Framing CLA: Openness in Namibia

This blog post is the second in a new Framing CLA blog series on USAID Learning Lab. Organized according to the subcomponents of the CLA Framework, the blog series features question and answer with development practitioners who submitted cases in the 2016 CLA Case Competition. This blog focuses on: openness.

USAID Learning Lab: What is your full name, title, and organization?

Posner: Stephanie Posner, Country Director, Pact, Inc. in Namibia

USAID Learning Lab: What was the development challenge you addressed in your CLA Case Competition submission?

Posner: The Kavango Region in Namibia had the country’s second-highest antiretroviral therapy (ART) treatment gap and was at risk of not meeting UNAIDS’s 90-90-90 targets.

In late 2013, Pact initiated the Namibian Institutional Strengthening (NIS) project supported by the U.S President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID. The aim of NIS was to build the capacity of local actors to support an evolving national HIV/AIDS response. Subsequent iterations of PEPFAR directed this overall goal toward regional and district-level coordination and systems support with a specific focus on ART treatment. The NIS team mobilized local political leaders, decision-makers from the Ministry of Health and Social Services NGOs and people living with HIV to form the Kavango Treatment Initiative, a “rapid response” team designed to tackle collectively the most pressing HIV challenges in Rundu, the region’s largest health district.

The region’s 50% ARV treatment gap was USAID’s (PEPFAR’s) primary concern.   Yet there was very real and ethical resistance from MOHSS to add more patients on treatment without addressing adherence first.   The Kavango Treatment Initiative needed to bridge these closely related, but subtly different goals to get alignment among the members.

USAID Learning Lab: Your case is a great example of one of the subcomponents of the CLA Maturity Matrix: openness. Can you tell us about how this aspect of CLA helped you address this development challenge? 

Posner: The Kavango Treatment Initiative was a catalyst for building understanding among a diverse group of local stakeholders around how to meet HIV and AIDS service delivery targets, and UNAID’s 90-90-90 targets. Members from the health sector, NGOs, other Ministries and people living with HIV in the region were identified through a series of processes including multiple interviews during an assessment process, nomination, and a social network analysis process.

While members came from different backgrounds and professional levels in their organizations, their contributions were equally valued, which increased the readiness to contribute and share perspectives.

Innovative and intentional facilitation approaches were applied, such as:

• carefully convened and facilitated panel discussions
• “stakeholder shoes” facilitation technique
• “learning journeys” which produced critical experiential learning that had direct personal and valued impacts on participants

These additional approaches contributed substantially to fostering open interaction, trust, needed dialogue, and idea exchanges between health care providers and people living with HIV. It also focused attention on shared objectives and freed participants to think about solutions creatively and collaboratively.  Sensitive data could be shared and discussed without fear of repercussions.  The whole experience created enthusiasm among participants and led a key participant to conclude: “I never want to miss a Kavango Treatment Initiative [meeting].”

USAID Learning Lab: What advice would you give to another team looking to be more intentional, systematic, and resourced in openness?

Posner: Many solutions can be found within existing systems and using existing resources. When local implementers clearly understand challenges and are motivated and empowered to take action, they often found solutions within their organizations or through cooperation. 

USAID Learning Lab: Why did you choose to use a CLA approach?

Posner: CLA facilitated trusting relationships in the Kavango Treatment Initiative, increased respect between members, promoted greater willingness to listen among members, and ultimately resulted in members taking ownership of the Kavango Treatment Initiative.

USAID Learning Lab: How did your holistic CLA approach influence your organization’s culture?

Posner:

• Increased data accuracy and timeliness for better service delivery. Collection and sharing of up-to-date client data resulted in tangible improvements to management of client flows and ARV stocks at all treatment sites. Waiting times were reduced, clinical teams could more easily identify treatment defaulters and, with up-to-date treatment figures for each facility, medical store staff could deliver appropriate amounts of medicines. This led to reductions in stock-outs and ad-hoc replenishments, limiting the risk of losing clients referred elsewhere for medication pick-up.
• Improved linkages between facility and community-based service providers. With accurate client data and greater awareness of local NGO service provision, tracing of treatment defaulters and referrals to treatment support groups improved. Community-based HIV testing sites increased referrals of HIV-positive clients to the ART program. 

USAID Learning Lab: How did your holistic CLA approach influence your project’s development outcomes?

Posner: Participation in the Kavango Treatment Initiative sensitized program implementers to the real challenges faced by many ART clients.  This led to a fuller acknowledgement of these issues and active work with clients and other community stakeholders toward practical local solutions.

The experience inspired a community member living with HIV to start organizing a much needed forum for people living with HIV in the region focused on strengthening the voice of HIV clients.

Click here to learn more about the Kavango Treatment Initiative.