It’s been a busy year for the Blood:Water team, and we’re proud to finally be able to introduce you to one of our new partners, Foundation for Community and Capacity Development (FOCCAD)!
As with all our partners, it’s hard to describe the full depth of what FOCCAD does and how much of a difference they’re making. But we’ll do our best to explain a little bit about why we are so excited about and impressed with this partnership and what we can do together for the communities they serve.
Since their start as a youth group in 2003, FOCCAD has used its grassroots programming to bridge the transport and logistics gap between health facilities and “hard-to-reach and underserved communities in Malawi” building their resilience, amplifying their voices and upholding their rights. Their mission is to alleviate human suffering from disease, hunger, poverty, and social injustice by creating and implementing participatory and sustainable health solutions in the Nkhotakota, Dedza, and Salima districts and bordering communities.
Primarily, they focus on preventing HIV transmissions and AIDS-related deaths and improving the health and livelihoods of young adults, women, and children, especially children who have lost one or both parents to HIV-related illnesses. They then generate evidence from their programming results to share with like-minded organizations to serve youth in the most coordinated and impactful way possible.
Over the past five years, they’ve developed six priority strategic areas comprising their theory of change:
Health and Nutrition
In addressing HIV, they provide prevention and testing and counseling services, often through door-to-door delivery, including tracing people who have defaulted on their treatment through networks of community agents, health promoters, and transporters. For women and children, they prioritize treatment adherence, health referrals, self-advocacy, early infant diagnosis, responding to and preventing stigma and discrimination, nutrition education and support, and pioneering emergency transport services for pregnant women living with HIV to access quality health services in health facilities. They work with health facilities to build community competence through coordination meetings, developing protocols and standards, training health workers, community agents, local leader networks, and committees, and advocating for women living with HIV. Other services include WASH (water, sanitation, and hygiene), general outpatient needs, and sexual and reproductive health and rights (SRHR) such as family planning and information about HIV.
Because of its prevalence in the area, FOCCAD targets early forced marriages, withdrawing adolescent girls and young women (AGYW) from them, creating role modeling networks in primary and secondary schools, addressing menstruation challenges, and engaging men and boys to support their female counterparts. They champion opportunities for girls to connect in clubs, have a voice, and develop strategies to deal with their challenges through local solutions and innovations in a friendly and dignified environment. They’ve given scholarships to over 170 vulnerable young people in secondary schools, and facilitated mentorships, coaching sessions, and life skills education and training.
Agriculture and Livelihood Development
FOCCAD has worked with 25 farmer organizations and 3 cooperatives on climate-smart agriculture, conservation, and modern farming technologies for 5,200 people in over 2,250 households for food security and nutrition. Women have gotten quality extension services and training in things like post-harvest management, backyard gardening, quality inputs and markets, farmers’ clubs that may have been limited to men, and savings and credit services and facilities.
Emergency and Disaster Risk Management
With the World Food Program, Department of Disaster Affairs Management, and district councils, they’ve dealt with food insecurity through emergency food response and cash-based transfers to over 120,000 people. They’ve also provided technical assistance and direct service delivery through training civil protection committees, identifying beneficiaries, and handling complaints and feedback. FOCCAD also supported women dealing with gender-based violence with protection from sexual exploitation and abuse, and people in need of WASH services during emergencies.
Child and Youth Development
At early childhood development centers, children’s corners, and various platforms in and out of schools, FOCCAD promotes early learning that has reached over 16,300 young people! Among other activities mentioned in their education strategy, they also train young people in social media for development, coaching, mentoring, and meaningful interactions about things like SRHR, health, HIV/AIDS, in addition to facilitating internships, talent shows, competitions, and radio programing. They’ve trained and coached over 1,200 young people out of school in technical and vocational education, entrepreneurship, and business and leadership skills.
Gender, Rights, and Governance
FOCCAD has different programs with training in capacity building for women’s groups to assume leadership roles and modeled “1 man can clubs” for male community groups to motivate each other’s and their communities’ health. They are challenging traditional barriers to health services, even helping trace women and children missing out on prevention of mother-to-child transmission of HIV (PMTCT), antiretroviral therapy (ART), and other health programs. FOCCAD also partners with district councils and stakeholders to end gender-based violence, promote access to rights, and allow for accountable, inclusive, and responsive governance in different sectors of government ministries, departments, and agencies.
According to their website, FOCCAD has so far in the history of their organization:
- Tested over 18,400 people for HIV
- Provided PMTCT services to over 5,234 mother and infant pairs.
- Reached out to 15,467 PLHIV to remain on treatment, care, and support.
- Addressed 192,000 people living with HIV and AIDS and women of reproductive age on differentiated HIV-TB prevention and HIV treatment and care strategies and activities.
Much of this information is from their website so if you’d like to see more about their full story, check out foccad.org!
Our Project with FOCCAD
The Local Context
Though the national HIV/AIDS prevalence rate is 8.5% in Malawi, adolescent girls and young women (AGYW) aged 15-24 comprise almost a third of new HIV transmissions in the country, 2.3 times higher than young men in the same age bracket. They face generational cycles of gender inequality, poverty, and economic dependence which limit their opportunities and exacerbate their vulnerability to HIV acquisition. They typically have more difficulties completing their educations–36% of those who finish primary school enter secondary school–due to challenges like early forced marriages, teenage pregnancies, and poor water, sanitation, and menstrual hygiene support in schools. Recent studies on PMTCT and ART retention in Malawi show tremendous disparities for mothers enrolled on ART and their infants being tested for HIV. While adult women adhere to ART and PMTCT services, seven out of every ten AGYW on ART and their children are likely to default on their treatment.
In Malawi, 35.2% of households have access to an improved toilet facility, 8.9% had no toilet facility, and 88% had access to improved water sources. Limited access to adequate water, sanitation, and hygiene facilities and practices are also prevalent, though essential for people living with HIV (PLHIV) to stay healthy since their immune systems are compromised. For example, diarrheal disease rates for PLHIV are up to six times higher than those who are HIV-negative, and can lead to dehydration, malnutrition, depleted energy and movement, and subsequent loss of earnings let alone if your body is incapable of fighting the illness off. Plus, diarrhea can reduce effectiveness of ART used to treat HIV.
Breaking Barriers to HIV Treatment, Care, and Support – Sustaining Community Interventions
FOCCAD therefore intends to implement a combined integrated HIV prevention, treatment, care, and support, and WASH intervention targeting 10,200 AGYW (adolescent girls and young women) and their children and adolescent boys and young men and their sexual partners. We officially started our partnership in April 2022, and the project goal is to reduce new HIV transmissions and AIDS-related deaths among 4,264 AGYW and their children by 2024 in fishing and sugar communities of the Nkhotakota district and border communities of the Dedza district in Malawi .
To do that, FOCCAD strives to radically change the lives of 3,480 young women and adolescent girls and 784 orphans and vulnerable children (OVC) who have lost or are at risk of losing one or both parents to HIV-related illness by reducing new HIV transmissions and AIDS-related deaths. They create and facilitate learning through tailored communication strategies for a variety of audiences (including impact and target groups), and increase access to and uptake of a core package of combined HIV prevention, treatment, care, and support services. Women and girls use safe spaces to freely express themselves without the fear of judgment or harm to deal with gender-based violence, norms and practices, menstrual hygiene, life skills, sexual education, HIV/AIDS, PMTCT, positive living, nutrition (which also helps ART work better), economic empowerment, and staying in school.
Objective 1. To increase access to a combination of HIV prevention and testing for 3,480 AGYW and their sexual partners in fishing and sugar communities of Nkhotakota and border communities of the Dedza district by March 2024.
Objective 2: To provide comprehensive HIV palliative care and support to 150 HIV positive AGYW mothers and 784 children through economic empowerment, treatment adherence, retention, and ART defaulter tracing in fishing and sugar communities of Nkhotakota and border communities of Dedza district in Malawi by March 2024
Community Engagement & AGYW Identification
The three project catchment areas are divided into manageable zones, and people join the project through 116 AGYW clubs with up to 30 members managed by 15 expert peer leaders who are key community contacts that directly report to Project Field Officers. After a two-week training on a combo of HIV/AIDS and WASH information, they get bicycles, bags, promotional and protective materials, and a monthly stipend to help build AGYW skills, and support small group and one-on-one information dissemination at the community level on HIV and AIDS prevention, testing and linkages with health workers, WASH activities, and mentorship with fellow AGWY clubs.
AGYW In and Out of school
Most AGYW are in school, and Malawi offers life skills education and youth-friendly, comprehensive sexual education as part of its curriculum in primary and secondary school. This is why the project directly works with schools in HIV prevention, treatment, care, and support and, at the community level, is a central point for AGYW club meetings. AGYW often drop out of negative school environments, so integrating household interventions with school-based activities helps keep girls in schools and prevent early marriages and teenage pregnancies, which in turn reduces their risk of HIV transmission. For AGYW living with HIV and still in school, children born to AGYW, and orphaned and vulnerable children, follow-up interventions with schools reduce stigma and discrimination as well.
The project has several key features of sustainability. It empowers Malawians to take control of their own future and encourages problems to be solved at a local level that do not require continued outside resources so AGYWs, youths, and their communities can continue their growth. It focuses on enhancing the everyday lives of program participants through approaches with long-term benefits, and on building relationships that enhance mutual support, opportunities, and exchange.
FOCCAD’s models have proven successful at increasing accountability of community leaders and higher status members, which builds ownership for results at the community level and promotes problem-solving using locally available resources. They engage community facilitators to train lead persons chosen by groups to train others, which creates better ties among community leaders, volunteers, group members, and other stakeholders. They also work closely with government entities and service providers where group members and community volunteers (predominantly women) can gain social standing and a voice from their leadership and management experience and where appropriate, facilitate smooth handover of activities.
Monitoring and Evaluation Plan
Also to help ensure greater sustainability, project participants are at the center of measuring, learning, and communicating how the project is going to empower them, and helping FOCCAD and its partners be held more accountable to marginalized groups. They are involved in designing monitoring and evaluation plans and key measures of success with flexibility in how this is done so that more of them can contribute, providing periodic feedback on findings, and discussing them with project management. FOCCAD believes this builds capacity, and if participants understand projected outcomes and feel the benefits, there is a more concerted effort to see to its long-term survival.
FOCCAD’s monitoring and evaluation system’s fundamental purpose is streamlining the process of planning to monitor results, and collecting and analyzing progress. Then they use this information to influence their decision-making and resource allocation for the program, and communicate their achievements.
Progress Since Partnership Started
- 165 individuals with advanced HIV infection newly initiated on ART, by age
- 176 OVC enrolled for ongoing care and support services
- 508 referrals made that resulted in access of health services, by service type
- 87 AGYWs trained on how ART works, the importance of treatment adherence, nutrition and other aspects of positive living.
Adolescent Girls and Young Women
Though we’ve only been working on this project for about a year, we’ve already been so impressed with what FOCCAD has done through it. For starters, 3,167 AGYW were engaged in 106 clubs to address norms and practices related to gender, separated by age group. These are one-on-one and small group discussions held every week on HIV prevention, testing, stigma and discrimination, medication adherence, life skills, menstruation, reproduction, child marriages, and sexually transmitted diseases. Fifteen trained peer leaders run these clubs, and they’ve had good interactions with AGYW that help them disclose their HIV statuses and experiences and participate in the group. One AGYW even decided to enroll back in school! Club members share with their peers how the groups work, and many more AGYW have joined as a result.
Teen clubs also encourage disclosure of HIV statuses and offer intensive counseling for adherence to HIV treatment; health workers use them as a key milestone in reaching teens and children living with HIV. 231 teens living with HIV have been supported through these clubs, in partnership with health workers, peer leaders, parents, and guardians. Twelve health providers from six facilities and four FOCCAD staff were trained on how to properly run each club, partial and full disclosure, project goals, core values, models of service, eligibility criteria for club, and roles of mentors. The teens can access their medicine at club sessions and give viral load samples to get an idea of how much the virus had spread in their bodies, helping to both improve drug adherence and reduce default rates among AGYW!
From the clubs and other touchpoints hundreds of the AGYW were also linked to ART, HIV testing, HIV prevention, and health facilities, and 71 AGYW and their children were traced and retained back in care and counseling sessions! AGYW living with HIV attended a series of trainings that utilized Ministry of Health staff, especially ART coordinators, on how ART works, importance of treatment adherence, nutrition, and other aspects of positive living. 400 AGYW were counseled and tested for HIV through moonlight and door-to-door testing drives where there is greatest need in hotspot and hard-to-reach areas. Health facility health diagnostic agents help so testing is done on site, and people testing positive are immediately referred to the facility and initiated on ART. Some people also get self-testing kits to take home to do with their partners.
Through mentor mothers or expert clients, FOCCAD targets mother-infant pairs to better support children born to HIV-positive AGYW. Expert clients work with peer leaders during antenatal care clinics to provide motivational talks to mothers and in homes to women who have not yet started this care, and helped identify and test 175 infants born to HIV-positive mothers who fit that description or couldn’t access testing. Those who needed it were referred to health facilities for antenatal care and anything else they needed, and those who couldn’t make the long distance got transport from FOCCAD through their networks of motorcycle and bicycles transporters. 312 pregnant and lactating AGYW were tested for HIV and counseled on the virus and other topics like birth preparedness, danger signs during pregnancy, the postpartum period, food groups, malaria in pregnancy, PMTCT, immunization, and hygiene.
FOCCAD strengthened 182 school life skills/comprehensive sexual education clubs in schools, particularly focusing on HIV prevention, helping 102 people in school governance structures on meeting national standards on the curriculum. They held 182 interventions in schools on stigma and discrimination through quiz and debate competitions, and the final round awards were prizes that the schools needed like plastic chairs and teaching materials.
Another special project they hold to engage and mobilize more children living with HIV, especially those born to AGYW, is children’s corners, with partnerships with parents, guardians, and government sectors. Hosted through early childhood development (ECD) centers, these are after-school activities that support kids with nutritious food, academic lessons, library sessions, rights education, positive living, play and sporting activities, and HIV/AIDS and life skills. Trained care providers use the national ECD curriculum in Malawi with their age-specific groups, and children are monitored on nutrition so they can get a healthy, hot meal if needed.
FOCCAD’s community systems model has a vibrant referral network dealing with gender, structure, stigma, and other gaps leading to treatment and HIV intervention defaults by AGYW, fueled by trained mentors and peer leaders. Tapping into community-clinic collaboration to advance delivery of treatment, care, and support through a differentiated service delivery model, health stakeholders have come together six times with representatives of AGYW living with HIV to strengthen the network and trace referrals that end in service access.
Through expert clients, FOCCAD conducts ART conference calls between community volunteers, health facility staff, and people living with HIV to help identify defaulters or self-transfers, deploying teams of health surveillance assistants to communities to trace and bring AGYW defaulters and their children back to care. Planned quarterly meetings with youth living with HIV (Y-plus) networks and health workers were conducted, helping AGYW, 21 Y-plus network representatives, ART providers, the district youth office, and the youth health-friendly services office understand and address issues to break cycles of self-stigma, discrimination, and high default rates affecting most AGYW living with HIV.
A few months ago, FOCCAD completed their IDF (Institutional Development Framework) assessment to identify their strengths and opportunities for growth. As a team, they chose the areas to focus on improving for the rest of their grant cycle. We’re so excited to see what they’re able to accomplish!
It’s also been really awesome to start doing partner exchange visits again as a way for partners to learn and get ideas from each other on how to do their work better! One of our Kenyan partners Our Lady of Perpetual Support (OLPS) got to visit FOCCAD this year, with more visits in the docket for the year.
One Young Woman with a Brighter Future
Aisha is 18 years old from the Chankhalamu village in the Nkhotakota district of Malawi. When FOCCAD deployed a team of health surveillance assistants and the village peer leader to trace and counsel people in her area on HIV, they identified as a defaulter on HIV treatment. As they interacted with her, they realized she defaulted due to self-stigma, discrimination, and the long distance of 22 km (about 13.7 miles) just to get to the health facility.
To get her back on the treatment she needed, they counseled Aisha and gave her transport to access her ART at the facility. Now back on her treatment, her immediate family members were also counseled to address any form of stigma that could prevent Aisha from adhering to her treatment, care, and support.
Aisha explains, “My life was not easy as I stopped being on treatment; I have been on and off with different opportunistic infections. I am happy that I was followed up and supported with transport and I won’t miss any appointments from now on. Through the counseling I was able to understand and overcome self-stigma.”