Select Committee on International Development Written Evidence


Memorandum submitted by Students Partnership Worldwide (SPW)


  In conjunction with the Governments of Uganda, Tanzania, South Africa and Zimbabwe, SPW is currently working on peer-education models which use trained local and overseas volunteers, based in rural schools, to address reproductive health and other threats to young people's livelihoods.

Introduction—a wasted decade

  In the Great Lakes region of Central Africa, the capacity of HIV/AIDS to devastate whole societies was painfully evident by the late 80s. In 1992, at the Earth Summit in Rio de Janeiro, the world's governments pledged to "mobilise and unify national and international efforts against AIDS to prevent infection and reduce the personal and social impact of HIV infection".

  Since 1992, while costly and effective measures have been taken to protect high-risk groups in the North, HIV/AIDS has been making horrifying inroads into the impoverished youth population of sub-Saharan Africa, leading to growing exclusion and unemployment, and the exponential rise of HIV infection.

  The commitment by governments at Rio was not simply a rhetorical call to arms; it was part of a carefully thought out and comprehensive strategy for sustainable living in the face of unprecedented threats to human health and the environment. This strategy took particular account of the demography of countries in the South, where already young people under 25 constituted a disproportionately large element in society—and insisted that young people must be central to sustainable development policy:

  "It is imperative that youth from all parts of the world participate actively in all relevant levels of decision-making processes because it affects their lives today and has implications for the future. In addition to their intellectual contribution and their ability to mobilise support, they bring unique perspectives that need to be taken into account."

  Agenda 21 made it clear that formal teaching was inadequate if long-term changes in young people's attitude and behaviour were to be effected; alternative learning approaches and methodologies were strongly recommended. The point repeatedly made in chapters 25 and 36 was that, in both the North and South, young people must participate in the design and implementation of programmes which raise awareness and stimulate action.

  The humane and enlightened global stance adopted in Rio has been reaffirmed annually at the Commission for Sustainable Development meetings in New York, and the component relating to youth has been reiterated in a succession of youth-focused global conferences sponsored by the UN agencies and yet it is only now, against a background of public indifference in the North, that co-ordinated global action on behalf of the world's most disenfranchised communities appears at last a real possibility.


  During this period of inaction, SPW has been recruiting and training hundreds of young Africans, alongside counterparts from the North, to work as peer leaders addressing reproductive health and other life issues in rural communities in Uganda, Tanzania, South Africa and Zimbabwe. By the nature of its work, SPW has been made all too aware of the gap between rhetoric and reality. Five years ago, SPW received the official endorsement of the UNDP and UNEP, acknowledging that its aims and methodology were entirely consistent with Agenda 21 and notifying all UNDP country offices; since then, apart for one isolated grant, these agencies have failed to provide anything more than moral support. SPW and other youth-focused agencies working in the South hope that this year's high-profile exposure of the HIV/AIDS calamity will not be seen in retrospect as part of the same pattern of rhetoric and inaction.


  DFID's two recent strategy papers, Fighting Back and Better Health for Poor People, are encouraging evidence of a profound shift in thinking. The strategic objectives of Fighting Back in particular bring policy back in line with Agenda 21: its commitment to regard youth as the primary target group, and the need for young people to take a pro-active role in the drive to control HIV/AIDS is especially to be welcomed. The challenge remains to find an effective means of implementation.

  DFID's policy in this regard is much less convincing. It presupposes a superstructure made up of governmental and multilateral agencies which would direct national strategy through inter-departmental groups, via local education and health authorities, into civil society and community-based organisations. The intention is that decentralised strategies would be reinforced, and responsibility devolved to local level. Attractive though this sounds, it simply will not work on the ground. The same powerful inhibiting mechanisms which have prevented co-ordinated and purposeful intervention in the past, will continue to do so.


  The following analysis of these inhibitors is based on SPW's experience in four sub-Saharan African countries of operating at the interface between government and multilateral bodies on the one hand, and schools and rural communities on the other.

Multilateral agencies

  Both DFID papers assume that under the new "crisis" dispensation that there will be an increased role for the multilateral agencies. Given their track record, this assumption is difficult to justify. During the '90s, the primary role of these bodies should have been to instil urgency in each national government to co-ordinate its efforts against AIDS—this they have failed to do. In the countries where SPW operates there are no active cross-sectoral groups targeting AIDS at any level, and no effective liaison between the two lead ministries: health and education. No strategic ideas for tackling AIDS on a regional basis have emerged from these organisations.

  A root cause of this disjunction is that that the agencies themselves do not work together. In Kampala, all five relevant UN agencies (UNAIDS, UNICEF, UNDP, UNESCO and UNFPA) have separate offices, with no established lines of communication between them. In Dar-es-Salaam, despite the presence of a UNAIDS co-ordinator, there is another AIDS co-ordinator within UNDP.

  In the face of increasing need for co-ordinated intervention, the response of these multi-tiered bureaucracies has been reactive; their habit of mind, at best, academic and detached. They have been more interested in circulating research papers than, offering advice to and facilitating the activities of disparate groups than co-ordinating practical action on the ground. Highly visible at conferences, seminars and workshops, they are rarely to be seen at the grassroots where HIV/AIDS is spreading.

  Furthermore, multilateral agencies deal almost exclusively with government, reinforcing central control at a time when what is urgently needed is decentralisation, local capacity building and community mobilisation. They are not designed to interact with civil society organisations, let alone community groups in the rural areas. Funding application procedures are generally arcane, and the result is that such money as is set aside for micro-project work in rural communities is frequently unspent. More than a year ago, UNESCO expressed whole-hearted support for SPW's work in Africa—it is still trying to find a mechanism for funding SPW within its inflexible parameters.

  Besides, the amount spent on sustaining these elaborate structures is already profligate—money which is desperately needed for practical intervention. In Better Health for Poor People, section 2.2.2, the point is bluntly made with reference to these agencies:

    The financial leverage of donor agencies in recipient countries, coupled with low levels of political profile and scrutiny "at home", combine to create a hazardous vacuum of accountability.

  The report also notes that there has been a "proliferation of the actors responding to global health needs over the last 20 years", and that "mandates and responses have become blurred, resulting in overlap and confusion". If this is an accurate judgement of the performance of these agencies, they are entirely unsuited to the implementation of grassroots strategies. As the report suggests, "The challenge facing the international health community is to mould these key actors—each pursuing often radically different agendas—into an integrated whole". The crisis management required cannot wait for these inflexible agencies to achieve the desired co-operation. While they try to become a genuine "international health community", millions more will contract HIV.

Civil society organisations

  Both DFID strategy papers rightly stress the need to work closely with civil society organisations if a genuinely national prevention strategy is to be put in place—but they do not make clear which organisations they have in mind. If they mean schools, churches and other religious institutions, rather than NGOs and community groups, then it has to be recognised that progress has been seriously retarded during the 90s by their damaging chauvinist and conservative attitudes. Given as they are to moralistic judgement and prescriptive advice for young people, they have shown themselves not to be natural allies in a campaign for community mobilisation in the fight against AIDS. While the school system must remain central in any strategy, it has so far failed in its responsibilities. Teachers are now one of the worst hit groups in society, and as such are not appropriate role models—to the point where girls are now at risk at school.

Local organisations

  In rural Africa, the AIDS epidemic has produced a plethora of AIDS service and community-based organisations. These paid and voluntary groups, which form the front line in the grassroots battle against AIDS, generally lack funding and administrative skills. Because they work largely in isolation, they cannot provide a reliable infrastructure for systematic AIDS prevention work. But if there were rurally-focussed umbrella organisations offering small-scale funding, training and advice, they could collectively become a force for change.


  Undermining any plans for implementation is the shortage of skilled people at all levels of African society. The strategy documents talk repeatedly of the activities that must be undertaken if its strategic objectives are to be met; but the human resource implications are not mentioned. In countries where few proceed to secondary education, and where training facilities are minimal, who will fill these vital roles?


  Given these fundamental systemic weaknesses, there must be a strong case for taking an entirely different line—which is the subject of the accompanying summary paper, "HIV/AIDS—a youth-led approach". This paper was recently circulated in advance to a range of organisations in Kampala and Dar-es-Salaam. Discussions followed with over 30 senior people in the relevant UN agencies, government ministries and key players in the donor community: DFID, USAID, GTZ, CIDA and others. There was unanimous support for its underlying principles. The papers and accompanying material have also been sent to the HIV/AIDS section of the World Bank by the London Director, who in his letter of recommendation called it "a fresh catalytic approach". SPW is currently in discussion with DFID, and is hopeful that it will support this initiative.


  In the countries most afflicted by HIV/AIDS there are no coherent nation-wide strategies for reaching the young generation. As a result millions of children—especially those living in the rural areas—are contracting the disease because of ignorance or because they fail to understand the full implications of their own behaviour. Already the high incidence of HIV infection among teenagers has staggering medium-term human and economic implications.

  Given that there is no vaccine nor cure for AIDS, the strategic emphasis must be on education—education which is powerful enough to overcome the inhibitors working against changes in attitude and behaviour. It must focus on children and young people because they are especially vulnerable, and because they are increasingly bearing the brunt of the epidemic.

  To achieve this, two conditions must be met. National campaigns must be integrated into the heart of civil society, and sufficient numbers of trained educators must be made available to implement them. These basic requirements are within the capacity of even the poorest countries. All have primary and secondary schools educational systems which give access to the great majority of children; these form a natural infrastructure for national coverage. Less obviously, all these countries have the potential to mobilise such educators in abundance.

  What form, then, should the educational campaign take? Evidence from UNICEF and other agencies shows that curriculum-based and teacher-led programmes have so far failed significantly to change young people's behaviour. Alternative strategies for HIV/AIDS education are urgently needed, which take into account the understandable reluctance of young people to listen and respond to the advice of their elders in sexual matters. The natural urge to explore sexuality, the risks and excitement involved are heightened in the young person's mind by the different risks and excitement of ignoring adult advice, and defying their rules. Approaches based on adult prescription must therefore be sparingly used.

  What then is the alternative? It is widely recognised that the strongest single determinant of sexual conduct is peer influence. The adolescent defines his or her sexual nature in ways which subtly conform to the standards and expectations of their group. Children are therefore more likely to be persuaded to review or change their behaviour by others close to their own age whom they look up to. This truth is borne out by a range of projects which show that clinics staffed with trained young volunteers attract more response, and are valued more highly by the young people involved, than those staffed solely by adults. Other projects confirm the power of peer influence—and yet young people have not so far been given a leading role in the HIV/AIDS offensive.

  All across Africa the secondary school and university systems are producing large numbers of graduates, who frequently remain unemployed for long periods. It is precisely these educated and confident young people who must spearhead national campaigns to change attitudes and behaviour among rural children. Attaching these young people to rural schools would add a dynamic peer education element to HIV/AIDS education. Their presence in rural communities would challenge the damaging reluctance of the older generation to openly discuss HIV/AIDS.

  At the same time this new focal point for youth and community action could grow organically into a sustainable community-based care system for AIDS sufferers in rural areas, surely preferable to the building of homes and hospices with no roots in the local society. A coherent response to the HIV/AIDS epidemic must seek to link prevention and care.

  For some time now SPW, a youth development agency, has been working along these lines in four of the worst hit counties in sub-Saharan Africa. SPW trains and attaches local and overseas volunteers to rural schools as peer educators for up to a year. The volunteers set up and run Youth Groups, which raise awareness of key social and environmental problems children face in their everyday lives—in particular, reproductive health. Through non-formal teaching methods they bring home the deadly immediacy of AIDS, and enable Youth Group members to acquire the self-confidence and life-skills necessary to translate information into behavioural change—especially amongst girls. They also gain the support of peer leaders, teachers and other community members to continue these activities after they leave. These clubs impact throughout the school and into the wider community.

  In co-operation with the Governments of South Africa, Uganda, Tanzania and Zimbabwe, SPW is currently developing a Demonstration Model, which uses task forces of approximately 50 volunteers in each country, based in 25 rural schools. Its purpose is to trial and test components for a comprehensive HIV/AIDS prevention programme, which would:

    —  use schools as access points to rural youth and their communities;

    —  be delivered by trained young adults;

    —  target specific age groups with appropriate techniques;

    —  draw on existing materials and best practice from other agencies;

    —  design effective strategies, materials and methodologies—capable of local and national replication; and

    —  use local culture and language to reinforce standard approaches.

  SPW's programmes have already produced a wealth of youth-friendly materials, training strategies and practical methodologies—drawn from first hand experience—and designed to make the threat of HIV/AIDS more real to rural children than formal classroom teaching ever could.

  To provide the necessary resources and expertise to sustain activities in the schools initiated by volunteers, SPW is piloting Youth Development Centres (YDCs) in each of its working districts. These interactive district centres would link young people in the rural areas to the providers of expertise and resources in the urban centres—including private sector partners. This model, if properly supported, has the potential to develop into national networks of linked, multi-purpose youth and community development centres.

  The South African Government's recent radical reforms confirm that this is a viable approach. Facing a desperate AIDS crisis, it has initiated two major social reforms. Firstly, it is advocating stronger links between rural schools and their local communities so that they can together engage with AIDS and primary development issues. Secondly, it is setting up a National Youth Service, which would encourage and enable young people to contribute through voluntary activity to community and national life.

  There is no time to lose, Initiatives to date have only had local and limited effect, failing even to stem the acceleration of HIV infection. Within a decade, a whole generation of young Africans could be lost. Rather than being dismissed as the helpless victims of the disease, they must be given the support and funding to take the lead in the next stage of the campaign.

Jim Cogan
Director, SPW
March 2000

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