Icomp Experiences on Linked Response to RH and HIV/AIDS
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Critical Need for Engendered Linked Response to HIV/AIDS and Reproductive Health - Experience of ICOMP and Partners in Uganda

The Population and Reproductive Health Capacity Building Program of the World Bank supported ICOMP throughn three cycles of projects from 2004. During 2004-2005 ICOMP started working to link RH and HIV/AIDS programs and services for developing institutional capacity of eight partner NGOs for linked response to RH and HIV/AIDS in four countries- Ethiopia, Uganda, Tanzania and Zambia. Building on the success and learning from this project, ICOMP scaled-up the innovations in linked response to RH and HIV/AIDS in three countries of Eastern Africa Region - Ethiopia, Uganda and Zambia - in 2006. This project enhanced capacity of 14 NGOs on linked response to RH and HIV/AIDS for accelerating diffusion of and creating a momentum for linked response. Feminization of HIV epidemic and higher vulnerability of youth to RH, particularly og girls, led to need for increased male involvement and enhanced women's empowerment in RH such as FP and MCH, and HIV/AIDS outreach programs as well as services such as VCT. Therefore, ICOMP requested and received support in 2007 to implement engendered linked response with 12 partner NGOs, of which seven are addressing engendered linked response to RH and HIV/AIDS for youth.

1st Project: Developing Institutional Capacity for Linked Response to Reproductive Health and HIV/AIDS (2004-5)

ICOMP started working to link or combine RH and HIV/AIDS programs and services through a project on "Developing Institutional Capacity for Linked Response to RH and HIV/AIDS" funded by the World Bank. The 2-year project (2004-5) was implemented in four countries - Ethiopia, Uganda, Tanzania and Zambia - in partnership wikth eight NGOs. The goal of this project was to create s sustained impact on sexual and reproductive health (SRH) and HIV/AIDS by increasing institutional capacity on linked response to RH and HIV/AIDS.

The project implementation comprised identification of eight partner NGOs; an orientation to enhance governance and leadership capacity of the Board members and staff of the partner NGOs, followed by a strategic planning workshop where partner NGOs developed an action plan; and implementation of the action plan. As a prelude to the strategic planning workshop, a needs assessment of the community was conducted to gather necessary information of the community needs. The information helped in informed decision-making, avoiding past mistakes and minimizing risks.

The linked response interventions implemented by the partner NGos were as follows:

Categories	Linked Response Interventions	Partner NGOs
BCC	BCC, condom promotion and distribution for dual protection against STI/HIV/AIDS and unwanted pregnancies	St. Lucia Nursing Home, Tanzania
	Increasing young people’s knowledge and Accessibility to FP and VCT services	HIWOT, Ethiopia
	Creating Awareness on and Increasing Accessibility to PMTCT: A community-based approach	Independent Churches of Zambia (ICOZ), Zambia
Linking Services	A comprehensive package of services for linked response – FP, VCT and PMTCT	Propride, Ethiopia
	Provision of PMTCT Services to ANC Attendees	Kyetume Community-Based Health Care Programme, Uganda
Reaching Special Group	Meeting RH needs of HIV+ people	Network of Zambian People Living with HIV/AIDS (NZP+), Zambia
Reaching Special Group	Addressing teenage pregnancies and reducing HIV infection through BCC with combined messages	Uganda Youth Development Link (UYDEL), Uganda
	BCC on HIV/AIDS and RH targeting young people at vocational schools and their gatekeepers	Chawakua, Tanzania

Positive changes were observed in the eight partners:
• Mindset change – partners more consciously related and linked RH to HIV/AIDS and vice-versa in their work;
• Structural changes – linkages between different units/departments of RH and HIV/AIDS were formed;
• Partnership and Networking – linkages between different RH and HIV/AIDS organizations, and government institutions were formed.

The project demonstrated many advantages of linked response:

2nd Project: Increasing Capacity of NGOs for Expanding Linked Response to Reproductive Health and HIV/AIDS in Sub-Saharan Africa (2006-7)

Building on the success of the previous project, ICOMP received support from the World Bank for scaling up the innovations in linked response to RH and HIV/AIDS in three countries of Eastern Africa Region – Ethiopia, Uganda and Zambia. The overall goal of the project was to increase NGO capacity on linked response to RH and HIV/AIDS for accelerating diffusion of and creating a momentum for this innovation to create sustained impact on RH and HIV/AIDS. The specific objectives were (a) to create a network of NGOs with enhanced conviction, commitment and capacity for linked response for wider diffusion of innovative linked response; and (b) to create a promotive environment for scaling up linked response innovations by strengthening capacity of these networks for sensitization, advocacy and policy dialogue with key stakeholders. Interventions by the NGO partners were completed by March 2007 which was followed by dissemination workshops.

The project implementation comprised of identification of 14 partner NGOs, strategic planning workshops of partner NGOs to prepare action plans for linked response; and implementation of these action plans. ICOMP provided technical assistance in this process through facilitating strategic planning workshops, monitoring visits, organization of dissemination workshops and partnering with the network of NGOs for advocacy.

The linked response interventions by partner NGOs included (a) youth RH and HIV/AIDS services; (b) PMTCT: (c) RH services for People Living with HIV; and (d) comprehensive services.

The linked response project has created positive changes at four levels – organization, program, service delivery and community.
• Organization - mindset change has been observed as the linked response approach was applied to programs and services.
• Program - The program managers have also consciously linked RH and HIV/AIDS in their work such as combining RH and HIV/AIDS messages in the behavior change communication activities.
• Service delivery - the healthcare service providers are also providing linked services such as anti-retroviral treatment with family planning. Partner NGOs also trained their staff and volunteers on linked response and they were able to provide linked-services, such as linking voluntary counseling and testing with ante-natal care, to their clients.
• Community - a number of outreach activities, such as panel discussions, peer education, and edutainment programs were organized by partner NGOs to sensitize the community on the linked response concept and services, for which demand has increased.

This enhanced capacity resulted in:
• Increased awareness among community members on linked response programs and services.
• Increased distribution of condoms for dual purposes – prevention of unwanted pregnancy and prevention of sexually transmitted diseases and HIV.
• Increased access to and utilization of voluntary counseling and testing; access to anti-retroviral treatment; and coverage for the prevention of mother-to-child transmission.
• Increased access to and utilization of RH / family planning services among people living with HIV.
• Strengthened networking and linkages among the partner NGOs and other stakeholders.

3rd Project: Increasing Capacity of NGOs for Engendering Linked Response to Reproductive Health and HIV/AIDS in Sub-Saharan Africa (2007 – 2008)

Feminization of HIV epidemic and higher vulnerability of youth to RH, particularly of girls, led to need for increased male involvement and enhanced women’s empowerment in RH such as FP and MCH, and HIV/AIDS outreach programs as well as services such as VCT. The first and second projects assessment found that male involvement in RH such as FP and MCH, and HIV/AIDS outreach programs and services such as VCT are very low. On the other hand, the previous projects have been able to reach young girls and women with RH and HIV/AIDS information and education as well as access to RH and HIV/AIDS services. However, due to low male participation, women are not able to practice their reproductive rights such as family planning and condom use, thus increasing the risk of unwanted pregnancy and STI/HIV infections.

To increase male participation and enhance women’s empowerment in RH and HIV/AIDS programs and services, ICOMP has developed a framework for engendering linked response. It is expected that the engendered linked response will empower women and at the same time sensitize men on reproductive rights, change their behavior and increase their participation in RH and HIV/AIDS programs and services.

Therefore, ICOMP requested and received support in 2007 to implement engendered linked response with 12 partner NGOs in Ethiopia, Uganda and Zambia, of which seven are addressing engendered linked response to RH and HIV/AIDS for youth. The goal is to strengthen the existing RH and HIV/AIDS services to improve SRH and combat HIV epidemic by meeting the SRH needs of a wider population.

Since April 2007, the partner NGOs have began to incorporate gender in their linked response intervention activities. The engendering linked response interventions developed by the partner NGOs are as follows:

The advocacy, IEC materials and BCC activities on engendered linked response will increase awareness and improve the knowledge of various stakeholders - particularly community leaders and members, partner organizations, local government units - on the relations between RH and HIV/AIDS, rights-based approach, and the importance and urgency to deliver engendered linked response. Focus will be given to gender issues and women’s empowerment with gender equity promoted through advocacy activities such as ‘increase male involvement and participation in FP, VCT and PMTCT’, and ‘advocacy for the sexual reproductive health and rights (SRHR) of HIV positive women’.

The direct output in the NGO served areas will be measured by an increase one or more of the following according to the monitoring indicators established:
• access to FP
• HIV+ women/men who accept contraception
• pregnant women under PMTCT, and MTCT plus
• men and women tested in VCT centers
• young men and women reached with life skills and sexuality and HIV/AIDS information
• condoms provided for dual protection
• number of women/couples counseled for HIV/AIDS in RH settings
• number of women/men/couples counseled for RH in HIV/AIDS settings
• number of men and women tested and provided treatment for STIs
• proportion of partner referral completed for STI patients

The expected outcomes and benefits of an engendering linked response approach are:
• Greater involvement and responsibility of men in RH and HIV/AIDS programs;
• Enhanced understanding of reproductive rights by women including adolescent girls and enhanced ability to negotiate for exercise of these rights;
• Increased awareness and reduced stigma of STI and HIV/AIDS;
• Increased satisfaction of clients by meeting the different needs of men and women;
• Improved service mix (RH and HIV/AIDS information and services are offered as a package to clients) and quality of care; and
• Access to comprehensive care for PLHIV including that for meeting their SRHR needs

Feedback provided by the partner NGOs shows that the project is making some positive outcomes such as increased number of men accessing VCT and know their status; and more HIV positive men are accessing FP and using condoms.