakeholders. process OVC orphans and vulnerable children Pathfi nder International’s Community-Based HIV and AIDS Prevention, PLHA people living with HIV/AIDS Care, and Support Program (COPHIA) in Kenya was among the programs TB tuberculosis chosen for the evaluation. COPHIA was funded by the US Agency for International Development (USAID) and the U.S. President’s Emergency Plan USAID U.S. Agency for International Development for AIDS Relief (Emergency Plan. Through COPHIA, Pathfi nder worked VCT voluntary counseling and testing with a number of community-based organizations (CBOs) implementing programs to support people living with HIV and AIDS (PLHA) and OVC. Pathfi nder provides CBOs with grant funding and a number of capacity building activities. COPHIA came to an end in 2006, but Pathfi nder is continuing to provide support to CBOs, such as IAP-Thika, through the AIDS, Population, and Health Integrated Assistance Program in Nairobi and Central Province (APHIA II NC). 8 Integrated AIDS Program Integrated AIDS Program 9 The evaluation concentrates on the work of IAP-Thika, a CBO and faith- also been a challenge due to IAP-Thika’s limited resources and its inability based organization (FBO) working within Thika District. to provide allowances for all CHWs. To address this issue, Pathfi nder has increased the number of CHWs who receive transport allowances and IAP- The program objectives of IAP-Thika are to: Thika has engaged CHW in microfi nance groups. 1. increase the number of people accessing voluntary counseling and testing (VCT) services; IAP-Thika has initiated program innovations and has achieved many successes. 2. increase the number of informed decisions that contribute to IAP-Thika has focused on building the capacity of local communities to preventing and controlling the spread of HIV and AIDS; address HIV and AIDS, involving the community in program planning and 3. strengthen the ability of PLHA to care for themselves and children operations whenever possible. The program builds the capacity of CHWs under their care by improving the health, nutrition, and economic through training and income-generating opportunities. Benefi ciaries also self-suffi ciency of PLHA; receive economic strengthening opportunities through a group revolving 4. improve the well-being of OVC by providing for their basic needs and loan system, with specifi c training designed to prevent default. The program assisting them in getting an education; and also encourages benefi ciaries to contribute to the support of other PLHA 5. build the capacity of youth and the community at large to address and vulnerable households as volunteers and through seed bank renewal. issues related to HIV and AIDS by raising awareness and decreasing Throughout the various components of the program, IAP-Thika emphasizes stigma and discrimination. the importance of positive living and seeks to form lasting relationships with benefi ciaries to better support their health and well-being in the long term. It To achieve these objectives, IAP-Thika provides comprehensive