My First Business Trip - Pemba Island

It feels like I have come a long way with ZANGOC, and work, since I first arrived on the island back in March. One of my main job duties for ZANGOC was to create their new strategic plan and the end of June I accomplished that task by completing the first draft of the plan. The past 2 weeks I have been meeting with a few members from the Executive Committee and we have been going through the plan literally page by page to incorporate ZANGOC’s suggestions and inputs to make it “ZANGOC’s” strategic plan and not “Lisa’s” strategic plan!

Another one of my main tasks has been visiting with the, now 45, member organizations that are under the ZANGOC umbrella. From my visits with the members I have been collecting basic information in order to create a database of NGO members as well as to analyze the strengths and weakness of each organization so that YCI and other donors can address the gaps in organizational capacity. For example, human resource and financial management, IT and website design, proposal writing and resource mobilization and Monitoring and Evaluation.

Of ZANGOC’s 45 member organizations, 4 are based in Pemba which is the smaller island to the north east of Unguja which, together make up the Zanzibar Archipelago. 

Map of Pemba highlighting the 3 towns of ZANGOC operation: Chake, Wete and Micheweni

At the beginning of my time here I was really keen on going to Pemba to visit with the members and facilitate a workshop but after looking into costs, the idea was put on the back burner for a little while. In late May I attended a workshop for ZACP (Zanzibar AIDS Control Program) and met a man who is from Pemba, works for ZACP in Chake Chake (the main town in Pemba) and who is also on the ZANGOC Board of Trustees. After talking with him about ZANGOC and Pemba, he convinced me that I just must go to Pemba! So I drafted a short proposal and budget and submitted it to YCI and in June it was approved as my first business trip!

On Friday July 15, I jetted off to Pemba with the ZANGOC Deputy Executive Secretary, and a box of supplies for the Pemba sub-office. After a short, and very beautiful flight over the Indian Ocean, we arrived at the Chake Chake airport 30 minutes later. 

Beautiful coral

Airplane shot of the Cost of Pemba

We arrived Friday, late afternoon so I had just enough time to check into my hotel and go for a walk around town before the sun set. It was more like a stroll as Chake town is so small that if I walked at a normal pace I would have seen the whole town in about 20 minutes! Also, the shops close around 5:00pm so I wasn’t able to browse or do any market shopping. Topographically, Pemba is very different than Unguja. While Unguja is flat, Pemba is very hilly even with some small mountains in the background of Chake. It was a nice change though, I know Unguja is very green in terms of forestry but in Pemba you can definitely notice it a lot more. Especially when you drive up the windy roads you get an amazing view of the villages below surrounded by palm trees and just general beautiful nature, I feel like my pictures didn’t capture the essence of Pemba as much as I hoped...

On Friday evening after my walk, I came back to the Pemba Island Hotel where I was staying for the weekend, I had a nice calamari and pilau rice dinner then finished planning my workshop for Saturday morning.  On Saturday I woke up early and met my Pemba colleagues at the ZANGOC/WAMATA office in Chake. 

Outside of the WAMATA Office, Chake, Pemba

WAMATA is a regional NGO in Tanzania that works to help those who struggle with HIV and AIDS in Tanzania. In Pemba, WAMATA is a ZANGOC member organization and operates a VCT clinic that is supported by the ZANGOC/ICAP funded project. The topic of my workshop was project design and proposal writing and my participants consisted of 10 people, 2 people from each member organization: WAMATA, NOAC (North Pemba Organization for AIDS Control), PEYVO (Pemba Youth Voice Organization) and YOEPA (Youth Organization on Education for the Prevention of AIDS), and the ZANGOC sub-office. The workshop ran for 3 hours and I feel as though it was well received, the participants were active in group discussion and, although all of the information might not have been new knowledge, I feel as though each participant walked away with useful information on project design and proposal writing.

How to write and effective "S.M.A.R.T" Goal

My beautiful LFA on flip chart paper

Before I left for Pemba I met with Shaib, who is the YCI Volunteer Manager here in Unguja. Shaib is originally from Pemba and he still has a lot of family members there whom he gave me some contacts. On Saturday after my workshop I contacted Cholo, who is Shaib’s brother in law and who also is the manager of the hotel I stayed at. I was very grateful for his hospitality in showing me around Chake and taking me to meet Shaib’s mother and family then even inviting me to his own house to meet Shaib’s younger sister and their new 7 day old son!

The house of Shaib's mother!

The village is new and houses are still being constructed

Saturday morning I was invited to attend the first quarterly meeting of the ZANGOC/ICAP VCT funded project that is taking place in Pemba. The meeting was held at the Gombani soccer stadium in Chake. All important stakeholders in the VCT project were invited to present the results of their VCT centre from April to June 2011. Stakeholders included: ZANGOC, WAMATA, Micheweni VCT Centre, ZACP and ZAPHA+.

View of the Stadium entrance from the Conference hall

The objectives of the ZANGOC/ICAP project are to control the spread of new HIV infections by providing counselling, testing and education services to general and key populations (being IDUs-Injection Drug Users and MSM-Men who have Sex with Men). The results for the 3 ZANGOC VCT facilities are outlined below.

ZANGOC VCT Results Q1 REPORT	APRIL		MAY		JUNE		TOTAL
	Male	Female	Male	Female	Male	Female	Male	Female
Micheweni	7	7	12	5	16	13	35	25
WAMATA (Chake)	6	5	25	25	7	6	38	36
ZANGOC (Wete)	32	19	43	30	52	48	127	97
			TOTAL TESTED IN Q1 by Gender				200	158
			TOTAL TESTED IN Q1				358

Of these 358 people who were tested in Q1, no positive HIV cases were reported. It was also reported that ZANGOC conducted one outreach activity consisting of 53 participants (42 male and 11 female). There was only one outreach activity conducted due to limited funds available for such an activity.

All in all, my first business trip was a success but I wish I had a few extra days to relax on the prestine beaches and visit the city of Wete, which I am told is a must. Perhaps it will be a must that I go back in October before I leave to sit in on the Q2 meeting!

ZANGOC VCT Results

Q1 REPORT

APRIL

MAY

JUNE

TOTAL

Male

Female

Male

Female

Male

Female

Male

Female

Micheweni

7

7

12

5

16

13

35

25

WAMATA (Chake)

6

5

25

25

7

6

38

36

ZANGOC (Wete)

32

19

43

30

52

48

127

97

TOTAL TESTED IN Q1 by Gender

200

158

TOTAL TESTED IN Q1

358

Just write a letter

Before I get into my letter frustrations I want to remind you all of the potential USAID funded project that I blogged about a few weeks ago (Refer to link for a reminder!). I am happy to announce that we got the "go ahead" to write the concept paper which is due on June 23rd. I told ZANGOC that I wanted to be fully involved in writing this paper and they agreed so I emailed the coordinator from VSO and told him that I would be the ZANGOC representative in drafting the paper! So now I am in the loop on this great opportunity for Zanzibar and I am really excited that I will writing to USAID, definitely something that is resume worthy!

On another note, I have figured out why it takes so long for things to be accomplished within ZANGOC...because for every idea you have you have to "write a letter" and submit it to the Executive Committee for approval. For example, during the ZACP workshop I met a lady name Frida who works for ICAP in Zanzibar and since they fund ZANGOC I thought perhaps it's a good idea for me to have a chat with them and show them the workings of the strategic plan. Since I have Frida's contact information I sent her an email yesterday and we set up a meeting for Tuesday of next week. However, I also had a meeting with my supervisor yesterday and told him about this meeting and by the expression on his face I thought he was going to tell me I couldn't go, until finally he told me..."well you have to write a formal letter on ZANGOC letter head and submit it to the Executive Committee for approval." I just think this process is a waste of paper (and time) considering they are going to approve the meeting anyway.

I hope you remember ZIFYA - Zanzibar Initiative for Youth? I have blogged about them a few times, the first time was in ZANGOC Member Orgs and the second time was after I facilitated a workshop for ZIFYA on Monitoring and Evaluation and effective group and team work. I am visiting with ZIFYA again this evening to discuss collaboration with them, ZANGOC and YCI in the formulation of youth groups within the area. The idea for these youth groups will be to work with YCI volunteers, similar to the mentorship program with the YMCA in Ghana, as well as to get youth discussing issues that affect their lives and how we can move forward in addressing these issues at the community level. I told my supervisor about this idea and he thought it would be beneficial but again, I was told to "write a letter." I do intend to write this letter, however I didn't tell them that I was meeting with ZIFYA this evening to hear their inputs and ideas about these youth groups. Oh well, at least I will have the ball rolling on this by the time the letter gets "approved"!

One more thing...ZIFYA has constructed a website which is pretty cool, I am hoping maybe they can teach me a few things about website design! Check them out here: Zanzibar Initiative for Youth

"Yes we can".... Can we?

Some interesting things have transpired this week during the ZACP workshop (round 2!)...

Monday was the beginning of round 2 for the ZACP strategic planning workshop. The last ZACP workshop I blogged about was in regards to a performance review of the previous ZACP strategic plan. During this 3 day workshop we reviewed the strategic activities, achievements, challenges and gaps in responses. From the  gaps we created new strategic issues at each identified intervention level that need to be addressed in the next strategic plan (2011 to 2016). 

This week's edition of the ZACP workshop is 6 days (Monday June 6 to Saturday June 11) during which time we are taking the identified strategic issues from each intervention level (ie: BCC, Home Based Care, Key Populations, etc...) to create outcomes, outputs and activities. This has been an amazing learning experience for me because I have been able to put my Results Based Management (RBM) skills to the test with the help of some really great minds. I ended up working with the Director of ZACP and an M&E Consultant who works for UNAIDS, to name a few. The M&E consultant was great as he was able to pin point the exact phrases and words that needed to be use to make each sentence either an outcome, output or activity. It may sound easy, but it's really a lot work! 

During Tuesday's workshop there was an American lady present who works for the Center for Disease Control (CDC) in Dar es Salaam. She made a little speech regarding the topic "yes we can" stop HIV and AIDS transmission in Zanzibar. I added "Can we?" to the title of this blog because I don't necessarily agree with her theories on this topic.

The theory was that since Zanzibar is a small island with an already relatively small rate of transmission, if we were to scale up prevention methods (focusing on early treatment) we could eventually stop new infections. Ok, that makes sense, but her implementation process would never fly especially in Zanzibar due to cultural and religious sensitivity.

She compared the implementation process of halting new HIV infections with the same tactics used to control malaria in Zanzibar which was achieved through 2 methods:

1. Prevention - providing bednets to everyone
2. IRS - indoor residual spraying 

She went on to say that we can use the same methods to stop transmission of HIV thus being

1. Prevention - providing condoms to all 
2. Door to door HIV testing

Both of these methods would never work in Zanzibar. First of all, I have spent the past 5 days discussing how highly regarded religious leaders are in Zanzibar and how difficult it is for them to allow the distribution of condoms in the public, an issue that was discussed heavily in my behaviour change communication (BCC) group. Second of all, it is difficult enough to get people, especially those who fall in the "Key Populations" group (MSM, IDUs and FSWs) to be tested for HIV due to the stigma and discrimination surround the disease. Therefore, it is in violation of a person's human rights to be forced into testing, even if it is in their benefit to know.

These were my opinions on her "yes we can" speech and I was curious to know what people from Zanzibar thought about her theories. I decided to do some reconnaissance work and ended up speaking with a few different people to hear their views. The first was a Zanzibari nurse who works for ZAPHA+ and she also said that it wouldn't work due to cultural factors. The next man I spoke with was a Zanzibari gentleman working for the Department of Substance Abuse. He said it would never fly because you would never be able to go door to door and test people as it's a violation of their human rights. Lastly, I spoke with a Tanzanian man who works for CDC in Dar es Salaam (a colleague of the lady who made the speech). He didn't agree with her and he told me that she had pitched the same idea to other people within the Ministry of Health and no one would really back her ideas. His issues were:

1. You will have a hard time convincing health people to go on ARVs at a young age for the rest of their life
2. There are 1.4 million people living with HIV in Tanzania and not even half of them have access to ARVs. Once funding is gone how will Tanzania be able to afford to keep 1.4 million people on ARVs for over 20 years.

Don't get me wrong, I enjoyed her optimism and if you do your research into early treatment as prevention for HIV you will find a lot of information. I just think that before she pitched this idea she should have had more support from Tanzanians in order to address cultural issues within this theory.

I'd love to hear your thoughts, please share with me!

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Quick Research: Early treatment as prevention

Treatment as prevention works

New Support for "Treatment as Prevention" Approach to HIV

Early treatment reduces HIV transmission in heterosexual serodiscordant couples

Performance Review Workshop for ZACP

The past 3 days have been really long but really productive and interesting days. I was invited to represent ZANGOC at a workshop hosted by the Ministry of Health and Social Welfare to review and evaluate the achievements, challenges, gaps and solutions that were utilized towards the achievement of the previous strategic plan for ZACP (Zanzibar AIDS Control Program) which ended in 2010.

There were roughly 30 participants in this workshop from various government and nongovernmental organizations such as:

• The Ministry of Health and Social Welfare
• The Department of Substance Abuse, Prevention and Rehabilitation (Read about their work in Zanzibar)
• ICAP (International Center for AIDS Care and Treatment Programs)
• ZAC (Zanzibar AIDS Commission)
• ZACP (Zanzibar AIDS Control Program)
• ZAPHA+ (Zanzibar Association of People Living with HIV and AIDS)
• ZANGOC
• ZANA (Zanzibar Nurses Association)
• UNFPA (United Nations Population Fund)
• UNICEF

One the first day of the workshops, 8 groups were established to represent each strategic area of ZACP. These groups were:

• Home Based Care
• Prevention of Mother to Child Transmission
• Monitoring, Evaluation and Management
• MARPs and STIs (Most at Risk Populations including: MSM [Men who have sex with Men], IDUs [Injection Drug Users] and CSWs [Commercial Sex Workser] and Sexually Transmitted Infections). This group also included condom programming and STI management
• Care and Treatment (including HIV counseling and testing, HIV in infants and blood transfusion
• Behaviour Change Communication (BCC) which included IEC (Information, Education and Communication), advocacy as well as stigma and discrimination
• Laboratory Services
• Institutional Capacity (including pharmaceutical services)

I was in the Behaviour Change Communication (BCC) group along with a colleague from ZANGOC, a Program Officer from ZAC, an Assistant Program Manager from ZACP in Pemba and a Program Analyst in Reproductive Health from UNFPA.

What is BCC/IEC and Advoacay? 

Behaviour Change Communication (BCC): This is a strategy, which refers to the systematic attempt to modify/influence behavior, or practices and environmental factors related to that behavior, which indirectly or directly promote health, prevent illness or protect individuals from harm.

Information, Education and Communication (IEC): IEC combines strategies, approaches and methods that enable individuals, families, groups, organizations and communities to play active roles in achieving, protecting and sustaining their own health. Embodied in IEC is the process of learning that empowers people to make decisions, modify behaviours and change social conditions.

Advocacy: aims to influence public-policy and resource allocation decisions within political, economic, and social systems and institutions; it may be motivated from moral, ethical or faith principles or simply to protect an asset of interest. Advocacy can include many activities that a person or organization undertakes including media campaigns, public speaking, commissioning and publishing research. Lobbying is a form of advocacy where a direct approach is made to legislators on an issue which plays a significant role in modern politics.

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Throughout the 3 days the BCC group worked on identifying the achievements, facilitating factors, gaps in previous response as well as challenges in achieving the strategic activities for BCC on the past strategic plan, what was done and what can be done within the next 5 years to achieve the BCC strategic issues that still exist in Zanzibar. 

We identified the following issues, challenges and goals within BCC:

Click the table to enlarge!

The next step:

The facilitator of this workshop will be combining the proposed strategic issues from each of the 8 groups over the course of the next week. After this is complete, we will all meet again for another workshop from June 6th to 9th in order to review the issues and work to draft a new strategic plan for ZACP. 

How this helps ZANGOC:

Since I am also working to draft ZANGOC's strategic plan for 2011 -2016, the information, issues and goals proposed during the ZACP workshop will be very useful. I will be able to identify the issues that ZANGOC can also work to achieve over the next 5 years, in accordance with those of the Government of Zanzibar (ZACP, ZAC and the Ministry of Health).