Namibia
Participatory Learning Assessments for Community Mobilization in Namibia
Activity Dates
2003 and ongoing
Activity Summary
In 2003, HCP in Namibia was challenged with developing health communication interventions to (1) reduce the incidence of HIV infections, (2) increase access to HIV counseling and testing, treatment and prevention of mother-to-child transmission services, (3) help coordinate and harmonize communication interventions, and (4) design, plan and undertake a strategic information system to give program implementers the information they needed to plan interventions, as well as track behavioral changes over time.
HIV prevalence in Namibia was 22% (UNAIDS, 2002), with significant regional variations. Communication efforts were largely focused on mass media approaches to condom promotion and stigma reduction. Community-based responses were limited and organized largely by the churches.
Through discussions with civic and community leaders, community members, and program implementers, it was found that, although awareness of HIV was almost universal, there was little appreciation of the ways that the behavior of individuals and community norms might fuel the epidemic, and community members had little confidence that they could effect change.
HCP decided that the initial goal of communication efforts should be to help stimulate a collective sense of understanding and ownership of the problem, and a move away from passive fatalism through increased community participation and increased individual and collective self-efficacy. The team also wanted to gain a better appreciation of how the different sections of the communities understood and conceptualized HIV so as to better contextualize communication messages to fit the reality of people’s every day lives. The challenge was how to do this at scale in an incredibly diverse country.
HCP decided that its initial response to the first two challenges was to facilitate participatory, reflective processes about HIV/AIDS in representative communities of the target population, as this would be the best hope of reducing individual and community paralysis in response to HIV. Through a process of community dialogue, communities could articulate their problems and identify collective solutions resulting in action towards necessary social change. One of the most eloquent and influential theorists for this type of approach is the Brazilian educator, Paulo Friere (1972). Friere emphasized that through dialogue and reflection the most marginalized in society would be better able to comprehend and analyze their situation, find their voice, and effect necessary, contextually appropriate and sustainable social change.
Central to this approach is the principle that those infected and affected by the epidemic must participate in the analysis of their own problems. As opposed to top-down approaches, participatory community mobilization helps communities and implementers better understand how they see and understand their problems and helps them identify their untapped community assets; therefore, the process acts as an intervention in and of itself. It is a process that fosters hope by helping community members appreciate that they have the power and tools at their disposal to create real and lasting change.
HCP’s Community Mobilization Activities (CMA) program was developed using a Participatory Learning and Action (PLA) approach. Following is a description of the participatory communication intervention, which HCP has implemented using the tool, For People Like Us, in sixteen sites across Namibia and reaching approximately 4,000 people.
Community leaders meetings. This is the first step in the assessment process. Community leaders are informed that the activity they are about to undertake will stimulate discussion about issues that most people find uncomfortable discussing in public, e.g., sexual behavior, gender relations, alcohol and substance misuse, partner abuse, and their relationship with the church. In particular, sexual behavior would be explored in some depth: Without the community having a collective understanding of how HIV had become such a problem, it would be unlikely that a collective response could be successfully agreed upon and developed. At this meeting, HCP gets the community leaders’ permission to work in their area and asks them to identify a section of their community in which the assessment can take place.
Trained peer facilitators. Peer facilitators, selected by the community leaders, are trained during a week-long workshop on how to facilitate community dialogue among their own peers using the participatory assessment tool, For People Like Us. The aim of the training is to help the facilitators understand and practice dispassionate observation, gain skills in encouraging dialogue and reflection, and learn the skills necessary to guide and support the participants through the assessment exercises.
Peer facilitator-led sessions. Information is collected via peer facilitator-led focus groups. In total, four focus groups take place with approximately 15 members of six peer groups: young women/young men aged 16-25, women/men aged 25-45, older women/older men aged 46+. The information-gathering exercises are done using symbols so as not to exclude those in the community who might be illiterate. As we are interested in understanding the collective perception and behavior of the distinct peer groups, we ask the peer representatives to answer all the questions asked by thinking about it “for people like you.” Although this approach has its limitations, it allows for more candid discussion of sensitive issues and also helped the community and the program understand better the varying needs and perspectives of the different peer groups.
Plenary community meeting. Following completion of the peer sessions, a community meeting is held where each of the peer groups feed back to the larger community their own responses to the questions asked. This format proved essential to the process of helping the communities explore, for instance, collective taboos about sexual behavior, sexual partner preferences, and collective perceptions of “blame” and “innocence” that were associated with stigmatizing behaviors. Following the presentation of results, there was much community dialogue and debate about the findings. This led to the community members collectively developing a vision of what changes they would like to see in their community in three years' time and how they might achieve that vision.
Develop Community Action Forums (CAFs). To sustain the process, each community developed a Community Action Forum, which is a small group of men and women between the ages of 16 and 46+, elected by the community, to act as the community’s coordinating body for the various interventions implemented by community members. The CAFs work in close cooperation with provincial HIV/AIDS coordinating mechanisms as well as all local actors--hospitals, clinics, NGOs, CBOs, FBOs--working in the area of HIV/AIDS and community development. To help build the capacity of these forums and nurture incipient initiatives, some communities had the on-site support of Peace Corps volunteers and all have regular contact and support from HCP staff and other local NGOs.
This holistic and dynamic approach helps each peer group, and the community as a whole, gain a better understanding of how the attitudes, beliefs and behaviors of each of the peer groups influence both individual and collective risk of HIV/AIDS. It also helps the communities identify those most vulnerable to infection and discrimination and those most in need of protection. It also helps identify the factors that enable or inhibit members of a community being able to access health care and other services. What emerged so powerfully in all the groups was the collective recognition that they needed to find ways of addressing the underlying factors that increase vulnerability to HIV infection: stigma, alcohol and drug use, gender and sexual norms, violence, and fear of change. After each assessment, a comprehensive CMA report is written up and shared with the community as well as other partners and stakeholders.
CMA soon became HCP’s core intervention, supported by a variety of behavior change communication initiatives. Through the CAFs, the communities are implementing HIV/AIDS-related interventions based on their own analysis, with the support of, and in collaboration with, HCP and other local actors. Baseline and mid-term household and social network analysis data continue to be collected to try to quantify changes in risk perception, individual and collective efficacy, as well as knowledge, access and use of services.
Research Reports/Publication
13 Assessment reports:
- Rehoboth Block B
- Rehoboth Block E
- Oshikuku
- Rundu
- Walvis Bay
- Nyangana
- Oshakati
- Grootfontein
- Gobabis
- Otjiwarongo
- Keetmanshoop
- Oniipa
- Katutura
Materials & Tools
Audience
Young men and women 16-25yrs, men and women 26-45yrs, older men and women 46+, PLWHAs
Partners
Regional govenors, traditional and religious leaders, Regional AIDS Coordinating Committees, Social Marketing Association, treatment hospitals, Catholic AIDS Action.
Back to Namibia
Note about materials: Some of the materials and resources listed on each page are available in their full form, others are represented by image or citation only. For more information and resources, go to www.jhuccp.org
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