From GIPA to MEPA: Toward a Community -Owned and -Sustained Response

October 23, 2010, Quezon City Philippines
John Piermont Montilla with Rituu Nanda






....Go to the community
.......Live with them,
...........Learn from them
...................LOVE them

Start with what they know, build with what they have.
But with the best facilitators, when the work is done: the task accomplished
The people will say: "WE HAVE DONE IT OURSELVES"

Lao Tsu. China, 700 BC
~~~~~~~~~~~~~~~~~~
Community Engagement as an Approach for Community Life Competence

The concept of community engagement takes its roots in the collective and collaborative actions that communities have always taken, and in the response they have shaped through the years to promote, protect and support their members. Community engagement is referred to variously as “community participation”, “community involvement” or “community competence”.

In the HIV sector, it has developed into GIPA or MIPA -- both are aimed at discovering and harnessing the inherent human capacities of individuals and communities towards a national HIV response that are truly community-owned and community-sustained. At the Philippine NGO Support Program, (PHANSuP), Inc., we are striving to fully operationalize MiPA and transition it truly and authentically engaging. We call this process MePA or meaningful engagement of people living with and at-risk of AIDS.

Deepening our thoughts of what “engagement” is and how it differs from merely participation and involvement, we have found it useful to see them as separate and distinct; and see involvement and participation as steps on the way to engagement[1] such that:
Involvement
is about involvement in community activities in a variety of different ways. Community involvement often starts with agenda and programmes that originate outside the community.

Participation
is about people being active partners in the regeneration of communities – contributing and sharing in the decisions that affect their lives. Participation should enable people to have a degree of power and control in the processes with which they are involved.

Engagement
is about continuous dialogue among various stakeholders – the development and maintenance of relationships between communities and organizations where decisions are shared and based on mutual and growing understanding towards a common cause or aspiration or goal.


With this in mind, the aim of community engagement in the context of the country’s response to HIV is to build mutual trust, common understanding and shared purpose through continuous dialogue and action between and among community groups and support institutions. Identify each strengths and use these strengths to reinforce each others efforts and make transformation happen at the response level.

[2]

The core principle is that everyone has the capacity to learn and share and eventually respond through the process of actually doing and “learning through participation”[3] and continuously engaged. When we communities and support agencies are open to learning in this manner, change and action are seen in individuals, families, communities and organizations, and response expands from one sphere of influence to the other.
Community engagement necessitates dialogue that requires "intense faith" -- a mutual faith between and among communities and institutions. Barriers toward authentic engagement is the lack of faith due to fear or stigmatisation of the other, competition on project funding, and when one is often consider as "a 'target' of an intervention" or "a 'recipient' of a fund" and not as "partner" with equal footing with donors and financing institutions.
Majority of marginalised community groups such as people who inject drugs (PWID), people in prostitution (PIP) and the street youth are low literate and due to the highly stigmatised nature of their conditions they fear those who are mandated to support them and further themselves into clandestine occupations that are even more risky and exploitative. The labels such as PIPs, MSMs, IDUs also undermines their sense of community and self-identity. It holds back the possibility to be transitioned out from these labels or for better opportunities and increasing their chances for a better life. Thus behavior change ceases happen and sustained. Thus, they lost faith.
In like manner, government and non-government support institutions seems to have difficulty in affording faith to individuals due to the stigmatized conditions and illicit nature of their work. Personal values and morality sometimes jeopardize or hinder compassion and understanding. These are more pronounced in punitive policies that restrains communities to access services that they bid to be delivered with respect and dignity. With the current gains, a number service delivery providers from NGOs, social hygiene clinics and HIV and AIDS Core teams are making a difference to address this.
If one or both fail to have faith to the other, each falls short in creating an avenue for a dialogue. When dialogue is missing, mutual trust is not developed and authentic and sustainable engagement fails. Then the response remain a status quo, services or targeted actions does not reach those who need them most and voices remains disenfranchised and the inherent abilities of communities to be involved in decision-making processes though afforded by law are disabled.
In the Philippine context, given the archipelagic nature of our geography, diversity and multi-cultural background of its peoples, “community engagement can be defined as the process of working collaboratively with groups of people who are affiliated by geographic proximity, shared interests, or similar situations with respect to issues affecting their well-being”[4] in this case community groups of at-risk, vulnerable and those infected and affected of HIV. This requires faith between key stakeholders and mutual faith is of utmost importance to regenerate human relationship through dialogue. As Paulo Freire reminds us of a Dialogue founded on love, humility and faith[5] in our fight against HIV in communion with every stakeholders.

[5]

One effective tool to address this is through the "SALT Dialogue". Its a way of facilitating learning that is based on drawing out community strength rather than analysis of weaknesses. Strengths are those things that communities already have, already know and are dreaming about on how they individually and communally grow and developed with core competence in responding to issues of life concerns.
Please see:
the community life competence process here:


Community Engagement Strengthening Critical

Approaches have long been in place and are evolving. These are enshrined in the Alma Ata declaration on Primary Health Care of 1978[6] as well as the World Health Organization on the social determinants of health[7]. These laid the foundations for much of the work that has been done, highlighting the role of communities in increasing the reach and impact of health systems, for example in TB, malaria and HIV care and prevention. It has become increasingly clear that community engagement for health and social welfare has unique advantages in its ability to make things happen through people’s own culture, resources, peer-sanctioned behaviors, and shared interests and to articulate these unique needs, and its ability to mobilise the many resources that community members can bring to the processes of policy and decision making and to service delivery[8].
Civil society and PLHIV groups have long been advocating for greater and meaningful involvement and, in general, government and private entities implementing HIV programs have responded to this call in various ways. In view of the findings and recommendations made in the midterm assessment of the 4th AIDS Medium-term Plan (AMTP) in November 2008 shows that:
“partnerships are critical to the success of the program” and reveals that “these partnership have either not taken off or not blossomed in the last few years…”[9]
Community engagement, however, should not be misunderstood as taking the role of Government in leading the country’s response to HIV and AIDS. It should instead emphasize common purpose and collaboration among stakeholders. It should be stressed that community actions and support actions (from GOs and NGOs) are mutually conditioning and leads to effective and successful HIV response. Once communities are recognized as key actors, they will offer their own small and yet significant efforts that contribute to the bigger response. Communities are like stars and the constellation of these stars is the National response as Jean-Louis Lamboray of the Constellation said:

"Communities that respond are like stars: they show the way to life competence. As communities connect for sharing and learning, they create an ever-growing Constellation" [10]

It is for that reason that the Philippine National AIDS Council (PNAC) was created. As the highest policy-making body, it ensures enabling policies set in place in order for Universal Access to HIV and AIDS prevention, treatment and care are available, accessible, and appropriate and are delivered with respect and dignity. Dr. Ferchito Avelino, Director IV head of PNAC in his speech during the validation forum underscored that:

“Engagement in the PNAC decision-making process, voices of key affected communities and populations are critical to inform policies, programs and interventions that serve them best and banking on their engagement, the PNAC is mandated to build a cohesive and accelerated response on HIV that is rooted in community action”[11]


To ensure this happens, structures and mechanisms are set in place such as the AIDS Medium Term Development Plan that guarantee Government accountability, as former Secretary Margarito Teves reminds:

“We civil society organizations should continue to respect the fundamental importance of government ownership and work closely with government authorities. This not only ensures sustainable outcomes but also strengthens accountability” [12]

In cognizance of the important and critical need to engage communities and of the role of Government and Non-government institutions in facilitating how a community-driven response can happen, the Philippine National AIDS Council and the Philippine NGO Support program believe that the National HIV Response shall be a response that is informed by both the emerging yet evolving needs and inherent capacities of the communities particularly those vulnerable and at-risk to HIV and those living with and affected by the disease. Recognising their leadership and local action is indeed critical in collectively influencing the country's response to HIV.

The current national response has been guided by the 4th AIDS Medium Term Plan (AMTP) of the PNAC and as the trend getting alarming, there is an expressed need for a more strategic and effective response. Pointing out the importance of community engagement, the Commission on AIDS in Asia Report finds that:
“partnerships and community engagement can foster a sense of ‘ownership’ of the response that tends to be absent when projects are externally run”. The same document recommended that “community and civil society involvement should be ensured at all stages of policy, program design, implementation, monitoring and evaluation”.[13]

This sentiment echoes the call and commitment of the 2nd Consultative Meeting on Universal Access to Prevention, Treatment, Care and Support in Low Prevalence Countries held on August 26-28, 2008 Heritage Hotel Manila Philippines that states:
“all stakeholders – governments, civil society, private sector, United Nations, donors and others – must be held accountable in their response to AIDS, and that in doing so, mutual accountability must be ensured. It is imperative that civil society organizations consult with and report back to their constituencies and be accountable to the communities they serve “[14]

The CES4PHR Project
Given the evolving nature of the country’s HIV epidemic where spikes in infections were observed in recent months and reaffirming the critical role of communities in responding to country’s evolving HIV epidemic, PHANSuP and the PNAC embarked on a joint initiative to help strengthen the engagement of community groups in the implementation of the AIDS Medium Term Plan (AMTP). With funding support from the International HIV/AIDS Alliance (IHAA), PHANSuP and PNAC implemented the Community Engagement.

Community Engagement Strengthening for the HIV Response or CES4PHR Project was implemented from September 2009 until August 2010. Over a 12-month period, the CES4PHR Project conducted an assessment survey and a series of workshops to assess the current level of community engagement and come up with a concrete set of recommendations that may be pursued by concerned stakeholders.

The assessment survey revealed, among others, the following:
  • Community-based group tend to consider themselves in the lower levels of the GIPA/MIPA enagement ladder as "target audience", "contributors", and speakers due to their "still needing assitance from other groups". Support groups such as NGOs, however, reported being in the higher levels as "decision-makers" and "experts".
  • CBGs identified the following areas for capacity-building: a) under policy advocacy: policy formulation and lobbying; b) under knowledge management: information processing and information utilization; and c) under service delivery: monitoring and evaluation, and sustainability.
  • Majority (92%) of the 67 respondents expressed the idea of setting up a country-level electronic website of portal for strategic information sharing and knowledge management in the context of community engagement. They recommended that such portal should feature: an updated information on HIV and AIDS, a directory of organizations that include their own highlighting the services they provide, a website hosting and marketing of project proposals, a community on-line forum and social networking.

The results of the assessment were presented in a one-day validation and planning workshop held at the Department of Health (DOH) Office of the Secretary (OSec) conference facility. The workshop participants provided comments on and inputs to the survey report. They also identified outcomes that may be pursued to promote community engagement as follow:



PHANSuP believes that supporting the CBGs, through the CES4PHR Project, to set-up an electronic platform for “sharing experiences and transforming these into useful knowledge” will provide an effective mechanism to “bring out” and engage “unheard voices” at the grassroots level. The results of this strategic initiative focusing on knowledge management will eventually help CBGs perform more effectively in the areas of policy advocacy and service delivery. Please see our terminal report here: CES4PHR Part 1 TERMINALREPORT.doc


The Call and Commitment: "Bring Out Unheard Voices"

During the planning session for the CES4PHR Part 2 held at the OSec Conference Hall of the Department of Health on September 17, 2010, stakeholders from NGOs, key leaders from community-based groups from people who inject drugs, street youth, PLHIV, MSM, people in prostitution as well as multilateral organizations such the UNAIDS developed the "Tree of Life" - a call and committment for community engagement in the Philippine HIV Response. The aim is to bring out unheard voices with the slogan: "Breaking the Noise... Raising Our Voice, Our Call and Commitment for Community Engagement"

"The Community Engagement Tree of Life"
The red ribbons represents HIV and with it the commitment of each stakeholders for engagement and the yellow ribbons represent the "new color of courage" and with it the "call" that needs courage for communities to raise their voices in every decision-making processes in their spheres of influence. Each participant wrote messages for each's "call" and "commitment" in each ribbons and are pasted in the tree of life. The the two ribbons are paired and cannot exist without the other and represents an empowered and empowering communities and an empowered and empowering support institutions. Once mutual trust, common understanding and shared purpose are built between communities and support institutions, authentic community engagement happens and sustains the shared response.Please see our action points in pages 11-14 here: SummaryofProceedingsValidation&Planning.doc
In her closing message, Miss Bai Bagasao, UNAIDS Country Coordinator offered the support of her Agency as an institution that gives importance to civil society participation. In her call and commitment, in her red ribbon, she wrote "open door" and sketched a human ear and a heart that listens to the unheard voices and in her yellow ribbon she wrote "meaningful engagement of the unheard voices". She reminded the group of "being the change we want to see" and keeping the spirit alive that generates support among stakeholders that fuels community-driven HIV and AIDS response.
The first part of the project ended on September 2010 and the second part will star on November 2010.Please see our 11-month workplan here:CES4PHRPart2 Workplan 26oct2010.docx.You can also take a visit in our facebook page here:http://www.facebook.com/pages/Community-Engagement-Strengthening-fo...

________________________________________

[1, 2] http://changesuk.net/themes/community-engagement/
[3] Captain ShanthiBabu, ICT in the AIDS Competence Process, ADB Resource Package, the Constellation)
[4] Principles of Community Engagement. Center for Disease Control and Prevention, USA, 1997.
[5] Training for Transformation: A Handbook for Community Workers Book 2, Anne Hope and Sally Timmel Mambo Press
[6] Declaration of Alma Ata – International conference on primary health care 1978 http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
[7] WHO – social determinants of health http://www.who.int/hia/evidence/doh/en/index.html
[8] Community Systems Strengthening – Civil Society Consultation; International HIV/AIDS Alliance 2010/ICASO http://www.aidsalliance.org/Pagedetails.aspx?id=407
[9] Mid-term assessment of the 4th AMTP, Philippine National AIDS Council
[11] Proceedings of the CES4PHR validation forum and planning workshop page 5
[12] 2007 World Bank Brochure
[13] Commission on AIDS in Asia Report
[14] 2nd Consultative Meeting on Universal Access to Prevention, Treatment, Care and Support in Low Prevalence Countries held on August 26-28, 2008 Heritage Hotel Manila Philippines


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Johnpierre as commonly called is a Biological Sciences graduate of the West Visayas State University as a feed the hungry scholar of the Department of Foreign Affairs, UNLAD Kabataan Program recipient of the Department of Social Welfare and Development and a ford fellow on gender, sexuality and reproductive health at the University of San Carlos.

He is known for his sexual and reproductive health and rights advocacy, particularly his HIV prevention work among young people in sexually exploitative environments. His work involves strengthening community engagement for at risk and marginalised youth who because of the their highly stigmatized conditions disabled their bid to engage in decision-making processes afforded to them by law. He champions youth-led development which gained recognition from the TAYO Awards Foundation, the Coke Barkada Award and the Starbucks Youth Action Grants.

His prominent regional engagements include serving as YouthActionNet Ambassador of the International Youth Foundation, an e-mentor of the Sprout E-Course of the TakingITGlobal in the field of HIV and one of the Young Leaders in Governance Fellow of the Galing Pook Foundation and UNDEF. He served as Asia-pacific national focal point for the global youth network under the UNODC and as current national focal point for the Philippines of the Global Youth Coalition on AIDS based in New York. At present, he is one of the 10 Asia Society Young Leaders Initiatve of the Phil21 Class of 2011

Currently he is deeply involved in the Community Engagement Strengthening for the Philippine HIV Response or CES4PHR - a joint project of the Philippine National AIDS Council (PNAC) and the Philippine NGO Support Program (PHANSuP), Inc.

Contact information:

John Piermont Montilla

Community Engagement Facilitator
Philippine NGO Support Program, Inc. (PHANSuP)

Learning Facilitator,

Founding President
Kabataang Gabay sa Positibong Pamumuhay
National Association of People Surviving Sexual Violence, Abuse, Exploitation, and Trafficking

Tel/Fax: (+632)-332-1914 | +639166682183 | email: johnpiermont_vm@yahoo.com | skype: fareasternsoul

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Comment by wiwin winarni on October 27, 2010 at 9:26am
Great John!
Another mental digest for me this overwhelm me with some insight and view about what should facilitator, community and me do for sustainability.
Thanks

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