Findings - Africa Region

Findings Infobriefs reports on Good Practice in ongoing operational, economic and sector work carried out by the World Bank and its member governments in the Africa Region. It is published monthly by the Knowledge and Learning Center on behalf of the Region. The views expressed in Findings are those of the author/s and should not be attributed to the World Bank Group.

IMPORTANT NOTICE: Effective November 2004, Findings and InfoBriefs will only be
available electronically. Register your e-mail address at www.worldbank.org/afr/findings
to continue receiving the electronic version.

The Gambia : Community-based Response to HIV/AIDS - Lessons Learned from BAFROW

Introduction

BAFROW is a local women’s NGO in The Gambia that is considered an example of “best practice” for its holistic and community-based approach to the promotion of healthy behavior, women’s activities and the fight against HIV/AIDS. A knowledge and learning team from the Africa Region’s Quality and Knowledge Department visited the NGO in January 2003 and the BAFROW team shared the lessons learned, the challenges encountered and the successes they have encountered thus far. The debriefings ( videotaped open-ended interviews ) on which this article is based, included many prominent members and leaders of local NGOs and HIV/AIDS projects.

BAFROW has been in operation for 11 years and offers services and preventive care to all members in their community, including men and youth. Their model is based on a holistic/integrated approach centrally based on the concept of the “Well Woman”. As a community-based organization, members of the community are involved in all aspects of community development, including identifying their problems, needs, and the culturally sensitive actions to resolve them.

One of the main features of BAFROW’s interaction with the communities is that each community has identified individuals as focal points to be consulted on the various issues that arise. BAFROW is headed by a Director who is assisted by a Program Officer. In addition, each of the following programs has a focal point person:

Adult literacy and skills development
STIs/HIV/AIDS
Family Planning services
Education about Harmful Traditional Practices/FGM
Youth Groups
Income generating activities

Lessons Learned

Integrated strategies must be designed in close collaboration with communities in order to sustainably incorporate health care and income generating activities. For example, following the massive sensitization on HIV/AIDS, communities want to be closely involved with what is happening on the ground.
Sensitizing people on HIV/AIDS is an ongoing activity : “they graduate from one level to another – they started meeting as a community, to being involved – now they are writing their own stories in newsletters. This has more impact.”
Provide continuing assistance to the extent possible “One cannot just come here and put up a well and leave it or put up a skill center and go’. What is required is to assist the community in determining how the people are going to continue maintaining the asset created.
The role of the Bank is to work with the community to elaborate strategies – this may involve providing them with resources and equipping them with the necessary skills. After making this investment, the Bank should give the community space to take the lead.
Building the community’s trust is a prerequisite for engaging in community development activities. With regard to BAFROW, the trust that was built with the community helped break or dispel many taboos. BAFROW also came to be regarded as a part of the community.
The holistic approach used by BAFROW has proven effective in increasing awareness about HIV/AIDS through education, participation and counseling.
Appoint a focal person, somebody that members of the community can consult on issues and seek advice from. The community has grown comfortable with this notion and discusses their issues quite confidently.

Challenges

Male participation is crucial for empowering women - Many women will not join the family planning program unless the men are convinced. Initially, “male” participation was a problem, but now not only are they participating actively but are competing with the women in activities.
Increasing levels of literacy has increased awareness, and not only of health issues. The community now appreciates that education is key to development. This education has helped communities to break their silence on many issues and to change negative beliefs and attitudes.
Addressing the root causes of the disease. Development of skills and improvement of lifestyles through income generating activities such as tie and dye batik designs on fabrics, soap-making, and bakery help to address issues of poverty and low economic status. BAFROW and the community hope that further developing these schemes will generate more income and help people to improve their lifestyle. In the long term, this would reduce their economic vulnerability and exposure to HIV/AIDS.
Providing ongoing assistance. UN agencies such as the WHO office have funded the development of communication materials and awareness raising activities. However, these are stand-alone activities, not ongoing assistance. The National AIDS Secretariat (NAS) is assessing a proposal for funding the replication of this type of project in other divisions.

Future Plans

Scaling up the BAFROW concept into other communities/projects.
Strengthening the existing Center – the need to intensify skill development, education, community advocacy activities, HIV sensitization, volunteer testing and counseling services..
Sustainability and integration of activities . These services need to be replicated all over the country and the lessons learned disseminated to other community-based organizations

Update

Since the team’s visit, BAFROW has expanded its activities as well as its facilities. A new “model” village was inaugurated in July 2004. New services such as HIV/AIDS testing and cervix screening and treatment are being offered. The new facility also has a place for women to sell their goods. BAFROW is also now offering some services on a fee-paying basis and continues to be a successful model of community empowerment.

This Good Practice Infobrief in based on interviews conducted inThe Gambia in January 2003. The debriefing was organized by the Knowledge and Learning Group of the Africa Region (AFTKL). We would like to thank staff from the Gambia National AIDS Secretariat and BRAFOW for making it possible. The note also benefited from inputs from John F. May, Task Team Leader of the Bank HIV/AIDS Rapid Response Project (HARRP).


	No. 108 January 2005
	*Findings Infobriefs* reports on Good Practice in ongoing operational, economic and sector work carried out by the World Bank and its member governments in the Africa Region. It is published monthly by the Knowledge and Learning Center on behalf of the Region. The views expressed in Findings are those of the author/s and should not be attributed to the World Bank Group. IMPORTANT NOTICE: Effective November 2004, Findings and InfoBriefs will only be available electronically. Register your e-mail address at www.worldbank.org/afr/findings to continue receiving the electronic version. The Gambia : Community-based Response to HIV/AIDS - Lessons Learned from BAFROW Introduction BAFROW is a local women’s NGO in The Gambia that is considered an example of “best practice” for its holistic and community-based approach to the promotion of healthy behavior, women’s activities and the fight against HIV/AIDS. A knowledge and learning team from the Africa Region’s Quality and Knowledge Department visited the NGO in January 2003 and the BAFROW team shared the lessons learned, the challenges encountered and the successes they have encountered thus far. The debriefings ( videotaped open-ended interviews ) on which this article is based, included many prominent members and leaders of local NGOs and HIV/AIDS projects. BAFROW has been in operation for 11 years and offers services and preventive care to all members in their community, including men and youth. Their model is based on a holistic/integrated approach centrally based on the concept of the “Well Woman”. As a community-based organization, members of the community are involved in all aspects of community development, including identifying their problems, needs, and the culturally sensitive actions to resolve them. One of the main features of BAFROW’s interaction with the communities is that each community has identified individuals as focal points to be consulted on the various issues that arise. BAFROW is headed by a Director who is assisted by a Program Officer. In addition, each of the following programs has a focal point person: Adult literacy and skills development STIs/HIV/AIDS Family Planning services Education about Harmful Traditional Practices/FGM Youth Groups Income generating activities Lessons Learned Integrated strategies must be designed in close collaboration with communities in order to sustainably incorporate health care and income generating activities. For example, following the massive sensitization on HIV/AIDS, communities want to be closely involved with what is happening on the ground. Sensitizing people on HIV/AIDS is an ongoing activity : “they graduate from one level to another – they started meeting as a community, to being involved – now they are writing their own stories in newsletters. This has more impact.” Provide continuing assistance to the extent possible “One cannot just come here and put up a well and leave it or put up a skill center and go’. What is required is to assist the community in determining how the people are going to continue maintaining the asset created. The role of the Bank is to work with the community to elaborate strategies – this may involve providing them with resources and equipping them with the necessary skills. After making this investment, the Bank should give the community space to take the lead. Building the community’s trust is a prerequisite for engaging in community development activities. With regard to BAFROW, the trust that was built with the community helped break or dispel many taboos. BAFROW also came to be regarded as a part of the community. The holistic approach used by BAFROW has proven effective in increasing awareness about HIV/AIDS through education, participation and counseling. Appoint a focal person, somebody that members of the community can consult on issues and seek advice from. The community has grown comfortable with this notion and discusses their issues quite confidently. Challenges Male participation is crucial for empowering women - Many women will not join the family planning program unless the men are convinced. Initially, “male” participation was a problem, but now not only are they participating actively but are competing with the women in activities. Increasing levels of literacy has increased awareness, and not only of health issues. The community now appreciates that education is key to development. This education has helped communities to break their silence on many issues and to change negative beliefs and attitudes. Addressing the root causes of the disease. Development of skills and improvement of lifestyles through income generating activities such as tie and dye batik designs on fabrics, soap-making, and bakery help to address issues of poverty and low economic status. BAFROW and the community hope that further developing these schemes will generate more income and help people to improve their lifestyle. In the long term, this would reduce their economic vulnerability and exposure to HIV/AIDS. Providing ongoing assistance. UN agencies such as the WHO office have funded the development of communication materials and awareness raising activities. However, these are stand-alone activities, not ongoing assistance. The National AIDS Secretariat (NAS) is assessing a proposal for funding the replication of this type of project in other divisions. Future Plans Scaling up the BAFROW concept into other communities/projects. Strengthening the existing Center – the need to intensify skill development, education, community advocacy activities, HIV sensitization, volunteer testing and counseling services.. Sustainability and integration of activities . These services need to be replicated all over the country and the lessons learned disseminated to other community-based organizations Update Since the team’s visit, BAFROW has expanded its activities as well as its facilities. A new “model” village was inaugurated in July 2004. New services such as HIV/AIDS testing and cervix screening and treatment are being offered. The new facility also has a place for women to sell their goods. BAFROW is also now offering some services on a fee-paying basis and continues to be a successful model of community empowerment. This Good Practice Infobrief in based on interviews conducted inThe Gambia in January 2003. The debriefing was organized by the Knowledge and Learning Group of the Africa Region (AFTKL). We would like to thank staff from the Gambia National AIDS Secretariat and BRAFOW for making it possible. The note also benefited from inputs from John F. May, Task Team Leader of the Bank HIV/AIDS Rapid Response Project (HARRP).