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.


Comments:
Thank you Alex for sharing that particular experience. One comment on the "local champion": having local authorities taking the lead for the promotion of AIDS Competence is really a fantastic opportunity, but you also have faced the "cons" of such a choice as the Dr ...(don't remember her name) was displaced. A facilitative leadership is strongly needed, especially during initial periods where the process has not been integrated in community life. But it may be better to have someone from civil society or a local association, working in collaboration with "established" leaders.
 
Alex, Thank you very much indeed. Its really interesting to know that community it seldf is responding world biggest problem. Once againg credit goes to you people who initiate this unoque approach. We TREE here in Bangladesh is trying to curb the IDU problem in a sub district savar under Dhaka dostrict. Here people is also very interested to participate. Could you please let us know how we can involved this very teriable group as you know IDUs are more vulnerable to HIV in all over the world particularly in the developing countries. Discussion with this group we are aware that they are intersted to come in to mian stream social life but the barrier is the initial resource and the wider community ......
 
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