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Visit Report, July 07

To
CYM, Kabwe &
YDF, Chipata in Zambia

YDF

CYM

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‘In Southern Africa, an HIV/AIDS epidemic, severe poverty in the agrarian
sector and external shocks such as drought threaten to create a famine with a
distinct vulnerability profile and a new trajectory of impoverishment and
coping: a new variant famine.’ (Alex De Waal, The New Variant Famine)

This report is drawn with the idea that MRDF is the longest standing partner
of CYM and has a special interest in the organisation’s growth. Our
partnership with CYM, we feel, places on us the added responsibility of
identifying areas of improvement for the latter in order to ensure its
continuous growth. As a result, a critical tone has been adopted throughout.
However, care has been taken to avoid a prescriptive tone and it is hoped
that CYM will take the suggestions in a positive light.

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Of AIDS and aids: Health and Economy in Zambia

Statistics and numbers are rarely evocative. Some figures, however, tell their
own story. For any development aid worker in Zambia, it is difficult to ignore
the fact that officially, 53% of the population suffers from hunger, while 21.5%
reels under the impact of the HIV/AIDS epidemic. These two figures are
mutually reinforcing and seem to continuously push each other on an upward
spiral. De Waal, from whose book we have selected the epigraph for this
report, makes the important point that the epidemic is creating a new category
of poor people: the AIDS-poor. A perpetual epidemic that shows no signs of
abating, it has affected the rural hinterland more than the relatively better
equipped urban areas. The two most daunting challenges for governments in
all underdeveloped regions, health and hunger, have thus acquired a more
intimidating form due to the epidemic. The government itself, underresourced
and therefore weak, has not been able to tackle the problems head-on. In
such a situation, the role of development agencies has become extremely
important.

Presented below is a table elucidating the poor health and income standards
in Zambia. A country where 53 per cent of its children are stunted and which
has an astounding child mortality rate of 202 would, according to most
sections of opinion, appear to have little hope of turning a corner in the near
future unless a concerted effort is made. This is a state of emergency by any
standards. The government, accordingly, has taken a few measures. A policy
of exemption from user fees, apart from a few other policies, has been
introduced. The aim is to improve the access of the poorest sections to health
facilities1.

Changes in selected poverty indicators/measures in Zambia, 1996-1998
Poverty indicators/Measures 1996 1998
Income Poverty
Overall poverty (percent) (National poverty line) 69.2 72.9
Extreme poverty (percent) (national poverty line) 53.2 57.9
Overall poverty (percent) (less than $1 a day) 72.6 n.a.
Health and Nutrition Poverty
Life expectancy at birth (years) 45.5 40.5
Infant mortality rate (per 1000 live births) 112 112
Under-5 mortality rate (per 1000 live births) 202 202
Maternal mortality rate (per 100,000 live births) 649* n.a.
Stunted children (percent) 46 53

However, as the figures continue to display little sign of any remarkable
downward curve, the question that needs to be asked is: how successful are
1
Under this policy, four groups of exemptions have been created based on age, disease and income. Children
under the age of 5 and those aged 65 years and above are exempted. All antenatal and post-natal episodes as well
as chronic illnesses such as TB, STD and HIV/AIDS are exempted. In addition, all those affected by disasters or
accidents are also not required to pay the user charges. Policy paper, National AIDS Control Office, Republic of
Zambia.

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such policies? The fieldwork suggested that the exemption mechanisms, even
if they worked as intended, failed to comprehensively redress inequalities in
the access to services based on income or geographical position. It revealed
that there is an intimate connection between poverty, vulnerability and spatial
location. To cite a poignant individual example revelatory of larger trends,
Easter Semya, boycotted and living on the outskirts of a village in Kawbwe, is
forced to trudge 20 miles to access her ARVs. Consequently, she frequently
foregoes her free doses from the centre, reducing her chances of recovery.

Also, development aid has created a paradoxical situation in Zambia. Funds
from many international donors, involved in larger geo-political formations, are
forthcoming only if the country is current on debt servicing. As a result, nearly
half the funds gained through external assistance go out straightaway towards
debt service payments2. Zambia today is dangerously dependent on aid, yet
simultaneously incapable of financing all its needs. Should donor sentiments
veer towards reducing aids, poverty levels are bound to rise sharply. Smaller
organisations like MRDF acquire a huge significance in this context, as their
grants are unconditional and can be used to bring about real and permanent
transformations into people’s lives.

It is within this scenario that the relative benefits of strategies such as
community support should be evaluated. Such projects ensure optimum
utilisation of resources, create a feeling of solidarity and strength, and offer
opportunities for the development of individuals within a secure environment.
Community structures that work as safety nets have a special significance for
countries such as Zambia with high HIV/AIDS prevalence rates. This report
shall assess one such project: the Community HIV/AIDS Intervention
Programme (CHIP) in Kabwe. The project is currently in its second year and
hinges on the strategy of mobilising and training young people to strengthen
community support mechanisms.

CHIPping in the Facts

Community Youth Mobilisation is an indigenous NGO running a rural, youth-
centric, community HIV/AIDS programme. It utilises the energy of young
people to implement change. Mr. Abhishek Musonda, the man behind the
organisation, has considerable global development aid experience. The
organisation also benefits from his strong networking skills. The team
currently comprises of a total of 10 members, all of them young and extremely
enthusiastic.

2
Zambia, UNDP representative’s statement.

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The organisation has been an MRDF partner since July 2005 and its funding
pattern has been as follows:

Project Year Duration Amount (ZK) Amount
(GBP)
CHIP July 05-July 1 year 110,000,000 £13,700
Phase I 06 completed
CHIP July 06-July 3 years (2nd 382,000,000 £54,072
Phase II 09 year
ongoing)

CYM utilises what it chooses to call a ‘Ballgame Plan’ to define its project
strategy. This plan is based on the proposition that the organisation should
start and end its programmes with the community. To achieve this, it
constantly seeks inputs from the community and other stakeholders in order
to strategize and adapt. The organisation organises youth gatherings,
organises door-to-door campaigns, community events and health days to
reach the message to the youth. Community Youth Resource Centres have
also been established to allow the youth and other community members
access to a friendly environment and to information about HIV/AIDS.3

Ideas and Implementation

The project relies on training volunteers to carry out these activities. The
enthusiasm of the volunteers is ably supplemented by the experience of a
Community Zonal Committee consisting of elderly community leaders. A CYM
Community Committee (CCC) has also been set up at the field level to help
volunteers plan and manage activities. The strategy is an ideal one in so far
as it institutionalises participation within project activities. It is also sound logic
to support young boys and girls (aged no more than 20-25 years) dealing with
a subject as sensitive as sex and sexuality with the considered opinion of
community leaders.

However, blueprints have a habit of losing a bit of their charm in execution. It
was thus noticed that volunteers were often left to their own devises in spite of
the support structures mentioned above. Perhaps this points out to a reduced
community interest in the organisation’s work and is a dangerous omen for a
project of such nature. There is a need to find new ways of generating greater
participation from key stakeholder groups. Before doing so, however,
feedback must be sought from volunteers about CZCs and CCCs and an
assessment should be made based on their contributions.

The visit also revealed that questions have been raised regarding the
resource centres being sometimes left unattended/unopened by volunteers.
This could be disastrous for a project which relies solely on creating ties
between volunteers and the community. The intervention has been in
operation for the last three years. It is important, at the present stage of

3
CYM Project Application ( July 06 – 09)

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transition from a small to middle level organisation, to review and reassess
the volunteer management policy.

During the fieldtrip I was able to attend parts of a three-day residential
volunteer training programme at Kabwe. The volunteers appeared well-trained
and capable of mobilising communities for addressing serious vulnerabilities.
They also seemed eager to share and learn. Such trainings, discussing the
volunteers’ work and strategy, are a powerful motivating factor for the
participants. They also help them gain respect within their communities and
thereby develop a positive self-image.

Although volunteers are the backbone of many AIDS organizations,
procedures to manage their contributions are often developed by accident or
experiment. Getting the volunteer management right is important for CYM to
avoid any damage to its several years of community standing, as well as to
meaningfully realize the organization's discourse on community ownership.
CYM needs to be able to consolidate the volunteer component of prevention
and care programs (all projects, including CHIP), and undertake a diagnostic
evaluation and design changes in volunteer management. The organisation
has no formal mechanism of recording volunteer turnover, gender ratio, exit
comments etc. Interviews with former and current volunteers, should be
carried out to record factors influencing commitment levels: personal issues,
such as harmful gossip, shifts in interests or priorities, and the volunteers
sense of being appreciated, of belonging, or of making a personal
contribution, institutional issues including lack of clarity about decision-making
and lines of authority, lack of communication, and inadequate supervision and
evaluation, burnout or stress. What I am trying to emphasise here is that with
the scale and size of the programme, it is necessary now that each stage of
the volunteer process-recruitment, training, assignment, supervision,
evaluation, and farewell-should be managed according to a precise plan,
whose outline is known to volunteers. Staff time and attention dedicated to
volunteer management would produce important returns and consolidate
institutional mystique. It was also noted that during training programme, there
was nobody continuously documenting the ongoings. Because of the
participatory nature of the workshop, volunteers expressed several concerns
about getting members from the Community Zonal Committees (CZCs) work
and participate. These are qualitative feedback that needs to be recorded and
utilised.
The challenge, however, which does not seem adequately addressed, is
meeting the capacity needs of the team through systematic capacity building
programmes outsourced or organised internally4

2.2 Community based Volunteer Training and Reference Manual:

CYM has been able to draw Training and Reference Manual for Community
based volunteers. This is definitely a good start, which ensures uniformity of
content and methodology for the trainings. However, having attended one of
the trainings and reviewed the manuals, I would suggest that it would be
4
Refer to Page

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useful to have more cultural referencing5 to the issues discussed. Also, the
topics covered in the reference booklets do not match with the training manual
and this might not ease the volunteers who are supposed to also provide
information to all their peers and other community members.

The training manual seems to be handling HIV/AIDS as an issue in isolation
and it is important to link poverty, human rights and gender in more stronger
terms, given the fact that no other country sees the links on an everyday basis
as clearly. Also, the Training Manual used for training the volunteers by the
CYM staff do not elaborate the content for each discussion; this could again
be a little worrying as the staff in themselves do not have many capacity
building sessions for them (see 2.4). This would also mean that the content of
the sessions would be dependent on the individual staff member’s knowledge
on the subject and might not cover all the aspects that the training intends to
cover for the volunteers. It would be useful to have discussion points clearly
documented after each exercise of the volunteer training workshop. Again, it
will be useful for CYM to review the manuals on a periodic basis in active
consultation with the volunteers. While one does understand funds are an
issue with community based organisations like CYM, in the long run CYM
should strive to make the reference manual which goes to the volunteers
more colourful with culture-specific pictures/ quotes/ songs and with an
annexure of the names of the current volunteers. Currently it does look a little
boring and out of its cultural context.

After having gone through the CYM CBV Reference Manual, I also felt that it
lacks the basic information if dealing with HIV/AIDS clients. I understand
Reference Manual as a useful information pack, which can be referred to
whenever a volunteer gets stuck or has to deal with an emergency issue.
Reference manual as I understand are not useful with essays on gender and
reproductive health, though it does help the reader gain a broader
understanding of the issue. It is useful when there are tips for approaching the
subject with youth groups, points for discussion, symptoms for concern6 etc.
While volunteers would be able to enlist the areas they most often need
information on: some of the areas that I could think of which needs to be
covered in the reference manual should be: useful tips to help PLWHAs who
do not know to read or write or follow the clock to develop regularity with their

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Cultural referencing : Negative Cultural attitudes towards the reality of the virus calls for eradication through
informing and educating communities. Among the Basotho, there is a general reluctance or blatant refusal to go
for HIV testing. This could be because of “denial” arising from cultural beliefs pertaining to sickness, disease and
witchcraft. Another reason for denial arises from the stigma and discrimination that people testing positive may
have to face in their communities because of the prevailing ignorance of the benefits of testing. This negative
attitude is detrimental and calls for urgent intervention of volunteers. Cultural referencing to the issues is crucial in
volunteer trainings. (e.g’s also given in page 6)

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Address questions related to: How to make sound decisions about relationships and sex and stand up
for them? How to recognise and avoid or leave a situation, which might be risky? How to negotiate
safe sex?

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dose7, tips for breast feeding counselling of positive mothers8, tips for talking
about PPTCT with pregnant mothers9, tips on motivating and helping parents
talk to their children about reproductive and sexual health(use natural
opportunities like when a calf is born or a relative has had a baby), handling
patients taking traditional medicines without hurting their sentiments. Also, I
am aware that CYM has a very strong referral system in place and it will be
useful for the volunteers to have the referral centres enlisted in the reference
manual10.

2.3 Monitoring and Evaluation framework:

With increased donor interest, there is a danger of upscaling the strategy
without adequate stock taking of the learning over all these years. CYM
currently has volunteer based interventions supported by OSISA, SIMAVI,
MRDF and UNICEF. MRDF is deligheted about this growth and takes pride in
being the earliest partners of CYM. However, while strong community
presence so far has been the reason for this increased donor interest; CYM
needs to ensure that the programme upscaling is rooted in adequate
assessment of the existing strategy and ensure mid-course corrections to de-
risk the element of any failure at a scale larger than the programme has
handled success. Also, while there is no attempt to discourage CYM in the
impressive work that they have been doing so far, and of which I have been
quite vocal about during my visit, I would want to caution them to avoid
expanding the programme without culling out lessons from the data/
experiences generated so far. If organisations are to survive, they must learn
and this is where CYM has to work the most; strengthening it’s M&E systems,
collating the findings, assessing it and revise the strategy based on the
findings.

Currently the staff’s understanding of M&E is limited to getting figures for the
number of people being reached out through each of the strategies. It is
important that CYM takes monitoring more seriously and is able to train its
staff on participatory M & E and draw up a more rigorous M&E plan for the
project11. Data for the sake of data is no good. CYM has to be able to collate
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People who are unable to read the clock time may not be able to follow the regime prescribed by the
doctors. Volunteers should be able to encourage patients to use methods like: use daily events as times
when patients should take the medicine (waking up, after food etc), draw a calendar with different
colours for different medicines and time of the day.
8
If positive mothers decide to breast feed, volunteers should be able to advice on ways to minimise the
risk: Exclusive breast feeding, maintain breast health (no bruises or cracks in the nipple), start solid
food at 4 months and stop breast feeding totally, avoid getting re-infected during breast feeding.
Mothers who do not want to breast feed should be prompted to think about affordability of buying
formula milk, resources for buying and cleaning feeding bottle, water supply is safe, cultural
acceptability of not feeding babies etc.
9
Taking AZT for four weeks before birth lowers the risk of transmission by 40-50%. A single dose of
Nevirapine given to the mother at delivery and within 72 hours of birth to the baby reduces the risk of
transmission by 70-80%.
10
The reference manual merely elaborates the concept of referrals in the HIV/AIDS context.
11
Good monitoring will allow project managers to gather information to be able to provide early warning about
problems in achieving the project’s indicators and targets. This can allow managers to make mid-course
corrections where particular methods and approaches are not working, and get authorisation for changes in the
targets or budgets where necessary. In some cases, timely monitoring will reveal unforeseen obstacles or
unexpected opportunities which call for a complete rethinking of the project’s assumptions and strategy.

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and analyse the data at least on a quarterly basis to capture the impact and
need for any strategic changes. As discussed extensively during my visit CYM
needs to be able to discuss amongst the team:
 What specific information does CYM or donors need?
 How often will CYM need to collect and record the information?
 Is the current monitoring and evaluation system providing useful
information?
 Does the project need to introduce new indicators? Or stop using any?
 How often is the indicator data collected and who is involved? Does
CYM need to change anything about collection and involvement?
 How often do you review and analyse the indicators and monitoring
practices? Who will be involved in this review?
 How does monitoring influence your planning and management?

Efforts have to be directed to encourage critical analysis of existing monitoring
practice and encourage thoughtful designing of new ways of monitoring
programme which captures not just the quantitative but also the qualitative 12
aspects of the work. Currently there is minimal or zero participation of the
volunteers/ community and /or any other stakeholder groups in the monitoring
exercise13. This is however, not to suggest that CYM has to channelise all its
energy into gathering data and analysing and transform into a research
agency. M&E activities should aim to meet information requirements without
overloading the staff involved and using up a lot of resources.14 It is common
for some staff and volunteers in NGOs to show impatience with monitoring
tools, because they perceive it either as something that interferes with the
work, or as a lack of trust by management. It is important to clearly explain
and internalise the tangible benefits of performance monitoring for improving
results for clients. Also, CYM currently has multiple donors and various
reporting requirements. The facilitation process should seek to build an
integrated system that incorporates these various requirements, rather than a
system that meets only the requirements of the MRDF or any one donor
agency.

Given that CYM already has an significant scale of intervention, it will also be
worthwhile considering a baseline rapid assessment surveys which could then
be utilised for making fresh applications and also study the impact of the
ongoing interventions. Without baseline surveys projects are forced to rely on
recall and retrospective techniques to study the impact. While such a stratgey
works for small scale interventions, it does not prove to be very effective
where the investment is significant. Here, I would also want to mention that
organisations often tend to believe the myth of Rapid KABP assessments
being a very specialised and resource draining exercise. I am suggesting the
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This needs to utilise open-ended PLA methods to capture experiences, feelings etc.
13
A participatory approach to M&E requires that a range of stakeholders are involved. Stakeholders are
those with a ‘stake’ or interest in the outcome of the project and may include staff responsible for
collecting and analysing monitoring data, those implementing the project, the beneficiaries or project
participants
14
Ideally, the budget for M&E activities should be less than 10% of the overall programme budget. (HIV/AIDS
Alliance NGO Support Toolkit)

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HIV/AIDS Rapid Assessment Guide, FHI as a reference document for this
exercise if CYM is convinced of taking up one. CYM should in anycase train
staff on Participatory Monitoring and Evaluation and develop a strengthened
M&E system. I would strongly recommend the toolkit on Participatory M&E,
HIV/AIDS Alliance15 for the purpose. It is a toolkit target at small and middle
level organisations and is extremely particpatory and easy to implement.
Concepts like developing indicators and analysisng it for the use of project
redesigning is beautifully handled for project managers to make use of.

2.4 Staff Capacity Building:

I have earlier mentioned the fact that CYM has a young and energetic team,
very eager to learn and improve on their organisational and professional
competencies to respond to the community needs. However, there seemed to
be rather limited capacity building support the organisation has been offering
to the staff. Once again, it is important that now that CYM is growing, it is able
to budget for outsourcing regional expertise to train its staff members on
identifed areas of capacity need. The steps CYM needs to follow in this
direction:

- Assess existing knowledge and identify capacity needs though
supervisor feedback, self-perceived capacity needs and programmatic
output.
- Draw up a capacity building calendar based on the avaialable
resources, identified capacity needs and avalaibility of regional
expertise.
- Ensure the most appropriate people particpate, whose work will
benefit from the training.
- Develop a regional resource person’s directory detailing their skills and
experience to match the calendar.
- Discuss beforehand with the facilitator to request for content that is up
to date and relevant and methodology that is participatory.
- Draw up a work plan to implement lessons learnt from the training
programme. In cases where one person is sent out on a course,
dissemination should take place before work plan can be drawn.
- Plan for documentation and evaluation of the technical assistance.

At the moment the staff have been assigned roles with often no prior
experience or training to understand their role beyond the administrative
context of the job. Commitment to meaningfully perform their roles often
keeps them ticking and continuosly gathering lessons from the field. However,
capacity building in some areas often is not adequately met by the field alone.
To cite an example a very young and smart lady is right now the IEC officer
for CYM’s several interventions and for no fault of hers she did not know
Behaviour Change Communication16, the concept, the link with IEC or the way
to approach it. Whiel there are many HIV/AIDS organisations which do
operate wonderfully at the field level without consciously operationalising
15
The e link could not be found. I am attaching this document as an attachment to the report for your
reference.
16

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these concepts but who denies the fact that the time spent in trial in error is
not what you can afford in an AIDS hit country like Zambia. Evidently in that
case if she has been planning for the IEC development for the organisation all
this while, it has lacked the approach of being more than just a
communication tool and rather aiming for behaviour change through clear ‘call
for action’, not just for the individual but also the community (gate keepers).
Similarly another staff responsbile for advocacy was unable to talk about
importance of networking for advocacy even when prompted. This is by no
means my attempt to point out individual capacity needs but organisational
failure in having addressed these needs. In the same breadth I must also
state that these members were extremely keen on knowing more about
whatever was pointed out during my visit and CYM needs to be able to make
the maximum of this attitude.

2.5 Staff Management:

Other than the fact that there is no capacity building support for the staff, the
staff management in something that can be something many organisations
can learn from. The relationship between the staff and the management is
extremely open and healthy. Mr Musonda is a dynamic leader and a very
caring boss. The team enjoys a very participative and collaborative approach
to work and there isadequate staff recognition. The organisation nominates
‘employee of the month’ and puts a picture of the person on the organisation
cock board about it. Team building exercises like joint team lunches and
dinners are frequently organised. The organisation also has a documented
HR Policy clearly detailing recruitment policy, staff holidays, salary structure
etc. CYM also has documented job descirptions for each of the staff
members. It is little wonder then, that there is very little staff turnover. This is
something CYM should further strengthen by setting up and operationalising
capacity building plan for the staff.

2.5 Information, Education and Communication/ Behaviour Change
Communication:

Talking about the IEC/BCC component, I was handed over a set of IEC
materials developed by CYM. Evidently CYM is giving adequate thinking to
the need for adequately meeting the communication needs of it’s target
population. Also, that there is no denying that these IEC materials would play
a very important role in the life of individuals who hardly have any access to
any other communication channel like TV/Radio/Newspapers. Uncovered by
the conventional communication channels, the access to information is rather
limited for villagers in rural Zambia. Further, coupled with other
communication methods like Inter-Personal Communication(IPC) methods
like Door to door campaign, the chances of message retention and recall
clearly goes up significantly. However, having said all this, CYM needs to
review the penetration of print media amongst a target group that essentially
comprises of people with limited or no literacy skills. Given that CYM has a
youth base in each of the communities and is struggling to get members of
CZCs and CCCs to get active on a more sustained basis, considering other
on-ground communication channels like street theatre (which involves mebers

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from CCCs), sports for awareness, other folk-forms could be considered.
Also, that I personally feel that with limited entertainment opportunities, such
mechanisms invariably attract people who would otherwise consider
discussing sex and sexuality with a serious tone a taboo.

What is IEC/BCC?
The terms "IEC" (Information, Education and Communication) and "BCC"
(Behavior Change Communication) are commonly used in discussing
adolescent reproductive and sexual health responses. What exactly do they
mean and what is the difference between BCC and IEC?
Information, Education and Communication:
IEC is a process of working with individuals, communities and societies to:
- develop communication strategies to promote positive behaviors which are
appropriate to their settings.
Behavior Change Communication:
BCC is a process of working with individuals, communities and societies to:
- develop communication strategies to promote positive behaviors which are
appropriate to their settings; AND
- provide a supportive environment which will enable people to initiate and
sustain positive behaviors.
What is the difference between BCC and IEC?
Experience has shown that providing people with information and telling them
how they should behave (“teaching” them) is not enough to bring about
behavior change. While providing information to help people to make a
personal decision is a necessary part of behavior change, BCC recognizes
that behavior is not only a matter of having information and making a personal
choice. Behavior change also requires a supportive environment. Community
and society provide the supportive environment necessary for behavior
change. IEC is thus part of BCC while BCC builds on IEC.
(Source: UNESCO, ARSH Project)

As explained in very simple terms above, BCC is a broader concept which
understands the need for enabling environment for the behavior change of an
individual. IEC is placed within this broader framework. Therfore, BCC also
addresses other ‘gatekeeper’ groups often known as secondary target group/
stakeholders for an attitudinal change to enable the cbehavior change of the
primary target group. Thus is a project which tries to advocate for safe sex
amongst sex-workers, it is important to work with their clients, pimps, bar and
hotel owners and police. Also, the conventional notion of IEC does not
necessarily aim for behavior change, it could merely be imparting information
(knowledge). The acquisition of knowledge might not necessarily prompt me
for a behavior change (change of attitude and practices). Thus the recent IEC
materials with this understanding of behavior change carried the message
along with a clear ‘call for action’ – like call 1097 toll free helpline for further
information, access condoms from your nearest public health centre, visit our
youth resource centre for discussing confidentially about any of these issues
etc. CYM is doing all this and more but often not consciously and this
therefore the approach is not consistent with all IEC materials and messages.

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Also, since CYM has realized the importance of IEC by having appointed a
person solely responsible for IEC work, it is time that the process of IEC
development is also documented for each of the IEC material:

 How was the communication need identified? (Analysis of M&E figures,
percived needs by programme mangers substantiated by an FGD with
the volunteers etc)
 How was the message developed? (IEC officer facilitated a discussion
with the volunteers & PLWHA members or other participatory methods)
 Pre-testing (The draft version of the IEC material was shared with
community, PLWHA members, other staff and finalized with suggested
chnages discussed and incorporated)
 Final roll out – printing and dissemination plan – Who will use it?
Where will it be placed for the easy access and availability for the end
users? (Youth resource centre, carried by volunteers in their IPCs,
used only for trainings and community events etc)
 Feedback – Number of people who have been given, Number of
people who have asked for it, FGD findings after 6 months/ 1 year of
usage with the volunteers.
 Any changes based on the feedback.

It is amazing how organisations in their effort of doing the same tasks in a
more conscious and systematic fashion discover unexplored areas of
strenghtening their IEC/BCC strategy. Finally I am also tempted to make
another suggestion for CYM’s consideration and that is renaming the position
of IEC officer as BCC officer.

At a more organisational level, I would recommend that with the kind of
energetic team that CYM has, it would be useful to implement the HIV/AIDS
Capacity Assessment tool17 on a 1 or 2 day out-of-office retreat exercise. This
tool assesses organisational capacity on all taking up HIV/AIDS projects in a
very participatory and activity based manner. Also, for a change it won’t be
outsiders deciding the level of organisational capacity but the organisation’s
staff coming to a conclusion.

2.6 Advocacy and Networking:

CYM has a very strong referral network which is utilised almost on a daily
basis and also systematically recorded. This network involves VCTC centres,
PPTCT centres, HIV/AIDS counselling centres and PLWHA support groups.
Such strong referral systems ensures 1) effective utilisation of limited
resources 2) ensures quality of service provision through avoding setting up
parralel set-ups requiring specialised technical skills 3) builds the regional
presence of CYM through networking with other organisations working on the
issue of HIV/AIDS 4) provides some scope for staff to meet other HIV/AIDS
service providers and learn from them. I visited CYM’s partner VCTC centre

17
http://alliance-uk.inforce.dk/graphics/NGO/documents/english/686_Capacity_Analysis_Toolkit.pdf

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Kara counselling centre. Kara Counselling is funded by few of the biggest
donors in the sector and has the infrastructure and technical skills to support
many organisations like CYM. The pre and post test counselling forms have
been developed by UNAIDS and is uniform for all the counselling centres in
Zambia. As shared during my visit, I was a little surprised by seeing that the
form does not record the reason for takign the test and the level of media
exposure and education. However, not being in a position to bring about
change in the forms, I just explained why I felt these aspects should be
captured in the form namely 1. it eases the client by telling more about
himself. 2. it serves as useful instruments to understand the link between
media exposure and education (TV/Radio/Newspaper) with HIV/AIDS.
UNAIDS being an organisation with considerable say in setting up of global
and national HIV/AIDS priorities should have interest in such data,e ven if
Kara on their own might not.

CYM is affiliated to some networks. Namely: the National Youth Development
Council (NYDC), an umbrella organisation of youth organisations in the
country. The NYDC operates under an act of parliament falls under the
Ministry of Sport, Youth & Child Development, Zambia Civic Education
Association (ZCEA). ZCEA is a civil rights group and helps member
organisations with civil rights issues. However, advocacy still seemed a little
neglected due to the huge catchment area that demands more fieldwork.
CYM in this transition period needs to be able to incorporate advocacy on
issues that is experienced at the field level e.g: need for decentralization of
ARV distribution. Evidently this is an uphill task and has to be done in
partnership with regional and national organizations with similar mandate but
such efforts would 1) create evidence based pressure on the government for
change of policy 2) establish the macro-micro linkages to the field work that
CYM has been doing over so many years and also help as an opportunity for
the organization to see their work in the broader context 3) provide visibility to
CYM in the sector which might prove very helpful for building on organizations
goodwill and growth.

CYM has lately also entered into a partnership with the Drug Abuse
Department of the government. This was in response to the identification of
the substance abuse problem. The issue has been covered in a small activity
in the training manual. However, the link between HIV/AIDS and substance
abuse has not been established in the session or anywhere else. There is
considerable alcohol abuse in the target area and CYM should be able to
adequately stress on the more direct link between injecting drug use and
HIV/AIDS as well as the indirect link between risky sex and alcohol and other
drugs18. It would be useful to consult the volunteers on the prevalent forms of
drug abuse and accordingly target the messages.
18
A history of heavy alcohol use has been correlated with a lifetime tendency toward high-risk sexual
behaviors, including multiple sex partners, unprotected intercourse, sex with high-risk partners (e.g.,
injection drug users, prostitutes), and the exchange of sex for money or drugs . There may be many reasons
for this association. For example, alcohol can act directly on the brain to reduce inhibitions and diminish
risk perception. However, expectations about alcohol's effects may exert a more powerful influence on
alcohol-involved sexual behavior. Studies consistently demonstrate that people who strongly believe that
alcohol enhances sexual arousal and performance are more likely to practice risky sex after drinking .
(AHRN, Substance use and HIV/AIDS)

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2.7 Financial Management:

The financial systems of the organisation could not be assessed as the
finance officer was engaged in taking sessions for the volunteers. However, I
hope that CYM has been able to cope with the scale of financial management
required for the increased volume of funding. MRDF as a norm for long
standing partners would now take up a financial audit exercise for the
organisation through an in-country expert. This audit exercise should be seen
as an assessment of the existing financial management system to draw
lessons for it’s improvement. MRDF funds such audits for it’s long standing
partners to help them develop and maintain standard financial management
systems and practices that enables the organisation maintain accountability
and transparency in its accounting systems both with the community and to
the donors.

2.8 Strategy:

CYM is an organisation which has identified the need and decided to
specialise as a youth organisation dealing with HIV/AIDS. However, in all my
field visits and discussion with the community and organisation staff and
volunteers, the single observation that hit me most strongly was poverty and
food security. Most positive mebers I met complained of their inability to visit
the health centre for collecting their medicines and in many cases even for
their CD4 counting. Non adherence to regime becomes all the more
dangerous when coupled with lack of adequate nutritional support to be able
to cope with the virus and the ART treatment. Many of the PLWHA members I
met in these villages didn’t have any land, or could not work in the field
anymore, lacked the support of their family or their was no family at all and
had minimal alternative income generating sources like poultry or small
kitchen gardens. Few of the volunteers who wanted me to see their
communities and assisted me during my field-trips seemed extremely
committed and concerned but had a feeling of hopelessness in few cases.
Michael a very energetic and committed volunteer stated in loud terms to Mr
Musonda the crux of what he had learnt over the months in his field; ‘You
know Sir, poverty and HIV/AIDS are connected and we are not doing much
about it’.

I have always believed in the fact that some organisations choose to
specialise in certain areas and that’s how we have expertise in each sector
and this is absolutely irreplaceable to build a body of knowledge one each
issue but specialisation is a luxury which organisations can enjoy only when
there are enough organisations working in the same field area. Kabwe is an
area with no other HIV/AIDS organisation working in these fields. With the
very clear pseudo-effect poverty has on HIV, maybe CYM should try to
respond to these needs through chalking out a separate programme on
income-generation and seeking donor interest for the same.19 Somegrassroot

19
Kofi Annan, UN Secretary General , after his field visit stated that ‘agencies need to combine food
assistance and new approaches to farming with treatment and prevention of HIV/AIDS. An agricultural
response to the AIDS crisis is urgently needed.’

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organisations in Southern Africa have already moved to piloting projects that
will test labour saving techniques and lowinput agriculture to ease the labour
pressures. I definitely do not want to be prescriptiv about the strstegies after
one field visit, but recommend that CYM staff who have shared similar
thoughts with me push the management to consider various options of
responding to the issue. My argument is well supported by the case study of
Easter Semya documented below.

2.9 Sustainability:

CYM is a very dynamic organisation, and has in these few years of work also
convinced donors about it. This is clear from the fact that UNICEF has
selected CYM to pilot a life skills module in a certain number of schools.
SIMAVI has recently started funding CHIP along with MRDF. Diversification of
donor base is a very important strategy for ensuring sustainability. Also,
building youth resource centres, run by community based youth volunteers
ensures the project is sustainable. CYM has also in response to the issue
stated in 2.8 decided to upscale it’s CHIP activities with a component of
nutritional training where PLWHAs or their care providers would be trained to
cook nutritios food out of cheap and locally available food options. This is
evidently what we call responding to the felt need of the community and CYM
should be able to seek donor support for the same. A list of donor bodies
interested in HIV/AIDS care and support in Zambia is attached as an
annexure for realizing this plan. CYM has a sufficiently big office space with
huge campus and considering other alternative income generation plans to
ensure organisation’s sustainability like letting out the garden for evening
parties or starting a photocopy centre could also strengthen the sustainability
plan of the organisation.

3. Conclusion:

Started as a project idea for a World Bank funded competition, CYM has
always been a very strong professional organisation with strong community
presence and a very dynamic leadership. MRDF takes pride in this
partnership and hopes to see CYM develop as stronger organisation
advocating and implementing for the rights of the community that it works for.
Adapting to chaging needs of the community and revisiting the ongoing
strategy is inevitable for the kind of work we have committed ourselves to. It is
organisations like CYM who make MRDF’s concept of ‘small miracles’ a
reality and we hope that this mircale which CYM has been able to create is
sustained and sees many more heights.

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