Government of Malawi
GUIDELINES FOR CONDUCTING COMMUNITY
DIALOGUE
A COMMUNITY ENGAGEMENT TOOL FOR SUSTAINABLE HIV AND
AIDS BEHAVIOUR CHANGE
March 2007
National AIDS Commission
P.O. Box 30622
Lilongwe
Malawi
Telephone: 265 01 770 022
Fax: 265 01 776 249
©National AIDS Commission March 2007
All rights reserved. No part of this publication may be reproduced, stored on
any retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the written
permission of the copyright owner.
Email: nac@aidsmalawi.org.mw
Website: www.aidsmalawi.org.mw
ISBN No: 99908-73-54-2
2
Acronyms
AIDS
BCC
BCI
CAC
CBO
DAC
DEC
DACC
FBO
HIV
IEC
IGA
MDHS
NAC
NGO
OVC
PLHIV
UNAIDS
UNICEF
WHO
Acquired Immune Deficiency Syndrome
Behaviour Change Communication
Behaviour Change Interventions
Community AIDS Committee
Community-based Organization
District AIDS Coordinator
District Executive Committee
District AIDS Coordinating Committee
Faith-Based Organization
Human Immunodeficiency Virus
Information, Education and Communication
Income Generating Activity
Malawi Demographic Health Survey
National AIDS Commission
Non-Governmental Organization
Orphans and Vulnerable Children
People Living with HIV
Joint United Nations Programme on HIV and AIDS
United Nations Children’s Fund
World Health of Organization
3
Acknowledgement
The National AIDS Commission would like to thank the following people
for their personal effort and support from their organizations in the
production of this very important guide. Without their technical input and
directions the guide would have been impossible. The experts are as follows:
Mr. Enock Bonongwe
Mr. Felix Mundukwa
Ms Lydia Fulirwa
Mr. Patrick Phoso
Mrs. Lucy Kachapila
Mrs. Olive Moyo
Mr. Ndindi
Mr. Rodney Chinangwa
Mr. Dominic Misomali
Mr. Mavuto Thomas
Mr Ben Tonho
Mr. Amon Chinyophiro
Mr. Mahara Longwe
Mrs. Maria Mukwala
Mr. Eliam Kamanga
Mr. Robert Chizimba
Mr. Christopher Teleka
: Ministry of Women and Child Development
: Malawi Network of AIDS Service
Organisations
: Creative
Centre
for
Community
Mobilisation
: Malawi Bridge Project
: United Nations Children Fund
: National Association of People Living with
HIV
: Ministry of Health (Community Health
Sciences Unit)
: Ministry of Local Government and Rural
Development
: Blantyre City Assembly
: Ministry of Health
: Salima District Assembly
: National Association of Farmers in Malawi
: National AIDS Commission
: National AIDS Commission
: National AIDS Commission
: National AIDS Commission
: National AIDS Commission
Lastly, the Commission wishes to extend its deep appreciation to the
Behaviour Change Interventions (BCI) team for providing very strong
technical leadership when developing the guide. It is hoped that the guide
will greatly assist community-based organisations (CBOs) and nongovernmental organisations (NGOs) to design and implement HIV and
4
AIDS community-led dialogue sessions that would bring meaningful
involvement of community members themselves. The team comprised
Bridget Chibwana, Robert Chizimba, Maria Mukwala, Eliam Kamanga,
Christopher Teleka, Redgeson Chikaya and Victor Khonde.
5
Table of Contents
ACRONYMS ................................................................................................... 3
ACKNOWLEDGEMENT ................................................................................... 4
TABLE OF CONTENTS .................................................................................... 6
1.0
BACKGROUND .................................................................................. 9
2.0
INTRODUCTION .............................................................................. 11
SECTION A ................................................................................................ 13
3. 0
DEFINITION OF COMMUNITY DIALOGUE CONCEPTS ..................... 13
SECTION B ................................................................................................ 19
4.0
THE CONCEPTUAL FRAMEWORK FOR COMMUNITY DIALOGUE .... 19
SECTION C ................................................................................................ 23
5.0
CONDUCTING A COMMUNITY DIALOGUE SESSION ........................ 23
SECTION D ................................................................................................ 32
ANNEXES..................................................................................................... 35
REFERENCES ............................................................................................... 50
6
Executive Summary
There is growing evidence in Malawi that communities can make a big
difference in the national response to HIV and AIDS once they are
empowered.
Continued distribution of information, education and
communication (IEC) materials, mere provision of services and health
products and granting of CBOs alone cannot improve the living standard of
people infected or affected by the epidemic. For meaningful change to take
place in the communities such as increased knowledge levels in HIV and
AIDS; change in behaviours; and increased utilization of services and
resources, community members must fully participate in what is being
planned and implemented for them. In fact they must be the actual agents of
change in the community initiatives and interventions.
For community members to fully participate, they must be engaged in a
dialogue with planners of various community initiatives and community
members themselves to identify issues that affect them, who to engage and
solutions to solve such problems. Without mobilizing community members’
informed participation, capacities, energies, and without increasing their
knowledge and skills, no initiative can yield any impact in the fight against
HIV and AIDS in the communities.
There is, therefore, a great need for the National AIDS Commission, CBOs
and all stakeholders to conduct series of community dialogue sessions at
different levels in order to empower community members to actively
participate in the planning and implementation of interventions that affect
them. Apart from empowering community members, dialogue sessions also
create a sense of ownership of interventions among community members.
It is, therefore, the intention of the Commission in collaboration with district
assemblies and all stakeholders to intensify community dialogue sessions in
HIV and AIDS in order to effectively mobilize communities in HIV
prevention, treatment, care and support programmes. Communities must be
in the forefront in identifying their HIV and AIDS problems, planning and
implementing interventions to address the identified problems.
7
This is why the Commission in collaboration with partners has developed
this Community Dialogue Guide as a tool to assist stakeholders to plan and
conduct dialogue sessions in HIV and AIDS efficiently and effectively. All
CBOs, assemblies and NGOs are requested to use the guide so that we all
improve the way we reach out to communities.
Dr. B.S.M. Mwale
Executive Director
8
1.0
Background
In a continued effort to reduce further spread of HIV infection and begin to
control AIDS, in July 2001 the Government of Malawi established the
National AIDS Commission (NAC) to provide leadership and coordinate the
national response to HIV and AIDS. The overall goal of NAC is ‘to prevent
the spread of HIV infection among Malawians, provide access to treatment
for PLHIV and mitigate the health, socio-economic and psychosocial
impact of HIV and AIDS on individuals, families, communities and the
nation’. This goal is currently being pursued within the context of the
National HIV and AIDS Action Framework (NAF) 2005-2009.
In exercising its role, NAC has provided leadership in the response by
producing relevant policies, strategies, guidelines and manuals aimed at
guiding partners to deliver quality services and interventions. The
Commission has championed planning, networking, monitoring and
evaluation of programs. Specifically, it has also coordinated and facilitated
development and production of mobilization related documents and plans in
order to direct stakeholders on how to plan and implement social and
community mobilization interventions at different levels.
However, despite availability of these documents NAC has noted that a
number of CBOs, assemblies and NGOs still fail to engage communities in
the planning and implementation of HIV and AIDS interventions. Most
interventions are still being planned at NGO or assembly level leaving the
intended beneficiaries out. This has resulted in NAC and other development
partners supporting interventions that have minimal impact among
community members since they do not address their specific needs and
challenges. Most programme planners do not enter into dialogue sessions
with communities.
To address this gap, the Commission in consultation with stakeholders
established a task force comprising experts in social and community
mobilization to develop this guide whose main aim is to promote dialogue
between planners and community members on HIV and AIDS issues. The
9
exercise involved review of various community mobilization initiatives and
assessment of numerous documents.
In summary, the guide presents directions on how to plan and conduct
community dialogue on HIV and AIDS and other related topics. It is
therefore, expected that this guide will be a valuable tool for all those
engaged in community mobilization initiatives at various levels.
10
2.0
Introduction
Malawi has one of the highest HIV infection rates in the sub-Saharan region
and in the world. In Malawi the principal modes of transmission of HIV
infection are unprotected sexual intercourse and prenatal transmission which
account for 90% and 9% of all HIV infections in the country respectively
(Malawi Demographic and Health Survey MDHS, 2004). The prevalence
rate has stayed at a high level for the past seven years ranging from 15.0% in
1999 and 14% in 2005 among people aged between 15 to 49 years.
According to the 2004 MDHS, HIV prevalence was higher among women
(13%) compared to men (10%). This high infection rate of HIV in women of
childbearing age suggests that many children are born with HIV infection.
The emergence of the HIV and AIDS epidemic has simultaneously affected
communities. HIV and AIDS which was initially perceived as a health
problem, requiring a public health approach is now a social issue and there
has been a growing shift in the emphasis of HIV and AIDS communication
interventions to focus on the social environment rather than the individual.
Previously, models of behaviour change perceived individuals as rational
when it comes to decision-making concerning the seriousness of health risks,
(UNAIDS 1999). Recent models such as Behaviour Change
Intervention/Behaviour Change Communication (BCI/BCC) approaches
advocate for a better understanding of individual and risk taking behaviours
(UNAIDS 1999). A review of literature also suggests that BCC interventions
can only be effective when combined with changes in the broader
environment which impact on people’s ability to adopt and sustain new
behaviours. Innovative ways to work with communities to generate an
effective and structured response therefore need to be put in place in order to
promote sustained behavior change.
The Malawi Government through the National AIDS Commission has
developed a number of strategic documents, manuals and guidelines to guide
the national response to HIV and AIDS. The Behaviour Change
Interventions Strategy was developed as a guide for planning behaviour
11
change interventions on HIV and AIDS and Sexual Reproductive Health.
Further to this was the development of HIV and AIDS Communication
Guidelines on Advocacy, Social Mobilization and Information, Education
and Communication.
This guide will enable communities to engage in constructive conversations
about HIV and AIDS. This will promote mutual understanding of the
epidemic and how to control it. These facilitated conversations
complimented with the distribution of leaflets, posters and other materials
will not only provide a platform for people to think through all the
repercussions of a situation but will also create space for mutual learning and
result in new perspectives and creativity which are sustainable.
12
SECTION A
3. 0
Definition of Community Dialogue Concepts
3.1
Definition
A community dialogue is a process of joint problem identification and
analysis leading to modification and redirection of community and
stakeholders’ actions towards preferred future for all. A community dialogue
is an interactive participatory communication process of sharing information
between people or groups of people aimed at reaching a common
understanding and workable solution. Unlike debate, dialogue emphasizes
on listening to deepen understanding. It develops common perspectives and
goals and allows participants to express their own views and interests.
3.2
Differences between debate and dialogue
Debate

Denying opposing views.

Participants listen to refute views of other people.

Questions are asked from a position of certainty.

Participants speak as representatives of groups.

Statements are predictable and offer little new information.
Dialogue

Allows expression of different views.

Participants listen to understand and gain insight.

Questions are asked from a position of curiosity.

Participants speak with free minds.

New information surfaces.
3.3
Concepts and principles of community dialogue
Community dialogue is based on the following two main principles:
13
 Problem based adult learning
i.
Individuals will go for things that are relevant to them.
ii.
Individuals have a lot of knowledge, skills and experience,
which can be built on or improved.
iii.
People like to be respected and will eagerly participate in
issues that affect their lives.
 Negotiation (dialogue is a process of bargaining, give and take)
i. Dialogue focuses on the problem to be solved together with all
parties based on existing experience, capabilities and
opportunities rather than pre-determined messages that must be
communicated by one party and received by the other.
ii. All partners involved, service providers and the community
may experience behavior change in the process of dialogue.
Other principles include the following:
 Sensitivity to local, family and community experiences: working by
invitation and commitment and not imposition.
 Facilitation rather than intervention of experts.
 Use of participatory approaches with space for listening, inclusion,
agreement and expressions of concerns.
 Respect for differences and mutual trust.
 Willingness of facilitators to engage in a process of self–
development.
 Working in partnerships with non-governmental and community
based organizations.
 Belief that communities have the capacity to identify needed
changes, own these changes and transfer change to other
communities.
 A grounding in universal human rights.
 Gender sensitivity, a focus on participation and inclusion of women
and girls.
14
 Mutual learning (facilitators with community, community with
facilitators, community with community, among community
members, organization to organization.
3.4







Objectives for conducting community dialogue
The main objective of community dialogue is to generate response
from communities and individuals that result into commitment to
addressing the identified problems (issues)/gaps in a participatory
manner. Community dialogue aims at:
Generating deeper understanding of the nature of the epidemic
among individuals and communities in order to influence change.
Surfacing common issues and the resources to address them, (helps
identify barriers to positive change and uncover innovative ideas).
Building a pool of resource persons with transformative leadership
abilities and facilitation skills to scale up the community response to
HIV and other related development issues.
Providing a forum for the unheard to be heard.
Promoting social contacts among various groups in the community.
Promoting
self-esteem,
self-confidence,
tolerance,
trust,
accountability, introspection and self-management.
Promoting ownership and accountability.
3.5
Characteristics and key components of a community dialogue
 It is firmly rooted in a common set of core values (inspiring,
harmonizing).
 It is directed towards a freely agreed common purpose.
 It is based on mutual respect, recognition and care.
 It is enabled by a safe environment and based on integrity.
 It entails genuine listening and acceptance of feedback even if it is
different from what is expected.
3.6
Benefits of conducting community dialogue
 It helps to identify and enlist key individuals for sustainable
partnerships.
15
 It helps solicit community participation, support and commitment in
problem solving for sustainable behavior change.
 It promotes sharing of information and ideas between individuals of
different cadres and backgrounds.
 It facilitates joint community assessment to identify community
problems and effective solutions
 It promotes deeper understanding of communities, their situation,
current practices, interests, existing opportunities and challenges for
sustainable behaviour change.
 It promotes skills building of the facilitator in the development and
maintenance of effective dialogue with the community in order to
facilitate joint decision making and problem solving for sustainable
behaviour change.
 It helps to generate local media attention.
 It helps leaders of all sectors to recognize their roles in building
sustainable healthy communities.

It promotes accountability and ownership of agreed interventions
A good dialogue offers those who participate the opportunity to:

Listen and be listened to so that all speakers can be heard.

Speak and be spoken to in a respectful manner.

Develop or deepen understanding.

Learn about the perspectives of others and reflect on ones own
views.
3.7
Challenges of community dialogue
 Dialoguing is time consuming; therefore timing for dialogue should
be appropriate.
16
 It requires good facilitating skills.
 It requires a good and suitable venue, which is free from any
disruption and where the participants are comfortable.
 Poor preparation and planning affects the quality of discussions
during dialogue sessions.
3.8
Where can a dialogue occur?
A dialogue can take many forms. It can involve five people around a
fireplace to a hundred or more people attending a village meeting. A
dialogue can occur:
 At a school.
 At a market place.
 In a boardroom.
 In places of worship.
 During club meetings.
 In meetings of existing partnerships.
3.9
Who can host a dialogue session?
Anyone can convene and host a community conversation and anyone can
participate in a dialogue. Community conversations may be initiated by:
 Non-governmental organizations (NGOs).
 Faith based organizations (FBOs) / faith leaders.
 Community based organizations (CBOs).
 Community leaders/community organizers.
 The youth.
 Health workers.
 Special interest groups like PLHIV.
 Extension workers.
 Officials from the local assembly
17
NB:
Before conducting these dialogue sessions organizations should go through the
District Assembly in order to formalize the process and gain authority to work
at both the district and community levels. This will enable the District
Assembly to become aware of what is happening in their district and they
should be able to help out with the dialogue session or any projects resulting
from it. At community level Community Based Organizations intending to
conduct dialogue sessions should also inform the District Assembly of the
activity and whether they require any support.
3.10
Methodologies and tools
The community dialogue approach is adapted to suit the participants’ level
of knowledge and skills. The following methods may be used depending on
the topic and assessment of participants’ capabilities:
 Strategic questioning.
 Story telling.
 Historical timelines.
 Mapping and transect walks.
 Traditional Wisdom (Proverbs, songs).
 Discussions.
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SECTION B
3.0
The Conceptual Framework for Community Dialogue
Step 1
Problem Identification
Step 7
Evaluate together and
provide feedback
Step 2
Problem analysis
Step 6
Acting together
Step 3
Identification of best
option(s)
Step 5
Planning together
Step 4
Prioritization of options
19
4.1 Steps for conducting community dialogue
i.
Problem identification
The first step in conducting a community dialogue is to identify the
problem or issue at hand. In this case the issue could be HIV and AIDS
focusing on HIV testing and counselling (HTC), human rights or
gender. It could be poor hygiene and sanitation due to lack of clean
water and sanitary facilities.
At this point the team will identify current problems/ issues. What the
community is doing about these issues, whether the actions are giving
the required outcomes and what are the constraints / challenges faced
by the community.
The gaps between the preferred behaviour and current practices will
determine what will be required to address the problem.
ii.
Problem analysis
Problem analysis involves a thorough analysis of the issue /situation at
hand. Questions that can be asked under this section include:
 What are the causes of the problem /issue at hand?
 Is the issue /problem a shared problem in this community or it is
perceived as a problem for only a few?
 How is the community responding to the problem? What is the
community’s current knowledge? What are current attitudes,
practices and beliefs about the issue at hand?
 Has the community previously dialogued on the issue?
 Have traditional, religious and political leaders been involved in
trying to address the problem /issue at hand?
20
NB:
Community members also have a wealth of knowledge, especially about
local conditions and practices and should be allowed to contribute to the
dialogue.
iii.
Identification of the best options
This section shall assist the user to identify the best options. In doing
this, emphasis is placed on actions to be taken to achieve the intended
behaviors and how to sustain them.
Identified options are prioritized based on their effectiveness,
feasibility, relevance and appropriateness within the community’s
context
iv.
Joint planning
At this planning stage participants will examine the priorities set during
the previous step before designing an appropriate Community or
Village Action Plan. The plan will include the following elements:
 What will be done.
 When it will be done.
 Who will do what.
 Resources required and potential challenges.
 Measures or indicators of success.
Participatory tools for monitoring and evaluating actions.
NB
The plan should be developed collectively amongst the interest groups in order
to collectively define results to be achieved and the activities to be carried out to
achieve such results. This will help promote ownership of the projects amongst
the members
21
v.
Acting together
After collectively developing an action plan, implementation of the
plan should be conducted in a participatory manner, with each member
recognizing her/his role in the project. It is therefore important to build
commitment of the various community members and stakeholders in
order to ensure the success of the project.
vi.
Monitoring, evaluation and feedback
Participatory evaluation involves a collective reflection of
achievements, identifying what went well and why particular actions
did not go well. Participatory evaluation creates a learning process for
the program recipients, which helps them in their efforts. After the
evaluation process the necessary feedback should be provided. This
promotes ownership of the process and the will to do better next time.
Reinforcement is also important to motivate participants to do better or
sustain the desired behaviour.
22
SECTION C
5.0
Conducting a Community Dialogue Session
Before conducting community dialogue a rapid assessment of the
community’s needs should be conducted. Rapid assessment is a quick way
of collecting information with a view to analyze the current situation for
effective decision making (Key Family and Community Childcare Practices,
WHO, UNICEF 2005).
A rapid assessment tool helps collect data from the community which
describes the community, outlines important issues and provides a deeper
understanding of the community’s organization, history, social context and
its ability to handle situations. The assessment helps:
 Capture unspoken, influential rules and norms that may have a direct
or indirect impact on the issue at hand.
 The team to take stock of the strengths and weaknesses, threats and
opportunities of the community in handling situations.
 To reveal the attitudes and opinions of the community before the
team embarks on the community dialogue initiative.
 The team to develop a deeper understanding of the issue at hand.
NOTE
Data collected during the exercise will act as a basis for community dialogue
and joint planning.
5.1
Preparing for the dialogue
A team approach to convening a dialogue will help build ownership and
share the tasks involved. Members of the planning team should be able to
articulate shared core values and work towards a vision that defines what is
to be done and for whom it is done. Members of the planning team should be
23
those who are credible and perceived to be trust worthy by the community.
The role of team members should be clearly spelt out.
The planning team should brainstorm on the following:
The specific goal of the discussion in terms of
 What is the desired behaviour or result, for instance increased
awareness and understanding of gender, HIV and AIDS? (A list of
expected outcomes should be developed).
 Will there be any follow up services that shall reinforce behavioural
change like victim support units or community action groups? These
could be set up after increasing the community’s understanding and
willingness to take part in the project activities.
The components of the discussion in terms of
 What topics should be addressed? Will the discussion be an
exploration of various topics identified during the rapid assessment
or is it designed to provide a single explanation of a specific topic or
issue.
 Who will facilitate the discussion? Good facilitation is critical to a
successful dialogue. A good facilitator should be selected (Refer to
Annex III for Qualities of a good facilitator).
 Where will the discussions take place? Dialogues may be
conveniently held in public areas like schools, the Traditional
Authorities’ Headquarters or at a community centre that is
comfortable and accessible by all.
 When will the discussions take place? When planning a dialogue
session it is important to consider participants schedules, for
24
example, a dialogue session held in the morning when individuals
are likely to go to work in their fields will not be well patronized. It
is important to be flexible with the program.
 What resources will be required?
Resources in terms of
organizations that may be able to assist with either the dialogue
session or any projects resulting from it are critical to successful
dialogue sessions.
 How will the project be sustained? In order to obtain lasting impact
of the dialogue session, sustainability of the project should be
considered from the start. These plans on sustainability also assist in
winning donor confidence.
 Who will participate in the dialogue session(s)? It is ideal to bring
together individuals with diverse experiences to share ideas and
opinions. Individuals of different status, gender, special interest
groups like PLHIV should be brought together. Participants may be
parents, elected officials, community leaders and members of
religious groupings depending upon the complexity of the problem.
Dialogue groups may be as small as five people or as large as two
hundred depending upon the initiators goals and objectives.
 What format will the dialogue follow? The type of discussions to
have, for example, small group meetings or a large meeting or a year
long commitment among a group of key community leaders to
study, reflect on and discuss the problem.
 Is the environment conducive? Seating arrangements are important
to ensure strong interaction among participants. Participants should
be seated in a circle or in a U formation.
 How to document the dialogue. An individual should be identified
from the group who will be responsible for taking notes, summarize
25
important points and document the dialogue session. It would be
interesting to involve the media who will document the process and
will be able to take a few photos and video clips. This could be used
as reference material for any future or repeat dialogue sessions.
NOTE
The brainstorming exercise will assist to determine the goal of the dialogue and
the desired outcomes.
Points to consider

Target decision makers /influential people and others at household and
community level.

Trust, credibility and ownership should be instilled in the participants
before the dialogue is initiated.
5.2 Welcome and Orientation Phase
This phase sets the tone and context of the dialogue, which could begin, with
the sharing of personal experiences and stories in order to level the playing
field among the participants.
During this phase the facilitator should:
 Greet participants as they come in to put them at ease and encourage
them to speak up.
 Conduct introductions, state the purpose of the dialogue, and ask the
group for any opinions before establishing any ground rules. (Refer
to Annex III for the role of the dialogue Facilitator).
5.3
Problem Identification
The problem or issue identified during the rapid assessment can be presented
in the form of visual media or other starters like role-play, pictures, posters
etc. The presentation should be short, simple, stimulating, realistic, and
26
posing one problem at a time, but mindful that it is not giving the solution to
the problem. This promotes thoughtful discussion.
Participants should then be encouraged to comment on what they observed
from the presentations where the facilitator should guide them by asking:
 What did you see/ hear?
 What was the problem?
 Is the problem evident in the community?
 Is it affecting the lives of community members?
 Are there any efforts that have been carried out by the community,
its leaders or any other external organizations to address the
problem?
 Is there anything that the community could do to improve on the
current situation?
 What can other organizations or the local assemblies do to make a
difference?
During this phase the facilitator should summarize the problem as
experienced by the participants. The current, preferred and recommended
practices should be recorded as below:
Current Practice
Preferred
and
Recommended
actices
Men and boys in
the
communities not involved
in HIV and AIDS care and
support activities
Increased
involvement
and
participation of men and boys in HIV
and AIDS care and support activities
5.4 Problem analysis
Problem analysis involves finding out more information about the current
problem. The facilitator will take the participants through a process of
understanding every aspect of the problem by answering the what, why,
who, when and how questions. This will assist the group to work towards
finding out:
 Reasons for the current behaviour
27





The frequency of the practice.
Length of time the behaviour has been in practice.
The impact the behaviour has on the lives of community members.
The perceptions of the community members.
Key players in solving the current problem.
Tips

The facilitator should be patient, respectful, open and not interrupting.

The facilitator should have confidence that local people are capable of
performing their own analysis.
5.5 Identification of the best options
Identification of the best options involves generating solutions to the
problem/issue, appraising the options and finally coming up with a decision
on what solutions to be tried first. This phase requires the group to be
creative in coming up with a range of solutions and it is therefore important
that the facilitator promotes open discussion and encourages group members
to give in their opinions.
The facilitator may use the go around method so that everyone is provided
with the opportunity to suggest ideas or group members may write down
their ideas on a piece of paper. These ideas will be collected, discussed and
summarized.
The facilitator may either use the brainstorming method, which is a tried–
and–true way of coming up with ideas in a group. If the recommended
practices have not come out of the group, the facilitator may provide such
alternatives.
28
After appraisal of all options the facilitator will then take the group through
a process where the solutions will be rated in order to make a decision on the
best option. Each option should be analyzed to find out whether:
 It is practical.
 It is effective.
 It is cost effective.
 It is easy to put into practice or it requires external assistance.
 It will be accepted or is consistent with the values and customs of
the community.
 It is sustainable.
Having weighed the solutions the facilitator guides the group in coming up
with a decision. The group by consensus discusses and negotiates until the
best option is reached. The facilitator finally summarizes the doable options.
Tips

Avoid arguing blindly for your own opinions.

Do not let vocal individuals dominate the discussions.

Do not change your mind just to reach an agreement.

If you are making no progress take a break.

The facilitator should encourage everyone to participate.

The facilitator should encourage everyone to participate
5.6
Planning together
In this phase, group members design appropriate plans of action based on the
best possible options. The group will be guided through a brainstorming
session to determine what needs to be done. The options will be broken into
doable parts or action steps.
The following questions should be answered:
 What will be done /is to be done?
 To what extent will the actions occur? What will be the strategies?
29
 Who will do the work (is it the group members or some external
assistance will be required)?
 When will the activities be done? (A deadline for action will help
participants to focus)?
 What resources are required?
 Who will provide these resources and what resources are already
available in the community?
 What are the potential challenges /constraints?
 How will these challenges be addressed?
 How will the activities be sequenced?
The action plan should be compiled as below:
Issue:
Objective:
Activity
Indicator
Lead
Agency
Partners
Resources
Time
Framed
5.8
Evaluating Together
An evaluation at the end of a dialogue session will allow:
 Participants a chance to comment on the dialogue process where
participants will be able to provide perceptions on how the dialogue
was conducted.
 Participants a chance to air their views.
 The dialogue leader to be provided with feedback on how the
dialogue session had been facilitated.
Evaluations can be written and/ or expressed verbally. A short evaluation
form may be distributed to get participant feedback and to measure the
impact of the dialogue.
30
NB:
If the response sheets are anonymous participants are more likely to give their
true opinions of what has happened.
5.9
Concluding the dialogue and next steps
At the end of the dialogue the facilitator thanks the group for taking their
time to share ideas and personal values and may give time to the group to air
out any concerns or observations. The facilitator should let the group share
the most important things gained from the discussion. The groups then
collectively consider some possible steps in the action plan, for example:
 The group may decide on a particular idea that demands an
immediate action.
 The group may decide to have more in-depth conversation and
involve some individuals who were not present at the time of the
dialogue.
 The group may decide to have additional dialogue sessions on other
relevant issues. The group may share information about existing
community initiatives that could benefit from volunteers, leadership
or such dialogue.
Points to consider
 Dialogue sessions should be recorded and documented. Such
documentation could help to measure success of the dialogue and
identify any needed improvements.
 Members of the group should be provided with a report on the dialogue
session with action points clearly outlined.
31
SECTION D
6.0
Monitoring, Evaluation and Feedback
Monitoring is a continuous assessment of the functioning of the project
activities in the context of implementation plans and schedules. On the other
hand evaluation is a technical activity that measures the impact and
effectiveness of any while monitoring is a methodological arm of evaluation
that tracks the programs incremental steps to its effects and forms the final
evaluation report. Monitoring, evaluation and reporting should be part of the
project design and not be added later when the project is near completion.
Monitoring, evaluation and reporting provide insight into what is working,
what is not working and help to identify ways of reviewing strategies that
are being utilized to implement interventions.
Monitoring community initiatives helps the facilitator and the participants to
weigh actions against results. Monitoring helps to:

Make decisions concerning the priorities of the initiative.

Promote awareness of accomplishment.

Solicit support.

Secure funding for the initiative.

Measure results.

Identify strengths and challenges.
Sound measurement tools are critical for an effective design and a good
implementation and evaluation plan. A good monitoring tool will help
answer the following questions:
 Are the planned activities being implemented?
 Are the activities being implemented correctly and according to
schedule?
 Are messages and services reaching their intended audiences?
32
 Are project funds spent according to budgeted amounts or do
resources need to be reallocated? Refer to Annex II for the
Monitoring Tool.
Progress towards achieving set objectives are tracked by monitoring changes
in specific variables or indicators. Indicators provide insight into the
progress of the program and help to determine which components of the
programme need to be changed in order to enhance progress. Indicators
chosen for monitoring depend on the objectives, scale and type of project or
programme. Good indicators should:
 Measure the phenomenon they are intended to measure.
 Produce the same results when used more than once to measure
precisely the same phenomenon (reliable).
 Be specific (measure only the phenomenon they are intended to
measure).
 Be sensitive (reflecting changes in the state of phenomenon under
study).
 Be operational, measurable or quantifiable with developed and
tested definitions and reference standards
After the monitoring and evaluation process the necessary feedback should
be shared. This promotes ownership of the process; helps maintain the
required standard and the will to do better next time.
33
NOTE

Indicators should be well defined, feasible to collect, easy to interpret and
able to track changes over time.

Key monitoring points for outputs are quantity, quality, unit costs, access
and coverage.

It is not cost effective to have high quality services available if those
services are unsuccessful in reaching significant numbers of people.
Similarly it is not good to provide services to a large number of people if
the services provided are of poor quality and result in low client
satisfaction and usage rates over time.
34
Annexes
Annex I: District and Community Entry Checklist
1.1
The district entry process
The district entry process shall include the following steps:
 Exploration.
 Courtesy call to the District Commissioner or Chief Executive.
 Awareness and orientation of district leaders including the District
Executive Committee (DEC), District AIDS Coordinating
Committee (DACC), etc.
 Identifying the animation team.
 Identifying frontline workers that may assist in the activities.
 Forming and training the animation team at the district level who are
responsible to the Local Assembly (for planning purposes).
 Creating awareness at the Traditional Authority level.
 Forming and training of a team at Traditional Authority level.
 Identification and equipping the community based resource persons
from CBOs, FBOs, and youth clubs.
1.2 The community entry process
 Exploration – gathering information, review of literature, meeting
the key informants.
 Observing protocols to formalize the process and gain the necessary
support.
 Carry out a participatory Rapid Assessment.
 Waiting stage (data analysis stage by initiators).
 Joint situational analysis with some members of the community.
 Feedback on the results of the analysis to the wider community.
 Training of frontliners based on interventions identified.
 Implementation.
 Monitoring and evaluation.
35
Annex II: The Community Rapid Assessment Tool
Steps in conducting a rapid assessment
I. Prepare for rapid assessment.
II. Establish rapport with leaders.
III. Brief community members.
IV. Prepare an assessment plan.
V. Collect data.
VI. Waiting stage.
VII. Give feedback to the community.
i.
Prepare for rapid assessment
Preparation for the rapid assessment will include:
 Gathering basic information from review of literature, health
facilities, and contacts with key individuals in the district like the
Director of Planning and extension workers.
 Deciding who to interview.
 Preparation of tools for data collection
ii.
Establish rapport with leaders
Initiating contact with community leaders is important to build support
for collaboration and to brief the leaders on the objectives of the project
and what is expected of them
iii.
Brief community members
Community members should be informed before hand of the activity
through their local leaders. Some community members will be invited
to take part in the data collection exercise so that they input into the
exercise and the prioritization of the issues.
iv.
Assessment plan
An assessment plan will be drawn collectively with the community.
Data collection
Data is collected using different participatory rural appraisal methods
such as:
v.
36










vi.
Transect walk / mapping.
Focus group discussions.
Venn diagram.
Role-plays.
Community history /timeline of events.
Daily activity calendars.
Pie charts etc.
Key informant interviews.
Seasonal calendar.
Community based information system (village registers).
Waiting stage
During this stage the team will analyze the data collected. Below is a
framework for analyzing the data collected from the rapid assessment
Current
Practices
Underlying
influences
Barriers to
adoption of
practices
Desired
Behaviour
Issue/
Theme
vii. Give feedback to the community
Feedback will be provided to the community in order to
validate the findings and prioritize the issues.
37
Annex III:
Facilitation
Facilitation is a skill that has to be learned, it is different from chairing a
formal meeting. In order to have a successful dialogue session a good
facilitator needs to be chosen. An effective facilitator will take the group
through the process of:
 Who are we?
 Where are we?
 Where do we want to go?
 What will we do as individuals and with others to make a
difference?
A good facilitator:
 Is trustworthy, impartial and culturally sensitive.
 Speaks clearly and positively.
 Listens and inspires conversations.
 Notices and responds when participants are losing interest.
A suitably flexible facilitator
 Plans the agenda in advance but is flexible on the day.
 Can engage participants in the conversation.
 Ensures that the purpose of the meeting is clear and agreed upon by
all participants.
An experienced facilitator
 Focuses on guiding the meeting rather than talking.
 Ensures that all voices are heard and prevents vocal members from
dominating the discussions.
 Listens actively and encourages all members to do the same.
 Constructively manages conflict.
 Clarifies where necessary by paraphrasing what has just been said
and checking accuracy.
 Accepts and summarizes expressed opinions.
 Summarizes at intervals the conclusion the meeting appears to be
reaching.
38
 Keeps the meeting on track.
 Helps participants to draw conclusions at the end and determine
clear actions.
 Builds on comments made by others so that the dialogue develops.
Points to consider
 Choose a facilitator who is culturally appropriate and familiar
with the community.
 The facilitator should have the necessary knowledge and skills for
the task.
 Seek views of communities and stakeholders who have worked
with the facilitator to get a balanced perspective.
 Contact facilitators on time to allow them to prepare for the
dialogue.
 Arrange an initial meeting with the facilitator to plan the
dialogue decide on the outcomes and let them ask questions.
39
Annex IV: Questions to help gather information about the community
Socio Economic Profile
A. History
 How far back was the community formed? History of collective
action to address any health issue(s) and what were the results?
B.
Geography
 Where is the community located? Characteristics that may affect
implementation of a community dialogue effort like dispersed
population, highly populated neighborhoods, weather /seasons,
mountainous topography
C.
Economy
Current economic situation of the community for example high
unemployment rate.
 What is the average income of the families in the community?
 What is the proportion of families considered poor in the
community?
 What is the level of external assistance?
 Employment by history.
D.
Gender relations/roles
 What are the traditional men’s /boys’ and women’s /girls’ roles?
 What proportion of men and women does the issue directly affect?
 Who has access to information, services and resources?
 What are the power relations between sexes?
E. Politics, leaders and organizations
 What is the traditional organizational structure of the community?
Who leads? Which groups of people participate in decision-making?
 Who are the official community leaders?
 Who are the informal /traditional leaders?
40
 How are community decisions made? Who participates in decisionmaking process?
 How is official leadership transferred?
 Links between the community and other external political systems
(representation in a district or municipal body).
F.
Social cultural context
 Class.
 Ethnic groups.
 Dominant languages.
 Religions available in the area.
 Age of the general population.
 Wealthy ranking. Who is rich? Who is poor? How do you know?
 How do people support themselves and their families?
 What is the coping mechanism of affected and infected families in
the community?
 How is land allocated?
G.
Epidemiology and health systems
 Frequency of health problems in identified groups (from existing
studies, health statistics).
 Factors related to the health issue i.e. how HIV is transmitted among
the general population.
 What role does traditional medicine play?
 Coverage /utilization of public/private /traditional health services.
 What challenges faced by the health system?
 What are the strengths and weaknesses of the health care delivery
system?
 Partner stakeholder analysis (How many NGOs, CBOs, FBOs, youth
groups, support groups work in the area?)
 How many organizations are engaged in HIV and AIDS prevention,
care, treatment and support activities?
41
NB:
Answers to some of the above may be sourced from books,
reports, facility based surveys, service coverage reports, etc.
42
QUESTION GUIDE FOR SPECIFIC HIV AND AIDS ISSUES
Below is a list of some of the specific HIV and AIDS issues that may be
explored (this is not exhaustive):
1.0 HIV Prevention
 What are the risky behaviour that people indulged in?
 What are the cultural practices for example traditional rituals that
expose community members to HIV infection?
 What has been the response of traditional and political leaders to the
increase in HIV infection?
 Can you give incidences of stigma and discrimination against the
affected families?
 Do you have groups addressing HIV prevention among major target
groups like women and the youth?
 Are condoms readily available for HIV prevention?
 Is the community having open and reflective dialogue on HIV
prevention?
2.0 HIV Prevention (Chichewa)
 Ndi njira ziti zimene zimathandiza kufalitsa kachirombo ka HIV?
 Nanga ndi mchitidwe uti umene ukupangitsa kuti ka chiromboko
kakhale kakufalirabe?
 Ndi miyambo iti imene tikuona kuti ikuthandiza kufalitsa
kachilombo ka HIV?
 Tikuchitapo chiyani kuti tipewe kutenga kachilombo ka HIV?
 Kodi achinyamata akutha kudzisunga mpaka atalowa mbanja?
 Kodi achinyamata akamalowa mbanja akumakayezetsa magazi
kaye?
 Ndi anthu angati amene tingakhale omasuka kugwiritsa ntchito
kondomu pogonana?
 Kodi anthu ndiomasuka kukambirana za Edzi kudera lino?
 Kodi pali magulu kapena mabungwe amene amathandiza kupereka
uthenga wa Edzi kuno?
 Ndi njira zina ziti zimene timamvera uthenga wa Edzi?
43
3.0 PLHIV
 How is the community currently coping with the increase in AIDS
related illnesses?
 What are the coping mechanisms for PLHIV?
 What community initiatives exist for PLHIV?
 What community support is provided for PLHIV?
 Do PLHIV participate in development activities?
 What are the priority needs of PLHIV in your community?
4.0 Care givers of PLHIV
 What type of support is provided to caregivers?
 What type of support do caregivers need?
 How do caregivers support one another?
 What is the level of involvement of men in care giving?
 What is the community doing to support caregivers?
5.0 Youth
 What youth programmes exist in the communities?
 What youth programmes exist in the communities?
 How is information on HIV prevention disseminated?
 How do youth learn about sex and sexuality?
 Where do the youth seek advice on sex and sexuality?
 Evidence of parent child communication on sex and sexuality?
 How are the youth practicing safe sex and who are abstaining from
sex?
 What motivated them to change their behaviour?
 How could they be role models for other youth?
 What influences them to have unsafe sex?
 For those practicing unsafe sex what strategies could they work on
as a community to protect themselves?
 What role do youth in the community play in supporting other
community based initiatives?
6.0 Orphans and vulnerable children
 Which children are vulnerable in the community?
 How are orphans defined in the community?
44
 Have orphans and vulnerable children been registered in each
community?
 How many orphans and vulnerable children are living in the
communities? Where do they live?
 How is the community currently coping and responding to orphans
and vulnerable children?
 Is there any presence of child headed households and how do they
feel about their role?
 Who supports orphans in child headed households?
 Are these orphans in school or not? If not why?
 What are their priority needs?
 Who provides psychological support to orphans?
 Who provides nutritional needs requirements to OVCs and women?
 How does the community ensure food security?
 Is there any educational support for OVC?
 Where do they get these services?
 What is the role of the community in care for orphans and
vulnerable children?
 How do you prepare the community for adult life?
 What kind of activities are communities involved in?
 What kinds of activities are communities involved in?
 How long do communities engage in such activities per day?
 Do you have village registers?
 Is stigma and discrimination an issue that could be prevented?
 Why is it important to prevent stigma and discrimination?
 What rights does an orphan have?
 How do you ensure that care and support is provided to OVC and
their families?
 Do you have any support groups in the community?
7.0 Guardians of orphans
 What problems do guardians of OVCs face?
 What types of support do guardians of orphans need?
45
 What type of support are these guardians already receiving from the
community, organizations working in the areas or opinion leaders?
 How do they think they may support each other?
8.0 Economic support
 What are the sources of income for community members?
 Do you have any lending institutions?
 Are women involved in IGAs?
 What IGAs do women and men have?
 Who controls the resources at home?
 What are the IGA support groups in the community?
 Is there a social cash/safety net scheme for the poor in the society?
 How does the community ensure food security?
 What support do groups provide to OVC and women?
9.0 Gender and human rights
 What are the roles of women and men in this community?
 Are strategies and activities involving all gender groups?
 Are these user-friendly by all these gender groups?
 What is the degree of involvement for women in decision-making
issues in this community?
 Do these vulnerable groups deserve equal access to services
 Who makes decisions concerning sex in the home, community?
 Are female controlled HIV prevention methods like the female
condom available in the community?
 Are there cases of gender-based violence in the community?
 What structures does the community have to handle gender-based
violence?
 What are human rights? How are they violated?
 Is there any violation of rights of other individuals?
 Who are the most affected groups in this community whose rights
are violated?
 What could the community provide to protect and fulfill the rights of
these vulnerable, marginalized groups of people?
46
10.0 Cultural practices
 What are the prominent cultural practices that you have in this
community?
 What are the advantages of these cultural practices
 Do you think some of these cultural practices can increase HIV
transmission or have negative reproductive health outcomes
 Is there any need to modify these cultural practices
 Does the community ever use traditional medicine? When?
 Are there any alternatives to traditional medicines?
 What are the responsibilities of community leaders as guardians of
culture?
 What role can these community leaders play in the modification of
harmful cultural practices?
11.0 Access to HIV and AIDS services
Treatment of opportunistic infections
 Kodi anthu amene akudwala amakapeza kuti chithandizo cha
mankhwala?
 Kodi pali zovuta zimene odwala amakumana nazo pofuna kupeze
chithandizo cha mankhwala?
Anti-retroviral treatment (ART)
 Kodi anthu akayezetsa nkupezeka ndi kachirombo ka HIV
akumalandira chithandizo chotani?
 Kodi anthu amakapeza kuti thandizo la mankhwala a ARV?
 Ndi zovuta ziti zomwe anthu amakumana nazo pofuna kupeza ma
ARV.
Pediatric ART
 Kodi ana amene anapezeka ndi kachirombo ka HIV amalandira
thandizo lotani?
 Kodi ana amene anapezeka ndi HIV akumalandiranso ma ARV?
 Nanga ndi zovuta ziti zimene zimakhalapo kuti ana apeze ma ARV?
47
Prevention of Mother to Child Transmission (PMTCT)
 Ndi njira ziti zimene mayi oyembekezera angapatsire mwana wake
kachirombo ka HIV?
 Tingasatire njira ziti kuti mwana asatenge kachirombo ka HIV
kuchokera kwa mayi wake amene ali ndi kachiromboka?
 Amayi oyembekezera amalandira kuti uphungu akapezeka kuti ali
ndi HIV?
 Amayi amene apezeka ndi kachirombo ka HIV amalandira
chithandizo chotani kuti asapastire mwana wawo kachirombo ka
HIV.
 Tingachite bwanji kuti mwana woti amai ake ali ndi kachirombo ka
HIV asatenge kachilombo kuchokera kwa mai ake.
PMTCT (English)
 Where do pregnant women access Antenatal services?
 Is there a programme in this community that ensures that all
pregnant women deliver at a health facility?
 Does the community have a say in ensuring that all pregnant women
access Antenatal services and deliver at a health facility?
 Who follows them up in the community to ensure that the women
maintain the post-natal checkups?
 What role does the community play in ensuring safe motherhood for
all pregnant women?
HIV Testing and Counselling
 Kodi ubwino woyezesta magazi ndi otani?
 Kodi anthu akafuna kuyezetsa magazi amapita kuti?
 Kodi anthu kuno amakhala omasuka kukayezetsa magazi?
 Kodi anthu akapezeka ndi kachirombo ka HIV amaulandira bwanji
uthengawu?
 Kodi anthu ali omasuka kuwawuza ena za mmene magazi awo alili?
Nanga anthu a m’banja amawauza akazi/ amuna awo za zotsatira
zakuyezetsa magazi awo akapezeka kuti ali ndi kachirombo ka HIV?
 Kodi achinyamata akamalowa mbanja akumayezetsa magazi awo?
48
Integrated home based care
 Kodi ndi mabungwe ati amene amathandizapo pa ntchito yo
samalira odwala?
 Kodi pali anthu odzipereka pa nkhani yosamalira anthu amene
akudwaloa?
 Kod udindo wa abambo pa nkhani yosamalira anthu odwala ndi
wotani?
 Kodi anthu osamalira odwalawa amathandizidwa bwanji?
 Kodi pamene matenda afika popita nawo kuchipatala timayenda
bwanji?
 Kodi anthu amene ali ndi kachirombo ka HIV amasalidwa?
Nutritional support
 Anthu odwala Edzi amadya chakudya chotani?
 Pali zovuta ziti zimene timakumana nazo kuti anthu odwala apeze
chakudya choyenera?
Psychosocial Support
 Kodi anthu amene akhudzidwa ndi matendawa timakhala nawo
bwanji kuti asamakhale modandaula?
 Timatengapo gawo lanji powapeputsa anthu odwala pa ntchito
zawo?
 Ndi ndani amene amapereka uphungu kwa anthu okhudzidwa ndi
nthendayi?
49
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