Working Together for a Shared Future Conference Proceedings Nairobi Deaf VCT* Project First Quarter 2004 Activity Report *[VCT means Voluntary Counselling and Testing services in Kenya] Prepared by Joel Omondi. Contents. 1.0 Project fact file. 1.1 Contacts. 1.2 Management. 1.3 Staff. 1.4 Trainers/Supervisors. 1.5 Current Donors. 2.0 Objectives. 2.1 Short-term Objectives. 2.2 Long-term Objectives. 2.3 Banking. 2.4 Current Committee. 3.0 Activities. 3.1 Preparations. 3.2 Launch of TV Commercial. 3.3 Issues in Community Mobilization. 3.4 Official Opening. 3.5 Issues in Mobile VCT. 4.0. Mobile VCT activities. a. Karen. b. Githunguri. c. Ikinu. 5.0 Management Challenges. 5.1 Country-wide Expansion of Deaf VCT. 5.2 Integration With National Deaf AIDS Policy. 5.3 Staff Issues. 5.4 Community Mobilization. 6.0 Recommendations. 1.0 Project fact file. 1.1 Project Contacts Mumias South Road, Buru Buru, opp. Buru Buru Police Station. Epren Centre (with HFCK on ground floor). 3rd floor suite 17 & 20. Mobile: 0721 544434 Email: nairobideaf_aidsproject@yahoo.com or Kenyadeaf_aidsprogramme@yahoo.com 1.2 Management Boniface U Inyanya (Project Director) (Cellular: 0721 544 434) (SMS) Aggrey Akaranga (Project Interpreter/Administrative Director) (Cellular: 0722 622 604) Email aakaranga@yahoo.com Joel Omondi (Programmes Director) (Cellular: 0721 562 574) Email: ojooel2@yahoo.co.uk 1.3 Staff Henry Maina (Deaf male counselor). Moses Nteere (Deaf male counselor). Susan Mwikali (Deaf female mobiliser). Josephine Shisia Were (Deaf female mobiliser). Leah Muruka (Female counselor/interpreter). 1.4 Trainers/Supervisors. Liverpool VCT and Care Kenya. 1.5 Current Donors CDC. 2.0 Objectives 2.1. Short term To expand the Deaf VCT services countrywide through expansion of mobile VCT and opening other stand alone VCT sites. Continuous deaf awareness on the importance of knowing your HIV status through the use of sign language in direct communication. To develop effective Information, Education and Communication (IEC) materials for use in community mobilization and training. Increase the number of Deaf persons knowledgeable in community mobilization and VCT deaf counseling. Provide quality Counseling and Testing services to the Deaf and hearing clients who come for VCT services. Organize quality mobile VCT Sessions in each area with a target of Deaf participants countrywide. To provide community mobilization opportunities for the Deaf VCT to work effectively within partnership with the Liverpool VCT and Care Kenya. To build the capacity to manage the site within standards set up by the donor, the supervision and regulators in order to serve the Deaf community well. To effectively integrate the VCT project within the HIV/AIDS programme towards mitigation and prevention of the pandemic. Manage the project with technical keenness to enable continuity after the end of the current contract phase. 2.2. Long-term Arrest the increasing incidence and prevalence of HIV/AIDS and STD’s amongst the Deaf community through acquainting the Deaf people on risky Deaf culture behavioral change and ways to curb the pandemic. Unify and mobilize local and national efforts and resources in their fight against HIV/AIDS through appropriate and accessible Sign Language media to the Deaf people. Take over full management of the VCT project after one year and open other Deaf sensitive VCT sites in the country with the supervision of Liverpool and NASCOP. To provide anti-retroviral treatment of the Deaf living with HIV within quality and national standard treatment regimes, within an VCT integrated HIV/AIDS programming. 2.3 Project Banking: BANK: Kenya Commercial Bank A/C: 140287857. BRANCH: City Centre 2.4. CURRENT COMMITTEE MEMBERS: Dominic O. Majiwa. Judith Mahindu Isabel Mugure. Dr. Michael Ndurumo – K.I.E Boniface Inyanya - Project coordinator. Aggrey Akaranga - Project interpreter. Joel Omondi – Project Consultant. Rep. Ministry of Health. Donor Representative. 3.0 ACTIVITIES 3.1 Annual preparation The year began in earnest with the client flow well above weekly average. Mainly from local residents and from the deaf within the estates around the site who were yet to go back to college or technical schools. The site also began the first new year with plans of how to improve various areas foreseen as challenging. The main objective was to increase client flow through mobile VCT and community mobilization around the city of Nairobi. 3.2 Launch of the VCT TV commercial The VCT TV commercial that included the first Lady Mrs. Lucy Kibaki and one of our staff, Susan Mwikali Mugambi that was shot in the Mombassa Serena Beach hotel in December 2003, was launched on the 16th of January 2004 at the Panafric Hotel. 3.3 Community mobilization Community mobilization faced few challenges which caused a reduction in the total number of clients, both hearing and Deaf. The main challenges were related to transport and the introduction of the new user fees. 3.4 Official Opening The Nairobi Deaf VCT officially opened on the 14th February 2004, Valentines Day. The occasion saw various visitors from the donor community, VCT trainers and supervisors, partners, regulators and officials from the Ministry of Health. The Guest of Honor was the Deputy Ambassador American Embassy Mrs. Leslie Rowe who represented the American Ambassador Mr. Bellamy. Dr. Elizabeth Murum represented the main donor from CDC; the National AIDS Control Council (NACC) was represented by the deputy director finance and administration Mr. Mathew Chepkwony. 3.5 Mobile Deaf VCT Mobile VCT continues to be the client growth point for the site. The number of clients seen during mobile VCT sessions was higher than those able to walk in to the site. The number of Mobile VCT sessions was however lower than expected due to annual transitional issues and work planning. The two activities took longer than necessary and the initial mobile activities were delayed. We had in the month of January mobile sessions in Karen and Githunguri and Ikinu in the initial four months of the year. The sessions saw clients seen rise with between 11 and 20 per mobile session. The greatest challenge was deaf access to basic health services caused by the general understanding that the VCT is a health facility. The use of health facilities for the Mobile VCT sessions and the need for support and care after a session made it necessary to repeatedly visit the deaf communities periodically. This also helped them have access to the local health facility through the interpreter. The advance team was important in getting the necessary arrangements and in enabling the preparation of the areas for the mobile session. 4.0 MOBILE VCT Activities a) Karen Mobile VCT The Karen site was planned from November 2003 when the Mobilizers went to Karen to teach about AIDS and show videos. Karen was not possible in December due to the fact that Karen Technical School of the Deaf is an institution of learning and it was thought that it was not wise to have a session just before exams and when the students are going for holidays. They may not be able to manage their status while at home as many deaf people do not have better support structures than they have in schools and such institutions. It was one of the best sessions as the number of people tested was about 22 clients out of a school of over 70 students. Various materials were used, but especially video were used. Deaf youth are specific about the kind of materials used during awareness. They love materials that relate to the kind of behaviour common among them. Issue of AIDS and drug abuse, relationships and sex. The need for more awareness and school based support and care structures was seen. It was important that selected teachers be given training on support and care to enable them support the students in whichever status. The students were also positive about plans to establish AIDS clubs that would not only develop drama and sign songs to be used in school and other deaf awareness but will also go a long way in developing school capacity to support HIV positive students and teachers. There are plans to visit Karen every term or three times a year. b) Githunguri Mobile VCT The Githunguri clients mostly young families and deaf couples with their first or second child. They were more concerned about AIDS within the family. The issue of extra-marital affairs is quite common within the deaf as with the hearing community. The issue of and the importance of using a condom in the family. The Mobile Site used the local health centre. The Githungurii Health Centre and about 14 deaf people were given VCT services. Mobilization was done at the Deaf church in Githunguri area. c) Ikinu Mobile VCT The advance team comprising a counselor and mobilisers went to Ikinu on Friday 16th April and made the necessary arrangements for the Sunday event. About 14 deaf people were tested on the Sunday of April 18th in Ikinu. The organizers used the local chief’s office for the VCT service. And the mobilisers used various materials in mobilization are the normal posters, drawings and verbal question and answer sessions. The KNDAEP t-shirts also were a crowd puller during ikinu mobile VCT. 5.0. Management challenges Several management issues arose which needed to be addressed. The management because of lack of individual training from the supervision created accounts according to the standards of other donors. This was however found to be unsatisfactory and several accounting challenges arose from this. The new MOU which increased the amount allocated for community mobilization and Mobile VCT session to 30,000 to be reimburse through the project account. After the three months this MOU was again withdrawn due to theses issues in reporting. There were attempts by the management to for the supervisors to help build accounting capacity within their requirements, which was positively responded to but the MOU was terminated. The supervision also had the interest of taking over the management of the VCT from the Nairobi Association of the Deaf. However it was agreed that the current control of providing funds and salary payments directly be maintained but the administration be left with the NAD, Since this was a Deaf community project. This meant changes in the way mobilization and mobile VCT will be organized. The NAD had now no powers to organize these prime activities with funding from the LVCT. 5.1 Countrywide Expansion of VCT Services Issues arose if mobile VCT from Nairobi Deaf VCT would provide countrywide services or if it were possible for a donor to finance the training and establishment of other DVCT in the provinces as an expansion strategy. CDC once again funded the expansion programme and it was decided that other deaf people be trained and DVCT sites be established in the regions. Though this phase was shrouded with lack of transparency finally the Deaf organizations were involved in the activity phase. There was the issue of sustainability of stand alone VCT sites within the rural areas without integration issues with health institutions. The development of support structures that are independent of the health system. Hospital Integrated DVCT and the deaf friendliness of most hospitals was an issue to be considered. The development of the accessibility of these hospitals to the Deaf community as a strategy for AIDS management was an issue that needs to be looked into. The access to basic health care let alone the free ARV treatments by the Government is an issue that needs planning from the initial stages. Coming at a time when there were plans for countrywide expansion and in which a strong national Deaf organization Kenya National Deaf HIV/AIDS Education Programme (KNDAEP) had just received funds from the NACC for the National Deaf AIDS awareness project. Bearing in mind the importance of the Deaf VCT within the national Deaf AIDS management Programme. There was a strong need for partnership between the LVCT and the KNDAEP which also happened to control the management of NAD. KNDAEP saw that since they were involved in the development of the VCT and its management through NAD there was need for a) the Deaf organizations to have direct administration of the VCT projects in partnership with the LVCT. b) There was need to build the capacity of the groups to manage the VCT c) there was need for joint participation in project activities with the LVCT taking training, supervision and counseling management issues and deaf organizations taking community mobilization. Mobile VCT sessions are jointly done. 5.2. DVCT Expansion and Integration with National projects The management basis for countrywide deaf VCT expansion. This arrangement was made necessary by the fact that the success of the project depends on the ownership of the project by the deaf community irrespective of its shortcomings. These shortcomings should however be dealt with within the premise of project sustainability. The countrywide expansion, which has, began with the training of deaf persons from Nyanza, Western and Coast provinces will also be done within these premises. The LVCT will pay rent the salaried staff directly, but the local deaf organizations will be in charge of administration of the sites. This will integrate well with the national Deaf AIDS Management programme. This will also enable the deaf to have access to other health facilities in an environment in which deaf organizations also grow towards the objective of ultimately managing the sites themselves. Sustainability issues should be looked at in the eyes of mutual growth. DVCT Programme Partnerships that are mutually beneficial and participatory should be developed through out. Each partner should be built within its area of expertise. These should be done to enable sustainability and growth. 5.3 Staff Issues As work has increased, there has developed an acute shortage of staff for the various activities. The community mobilization activities organized by the LVCT and the community mobilization activities organized by the NAD or the KNDAEP. First they cannot be completely separated, yet they cannot be effectively staffed without additional staff and resources. It is hoped that with additional training and better use of the already trained staff they can help reduce the workload. Better planning and resourse management will also improve workflow. There was the need to make better use of staff trained in the first training, but who did not get a job. William Nyakinya and Lydia Wagatwe as counselors and Elizabeth Khamalla and Caroline Atieno as community mobilisers. They would be brought in to improve their practical ability and would be paid part time rates. The new training for the three provinces was also seen as important and already during the official opening of the Nairobi De4af VCT Dr. Murum of CDC pledged to support funding for expansion of the VCT services to the rural areas of which training is a component therein. LVCT meetings with the KNDAEP in this direction also indicated that the need for training deaf representatives from the various provinces. To this end selections were made from the Nyanza, Western and Coast regions. The KNDAEP was directly involved in the coast selections, which was done with a representative from LVCT Prince Bahati. KNDAEP was not directly involved in the regions of Nyanza and Western. Six deaf persons were selected in each of the provinces and two community mobilizers from the Central and Rift Valley. Adequate time was not available during planning to enable effective mobilizers from Central and Rift Valley. Mwamburi (interpreter), Ruth, Rose, Abdalla, Kagunya, Tsuma, and Truphosa were selected to training in Nairobi late April with others from other provinces. It is hoped that expansion will enable the acute staff shortages to be eased. This will give way to an effective national mobilization and education of the deaf community countrywide. Publicity of the Deaf VCT The NAD and the KNDAEP made several attempts to increase publicity of the Deaf VCT. This was necessary due to poor accessibility and awareness among the policy makers of the status of close to a million Kenyans who are deaf and do not have access to health facilities due to communication barriers. This media campaign however had side effects that gave the wrong impression of things, and also brought images not conducive to VCT growth. There were people who felt that the high media publicity will play into the hands of those opposed to VCT sites which do not have laboratory assistants. But this was a media campaign that could not be stopped as the DVCT was the first health facility in which service was in sign language. The need for more health personnel who know sign language cannot be overemphasized. The project got publicity from local and international media; including BBC radio, New York Times, Internet media sites, California News, and various international health journals. Locally the DVCT project had a good amount of press the Nation Newspaper, the Standard newspaper, the people newspaper, the Nation TV, KBC and the KTN. KNDAEP plans to continue with the media campaign to enable the deaf community has access to equal life opportunities as the hearing especially within the implementation of the Disability Act. 5.4 Community Mobilization There were various challenges to this activity. The main problem was the transport crisis, which made it difficult for the mobilisers to organize facilitation activities within the city centre. The issue of KSL materials continues to bog down community mobilization. The KNDAEP is in the progress of developing various materials in KSL to be used not only within VCT community mobilization, but also in education programme within Deaf sensitive health facilities and organizations. Community mobilization was done in the following areas: Different Deaf business areas in town area periodically at the areas where deaf people do business and always mobilisers can get 5 deaf people per day from various parts of the country. Deaf churches where every Sunday when the mobilisers goes to church is able to find discussion points erupting from various issues or cases in the Deaf church. Dandora where there are quite a number of deaf people over 250, but who are not easy to bring together in one forum always a mobilisers uses the homes of deaf leaders or deaf sports meeting or funerals and community meeting. This is the same in Kariobangi North. Huruma targeting 91 deaf people at the deaf group in huruma mathare areas. Kayole at the tushuriane dea