FAITH-BASED CAPACITY BUILDING FOR HIV/AIDS INTERVENTION PROGRAMS IN THE NORTH WEST PROVINCE OF CAMEROON Dr. NSAGHA D.S.

1. FAITH-BASED CAPACITY BUILDING FOR HIV/AIDS INTERVENTION PROGRAMS IN THE NORTH WEST PROVINCE OF CAMEROONDr. NSAGHA D.S. (Ph.D)

2. 1. CONTEXT In Cameroon, it is estimated that 40.2% of the population live below the poverty line. The North West province is among the three provinces with the poorest rural dwellers. This is not only explained because it is among the most populated provinces but also her poverty index is the fourth behind the Far North, North, Adamawa and East provinces (Table 1).

3. Poverty and HIV/AIDS are interwoven in many ways. Poverty can lead to the absence of preventive measures which entails high prevalence of many diseases including HIV/AIDS. (Figure 1 gives a conceptual framework of the manifestations and causes of HIV/AIDS in local communities and schools in Cameroon). Poverty is related to poor hygiene and sanitation, risky sexual behavior: promiscuity, unprotected sex, sex at young age, inappropriate awareness raising and behavioral change interventions.

4. In 1997, Meeker and Calves found that in Cameroon, all boyfriend/girlfriend relationships have an economic component, either sexual experience and satisfaction, or marriage, or for other economic benefits. This shows that younger age people are exposed to HIV/AIDS in the country because of poverty. Sexual promiscuity among the female folk especially young girls and ladies, students in institutions of higher learning and commercial sex workers is on the increase because of poverty and economic hardship. Migration of rural poor girls to the big cities in search of jobs as house helpers, babysitters and apprentices continue but most of them end up as prostitutes in what is known as “chicken parlours” to raise money for themselves and the poor parents back in the villages.

5. For a good multisectorial and multidisciplinary approach to the prevention of HIV/AIDS and other STIs in FBOs, human, economic and organizational resources are needed to combat this scourge. Human resources include knowledge, expertise, time and money. Economic resources include activities that generate money and well being: community organization to support PLWH and affected families include women associations, youth groups, religious groups, etc. The fundamental causes of poverty include physical and technological conditions (such as lack of competence), social (such as means of livelihood and gender issues), economic, political and ideological factors.

6. 2.0JUSTIFICATION OF THE PROJECT The government of Cameroon has identified the fight against HIV/AIDS as one of the urgent actions in the strategy of the poverty alleviation programs. In the partnership with international organizations and the mass media, the strategy is based on mass sensitization and information on the HIV/AIDS pandemic among highly susceptible groups. This falls in line with the global strategy of HIV/AIDS and other STIs prevention adopted by the UNO and its agencies, USAID and the European Union.

7. 2.1 HIV/AIDS AND FBOs In some countries, for example, USA, South Africa, Nigeria, FBO interventions for the prevention, care and mitigation HIV/AIDS are at a very advanced stage. For example, the Catholic archdiocese of Durban has an AIDS Care Commission involved in parish mobilization to fight HIV/AIDS. FBO teachings on HIV/AIDS prevention and other STIs in Cameroon is not a new concept but the problem is that it has not been focused and each church struggles in her own way to address this problem. By 1998, the Cameroon Baptist Convention churches and hospitals had trained pastors as counselors for HIV/AIDS prevention.

8. Churches are very well structured organizations in Cameroon since before independence. These churches set pioneer roles in the education and health systems which are landmarks in the history of this country. Churches are institutions that can play a major role in the communication for change of behavior towards HIV/AIDS prevention, care and mitigation. They have responsible leaders who are less engaged in irresponsible sexual life who can act as models for congregational members to follow. Churches can change the lives of many of its members towards living a responsible life through sermons with interludes on HIV/AIDS prevention, care and mitigation.

9. 3. DESCRIPTION OF THE PROBLEM TO BE ADRRESSED About 70% of persons infected with the HIV in the world are from Sub-Saharan Africa where more than 29 million people have HIV/AIDS. Of this number, 10 million are young people and 3 million are children. HIV/AIDS is a public health problem of primary importance in Cameroon that poses social, cultural and economic problems to the victims, their immediate families and the community. Most deaths from HIV/AIDS in the country are adolescent who are in their economic active life.

10. There has been a relentless effort by the government, national and international organizations and NGOs to fight against HIV/AIDS in Cameroon. The driving force in the fight against HIV/AIDS in Cameroon is the strong political commitment of the government through the creation of the National AIDS Control Committee (NACC) coupled with bilateral and multilateral support from the UNO and its agencies (UNFPA, WHO, UNICEF, UNDP, UNAIDS), the World Bank, European Union, CIDA and USAID. Following these efforts, 20 million condoms have been distributed to the local population (Zekeng, 2003). With the creation of the Cameroon children’s parliament in 2001, the political will of the government may be more focus on adolescents and children.

11. Since the first case of HIV/AIDS in Cameroon was reported in 1985, there has been a steady increase in the HIV/AIDS prevalence in the North West province. This province is ranked fourth among all the ten provinces in the country after Adamawa, Far North, and the South West with a prevalence of 11.5 % in 2000. By 2002, this prevalence rose to 12 % corresponding to the country prevalence. In the Menchum and Donga-Mantung divisions, the HIV/AIDS prevalence is high.

12. 4. DEFINITION OF CAPACITY BUILDING Capacity development or building has been severally defined as: ·Increasing the potential or suitability of performing a certain function.·An explicit outside intervention to improve an organization’s performance in relation to its mission, context, resources and sustainability (INTRACT, 1994)·A process by which individuals, groups, institutions, organizations, and societies enhance their abilities to identify and meet development challenges in a sustainable manner (CIDA).·

13. 5. OBJECTIVES 5.1 Goal of capacity building Amelioration of the prevention, care and mitigation of HIV/AIDS and other sexually transmitted infections in faith-based organizations.

14. 6. COMPONENTS OF CAPACITY DEVELOPMENTThis study has been designed taking into consideration the following components of capacity development as proposed by FHI. Capacity development can be defined as a process in which human resources, as well as organizational and operational capabilities of institutions, are improved to better perform priority functions. The overall purpose of capacity building in expanded and comprehensive responses to HIV/AIDS is to ensure effective design, implementation, coordination and management of wide-scale prevention, care and support efforts.

15. Sustainable capacity development requires creating new or employing existing systems, through which one or more of the above components can be operationalized on a sustainable basis. Adopting a participatory process to develop a strategy and approach to capacity development is as essential to eventual success as the strategy itself. It is important that members of the target audience for capacity development participate in identifying and prioritizing needs; selecting the most appropriate methodologies, media and general approaches adopted.

16. 7.DESCRIPTION OF THE INTERVENTION 7.1 Study areaThe intervention will take place in the Donga-Mantung and Menchum divisions of the North West province of Cameroon (See Map). The population of Donga Mantung division (226452 inhabitants) is principally rural with two major towns: Nkambe and Ndu. Nwa, Misage and Ako are smaller sub-divisional head quarters. The main ethnic groups are Wimbum, Mfumte, Yemba, Nchanti, Hausa, Bessa and Fulanis. The population of Menchum division is 119,921. Menchum division is predominantly rural with Wum being the only town. Menchum division is an enclaved area. The principal ethnic groups are the Aghem, Essimbi, Fulani, Esua and Nyos.

17. 7.2. Justification of the Study Area In the North West province, apart from Bamenda that is the capital and commercial chief center of the province with high numbers of prostitutes and bars, the rest are borders towns. The border towns are transports routes used by business men along the Nigeria-Cameroon border [it is worth noting that France is the highest exporter of goods to Cameroon followed by Nigeria (Agenda des Douanes camerounaises, 2003)].

18. 7.3. Type of StudyThis is an intervention program comprising of the following components :i) FGDs and I Is in the congregation (church members)ii) Pre-test study to fine-tune the questionnaire and test the acceptability of the instrument. iii) Intervention: pretest to make a needs assessment of the church members  training the pastors to give sermons on HIV/AIDS prevention, care and mitigation  Post-test or final evaluation to assass the intervention.

19. 7.4. Result ChainBaseline survey (KAP survey) : 2 months- Development of FGD/I I and questionnaire guides.- Training of interviewers.- Pre-testing of the baseline data collection instruments.- Conduct FGDs and I Is which will give more knowledge on beliefs and practices relating to HIV/AIDS. They will also help to fine-tune the questions and change ambiguous questions in the questionnaire.- Interview using structured Questionnaires.

20. 8. IMPLEMENTATION The authorization to carry out this HIV/AIDS intervention program will be obtained from the Ministry of Public Health. Contacts will be established with the NACC. In the North West province, this letter of authorization will be presented to the provincial delegate of Public Health and the provincial coordinator of the NACC and in the Donga-Mantung and Menchum divisions, to District Medical officers and representatives of the NACC. The same procedure will be used to contact the authorities of faith-based organizations ( churches and mosques) at the provincial level and in the two divisions.

21. A similar questionnaire that was addressed to the congregational members to assess their needs vis-à-vis HIV/AIDS prevention,care , and mitigation will be administered to them again. There will be mid-evaluation evaluation of the intervention program every six months by an external evaluator. The output of the congregational members on the pre- and post-test interviews will be evaluated after a thorough analysis using appropriate statistical packages. Reports will be prepared and sent to the NACC, sponsoring bodies and all faith-based institutions after each activity is finished.

22. An HIV/AIDS prevention, care and mitigation and other STIs manual will be developed from all the activities above for all faith-based organizations in collaboration with our partners. An institutionalization of sermons/teachings in all faith –based organizations incorporating HIV/AIDS prevention, care and mitigation and other STIs will be carried out with the assistance of FBO leaders/authorities and the manual on curriculum development In each village among the different FBOs, HIV/AIDS communities such as AIDS clubs shall be formed at different strata of the congregation. These shall be supported by traditional authorities (chiefs, quarter heads, sub-chiefs) and village development organizations.

23. 8.1. Multi-sectorial CollaborationCollaboration will be established and sustained with government structures (NACC, Central and provincial technical groups) and the civil society (churches, mosques, and development associations) in order to create a synergy in our activities and increase cost-effectiveness. GRSP is, in effect a public health community-based association that focuses on multidisciplinary approach to solving health problems. The provincial and divisional delegations of public health as well as Presbyterian, Catholics, Baptist churches, etc. have a network of hospitals and health centers that fight for the prevention, care and mitigation of HIV/AIDS.

24. 8.2 Main Partners“Groupe de Recherche en Santé Publique” was recognized by Plan Cameroon due to her role in public health projects in Cameroon. GRSP is negotiating with Plan Cameroon in the design and implementation of HIV/AIDS intervention programs among children in Plan Cameroon Programe 2. Areas of the North West, Center and East provinces consisting of 10 health districts. GRSP works with community-based organizations to respond to orphans and vulnerable children (OVC) needs and PLWH in their communities.

25. The magnitude of HIV/AIDS pandemic is such that GRSP will continue to establish partnership with the UNO and its agencies (UNFPA, UNAIDS, WHO, UNDP, UNICEF), the World Bank, international NGOs, USAID, CIDA, French Cooperation, European Union, etc.

26. 8.3 Role of Major Organizational Groups/ Personalities1) village church organizations2) Church associations, churches, mosques, etc.3) Local village development associations4) Local NGOs5) Divisional delegation of health through hospitals, health centers.6) Provincial delegation of health.

27. Role interviewers They will administer pre- and post-sermons questionnaires to pastors, priest, FBOs members, etc. Three hundred and twenty four interviewers will be used in the 108 villages i.e. 3 per village.Role of church promoters (local supervisors): Fifty promoters shall be recruited and trained in the 8 sub-divisions of Menchum and Donga-Mantung i.e. 6 per sub-division with two reserves. Each promoter will take care of the villages and interviewers in the sub-division. They will ensure the smooth running of the project in the different villages ensuring that the methodology is followed.

28. 8.4. Chronology of ActivitiesThe intervention will take place from January 2004 to December 2005. The program is made of the following principal phases:1) Administrative phase 2) Baseline survey3) Preparation for the intervention4) Intervention phase5) Follow-up and evaluation.6) Final evaluation7) Data analysis8) Restitution of results 9) Institutionalization of the Strategy

29. 8.5 MANAGEMENT PLAN AND ORGANISATIONAL STRUCTURE The national AIDS control committee (NACC) will technically assist GRSP in the execution of the program against HIV/AIDS and other STIs which will be carried out by the GRSP and community-based organizations in FBOs of the study area. Plan International (a not-for-profit children-based community organization) has recognized the local role of GRSP in the fight against HIV/AIDS and other STIs in Cameroon. GRSP will benefit from the wide experience of Plan International in community-based prevention, care and mitigation of HIV/AIDS in this country.