A Case Study: Integrated AIDS Programme Thika, Kenya

This 41-page case study, published by MEASURE Evaluation, aims to provide a better understanding of one of four orphan and vulnerable children (OVC) programmes previously evaluated by MEASURE, and to identify lessons learned that could be applied to other initiatives. The original evaluation was designed to assess the impact and effectiveness of four selected programmes in Kenya and Tanzania in an attempt to fill a gap in knowledge, and included household surveys, focus group discussions, a costing analysis, and in-depth case studies. The evaluation found that the programme demonstrated some clear successes, although resources, capacity, and discrimination continue to be challenges.

The case study presented in this report - Integrated AIDS Programme-Thika (IAP-Thika), located in Kenya - is based upon programme document review; site visits, including discussions with a range of stakeholders; and observations of programme activities. According to the study, IAP-Thika provides comprehensive HIV/AIDS awareness campaigns, supports home-based care using community volunteers, and provides voluntary counselling and testing (VCT). It also provides a number of support services for people living with HIV/AIDS (PLWHA), including income-generating activities, psychosocial and nutritional support, and treatment of opportunistic infections. In addition, it has a number of services specifically for OVC such as educational support, vocational training, para legal services, and counselling. The organisation focuses on building capacity within the community, training volunteers, local leaders, and teachers on a number of skills.

The study found that the programme faces a number of challenges. It lacks the resources to address the holistic needs of children in homes with PLWHA, or extend services to other OVC in the wider community. The workload of staff is continually increasing, and there are not enough resources to help all the children who need support. It also initially struggled to identify people living with HIV and OVC (likely because of fear of stigma and discrimination) and had to wait until word spread about the value of the services. Preventing discrimination, and administering a programme that specifically addresses the effects of HIV/AIDS without increasing discrimination and marginalisation of beneficiaries has, according to the study, been a great challenge. Finally, retaining volunteers without providing incentive packages such as transport allowances or access to microfinance remains difficult, and there is a higher dropout rate among volunteers in areas without these packages.

Despite the challenges, the case study documented some clear successes made by the programme. The training that volunteer community health workers receive has enhanced their abilities to address the needs of PLWHA and OVC, as well as made a positive impact on their own lives through economic empowerment and the application of the counselling and communication skills in their own families. The programme has established local support networks and partnerships with community stakeholders in order to respond to the ever-increasing needs of PLWHA and OVC. It has been able to prevent loan default among participants in income-generating activity (IGA) groups via emphasis on IGA group management training. IAP-Thika promotes positive living for beneficiaries, focusing on giving hope to individuals and families affected by HIV/AIDS by discussing treatment options and support, and emphasising the importance of living positively. According to the evaluation, the programme has also implemented a number of awareness campaigns designed for specific groups in the community, for example providing VCT clinics specifically for couples on Valentine's Day. The programme also encourages beneficiaries to give back to its various structures, in order to help keep its projects running. For example, all recipients of seeds and fertilizer are requested to donate to the seed bank after their first harvest, in order that those seeds can be redistributed to other beneficiaries.

The case study also outlines a number of steps and ways forward that IAP-Thika intends to take to improve its programmes and service delivery. This includes increasing self-sufficiency of beneficiaries by expanding parts of existing projects, as well as increasing the number of beneficiaries with support from external partnerships and funders. It also plans to open two more VCT clinics. In addition, the organisation intends to make internal improvements, such as strengthening its monitoring and evaluation system, and improving record-keeping, documentation, and management skills.

The study concludes by outlining MEASURE's plans for an impact assessment of IAP-Thika's programme to complement lessons learned. The study will be applied to gather data concerning programme impact and will involve household surveys and focus groups. According to the authors, this assessment will present the opportunity to examine child, guardian, and community-level outcomes resulting from community strengthening efforts.