The EAC/AMREF Lake Victoria Basin HIV&AIDS Partnership (EALP) is a three-year programme of the East African Community (EAC) which is coordinated by the Lake Victoria Basin Commission (LVBC), and managed by AMREF. The programme intends to establish a framework for improving the effectiveness of HIV and AIDS responses for mobile populations within the Lake Victoria Basin. This will be done through policy and practice harmonization, strengthening the capacity of key regional institutions, and strengthening networks and organizations of mobile populations within the Basin. A major aspect of the programme is strengthening the capacity of the East African Community (EAC) to effectively coordinate regional HIV and AIDS responses generally, but specifically those responses targeting mobile populations within the Lake Victoria Basin (LVB).
A harmonized and coordinated framework offers the most effective and efficient way of responding to the multiple and complex contextual HIV and AIDS vulnerabilities that result from intensive population movements within the LVB. Such a framework will provide a firm foundation for ongoing and future HIV and AIDS responses within the LVB. It will also enable diverse actors to structure their responses within a framework coordinated by the EAC. The programme is designed to respond to the vulnerabilities that arise from intensive population movements within the Lake Victoria Basin (LVB), whether such movements are internal or cross-border. The major populations of focus include communities in fishing, agricultural plantations, and students in institutions of higher learning. To add value from a regional perspective, the programme is collaborating with other institutions and networks which already have a regional reach, or those with a potential to develop this in order to reach the communities of focus.
Within the EALP, EAC provides the overall leadership in the harmonization of HIV&AIDS policies, standards and protocols as well as region-wide advocacy on HIV&AIDS. LVBC manages an HIV&AIDS Coordination mechanism for the programme, to ensure that interventions within the Lake Victoria Basin are harmonized and coordinated effectively. AMREF, accountable to LVBC is responsible for programme management and technical quality assurance of the EALP programme. Lake Victoria Fisheries Organization (LVFO) and Interuniversity Council for East Africa (IUCEA) which are institutions of the EAC are the implementing partners.
The programme works in collaboration with national HIV and AIDS coordinating agencies, National Technical Teams and Technical Counterparts ( Focal Point Officers) from the EAC Partner States. It covers 84 districts of the LVB region (57 in Kenya, 18 in Uganda and 19 in Tanzania) and maintains strategic presence in Rwanda and Burundi through collaborative research and information sharing including conduction of sero-behavioural studies in universities and establishment of the Monitoring, Evaluation and Health Management Information Systems.
The programme is being implemented in 20 universities in the EAC Partner States namely: Kenya (Maseno, Moi, Masinde Muliro, Baraton, University of Nairobi and Jomo Kenyatta University of Science and Technology) Tanzania (Mzumbe, Sokoine, St. Augustine, University of Dar es Salaam, Muhimbili and Iringa) Uganda (Makerere, Gulu, Uganda Christian Univ, Mbarara, Kampala International University and Nkumbe) Rwanda (National University of Rwanda) Burundi (Burundi National University). In the agricultural sector, a total of nine (9) plantations are involved in the programme namely: Kenya (Mumias Sugar, Sony Sugar and Unilever Tea) Uganda (Tilda Rice, Kakira Sugar, Kaweri Coffee and Wilmar Palm Oil) Tanzania (Kagera Tea and Kagera Sugar). In collaboration with LVFO, over 2000 Beach Management Units are participating in the programme.
The Shared Vision and Strategy Framework for Management and Development of the Lake Victoria Basin developed in 2003 is a strategic framework that is to guide the work of the LVBC and all its stakeholders. The Strategy Framework is clustered into five Policy Areas. However, the EALP programme addresses two of the five policy areas shown below:
Policy Area 2- Production and Income Generation: The objective is to ensure that resources are sustainably and equitably utilized for increased income and poverty reduction in the Lake Victoria Basin. One of the strategies is management of HIV&AIDS; through implementation of strategies to fight the impact of the epidemic on production and productivity, as the majority of those affected are productively active members of society.
Policy Area 3- Living Conditions, Poverty and Quality of Life: The objective is attainment of a healthy, well educated society with high quality of life, and well developed infrastructure. One of the strategies is to strengthen health programs targeting HIV&AIDS and strengthen awareness, sensitization and capacity building on HIV&AIDS to communities.
The EALP Programme is also being implemented in accordance with the Operational Strategy of the Lake Victoria Basin Commission (2007 – 2010). The strategy has nine (9) programmatic clusters one of which is the Social Development Programme that aims at promoting improved health services with emphasis on HIV&AIDS; education and training; water supply and sanitation; and nutrition status. It also seeks to influence change in socio-cultural behavior in the Lake Basin. Based on the prioritization criteria spelt out in the Operational Strategy, Production and Social Development is one of the seven priority programme areas proposed for implementation between 2007 and 2010.
Implementation of the EALP Programme is also in line with the EAC Regional Integrated Multi-sectoral Strategic Plan for HIV and AIDS (2008-2012). In the latter, the programme is described as the only EAC regional HIV&AIDS programme being implemented currently under objective 8 of the strategic plan that aims at reducing risks and vulnerability to HIV among mobile populations in East Africa.
The goal of the EALP programme is to reduce the risks and vulnerabilities to HIV&AIDS among mobile populations within the Lake Victoria Basin region
The programme has three specific objectives namely:
To strengthen the capacity of the EAC, its key institutions and select regional networks to coordinate HIV&AIDS responses in the LVB region
To promote the harmonization of HIV&AIDS policies and practice for mobile populations across the East African region
To strengthen the capacity of organizations of mobile populations to address HIV &AIDS related risks and vulnerabilities
Objective One: To strengthen the capacity of the EAC, its key institutions and select regional networks to coordinate HIV&AIDS responses in the LVB region
Activity One: Strengthen HIV and AIDS coordination by the LVBC
LVBC has continued to enhance and strengthen the link between the EALP project and the EAC Partner states through meaningful engagement of the Technical Counterparts (Focial Point Officers) and National Technical Teams (NTTs). The NTTs continue to play a crucial role in the planning and implementation of the HIV sero-behavioural studies and other programme activities in the respective Partner States. The EALP programme has developed a Communication Strategy that has since facilitated effective sharing of information amongst the partners. As part of strengthened coordination, there are evident technical and policy links between the EALP and the HIV&AIDS Councils/Commissions of the EAC Partner States. There are established regular stakeholder forums at national and regional levels that enable the partners to discuss progress in implementation of activities and suggest solutions to fast tract the activities. Development of the Programme Implementation Manual is underway. When completed, the document will define the scope of the programme, clarify the roles of the different partners and how the programme activities contribute to the ongoing interventions in the respective countries.
Activity Two: Development of the Monitoring, Evaluation and Health Management Information System (M&E/HMIS)
Establishment of a regional programme M&E/HMIS is ongoing. The first phase which encompassed assessment of the existing M&E/HMIS capacities of EALP partners, LVBC, EAC and Partner States has been completed. The regional M&E system and the web-based and Geographical Information System (GIS) enabled HMIS will be hosted at the LVBC interlinked with the EAC database and HMIS of the Partner States. In addition, each of the EALP partners will develop organizational Management Information Systems (MIS) which will be linked to the system at LVBC. The system will provide a one-stop information hub on HIV&AIDS, as well as other socio-economic data on the Lake Victoria Basin. It will also ease data comparability across the Partner States, and facilitate harmonization and standardization of data capture, analysis and reporting on HIV&AIDS and other development indicators across the EAC region generally, and the Lake Victoria Basin specifically.
Activity Three: Gender and Rights Based Approaches (GRBA) Mainstreaming
The EALP programme has developed regional Gender and RBA mainstreaming guidelines. Each sector of focus is in the process of identifying strategies for customizing the guidelines. A regional HIV and AIDS and gender mainstreaming workshop for the universities was held in Dar es salaam, Tanzania on the 26th to 28th November 2008. The IUCEA was mandated to form a taskforce comprising of gender and HIV and AIDS specialists from universities in East Africa to review the generic GRBA mainstreaming guidelines with a view to customizing them to reflect the situation in the higher education sector. In the fisheries sector, a regional meeting on Gender and Rights Based Approaches and HIV/AIDS mainstreaming was held from 11th to 13th March 2009 in Mukono, Uganda. A task force to spearhead the customization of the GRBA guidelines and development of the gender and HIV and AIDS mainstreaming manuals was formed. The task force is currently in the process of customizing the GRBA guidelines and shall report back their progress to the stakeholders in May 2009. Sensitization on Gender and RBA mainstreaming in the agricultural plantation sector is ongoing.
Objective Two: To promote the harmonization of HIV and AIDS policy frameworks and practice for mobile populations across the East African region.
Activity One: Advocacy for harmonization of HIV&AIDS
The EALP programme has continued to front the HIV&AIDS advocacy agenda for mobile populations in policy level fora of the EAC. The programme progress report was presented at the 3rd meeting of the EAC Council of Ministers of Health held from 22nd to 26th September 2008 in Arusha Tanzania and the 4th meeting of the EAC Sectoral Council of Ministers of Health held from 23rd to 25th March 2009 in Nairobi, Kenya. In the respective meetings, the EALP programme emphasized the need for Partner States to expedite the process of constituting and mandating the Multi-sectoral National Technical Teams (NTTs) and also meaningful involvement of the NTTs in offering technical and policy guidance to implementation of the programme. In addition to the HIV pandemic, the Sectoral Council of Ministers of Health recommended to the Sectoral Council for LVB the need for establishment of the position of Public Health and Sanitation at LVBC in order to address other Public Health related diseases that exacerbate the HIV epidemic in the LVB. Subsequently, the 6th Sectoral Council of Ministers for LVB approved the establishment of the position of Public Health and Sanitation at LVBC and also noted the magnitude of the HIV pandemic in the LVB and the need to fast track implementation of the activities of the EALP programme and possibly widen the scope of the programme to include other populations at risk.
In addition, LVBC hosted the 2nd EAC HIV&AIDS Multisectoral Transport Corridor HIV&AIDS Stakeholders conference from 19th to 22nd May 2009. Through this forum, the EALP Programme articulated HIV &AIDS issues of mobile populations in the LVB with special emphasis on the maritime transport corridor users. This advocacy forum recommended that the EAC Secretariat and its Organs and Institutions, Partner States, International and National implementers and Development Partners need to re-focus their HIV &AIDS interventions and resources to target mobile populations in the maritime transport corridor including Lake Victoria, its islands and beaches.
Activity Two: Documentation of programme activities and Best Practices
Since its inception the EALP has experienced and learnt a lot of lessons in respect to regional HIV and AIDS responses. As a means of sharing its experiences and lessons, the EALP has embarked on documenting its experiences. When finalized and published the document will provide guidance to other regional programmes on issues of partnership development and management, policy influencing and harmonization from a regional perspective as well as provide benchmarks on the engagement of governments in regional HIV and AIDS initiatives. In addition, the document will also provide guidance to future regional initiatives especially those that seek to influence policy.
Objective Three: To strengthen the capacity of select organizations of mobile populations to address HIV &AIDS related risks and vulnerabilities.
Activity One: Sector population-based studies HIV&AIDS Sero-behavioural studies
HIV sero-behavioural studies are being conducted among target populations necessitated by the lack of relevant and disaggregated HIV prevalence data on the fisheries, agricultural and education sectors in the East African region. What exist in each of the countries is aggregated general population data that gives little indication of the specific risks and vulnerabilities of mobile populations. It is difficult to plan on the basis of such data, nor make informed policy choices based on it. The studies are focusing on four main parameters namely: Mobility & sexual behavior; Service availability & utilization; Policy and coordination and Sero – prevalence. Studies have been completed in twelve universities in Kenya and Tanzania while the study in Uganda based universities is due to start in August 2009. Studies in the fishing and plantation sectors are underway.
Activity Two: Preparations for Pilot Interventions
EALP Partners conducted visits to all the nine (9) plantations and held fruitful discussions with the plantation management around the design and implementation of the pilot interventions. The LVBC is in the process of officially engaging the agricultural plantations; Memoranda of Understanding have been drafted and shared with the plantations. Once finalized, the MOU will pave the way for the plantations to submit action plans to LVBC for consideration. Gaps in HIV service provision in the target populations are being jointly identified. Initial HIV&AIDS interventions which will complement existing activities are due to commence. Other interventions will be initiated following evidence from the ongoing HIV sero-behavioural studies.
PROGRAMME MONITORING MEETINGS
The programme has held several consultative meetings that have helped clarify the roles of the different partners and also provided platforms for harmonizing work plans and budgets. The meetings also facilitated sharing of experiences with other regional organizations implementing HIV&AIDS activities in the Lake Victoria Basin. So far the EALP Partners Forum which brings together heads of the EALP implementing organizations, funding partners and other stakeholders has been held four (4) times since the initiation of the programme. The forum discusses implementation of the programme activities and offers guidance on how to fast track implementation. The Programme Implementation Team (PIT) meeting is a consultative technical meeting that plans and designs the programme activities and also allocates resources to the implementing organizations. The PIT has been convened six (6) times since the programme was launched. A mid-term evaluation of the EALP programme is planned for July 2009.
LESSONS LEARNT, CHALLENGES AND RECOMMENDATIONS
All institutions involved in the EALP Programme, at whatever level – demand some form of ownership. This has become apparent in working with third-tier organizations – universities, agricultural plantations and fishing communities. Each organization and individuals involved thereof want to feel a sense of ownership in the activities they are undertaking. The sense of ownership is critical for the sustainability of the outcomes the EALP programme intends to achieve.
As a broad-based partnership, the reality is that institutions and individuals have vested interests. The EALP programme has learnt that such interests need to be managed – whether they are from the consulting teams, technical teams, or the primary EALP institutional partners. The mechanism for managing these interests is through regular consultative meetings.
Communicating through clearly established channels and providing sufficient information is important. Over time, the EALP partners have learnt that any lapses or delays in communication result in frustration across the Partnership. It is hoped that the M&E/HMIS system will ease this.
Multiple levels of ownership are difficult to sustain, and with ownership comes expectations from partners that may be difficult to meet within the mandate of the EALP programme.
The EALP programme has established a standardized Daily Subsistence Allowance rate at the regional level. However, rates paid in-country still vary across the Partner States. This fairly benign issue has been difficult to deal with. This challenge needs to be handled, because it distracts focus of the teams from pertinent issues and creates unnecessary tension in the Partnership. To overcome it, the programme is in the process of having in-country negotiations with the respective national technical teams (NTTs).
Linkages between the EALP and the NTTs in some countries remain a challenge. The technical support provided by the NTT is invaluable, but in some countries the NTTs have made demands that are not easy to accommodate. This challenge remains unresolved in some Partner States but Senior Officials in the focal point ministry (Health) have been informed and it may be resolved in due course.
NTTs and Technical Counterparts are a key structure in the EALP programme given the need for ownership and sustainability of the programme by the Partner States. The lifespan of the programme based on the initial design and donor funding ends in April 2010. However, implementation of most of the activities has just started due to delays in the planning stages of the programme. Furthermore, the programme is being integrated into the wider EAC Muslti-sectoral HIV&AIDS Strategic Plan 2008-2012.
In line with the above, it is recommended that:
The offices of the EALP Technical Counterparts (Focal Point Officers) need to be strengthened in terms of provision of resources to facilitate national coordination of EALP programme activities.
The programme be extended on a no-cost basis for at least one year after April 2010 to allow for completion of the just initiated activities
The process of integrating the programme into the EAC Multi-sectoral HIV&AIDS Strategic Plan (2008-20012) be clearly described and documented
PROJECT EXPECTED OUTPUTS
The EALP Programme has eight (8) main expected outputs namely:
Development of a coordination framework by LVBC
Strengthening the capacity of key EAC institutions (LVBC, LVFO, and IUCEA) and other regional networks on implementation of HIV & AIDS interventions.
Development of an M&E framework and a Health Management Information System (HMIS).
Mainstreaming gender and Rights Based Approaches into HIV and AIDS policies and programmes targeting mobile populations
Sector-specific sero-behavioural studies on fishing communities, agro-plantations and universities
Piloting innovative models of service provision for the three mobile populations
Influencing harmonization of HIV and AIDS policies on mobile populations at national and regional levels
THE FUNDING AGENCY AND LEVEL OF FUNDING
The EALP Programme is funded by the Swedish and Norwegian governments through the Swedish International Development Agency (Sida). The total fund for the programme for a period of three years is US$ 6,443,251. Funding is channeled through the Swedish/Norwegian HIV&AIDS Regional Office for Africa based in Lusaka Zambia to AMREF then to the implementing partners.
The planning stage of the EALP Programme took longer than expected because of the complex partnerships involved. However, the programme activities are now on course and tangible outputs are being realized.