Protecting Children from AIDS (Part 2 of 2)

Chiedza is the Shona word for “light.”  The Chiedza Community-Based Orphan Welfare Organization was formed by a group of teachers, health workers, and women from the Mutare District of northeastern Zimbabwe in 2005.  Gladys Mukaratirwa now leads that group as it fights the transmission of HIV at birth, known as “mother-to-child transmission” or “vertical transmission.”  She recently presented in Geneva to the Coalition on Children Affected by AIDS. Part one of this story was published last week. Chiedza is housed in a modest building.  They have four paid staff and nearly 100 volunteers.  Their annual budget amounts to about $50,000, and Chiedza spreads those resources across four impressive programs.  Their programs create access to education, health, and nutrition services, provide care and support for vulnerable children, empowerment and income generation, and HIV prevention.  They have helped 38 women from 14 villages register in the “prevention of mother to children transmission” (PMTCT) program and have four support groups for young HIV positive mothers.

These numbers may sound small until you realize that there are hundreds of thousands of organizations in southern and eastern Africa, which could do the same.  These grassroots organizations are widespread and connected to households in ways government health services are not.

Gladys explained to this meeting of HIV and AIDS funders that so far the main role of Chiedza has been to make sure that community leaders

understand the importance of preventing vertical transmission.  They provide accurate information on how to prevent it.  And they want to get communities and individuals to think of preventing transmission at birth as part of their everyday values, norms, and expectations.  Much of their work happens by encouraging expectant women to make use of PMTCT services provided at clinics and hospitals.  Gladys’ presentation can be found at http://www.ccaba.org/resources_geneva2.html

This meeting was to spell out what health services and communities need from one another in order to work effectively together.   If you’ve ever been in a government related planning meeting, you know this isn’t a small task.  From the health service point of view, government needs communities in order to bring women to services, and to reduce the “loss to follow-up” that happens when women come for an initial prenatal visit but don’t return.

What government struggles with are the large numbers of varied and loosely structured community-based organizations (CBOs) out there.  Governments are used to working through chains of command and hierarchies, and not with large crowds of autonomous organizations.

The advice given to governments was that they should not try to control or regulate CBOs, but rather to understand and support them, and invite them to reinforce government efforts.

On the community side, you could say that Gladys was asking for recognition, respect, and resources.   Often CBOs feel that they are very unequal partners to health officials.  It’s difficult for CBOs to convince mothers to use health services when the mothers feel they are received with disdain or stigma.  Both CBOs and African governments are chronically under-resourced, making collaboration even more necessary.  On the bright side, the global plan of action to end vertical transmission should make considerable funding available to both groups.

Gladys was glad she came, “I felt that I was the voice for the CBOs, communities and the marginalized grassroots families.  I also felt energized to put more effort in my work.  I felt I was sharing and networking with other people who have the same interest and goals as me, even though they come from very different places.  It was a lifetime experience for me.”

This Geneva meeting was the first of three sponsored by CCABA in preparation for the Washington AIDS conference in July 2012.  The next meeting will be held in Addis Abeba, Ethiopia, in December, to describe and analyze strong examples of government-community collaboration on vertical transmission.

CCABA has a very important role to play, in fostering this “handshake” between health services and community action, and Firelight and our grantee partners will help them to play it fully.