IFGH 2012: Sustainability of Community Based Organisations for HIV/AIDS Care and Support Services in Zambia

Authors: Walsh A.1, Mulambia C.2, Hanefeld J.3, Brugha R.1, 3

Author Affiliations: 1Royal College of Surgeons in Ireland; 2Institute of Economic and Social Research, Universityof Zambia, 3London School of Hygiene and Tropical Medicine

Option 1– Scientific / Empirical Research Findings

Presented as – Oral Presentation

Aims:

Community Based Organisations (CBOs) provide important advocacy, care and support services for people living with HIV and AIDS (PLWHA) in Zambia. This study assessed whether Zambia’s World Bank-funded Community Response to HIV/AIDS (CRAIDS) project, 2003-2008, contributed to CBO sustainability.

Methods:

In-depth interviews with representatives of all CBOs that received CRAIDS funding (n = 18) and district stakeholders (n= 10) in Mumbwa rural district in Zambia, in 2010; and national stakeholders (n=11) in 2011.

Results:

• Health services: While all CBOs were functioning in 2010, most reported reductions in AIDS service 
provision since CRAIDS funding ceased. Home visits had reduced due to a lack of food to bring to PLWHA and lack of funding for transport, which reduced ARV adherence support and transport of patients to clinics.
• Organisational capacity and viability: All 18 CBOs had existed prior to CRAIDS, contrary to national level perceptions that CBOs were established to access CRAIDS funds rather than from the needs of communities. CRAIDS promoted CBO sustainability through funding Income Generating Activities. However, there was a lack of infrastructure and training to make these sustainable. Links between health facilities and communities improved over time, with volunteers working on teams with clinic staff. After CRAIDS ceased, CBOs were not aware of new funding opportunities.
• Volunteerism: Volunteers’ skills’ levels had reduced over time, as some who had received training had left the district, and medical guidelines had become outdated.

Discussion/conclusions/ implications: CBOs in Mumbwa district, which had existed prior to new HIV funding, remained in existence after the funding stopped, though with reduced levels of service provision. This highlights the importance of enabling, working with, building the capacity of and putting in place sustainability plans of existing CBOs and community structures, rather than creating new mechanisms for delivering HIV care and support services.

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