Tuesday, January 31, 2006

Reflections on 2 Support and Learning Team Visits in Northern Thailand in January 2006

Here are 3 thoughts that come from the 2 visits to communities that we made during our visit to Chiang Mai and Phayao last week. I’ve not found them easy to write about and I am not at all sure that I am being fair, but perhaps it will stimulate others to add their thoughts and thus provide a more balanced view of the visits.

After the 2 visits, I remembered what Alison Campbell of the Salvation Army told me 2 years ago. “It’s very easy when a meeting is dominated by people with relatively more power that certain voices are invalidated.” And again, “It’s nice to be included but that doesn’t mean that what you say is going to be heard.”

Well, in one of the communities, the woman representing the PHA (the part of the community living with HIV/AIDS) was emotionally supported and at times was almost physically supported by the other people at the visit. Hers was a vigorous voice and I would be very confident that what she said at a meeting would be heard. When I think of the other community, the member of the PHA made his contribution and he was certainly at the centre of what the other members of the community were saying, but he felt a much more isolated figure. It felt as though there were others who had more power than he had and you felt it would be very easy for him to be included in the groups deliberations without being heard. Perhaps, I am being unkind, perhaps, it was just that these people were shy of strangers coming into their community and so they become bureaucratic and formal (just as we do). But what we did see was the power of the group which owns the problem and which is emotionally involved with the problem.

The second thought is a very selfish one. It is my pleasure at seeing people using this Self Assessment tool. This wasn’t people talking about people who had used it, this was people who had used it and were continuing to use it because they found it helped them to address the problems in their community. The community showed their emotional support for their problem with their body language. But they were using the tool in a very hard headed and hard nosed way to address the issues they needed to address to solve their problems. This was something that I have wanted to see for a long time and it was a source of real pleasure to see it being used so intelligently. And I learned one specific thing from them about the tool that I can put to use very easily in my own work. These people have real expertise that can and should be shared by others. I believed that before. I know it now.

And then the third learning. What did we give them? What did they get from us? Well, we listened. And I hope and I think that we listened carefully. But it felt that it was a lot easier to give encouragement and support to the group which, I felt, really didn't need it all.

Thursday, January 26, 2006

Malaria Competence Guinee: Bien Reussie

*****Message from Idrissa Souare (UNICEF, Guinee Conakry) in English below*****


Chers Amis de la Constellation, bien a vous,

Il m'est agréable de vous faire savoir que le Bureau Unicef Guinée a présenté (au Bureau Régional et au siège) dans son "Rapport Annuel 2005" les résultats de la "Malaria Compétence" comme une innovation bien réussie.
Depuis, ce volet fait l'objet d'un grand intérêt à ces niveaux, certifiant d'avantage toute la pertinence de cette approche d'auto évaluation des compétences.

En effet, il reste évident qu'un fort engagement de chacun et de tous dans la promotion des cette approche de "responsabilisation des communautés contre le palu", permettrai de sauver de nombreuses vies, notamment chez les enfants et les femmes, a des coûts moindres, et de contribuer en même temps a réduire la pauvreté qui accable surtout les pays touchés par cette maladie.

Je vous fait parvenir en dessous, un extrait de ce volet. Je profite pour remercier les collegues Jean-Louis, Marlou et dr. Petas pour leur contribution de qualité à la formulation de ce rapport.

Amitié

Idrissa SOUARE, facilitateur Malaria compétence - Bénin / Guinée :
E-mail :
isouare@yahoo.fr,
Tel : (224) 26 47 04
« FAISONS AVANCER L’UMANITE AVEC LES ENFANTS »

********

Dear friends from the Constellation,

I am happy to announce that the UNICEF Guinee office has in its Annuel Report 2005 mentioned the results of the Malaria Competence Approach as a succesful innovation.

Since, the document got a lot of attention, regional and national - confirming the strength of the approach whereby communities self assess their competence.

In fact, it is clear that a strong engagement of each and everyone in the promotion of this approach of making communities responsible in the fight against malaria is saving lives, especially among children and women, at minor costs - and contributes at the same time to poverty reduction in countries touched by malaria.

I am copying below a summary of the document (in French). With thanks to Jean Louis, Marlou and Dr Petas for their contributions to this report.

Best wishes,

Idrissa SOUARE, Malaria competence facilitator - Bénin / Guinée : E-mail :
isouare@yahoo.fr, Tel : (224) 26 47 04



****************


Malaria compétence ;
« Une innovation bien réussie en Guinée Conakry »
(soutenue par l’Unicef Guinée – Rapport annuel 2005)

a)- Titre : Expérimentation de l’auto évaluation des compétences dans la lutte contre le paludisme.

b)- Problème adressé :
La mortalité des moins de cinq ans reste très élevée en Guinée : de 177‰ en 1999 à 163‰ en 2005 ne baissant que de 14 points en 6 ans ; le taux de mortalité maternelle est de 528 pour cent mille naissances vivantes en 2005. Le paludisme reste la principale cause de cette situation avec 31% des décès et avec une incidence hospitalière croissante de 108,3‰ en 1998 à 115,3‰ en 2003. La saison des pluies est la période de l’année durant laquelle le plus grand nombre de cas est enregistré avec des pics en juillet et en août. La Guinée Forestière – Région à grandes forêts dans laquelle l’approche a été développée – et celle côtière marécageuses, sont les plus touchées. L’incidence y atteint le plus souvent 224‰. Des cas de résistance à la chloroquine ont été observés à des degrés souvent très élevés : 28% à N’Zérékoré et 21% à Boké. Cette maladie influence négativement les indicateurs économiques du pays avec plus de 4 055 000 journées de travail perdues par les malades et leurs accompagnateurs. Son traitement et sa prévention constituent de lourdes charges difficilement supportables par le gouvernement et les familles.

Face au poids que représente le paludisme pour le Pays et tenant compte de l’efficacité de cette approche, qui a déjà fait ses preuves dans d’autres domaines notamment dans l’industrie et la lutte contre le VIH/SIDA, le Bureau a décidé d’appuyer l’expérimentation de l’approche «Auto évaluation des Compétences » dans 2 collectivités, Fermessadou et Sangardo, du District Sanitaire de Kissidougou. Se situant respectivement à 12 km et 25 km du chef lieu de la Préfecture, chacune des 2 collectivités couvrent 10 districts ruraux ; leurs populations est de 34 167 habitants dont 17 582 femmes et 16 585 hommes ; 3 623 enfants de 0 à 59 mois; et 4 531 femmes en âge de procréer (RGPH96 actualisé).

c)- Stratégies utilisées :
D’une manière générale, la stratégie de base de cette approche repose sur ce qui suit :
Il s’agit avant tout, de transformer les responsables de la lutte en facilitateurs. «Nous avons notre propre expertise et nous fournissons la solution» devient «nous croyons en la capacité des personnes à répondre», «nous contrôlons une maladie» devient «nous nous mettons au service de votre action», «nous répondons aux besoins» devient «nous révélons votre capacité» et «vous avez un problème» devient «ensemble, vous et nous avons des solutions».

Pour arriver à cette transformation, les facilitateurs travaillent en équipe. Ils apprennent ensemble à apprécier les expériences des communautés qu’ils accompagnent, en dégagent les leçons communes, adaptent ces leçons dans leur propre organisation. En outre, l’équipe de facilitation partage son expérience avec d’autres équipes. La compétence s’accroît progressivement grâce à l’interconnexion des équipes de facilitation. La formation de l’équipe se fait principalement par la pratique, au cours de visites d’expériences communautaires, en anglais Support to Action Learning and Transfer ou « SALT » visit.

Avec l’autoévaluation de la compétence face à la malaria, le facilitateur dispose d’un outil qui permet la prise de conscience, le dialogue, l’action et la mesure du progrès au sein des communautés qu’il accompagne, y compris sa propre organisation. Au cours de l’autoévaluation, des membres de l’organisation (au sens large : village, quartier, commune, association, entreprise, ONG, service public, …) utilisent un canevas qui leur permet de situer sur une échelle de 1 à 5 leur performance par rapport à quatorze pratiques essentielles pour la compétence face à la malaria. Ils se fixent ensuite des objectifs de performance pour les pratiques qu’ils souhaitent améliorer. La communauté mesure les progrès accomplis en répétant l’autoévaluation régulièrement, par exemple tous les six mois.

Dans la trajectoire de cette stratégie de base, la démarche s’est essentiellement articulée sur le terrain comme suit ;
· D’abord, une orientation préfectorale a été menée, avec un fort plaidoyer auprès des autorités préfectorales et communautaires en vue de leur adhésion et leur support au processus. Deux collectivités ont été alors choisies pour abriter l’expérimentation sur la base des critères de 1) disponibilité d’animateurs communautaires (AC) formés à l’animation, expérimentés dans la mobilisation sociale, 2) l’existence d’organisations communautaires partenaires à l’Unicef et 3) des responsables/leaders locaux très motivés. Pendant cette orientation, 16 AC, 12 représentants d’ONG et des structures administratives et communautaires en charge de la promotion et de la coordination des interventions de développement à l’échelle communautaire ont été initiés à l’approche d’auto évaluation des compétences. Ces 28 personnes ressources ont été organisées en 3 équipes de facilitation (une préfectorale et une pour chacune des deux CRD) chargées de l’appui technique et du suivi du processus.

· En suite, les activités d’auto évaluation des compétences proprement dites ont été organisées dans chacun des 10 districts ruraux des deux CRD avec une forte mobilisation de l’ensemble des couches sociales de la communauté à la base. Ces activités ont regroupé dans les dix districts, 445 citoyens dont 160 femmes, 132 jeunes et 153 leaders communautaires, issus de 30 organisations communautaires formelles (conseils communautaires, conseils de districts), organisations villageoises de femmes et de jeunes ; dont dix (10) groupes femmes, dix (10) groupes de jeunes, et dix (10) groupes de leaders et élus locaux. A l’aide de la grille d’évaluation renforcée par la méthode participative chaque couche de la population a été mieux informée, a mesuré son potentiel de compétences par rapport à chacune des 15 pratiques (y compris la nouvelle pratique ajoutée), a choisi 3 pratiques comme priorité sur lesquelles elle veut agir, a micro planifié les actions liées à ces pratiques prioritaires et a assuré elle-même la mise en œuvre et le suivi de son micro plan.



· Enfin, le Suivi et l’évaluation des actions communautaires planifiées ont été réalisés par les leaders des organisations communautaires, le pool de compétences au niveau sous préfectoral et préfectoral. La restitution des résultats a été effectuée avec le niveau central au chef lieu de la préfecture.

d)- Résultats obtenus :
La mise en œuvre de cette approche dans les deux CRD a permis d’enregistrer des résultats éloquents contre le paludisme parmi lesquels on peut noter :

1. Avant la mise en oeuvre de l’approche auto évaluation des compétences, seulement 2 079 sur 34 167 personnes dormaient sous des MII, soit 6% de la population totale des deux sous préfectures. A la suite des activités d’auto évaluation et la mise en œuvre des micro plans communautaires, et ce, malgré la très faible disponibilité des intrants par rapport à la demande actuelle (MII, produits d’imprégnation, etc.) et le faible revenu des populations, 9 447 personnes dorment sous MII, soit 28%, avec une nette amélioration de 22% en deux mois seulement.
2. Durant les activités d’auto évaluation sur le terrain, huit (8) sur dix (10) districts touchés ont choisit la pratique N°4, accès prompte au traitement adéquat du paludisme. Plus 29% des populations des districts ont été directement touchées par les séances de sensibilisation sur le TRP et connaissent les méthodes de prise en charge. 189 agents communautaires (AC) et accoucheuses villageoises (AV) sur 195 identifiés, ont été rendu capables de prendre en charge le traitement recommandé du palu simple dans les villages. Les médicaments de prise charge du TRP ont été aussi rendus disponibles au niveau de ces 189 AC et AV.
3. Tel que prévu dans les micro plans, les activités d’assainissements ont permis de maintenir une salubrité sans précédent dans ces villages. Des campagnes de nettoyage des lieux publics et des habitations ont été réalisées toutes les deux semaines ; 42 fosses à ordures ont été ouvertes dans les 3 villages qui ont ciblés l’assainissement comme priorité avec l’appui des animateurs de l’ONG Plan Guinée. Le comité villageois de salubrité installé dans chacun des villages, avec l’appui de l’«Association des Femmes Rurales pour la Lutte contre le Paludisme», a assuré le suivi de ces actions. Tous les lieux retenant des flaques d’eaux usées out pluviales ont été soignés.
4. A l’issue de cet exercice et des activités de sensibilisation porte à porte qui ont suivi, la population de secteur de Deyah (plus de 1 500 hts), dans le district de Mermereyah (CRD de Sangardo), a réuni toutes les moustiquaires du village (195 au total) et a invité à ces frais, l’unité d’imprégnation de la CRD de Sangardo. En suite, les femmes de ce village ont mis une tontine en place, qui a permis en deux mois (septembre et octobre), de mobiliser de l’argent avec lequel elles ont payé des toiles de moustiquaire dans la friperie et les faire coudre par le tailleur local ; 43 moustiquaires nouvelles moustiquaires ont été confectionnées et imprégnées à l’issue de cette organisation féminine du village ; 3 de ces moustiquaires ont été octroyées à 3 indigents de la localité qui n’auraient aucune possibilité de se doter de MII.

e)- Implications potentielles :
Cette expérimentation a montré que cet outil permettra d’accélérer le recul du paludisme avec l’implication des communautés.

Les communautés sont mieux informées et plus responsabilisées autour des questions liées au paludisme. Elles ont pris en charge des aspects liés à la prévention qui sont à leur portée. Des comités villageois de salubrités ont été installés dans les 100% des villages touchés.

L’assainissement des lieux publiques et intra domiciliaire a été organisé et suivi. L’utilisation des moustiquaires imprégnées d’insecticides a été bien perçue à tous les niveaux et la demande liée à l’acquisition de moustiquaire est devenue très forte. Les femmes ont mise en place des tontines villageoises pour l’achat et l’imprégnation des moustiquaires à leur frais.

Chaque village dispose d’un micro plan issu de consultation communautaire interne, mobilise elle-même les ressources nécessaires et suit de façon responsable sa mise en œuvre. Cette réalité vivante sur le terrain constitue aujourd’hui une véritable opportunité pour réduire l’incidence du paludisme et sauver de nombreuses vies, notamment au niveau des enfants et des femmes.

f)- Défis restants :
La mise en œuvre de cette approche a relevé le défi lié à la banalisation de la lutte contre paludisme et à la responsabilisation de la communauté. Dans ces localités touchées, le palu n’est plus une affaire seulement médicale, mais plus tôt une préoccupation communautaire, et est en passe d’être réellement sous le contrôle de cette dernière.

Cette situation a soulevée de nouveaux défis à relever:
i - fournir d’intrants, notamment toiles de moustiquaire, insecticides, médicaments, pour satisfaire la demande croissante,
ii - assurer l’extension de l’approche à d’autres Préfectures/Régions qui sont fortement touchées par la maladie,
iii - mobiliser d’autres partenaires dans le processus ;
iv - utiliser cet outil pour la lutte contre les diarrhées, les IRA, le DIJE, etc.

g)- Personnes de contact :

Dr Aboudou Latifou SALAMI, Coordinateur des programmes Unicef Guinée :
lsalami@unicef.org,
Tel : (224) 25 09 42
2. Idrissa SOUARE, facilitateur Malaria compétence - Bénin / Guinée :
isouare@yahoo.fr,
Tel : (224) 26 47 04
3. Mr Mamadou Oury BAH, administrateur de programme à l’Unicef Guinée :
Mobah@unicef.org
Tel : (224) 23 31 05






Monday, January 16, 2006

Access to Treatment & Money is NOT Enough



Last Friday afternoon I had the opportunity to visit a community in Lamphun in Northern Thailand. What I learned was that this community had access to treatment and didn't see money as an issue - but still they hadn't "solved" the problem. So what I take back to my work is that while treatment and money are necessary they are by far not sufficient to respond to the challenges of HIV/AIDS in our society!

The group I visited in Lamphun with a team of colleagues came together to learn about Human Capacity Development (HCD), to do a self-assessment of their AIDS Competence and to come up with action plans to respond to HIV/AIDS. The community group consisted of a very diverse range of people, including children and including families directly affected by the virus.

You can see the outcome of the self-assessment in the above picture. I was struck by some particularities that I commented in the image and outline in the following points:

  1. This communty feels that all those in need of treatment have access to them and are using them effectively.
  2. They see the mobilization of resources as one of their strenghts even if they want to further improve.
  3. The community puts a lot of emphasis on the fact that they want to improve "learning and transfer". They assessed themselves at the basic level for this issue, but want to strongly improve.
  4. Similarly, they show a strong commitment to improving "measuring change", which they also feel less strong on.
So what does this self-assessment really reflect? It shows that accesss to treatment is currently not an issue, which is among other things based on the relatively strong healthcare system in Thailand. Money is also accessible, which one of the government officials confirmed. He stressed the fact that when action plans and proposals are well prepared money can be mobilized relatively easily. However, besides these strenghts the self-assessment also shows that "learning and transfer" as well as "measuring change" have been strongly neglected, although the community really seems to want to improve on these issues. My interpretation would be that these two issues really require that a community takes ownership of responding to HIV/AIDS before strong levels of competence appear. This is not something that a government intervention can easily achieve. And indeed, this has been the first time that this particular community as come together to discuss and assess their AIDS Competence (overall, the local government has promoted this approach for 2 year now).

In the discussions with the present local municipality officials I also learned that applying the AIDS Competence approach has led to a different attitude in communities. PLWHA groups and the communities smoothly worked together. People living with HIV/AIDS (PLWHA) became integrative part of the community discussions. Focused action plans were developed based on self-assessments. Communities assumed ownership and leadership.

But what I also learned was that applying the AIDS Competence approach needs local champions and leadership inside the government structures that will not only promote the approach, but transfer knowledge about it. The approach was applied for over two years now in these sub-districts thanks to the motivation and knowledge of Khun Or, a restless promoter of AIDS Competence. Yet, when she was promoted to another office, the local officials had the feeling they weren't competent enough to further push AIDS Competence. As a consequence the program did not further expand to other communities. Thus, while local champions are needed to get things going it is equally important to develop local facilitation teams that will continue to expand to and connect other communities.

I was deeply touched that Friday afternoon because I experienced first hand how important local ownership is to respond to HIV/AIDS. Even in a place where access to treatment and money is not perceived as problem HIV/AIDS can only be tackled when people own the issue.


Friday, January 13, 2006

Training for the AIDS Competence Process in the City-AIDS project

I have had the opportunity to facilitate a City-AIDS workshop mid-December 2005 in Lyon. As many of you already know, the City-AIDS project aims at building capacities of Local Authorities (City Managers) and stakeholders to develop an efficient response to the HIV/AIDS epidemics. The main strategy of the project is based on Human Capacity Development implemented through the AIDS Competence Process and the development of learning capacities as well as sharing of experiences/knowledge.

As we started a new session for the project, CIFAL Lyon (International Centre for the Training of Local Authorities) and its main partners (UNITAR/DCP and UNAIDS) decided to start a more quality-oriented process in order to ensure a better promotion of Learning and Experience Sharing among local authorities. It was then decided to run that session over two periods: (a) the training of facilitators coming from 20 invited cities, and (b) a Knowledge Fair where representatives of local actors and local authorities from the same cities will come to share their experience and knowledge regarding the HIV/AIDS epidemic and the interventions they implement. Between the 2 periods, each cities would have carried out a Self-Assessment with all actors. For the first period (12th-13th Dec. 05), CIFAL Lyon requested the local authorities to identify an potential facilitator and a profile was sent in advance to help the identification of the person.
The December workshop was co-facilitated by UNITAR and UNAIDS. All of the facilitator have a very good knowledge of the process. Emphasis was put on the facilitation skills needed to conduct the AIDS Competence Process with all city actors. City participants are actually supposed to kick-start a process when back into their home city, and a Self-Assessment exercise with all local actors involved in the fight against HIV/AIDS should be carried out before the next period.

We developed a format for this two-days workshop: it may look brief, but in most of the cases, we need to make a balance between an ideal time-length during which we need to meet with local communities and NGOs around the site of the workshop and the fact that participants do not have the possibility to stay very long, away from their city/work.
In Lyon, we have the privilege to work with a large number of NGOs, under the umbrella of the CRIPS (Centre Regional d'Information et de Prevention du SIDA), and all of them areimplementingg effective and interesting activities with PLWHA and other vulnerable groups. In fact, the so-called "technical visit" was the most successful exercise of the workshop and the most satisfactory activity for the facilitators. Participants could not only created a comfortable and at ease ambiance for the exchange of experience but carried out a self-assessment exercise with actors in the field (already prompted to the City AIDS initiative, resulting in a successful exercise).
As we review the format, we think that for the next "training sessions" we may need to further reduce the presentations on Knowledge Management and on tools which are probably much more simple as people get to understand the basic SALT principles.
Our main concern for this particular workshop was the limited number of participants. As I mentioned before, 20 cities were invited. In addition to the cities participants, there were representatives from two partners, Handicap International and GIP-ESTHER. While invitations for this first period were sent end of July 2005, only 7 cities sent representatives for this training of facilitators (Bujumbura, Antananarivo, Bucharest, Kayes, Rabat, Agadir and Porto-Novo). Some others could not come for "external" reasons (Visa problems for Kinshasa and sickness for Douala and participation at ICASA for Bangui). But most of the others either did not respond at all (Tunis, Bruxelles, Kiev, Nouakchott, Vientiane, Phnon Penh, Hanoi, Ouagadougou) or declined the invitation (Dakar, Victoria and Paris invited as "observer").
Why so few cities responded? Following are attempts to explain this low turn-over. As usual, the reality is likely to be a mixture of all or part of them. But it may be important to have them in mind as we go along with the project.
(i) One of the first reason may be that CIFAL does not have any direct counterpart within these municipalities, in spite of its intend to work with local authorities. It is a recent institution, not very much known and whose purpose and strategy is quite innovative; therefore, local actors may not have paid the relevant attention to the invitation. It is always necessary to have a kerespondentnt in the city or the country in order to mobilize people asw it was shown through some UNAIDS officers.
(ii) The logistical arrangements (only local accommodation was paid) may have defeated a few cities to send participant. Such arrangement was decided in order to favor highly committed participants and ensure a better follow-up. Meanwhile, it must be noted that some of the participants (Porto-Novo, Kayes) decided to come in spite of the absence of support from their municipality. About that aspect, CIFAL decided to modify its point of view and it will pay for all aspects for the next period. it will probably bring more people on board, but it will be interesting to see how that may affect commitment and implementation of the process.
(iii) Local authorities, and in particular Mayor's offices, are not used to work with multilateral institutions like the UN system. Therefore they may not give the right priority to the proposed activities.
(iv) The heavy agenda of some municipalities did not allow (even with a five-month-in-advance invitation) them to release the appropriate person.
Because of the limited number of cities that participated at this first training workshop, CIFAL, UNITAR and UNAIDS will have to decide quickly how, and to who, the invitations for the next period will be done. While it would not be appropriate to invite cities that would not have performed their Self-Assessment before the session, it is worth noting that exchanges are much more powerful and rich as we increase the opportunity of mutual learning. It was then agree that invitation will be sent to the 20 initial cities. For those that did not participate in December (which don't have any facilitator), all efforts will be done to make distance-coaching so that they can realize their Self-Assessment exercise in due time.
It seems that CIFAL Atlanta and Lyon have not the possibility - for the time being - to make use of other existing cities networks. Such possibility should be developed as the City AIDS project should complement activities undertaken by other networks (including the AMICAALL). This will provide entry points and identify city counterparts who can support and mobilize local authorities whenever necessary.

Sunday, January 08, 2006

Smoke-free cities: what can we learn?

On November 28th and 29th, 2005, I have participated at an "Expert workshop" on Smoke-Free satisfying request of the CIFAL Lyon. As I informed some of you in a previous message, the purpose of this participation was mainly to present the AIDS Competence approach to that group, and to see if there is any added-value to develop a similar process for achieving the ultimate goal of "Smoke-Free Cities".
Here are my comments/lessons from these two days:

1. First of all, it is now clear for me that the goal of having "smoke-free cities" is limited; it mainly focuses on the development and implementation of tobacco-control policies and rules. Most of the participants were in the controlling mode and aimed at enforcing legislation at city level. We all know that putting a ban on smoking in all public buildings and settings etc... will only reduce tobacco prevalence by 20%.

2. Second, the main target of the group was not so much people, but Mayors and other local authority decision-makers. They needed to develop advocacy or communication strategies to convince or attires City Halls to establish tobacco-control regulations.

3. Third, most of the participants were still convinced they know exactly and extensively what to do to have smoke-free cities. They didn't see as an issue the fact that applying a smoking ban in e.g. restaurants is probably not as simple as it appears; it is not so much to make tenants to sign at the bottom of a document and putting posters. How bar tenants are dealing with reluctant people? How do they explain this rule to the "hard-to-change" consumers so that they don't lose too many clients?

4. Smoke-free cities are different of tobacco-free cities. The group stated that they wanted to focus on Smoke-free cities at first. Decreasing tobacco prevalence further will need other strategies and approaches, more related with behavior changes, for which they didn't have a clue.
While they realized that an ACP-Like process may be useful for tackling smoking attitudes, they didn't have any knowledge of successful aproaches or interventions which could apply.

I think the goal of such Smoke-Free Cities group is worth to implement, but limited. In spite of these limitation, there would be some interest to develop a learning and exchange process for increasing efficiency of some "control" measures. However, an ACP-like process would be much more interesting and efficient if the group would have considered a tobacco-free cities goal!
At the end, the group designed a classical approach to organize a workshop where local authorities will be trained (taught) to implement control strategies in their respective cities.

I am, more than ever, convinced that tobacco issues is one of interest for learning and exchanges process. But, such process cannot be initiated by an expert group: local authorities who are willing to reduce tobacco prevalence in their city are probably the right people to talk to. They will be much more interested in action-oriented and result-oriented strategies. If the Constellation is approached by such partner, than it will be possible to propose an appropriate process.

The real success for a Smoke-Free city would be to influence behavior of the citizens, through a collective approach led by a Mayor or other local authorities; non to inforce rules which may only marginalize smokers and make them "hard to reach". Next step would be to develop a Tobacco Competence concept!

Thank you.

Wednesday, January 04, 2006

The Constellation facilitates global malaria meeting


On the 18th and 19th of November 2005 the Constellation facilated the core parallel sessions of a global malaria meeting, the Forum V. It brought together an assembly of all partners and constituencies of the Roll Back Malaria (RBM) Partnership of the United Nations.

The forum was designed around a participatory approach that aimed at giving all participants the opportunity to share their experience in rolling back malaria and to contribute to defining the actions needed for a successful fight against malaria. This participatory process culminated in the common ownership by the assembly of the Yaoundé Call to Action published at the end of Forum V.

Could this be the beginning of a new era of UN meetings based around sharing of experience rather than opinion or ideology?

AIDS Competence in the Democratic Republic of Congo

In December 2005 the Constellation visited the Democratic Republic of Congo (DRC) to help build a new AIDS Competence Process that will be launched throughout the country. The Belgian Technical Cooperation is sponsoring this process together with the ministry of health to support learning and sharing in existing networks. It will give local responses a boost in DRC in 2006 and will hopefully help to a scale-up positive success stories!

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