2 Decades of Promoting positive change in the lives of many
WAAF has implemented hundreds of projects across Ghana since it was founded in 1999. From In School education targeting the youth, to Out of School education targeting the out of school youth, to Home based care to trainings, stigma reduction, empowerment of Persons infected and affected with the disease to human rights issues as well as economic empowerment, all these past projects showcase the diversity of initiatives WAAF has and continues to work on and they also showcase the contributions WAAF has made towards Ghana’s efforts in the area of Public Health.
WAAFs Past Projects section has a list of selected projects, detailing the Title, Funder, Timeframe, a brief description and their achievements.
WAAF and IHCC have implemented many projects in the past. Read through the following summaries to get a better idea for the type of work we have done, and the wonderful partners we have worked with from across the globe. Current projects running now in 2018 can be found here.
STAR-Ghana Anti-corruption project in Ghana’s health sector
Project Name: Not in our Name – Tackling extortion in the Ghanaian health care system
Partners: WAAF, the lead on this project is co-implementing it with Hope for Future Generations and Socioserve Ghana.
Project Timeframe: 2 years – 2018 through 2020
Geographical Scope: The project is being implemented across 6 regions of the country. Each implementing partner is focusing on 2 regions and the 6 regions are:
- Greater Accra Region – managed by Hope for Future Generations
- Central Region – managed by Hope for Future Generations
- Volta Region – managed by Socioserve Ghana
- Eastern Region – managed by Socioserve Ghana
- Northern Region – managed by WAAF
- Upper East Region – managed by WAAF
Project Objective: To reduce the occurrence of corruption within private and public healthcare systems through:
- Addressing the root causes of extortion in the healthcare sector
- Increasing the exposure of corruption
- Increasing client confidence in healthcare system delivery
- Improving the overall quality of care
Rationale for the Project: Extortion within the healthcare system is harmful towards the health of the public in general, and the impact is particularly acutely felt by the poorest individuals who are easily exploited due to their lack of knowledge of their rights, including people who do not speak English. Those who live in rural communities who may have made a long journey for medical attention then face a choice between paying a higher price than they had anticipated or can afford for treatment, or going home with their problem unsolved.
Those who cannot afford to pay the bribes for quicker treatment are pushed down the queue, which can make serious health issues worse. Often this can include People with Disabilities – PWDs. The health of women and girls may not be prioritized in such a situation in farming households where male family members provide financially for the rest of the family.
Corruption within the health service decreases the efficiency and quality of care for all patients, and diminishes trust and confidence in healthcare workers
Extortion at the point of use within both private and public sectors can take several forms. These include:
- Demands of unapproved and unnecessary fees by healthcare workers, without issuing of official receipts;
- Healthcare workers referring patients to private facilities or services where suitable public alternatives are available – ‘quiet corruption’;
- Doctors vacating or using paid hours for locum;
- The extortion of bribes in order to be treated more quickly;
- Demands for payment for items covered by the patients’ insurance; and
- Unnecessary overnight admission of patients for profit
Evidence to support the need of such a project: Studies have been conducted including a 2012 KNUST paper ‘Corruption in Ghanaian Healthcare System: The Consequences’, which focused on patient experiences of corruption in the Ashanti Region. The paper concluded that ‘quiet corruption’ is endemic, with doctors viewed as the most corrupt workers in the healthcare system. This can and does lead to loss of life resulting from delay in medical care and/or lack of financial capacity.
WAAF and its partners believe – When patients are dying as a result of corruption, we must act.
Progress so far: Having kicked off in March 2018, a baseline study to ascertain the actual status of monetary extortion from patients in the selected districts of the project has taken place and the findings presented to key stakeholders such as District health Management teams/Directors, National Health Insurance Schemes and other key stakeholders during a stakeholder meeting.
Community entry exercise is now taking place and then the project will roll out. We shall be presenting updates as it moves along.
Coming out Proud
Project Name: Coming out Proud – tackling self stigma amongst MSM
Donor: US Embassy – Accra
Project Timeframe: April 2018 through September 2018
Geographical Scope: Western and Eastern Region of Ghana
Project Goal/Objective: Empowering MSM to address self stigma as a gateway to enhancing health and wellness.
Rationale / Evidence for the need for the project: The MSM community in Ghana experience various forms of stigmatisation and discrimination and many of such cases involve abuse of basic human rights. Over the years, therefore different interventions have been deployed by various entities to tackle stigma and discrimination however within all of these, Self Stigma has not received the necessary attention. As such this has continued to remain a huge barrier for MSM accessing services such as quality health care. As one of the few entities equipped to provide services across the HIV care cascade, WAAF is realizing more and more how Self Stigma amongst the MSM community continues to be a major obstacle not only for MSM accessing care but also in complementing the efforts of other programs seeking to address barriers to quality health care.
Progress so far: 2 support MSM support groups formed in the Western Region. These groups meet regularly and form a place where MSM feel comfortable discussing issues of concern to them especially in relation to health. They get advice and support from group members who through the project have undergone capacity building in various areas such as:
- Pros and Cons of living openly as an MSM with or without HIV
- homophobia communication skills
- sexism assertiveness training
- Workplace issues and many more
1 vibrant MSM support group formed in the Eastern Region of Ghana doing the exact same thing as those in the Western Region.
Capitalizing on these groups will enable WAAF continue to address the issue of self stigma especially in relation to how MSM seek health care.
Project CAPHA Positive Action for Children Fund (PACF) (ViiV*)
Project Name: Communities Against paediatric HIV and AIDS – CAPHA
Donor: Positive Action for Children’s Fund (PACF) of the ViiV healthcare
Project Timeframe: 3 years (2017 -2020)
Partners: WAAF as the lead organization is implementing this project in collaboration with GEP Social Marketing Foundation
Geographical Scope: 3 Regions of the Country
- Central Region – managed by GEP Social Marketing
- Volta Region – managed by GED Social Marketing
- Brong Ahafo Region – managed by WAAF BAR – office
Project Goal/Objective: With the overall goal of contributing to Ending Paediatric HIV in Ghana, the West Africa AIDS Foundation, put together a proposal that sought to assist the Ghana Health Services (GHS) and the National AIDS Control Program (NACP) address four (4) key bottlenecks that continue to hinder progress in Ghana’s National Prevention of Mother to Child Transmission of HIV (PMTCT) response. These are:
- Low numbers of women who know their HIV status
- Low percentage of HIV+ women who receive anti retroviral to reduce MTCT
- Low % of infants born to HIV positive mothers who received an HIV test within 2 months of birth
- The increasing numbers of loss to follow up cases which include HIV positive pregnant women.
Rationale: With the advancement in HIV care, it is not surprising that many countries today are working tirelessly towards reaching Elimination of Mother to Child Transmission of HIV as any child born to an HIV infected mother today, with all the available treatment and prophylaxis is unacceptable. Children today are the future tomorrow and anything we can do to ensure they are healthy is top priority. WAAF therefore has taken Prevention of Mother to Child Transmission efforts to the next level and will ensure it can do all it can to contribute to Ghana’s efforts in eliminating Mother to Child transmission of HIV. However to achieve this means that all loop holes need to be addressed and that is where this project comes in as it seeks to ensure very hard to reach communities who fall through the cracks are not left out. Many a time in reaching such goals, communities themselves need to be at the forefront and that is what project CAPHA focuses on – it is all about Communities against Pediatric HIV and AIDS.
Evidence to support need for the project: Although Ghana continues to make good strides in HIV care, there are still loopholes and programmatic data from the National AIDS Control Program continue to showcase the constraints with women who default from treatment, women of child bearing age who are not tested for HIV and therefore do not know their HIV status, women who are HIV positive and pregnant who do not have access to ARVs due to various reasons, mainly ART sites inaccessible to them and their communities, infants born to HIV positive mothers who do not undergo Early Infant Diagnosis (EID) due to various factors including poor knowledge of the importance of this. As a way to address some of these bottlenecks, involving the communities, especially hard to reach communities is key and therefore WAAF and it’s partner GEP Social Marketing in collaboration with the Ghana Health Services in selected districts in the 3 Regions are ensuring to leave no woman of child bearing age and their infants behind when it comes to HIV.
Progress so far: Half way through the project, lots of gains have been made.
- 71207 women of child bearing age reached with PMTCT education
- 13560 women age 25 years and above tested for HIV and know their status
- 651 women age 20 -24 years tested for HIV and know their status
- 42 babies tested for EID
Additionally, to ensure access to ARVs, a center in one of the communities was assisted by WAAF to complete check list to qualify as an ART site. This will ensure ARVs are brought closer to the women. Children have been tested for EID and so far no positive infant case has been detected. Detailed reports of the project will be appearing on our website as we move along with the project.
Orphans and Vulnerable Children’s Project
Project Title: Nkanbom – (A Twi word meaning Togetherness) – Caring for our Future Leaders
Funders: Various entities such as – International Women’s Club, QWAAF, Save a Million Lives, WAAF/IHCC, Beekdal Lyceum, Individuals, etc
Project Time Frame: 2004 to 2018 and beyond
Description: The OVC project began in 2004 when the onsite clinic of WAAF realized many clients attending were having difficulties fending for their children. The staff of the clinic decided to set the program up to provide care for the physical, mental and emotional health of children orphaned or made vulnerable by HIV.
Project Outline: The Orphan and Vulnerable Children project (OVC) aims to combat the vulnerably of children impacted by the HIV&AIDS crisis by providing funding for school fees to enable them enrol and stay in school at least till the end of the senior high school cycle. Children hit by the double hammer of HIV&AIDS and poverty require unique care in a comfortable and compassionate environment. As these children face the biggest challenges of their young lives, their need for security, comfort, acceptance and affection is magnified. Incongruously, children orphaned by HIV in Ghana suffer from severe stigmatization and rejection.
When a parent dies of HIV, his or her child is three times more likely to die – even when that child is HIV negative. Children orphaned by HIV often experience emotional distress, malnutrition, lack of health care, and poor or no access to education. Increasingly, OVCs are at high risk for labour exploitation, sex trafficking, homelessness, and exposure to HIV.
Goal and objectives: Minimize the stressful and negative impacts of HIV in OVC while maximizing their access to educational and supportive opportunities by putting emphasis on creating educational opportunities.
Most OVCs cannot afford school related costs where schooling is supposed to be for free. They are for instance unable to buy school books, unable to have adequate school wear such as decent uniforms, school shoes, school bags etc. All of these results in inconsistent attendance to school where in some cases the children are even sent away from school.
School disruption can create a discontinuity in education and hinders normal development. Because of this, WAAF’s goal is to continuously try to sponsor children through sections of their schooling up till a point where they can be meaningful persons in society.
- over 50 children assisted through some sections of their education
- Created an environment that promotes children’s emotional, social, physical and cognitive growth in a developmentally sensitive approach.
- 14 of supported children were able to make it to tertiary level
- Increased the awareness of HIV amongst vulnerable children to enable them make informed choices
Self sufficiency for Persons Living with HIV
Project Title: The Almond Tree
Project Time Frame: 2004 – 2015
Funders: CCI, Save a Million Lives, QWAAF, Dr. Rose Walls, TransCap Foundation, Denise Davidson, STAR-Ghana 1, etc
Description: The name Almond Tree originates from a special tree that sat in the middle of the compound of the first premises of WAAF and IHCC in Roman Ridge. The tree provided shade which was used as a meeting place where people found support, laughter, a sense of belonging, and could escape the stigma in their communities.
Project outline: The Almond Tree is an income generating project created for people living with HIV (PLHIV) in Accra, Ghana by WAAF in partnership with the AIDS Committee of London in Canada facilitated by Canadian Crossroads International.
WAAF and its partners recognize effective HIV programming must involve a strong focus on gender equality. The Almond Tree Project seeks to empower women and encourage male involvement in HIV prevention, intervention, care and support. Workshops will address these issues with guest speakers to promote a better understanding of gender relations and address the needs of both men and women. In addition, the structure of the project will make certain both genders have an active voice in decision making and the opportunity to take on leadership roles. The Almond Tree Project thus improves women’s access to skills, information and services while giving men their needed support.
In phase I of the project, fifteen PLHIV have come together to form eight group and individual ventures. The businesses engage in crafting beaded jewelry, batik / tie and dye, sewing, bread, poultry farming, and petty trading. Beginning in January 2007, they spent four months learning their chosen trade and preparing to run their own businesses. At the end of the training period, those who were ready to start a business applied for small loans. In total, the fifteen participants borrowed approximately 80 million cedis (800 US dollars).
WAAF has formed a partnership with ECLOF (Ecumenical Church Loan Fund – Ghana) to disperse and manage the loans for the Almond Tree Project. ECLOF is a reputable organization, and this partnership will be important in ensuring proper financing structure and loan management expertise to the project.
The Micro and Small Business Loan Centre, an office of the Ghanaian government, is providing the funds for this first loan and for future loans as well. ECLOF’s loan officers will manage the loans and ensure prompt repayment.
Since receiving their loans, the participants have been busy establishing their businesses – paying rent, building structures, and purchasing stock. The sewing and bead group have adopted The Almond Tree as their product label, and have been selling products locally and internationally since May. The bakery is nearly ready to begin making bread.
As the first group begins operating their businesses, WAAF has begun training with a second group of six women. The funding for this training is being provided by the Sisters of St. Joseph in London, Ontario, Canada. These women were all engaged in producing, selling, and trading before they became ill and learned their HIV status. Due to their experience, they do not require any skills training, and so the three months of training will be spend learning business skills, improving literacy, and discussing issues related to living with HIV. We expect the five new participants to apply for their loans in September. Successful applicants will receive their loans in early October.
As the new group meets three times a week, the first group of participants will continue to meet every two weeks, to make payments to their savings accounts, share their challenges, and successes, and support each other.
WAAF is very pleased that its partnership with ECLOF will extend for five years, ensuring that loan funds will be available to many more PHA in the future. However, funding for business and skills training is not readily available. WAAF is currently seeking donors to help us fund this necessary aspect of the program.
Goal and Objectives: The goal of the Almond Tree project is to help PLHIVs gain solidarity and self-sufficiency through group training and micro-enterprise loans. By learning technical skills, business skills, as well as literacy and social development skills, participants gain many of the tools necessary to live independent lives.
- Over 50 PLHIV were able to enrol into skills training programs to enable them become self sufficient
- Over 30 were able to access micro loans to start up their businesses
- As many women were empowered through the programme, their children were also better equipped
Impact: Years after the empowerment, most of the members remain either self employed or have gone on to get employment and are self sufficient.
Women are able to take care of themselves, adhering better to treatment and able to take better care of their children.
Empowerment of Persons Living with the Disease
Project Title: Nothing for Us without Us (NUWU)
Project Timeframe: 2014 – 2015
Funder: Stop TB Partnership
Project Description: The experience WAAF has gained during years of operation dictates that if civil society organizations (CSOs) in Ghana want to make any significant impact on the wellbeing of the citizens they claim to be representing or working for, then they must engage with them. CSOs must seek to help less powerful citizens have a voice in the social and political arena. Many groups have been identified as having clear needs but because they have such a significant lack in resources and political power, their needs are often not translated into demand. The role of civil society organizations is to make these groups visible so they are able to participate in the world of politics and influence public institutions to better serve their needs.
As an organization with over 14 years of experience working in the field of infectious disease in Ghana, WAAF has acquired meaningful experience and in-depth knowledge of these issues that marginalized populations face. WAAF therefore appreciates the need for inclusion of communities affected by TB in the delivery of TB health care in Ghana.
With a CEO who served two full terms on the Ghana-CCM and who acted as the Ghana representative for the Regional Coordinating mechanism of Abidjan Lagos Corridor Project (ALCO) from 2008 to 2012, WAAF had the opportunity to actively participate in high power meetings to attempt to bring issues from the ground to the attention of major stakeholders. WAAF can concretely attest to the lack of substantial contributions and input from smaller community based organizations and more so, members of the affected community.
The source of this problem lies mainly in these groups being ill equipped in terms of knowledge about current TB issues and grant organizations. These groups also have insufficient skills to allow for effective communication on matters they consider important and in even assessing their own needs and preventative measures for tackling disease.
Due to this large gap in communication between TB affected individuals and powerful stakeholders, WAAF wishes to focus on strengthening community systems ensuring that citizens are engaged in every point in matters of concern to them.
Goal and Objectives: The goal of this project was to have a well established TB constituency who would be able to prominent on key platforms and who are well equipped to speak on behalf of their constituency. This was to be established through:
- Educating & Empowering TB Communities with subject knowledge. This project will run from July 2014 – June 2015.Upon completion of the project, 40 persons sourced from TB affected communities and CSO reps on CCM will have their knowledge surrounding TB infections enhanced. Such knowledge enhancement will consist of, but is certainly not limited to, the background of TB (causes, symptoms, and treatment), plus the latest information (research and developments) on TB as well as local information regarding TB prevalence in the Greater Accra and Western regions of Ghana.
It is extremely important to WAAF that TB patients are provided with useful health delivery mandates so that TB communities can be up-to-date on the current professional information on prevention, treatment, and care. In this regard, WAAF will work to equip representatives from various community organizations involved with TB affected and infected communities (in particular TB affected communities with skills in communication) with the latest knowledge in TB, MDR-TB and TB/HIV. This process includes sharing of knowledge about country-level information to enable these constituents to make effective contributions at the policy-making level.
- Training in Advocacy. Upon completion of the project, persons sourced from TB affected communities in the Greater Accra and Western Region of Ghana will be given extensive training in advocacy in order to strengthen representation. These representatives will already have the knowledge capacity in relation to TB and the understanding of relevant TB programs in Ghana, built up by the previous project mentioned; however, their ability to champion representation of TB affected communities is limited. Therefore, at the end of this project, the representatives will be given a platform of opportunity to represent their constituency on the CCM and get involved with action for change surrounding the TB domain.
- WAAF’s desire is to equip the same target group previously mentioned with information on the functionality of relevant bodies like Global Fund, CCM, NTP-Ghana, Stop TB- Ghana Partnership to allow these communities to be knowledgeable about TB program management and to build an active voice. WAAF purports to achieve this objective mainly through extensive, practical workshops on active advocacy. The program will include working on the design of training workshops, which will be developed and implemented with members of the newly created support groups.
- The Ghana National TB Voice Network, an organization made up of cured TB and TB clients was revamped to enable them stand for their rights and speak on behalf of their constituency
- 2 seats on the Ghana CCM were secured for 2 GNTBV network members
- These 2 members have since been very active bringing matters pertaining to TB to the attention of policy makers
- The TB constituency have had their knowledge enhanced on TB related matters to enable them confidently speak about matters of concern.
National Strategic Plan
Project Title: NSP
Project Time frame: 2014 – 2016
Funder: Ghana AIDS Commission
Project Description: Although starting at a time when the 90-90-90 targets had not been set, the NSP funded by the government of Ghana through the GAC was geared towards reaching the general population with HIV prevention messages, offering testing to as many as possible, linking positive cases to treatment so they can be enrolled and managed. The project also sought to reach out to women of child bearing age as well as expecting mothers on Prevention of Mother to Child Transmission of HIV. All of these in 2018 is known as the 3 90’s, which is basically providing services across the care cascade.
Project outline: HIV and AIDS continue to pose a threat to achieving global health outcomes. Many more people get infected on a daily basis, discrimination still persists, babies are being born with the virus and people still die from AIDS as a result of extreme health complications. In some instances, access to comprehensive HIV treatment has become a challenge. Factors such as limited supply of HIV commodities, particularly antiretroviral drugs and the inadequate number of HIV service providers contribute significantly to challenging the AIDS response efforts. In its 2014 technical report, the WHO recognized that there was a need for increased efforts to scale up access to HIV treatment especially in lower and middle income countries if the dream of ending the AIDS epidemic can become a reality. The WHO further calls for sustained partnership with key stakeholders to reduce the HIV burden and work towards achieving the common goal.
Efforts to battle HIV spread in Ghana has been phenomenon in the past decade. There’s been a consistent decline in the prevalence rate from 2010 to date. Government commitment to reducing new infection and ending AIDS related death has been encouraging. This has come as a result of the contributions civil societies and community based organizations have made in support of government efforts in the AIDS response. Despite the achievement however, Ghana is still bedeviling with the risk of high transmission. Having multiple sex partners, engaging in unprotected sex and infecting babies during delivery remains a major problem. Comprehensive HIV education needs to be reinforced in the Ghanaian society to keep people informed on positive sexual behavior.
In view of maintaining effective HIV response, the NSP 2011-2015 was developed on the premise that HIV is a developmental issue and a health challenge and must be dealt with as such. Overall, the focus of this strategy is on reducing by half the HIV infections in the next five years with a virtual elimination of mother to child transmission of HIV, as well as sustaining and scaling up the proportion of people living with HIV (PLHIV) who are on treatment. This plan seeks to leverage treatment as a prevention strategy.
Project Goal: The goal of the project is to contribute to the prevention of new HIV infections, increase the uptake of HIV Testing and Counseling (HTC) services, reduce HIV-related stigma and discrimination against PLHIVs, promote positive BCC activities among the general population with special focus on, youth and Key Populations (KPs) in the two districts.
- Reduce sexual transmission of HIV.
- Increase the proportion of women and infants completing PMTCT program
- Many Ghanaians from the general population have had access to HIV education and prevention services
- Women of child bearing age including pregnant women have had access to PMTCT services
- Many children have been born to HIV positive mothers who are HIV negative
- There has been awareness and sensitization on Stigma and Discrimination at various levels that has led to stigma reduction
- Many from the general population have gotten to know their HIV status
- HIV awareness has been maintained
- Many HIV positive persons detected through the project are in care and healthy.
- The project has contributed to the reduction in the spread of HIV
STAR – GHANA Funded projects
STAR-Ghana is a multi-donor pooled funding mechanism (DFID, DANIDA, USAID, EU) to increase the influence of civil society and Parliament in the governance of public goods and service delivery with the ultimate goal of improving accountability and responsiveness of Ghana’s Government, traditional authorities and the private sector.
Project duration: From February 2013 through February 2015, WAAF embarked on the two above mentioned projects funded by STAR-Ghana:
1) Strengthening HIV programming through the use of ICT and improving quality of treatment and care through effective management
- Ga East District, Lejor Kuku District, (James Town), (Chorkor); in the Greater Accra Region;
- Keta Municipality in the Volta Region;
- Savelugu- Nanton District in the Northern Region
- STMA in the Western Region.
- Cape Coast in the Central Region
Project Description: Findings from various surveys such as a 2012 cross-sectional survey conducted in 3 administrative districts in Ghana, a study in 2005 that compared the stigma felt by Ghanaian males living with HIV to that felt by African American HIV + males and WAAF’s own experience from the field indicated high levels of stigma towards Key Populations at risk for and living with HIV throughout the health care profession. This often led to Persons Living with HIV ( PLHIV) feeling that they received sub-standard treatment, were discriminated and misinformed at ART centres, all leading to high numbers of lost to follow up cases, delays in seeking treatment with all the negative consequences. This coupled with a knowledge deficit in health information and referrals among especially certain Key populations often led to negative consequences such as individuals not seeking health care treatment or waiting until they were very sick. This is a serious problem given the necessity for proper care in combating HIV.
Equally, as of 2013, Spectrum/EPP modeling estimates 224,488 persons, made up of 189,932 adults (85%) and 34,557 children (15%), are living with HIV and AIDS (PLHIV). Sadly in 2013, 10,074 people died from AIDS including 2,248 (22%) children 0-14 years; 472 of the children who died were infants of 1- 4 years of age.
Although specific numbers cannot be associated, one cannot help but recognize the vast number of individuals that need stigma and discrimination free care but who currently are not receiving it. This lack of proper care can be a significant barrier in preventing HIV/AIDS related mortality and morbidity.
As a result, WAAF embarked on the project to try and combat HIV related stigma at the health care setting using various approaches.
- Increasing the numbers of Men who Sleep with Men (MSM) accessing health information and referrals for treatment through the use of mobile phones (mHealth) where the target group receive health information and referrals through live educational sessions and subsequently recorded information dissemination.
- Acquiring a document containing experiences of MSM’s and PLHIV’s with health care professionals as well as grading selected treatment centers by the target groups themselves in terms of quality and friendliness of services rendered there.
- Improving the quality of treatment and care of both Men who sleep with Men and persons living with HIV at selected treatment centers, through trainings of Health care workers.
Results/Outcomes: The overall outcome of the project was Increased number of Key population members from across Ghana accessing Health information and treatment referrals & Improved client friendly heath care services at selected Anti retroviral clinics (ART) in 4 regions of Ghana and with this the significant changes seen are: Overall, WAAF is proud of the significant changes this project has been able to bring to pass. As of now, more health care workers from various ART sites are conversant with the specific health needs of key populations which has led to the provision of enhanced quality care in terms of HIV related stigma as depicted by the mystery client exercise conducted.
At WAAF, we believe this is key to ensuring the safety of not only those key populations but for all Ghanaians. As those key populations feel safe enough to access health care, the burden of disease decreases and thus benefits the individual and the country as a whole.
WAAF is also proud that those key population are able to access health information and referrals via live conferencing and pre-recorded platforms. We continue to see improving patronage of the sessions as well as use of other social media platforms for the same purposes that were brought about by the project. This is important as those key populations begin to access health care more they need to be advocates for themselves and know what services and care to expect. Likewise, it helps the key populations learn information that otherwise might be difficult to get in a different setting and context.
Project title: Implications of the emergence of the oil and gas industry on HIV in the Western Region:
- Sekondi Takoradi Metropolis
- Ahanta West District
- Ellembelle District
Project Description: The discovery of oil and gas in the Western Region created an avenue for increased economic and social activities resulting in the importation of different cultures and values from people coming from within and outside the borders of Ghana. The oil discovery brought together different kinds of people to work to share in the opportunities presented by the oil production. These included commercial sex workers, men who have sex with men, single men and expatriates. Within the context of HIV spread, the movement of various groups of people into the oil production communities had the potential to increase HIV transmission which would have a negative impact on community development.
Goal and objectives: This project therefore sought to contribute to efforts to avert any possibility of an increase in HIV transmission as a result of the oil discovery using different approaches namely: by making sure that community members are well informed and well sensitised to practice safer sex, encourage community participation in the battle against the spread of HIV and also to enhance effective treatment with a structured referral system/network. The overall outcome of this intervention was to ensure that Ghana’s oil discovery did not become a reason for increased HIV prevalence in the Western Region.
Results / Outcomes: The project has led to a significant increase in in-depth knowledge on HIV related matters especially in connection with some socio cultural changes that have come about as a result of the oil discovery in the Western Region.
It has also encouraged behaviour changes among some community members in terms of high risk lifestyles and an increase in community members going in for STI screening as shown by the number who participate in outreach screenings and health facilities report showing increase in number of community members accessing voluntary testing and counselling in their communities.
Project Title: Demand creation for the use of online discrimination reporting system
Project Time frame: Jan – June 2014
Funder: RTI (Research Triangle Institute)
Project Description: Despite the knowledge in circulation regarding HIV and AIDS, stigma and discrimination (S&D) continues to remain a significant problem for Persons Living with HIV (PLHIVs) and Key Populations such as Female Sex Workers (FSWs) and Men who have sex with Men (MSMs). HIV disproportionately affects these aforementioned key populations, meaning that PLHIVs who also fall into one of the categories of Key Populations, especially MSM or FSW can face two layers of S&D in society. This is a huge problem, because the impacts of stigma can be extremely negative. Stigmatized individuals can be faced with avoidance by their communities, rejection by their families, isolation, denial of access to basic services and in extreme cases, physical violence, torture and murder.
While stigmatization and discrimination does not generally escalate to a level of physical violence in health care facilities, it still remains a problem to the extent where it can prevent key affected groups from wanting to seek health care. More so the need for continuous efforts in fighting Stigma and discrimination within health care facilities across Ghana. It is also imperative that PLHIVs and key populations be aware of their basic human rights and know of the resources available to them in case they encounter stigma or discrimination.
Between 2011 and 2013, the Health Policy Project with support from PEPFAR and USAID spearheaded a project aimed at developing an online discrimination reporting platform. Through various collaborative and strategic meetings, particularly with CHRAJ, Ghana AIDS Commission, governmental and nongovernmental stakeholders the efforts of HPP culminated in the launch of a web-based Discrimination reporting system in January 2013.
To facilitate demand and uptake of this innovative Discrimination Reporting system housed and managed by the Commission on Human Rights and Administrative Justice (CHRAJ), the West Africa AIDS Foundation (WAAF) partnered with the CHRAJ to educate key populations, especially MSMs and FSWs as well as PLHIVs about their basic human rights and what to do when these rights are violated, including reporting the case onto the Discrimination Reporting System.
The project consisted of three parts: 1) the planning and organizing of trainings on Basic Rights including responsibilities within those rights for PLHIVs, key populations (MSMs and FSWs) as well as service providers, across the Greater Accra, Ashanti, Eastern, Central and Western Regions, 2) the carrying out of these trainings and encouraging and assisting those trained and their contacts to report cases onto the system and 3) the design, printing and distribution of posters to vantage facilities in the five regions to remind viewers to report discrimination that they encounter or see happening to others.
Project Beginnings: The project kicked off with an inception meeting, held on the 3rd of February 2015 at the CHRAJ office. CHRAJ headed the meeting and expressed a need to connect with partners in order to fully and adequately protect the human rights of Ghanaians. At the meeting, thirty-three (33) participants were present representing the target groups, service providers, CSO allies and CHRAJ representatives. The problems of stigma and discrimination were discussed, especially in relation to how this affects key populations and how the project could contribute to addressing these. Participants stressed on the need for new and creative ways in handling stigma and discrimination issues, in the hopes of reaching the greatest number of people.
Unfortunately, even though the platform had been designed for people to report instances of stigma and discrimination remotely allowing for anyone from the key population group or a PLHIV to report any case of rights violation easily to CHRAJ for investigation, either by phone, texting “Chraj” followed by a short description of the complaint to short code 1406 on all networks except Glo or by filling out the web form available at https://drsystem.chrajghana.com, patronage of the Discrimination Reporting system was low As of the time of the meeting, twenty-two (22) cases of stigma or discrimination had been reported after almost two years of the launch, a bit lower than had been anticipated, highlighting the need for more outreach to create demand and uptake of the system.
Participants at the inception meeting also discussed the need to reach out more to the KP community in the formation of health care initiatives as it is difficult to have successful interventions in health for KPs if they themselves are not involved in the design of the intervention. CHRAJ confirmed this to be their goal and they were definitely tapping into networks of beneficiaries more in developing interventions.
Participants were also tasked o contribute to ideas for marketing materials and to involve their constituencies in the design of these. It was unanimously agreed that marketing materials be developed with the following points in mind:
- The message should be general, not only for specific populations, so that it has a wide appeal.
- The message should be based on the constitution of Ghana, and maybe even list some of the rights.
- The message should be simple, such as something like “Have you been stigmatized? Call here.” If it is too complicated, no one will read it. It should be a short and catchy message.
- Cartoons can be used to attract the eye along with a simple, catchy message.
- The materials should appeal to diverse target populations, as it will be distributed to a wide variety of sites.
Development of Training Manual: Evidence from the field had revealed a general lack of knowledge in human rights among PLHIVs and KPs and as such a training manual focusing on PLHIVs and KPs understanding their fundamental human rights had to be developed. Surfing through a number of available literature, it became evident that in spite of the many works that have been done on PLHIV and Key Population related stigma and discrimination through trainings, gaps still existed in almost all the HIV related Stigma and Discrimination training modules from a human rights perspective. While there are excellent training modules available on PLHIV and Key Population related Stigma and Discrimination, in terms of material contents, there is very little or nothing at all on HIV and Key Population related Human Rights education in Ghana. The design of the training module therefore aimed at filling the missing gap of Stigma and Human Rights.
Like many other training modules, the design of this one, drew on existing best practices and adapted a number of existing training modules and manuals to provide facilitators with the information, specific activities, and materials needed to effectively plan and deliver a hands-on training programme.
Designed to address the knowledge and skill gaps reported as the cause for the underutilization of the Reporting system, it provided participants with a complete understanding of the purpose of the system and the benefits to the community, as well as created a sense of agency within the participants. Emphasis was placed on participant reflection, discussion, and action.
Trainings: Training sessions using the designed training manual were planned for PLHIVs, MSMs, FSWs as well as selected service providers in five (5) regions of the country.
Prior to the trainings, an orientation workshop was put together to allow for trainers from CHRAJ and selected CSOs to acquaint themselves with the training manual.
It was a successful orientation which allowed for specific teams of trainers to be put together for the trainings in the various regions.
Objectives for the trainings were as follows:
- To help participants understand stigma and discrimination faced by PLHIVs and KPs in the context of fundamental human rights,
- To build the capacity of KPs and PLHIVs, in order to enable them to identify specific human rights violations, and
- To help participants understand the impact of reporting human rights violations faced by PLHIVs and Key Populations to CHRAJ.
The trainings took place over the span of a month, from the 8th of April to the 8th of May 2015. A total of twenty (20) trainings involving a total of 382 participants were conducted in the Greater Accra, Ashanti, Eastern, Central, and Western Regions of the country. (Refer to table below). Each region had a total of four (4) training sessions, each training session dedicated to members from a specific focus group. Each day was set aside for a particular group: PLHIVs, MSMs, FSWs and service providers. This was done such that the members present at the trainings could have free and open discussions about issues relating specifically to their target group. The trainings for the service providers were always held on the last day so that the issues from each of the target groups could be discussed with them.
Trainings were led mostly by CHRAJ trained facilitators as well as facilitators from Civil Society Organizations (CSOs) namely Kharis Foundation, ProLinkand 4H. A representative from the Ghana AIDS Commission National Office was also present at the Western Region trainings.
Trainings were participatory, interactive and informative and topics covered included “Key Fundamentals of Human Rights,” “Stigma and Discrimination,” “Rights and Responsibilities,” “Reporting Stigma and Discrimination to CHRAJ using the online system,” “Case Studies,” and “types of cases to report to CHRAJ.
One of the facilitators at a training session.
Examples of activities under the various topics: An example of activities under the “Key Fundamentals of Human Rights” section involved having participants look at cards that had been labeled with different human rights which they had to organize into a pyramid with the human rights they felt most primary toward the top of the pyramid and those of less important towards the bottom of the pyramid.
Another example activity under the “Stigma and Discrimination” section involved having participants write down causes of stigma on pink post-its and examples of stigma on green post-its and placing their post-its at the appropriate end of the “stigma tree trunk” that was drawn on a piece of chart paper. Participants then placed possible causes of discrimination at the bottom of the tree to function as the “roots” and placed causes of stigma at the top to serve as the “leaves.” Activities like these helped participants understand the information that was attempted to be conveyed in the trainings
Emerging Issues from the Training sessions: There were several issues that arose during the course of the trainings and the important ones have been highlighted below.
Some FSWs were very concerned about the fact that some CSOs with which they worked were unhelpful in aiding them in reporting issues of stigma and discrimination. According to them, some FSWs had reported cases of discrimination to the CSOs, believing that the CSOs would report to CHRAJ. Unfortunately in some cases, CSOs failed to report.
The same FSWs reported that they sometimes faced harassment from police officers who abused their position in a variety of different ways, including verbal harassment and forcing FSWs to have sex with them under the threat of arrest.
Lastly, FSWs on the fact that it was sometimes very difficult for young FSWs to receive HIV testing. As per the law in Ghana anyone wanting to have an HIV test conducted who is under the age of 16 must receive the consent of a parent or guardian. This was preventing young FSWs who wanted to test and know their status be denied this by service providers.
From the PLHIV group, an important emerging issue was that of having to come with a “treatment supporter” before anti-retroviral therapy (ART) could be initiated. As is the practice in many health facilities, especially the government facilities, in order to begin treatment, a patient must have the support of a person close to them, whether that be a friend or a family member. That support person must be willing to check in with the patient every day in order to make sure that he or she is taking their medications. Many PLHIVs from the various trainings indicated they themselves or others they knew were deterred from starting treatment by this because it meant that they needed to disclose their status to someone, which was not always that easy to do. As a result, some of them will delay treatment until their health has deteriorated.
One PLHIV participant stated that “as a result of being asked to bring a treatment supporter before I could start treatment, I waited for almost a year until I started deteriorating.” This, according her, affected her badly, and she had lots of side effects from her medications when she finally started.
Another participant reported, “to enable me to start treatment, I was forced to disclose to a friend who immediately went and spread the news to all, including my wife, before I could gather the courage to disclose to her personally…my wife divorced me immediately, leaving me at a time when I was in a bad state of health.” He added, “I have to struggle to stay alive and it is a miracle that I am still alive today.”
Many stories like these two were shared, indicating a deep need to address this issue.
Another emerging issues had to do with some health care facilities that use folders for PLHIVs that are distinct from the folders of non-HIV patients, making it apparent to anyone that sees their folder in the facility that they are HIV positive. The PLHIV group indicated that the privacy of those patients weren’t being respected.
Suggestions on how to address these emerging issues: With respect to FSWs facing harassment and CSOs not assisting them report abuses to CHRAJ WAAF envisages to together with other stakeholders continue to encourage and engage CSOs through focus group discussions to stand for the rights of key affected populations as well as continue to educate them on how to use the reporting system. There should also be an established monitoring system that would allow for regular visits to service providers to take records of human rights violations that have been reported to the facility in a particular period. Additionally, we suggest that the scope of work of KP CSOs should include helping KPs report instances of stigma onto the reporting system.
With respect to the issue relating to young FSWs’ access to HIV testing without parental /guardian consent, WAAF has two suggestions. The first involves a review of the current policy stating the need for parental consent if one is under 16 years for an HIV test. In the special-case context of FSWs who are under16 years of age, it will be difficult to lump already sexually active teenagers among the general population and so we suggest they be exempt from this rule. The second suggestion is that service providers should advocate for changes in procedures relating to HIV testing and young FSWs.
Regarding the issue relating to the difficulty many PLHIVs have with having a mandatory treatment supporter in order to start ART, there are a couple of suggestions from WAAF.
Policy makers and the National AIDS Control Programme should review national guidelines in relation to ART policies to include exceptions in the case it is not possible for a client to present a treatment supporter. In addition, the National Association of Persons Living with HIV (NAP+) should advocate for a review of this policy of needing a treatment supporter for ART to be a discretionary one, rather than mandatory as well as to appeal to Ghana Health Services to advise health care workers to not deny PLHIVs treatment if they are unable to bring supporters. Finally, NAP+ should be encouraged to sensitize their members on the need to adhere to treatment and encourage older members to act as treatment supporters for newly diagnosed patients through the Model of Hope program.
With regards to the use of distinct medical folders for PLHIVs in certain clinics, we primarily suggest that CSOs and service providers advocate for increased use of electronic patient data management systems in health service delivery institutions. We feel it is also imperative that Ghana Health Services enforces the use of facility folders in addition to PLHIV specific booklets that will be kept inside the folders, so as to prevent clients being able to be identified based on their medical charts.
Poster Creation and Distribution: The final part of the project involved the designing, printing and distributing of marketing materials with the goal of reminding people of the CHRAJ’s Discrimination Reporting System and to prompt them to report any instances of rights violation. Based on recommendations from the target group themselves, posters were developed which were subsequently approved by the Communications Technical working group of the Ghana AIDS Commission. The posters have been distributed to various facilities in the 5 regions such as
the OPDs of hospitals and clinics, ART centers, counseling centers of the clinics and hospitals, DICs, office places of partner CSOs with the goal of adding value to the project as many would constantly be reminded of the Discrimination Reporting System and would more likely use the platform.
Dissemination Meeting: An exit conference was organized to engage key stakeholders as part of efforts to climax the project. The meeting which was held to officially announce the closure of the project brought together key partners and beneficiaries to share their responses and contributions to the course of promoting human rights and addressing the issue of stigma and discrimination against the marginalized in our societies.
In his opening remarks, the acting Commissioner for the Commission on Human Rights and Administrative Justice, Mr. Richard Quayson, reiterated the need to fortify efforts of upholding individual’s rights within the context of humanity development and peace sustainability. According to him, the risk associated with right abuses are tied into lack of knowledge and respect of the law which has intricately woven into the sociocultural fabric of our societies. Combining efforts with state institutions is therefore one of the ways of building stronger campaigns against right abuse in Ghana. He said the commission remains resolute in protecting individuals right and will continue to open its doors for collaborations in pursuing this course. He expressed gratitude to the West Africa AIDS Foundation for playing a central role in raising the bar for the demand and use of the S&D reporting systems.
Other partner organizations who participated in the meeting including FHI 360, WAPCAS, Prolink, and NAP+ gave brief presentations on their contributions to generating demand for the use of the platform. According to them the collaboration has seen a rise in cases reported by each organization indicating a general acceptance and trust of the system as a means of bringing to light the darkness of stigma and discrimination. They touted the system as being user friendly and easy to complete. One partner organization shared a success story of using the system to report a case on behalf of a beneficiary and receiving a quick response to that effect. They pledged their commitment to promote awareness and the use of the system.
Details of the entire project which bothered on its rational, the approaches engaged and issues identified in the course of implementation were then presented by WAAF. This was done to refresh the memories of the audience on how the project started, and to inform them on where it has come so far, and what the next steps are. Concerns of beneficiaries which were noted during the trainings were also presented with some suggested recommendations in response to those concerns. Stakeholders were urged to increase their support of helping to address particularly the issue of police harassment of sex workers. The next steps are for key partners to continuously admonish their target groups not to feel intimated but rather report cases of right abuse to CHRAJ using the S&D system.
Lessons Learnt: Various lessons have been learnt over the course of implementation of this project. Worthwhile mentioning is the recognition that in the fight against stigma and discrimination it is important to not only focus on those who discriminate but also on those who are discriminated upon. Contrary to efforts taken over the years that have mostly fought stigma and discrimination focusing on those who might discriminate, the Discrimination outreach project focused on those who are discriminated upon. Bridging the knowledge gap on their fundamental human rights and what to do when these are violated, is indeed leading to increased reports of such cases which eventually will fight stigma and discrimination as perpetrators are dealt with.
The implementation of this project has given us great insight into what is perceived as stigma from the perspective of key populations and PLHIV’s which is somewhat anomalous to what is viewed by many activist. From the engagement with them, we realized that the use of some words and phrases which are considered normal are often viewed as offensive on the part of key affected population. Words such as “boisterous” to describe a lady could make her feel offended. Likewise the use of “effeminate” to describe a man who behaves like a lady could also make them offended. These experiences have taught us and many other service provides to be mindful of our choice of words especially when dealing with KP groups to avoid creating animosities which could impact negatively on service delivery.
Working closely with the various groups has also led to those of us working on their behalf get to understand them better. During the various participatory trainings, representatives from the ally CSOs as well as the CHRAJ facilitators, continued to learn more from the different groups such as clear examples of stigma they continue to face which would only enhance the way we work with them. It also enhances our understanding of how to involve beneficiaries in projects we undertake on their behalf so as to ensure a bottom up approach to tackling issues that concern them. Indeed the project has better enhanced our understanding on how to tailor interventions to address the core needs of KPs.
The overall partnership between CHRAJ and WAAF and other CSOs has allowed for better understanding of not only fundamental human rights but also the responsibilities that come with these which will only enhance our efforts on behalf of PLHIVs and KPs.
Way Forward: Over the course of this project, a lot has been learnt that have helped generate a plan to keep up the momentum of the project.
The first set of strategies are centered around addressing the issues that emerged during the trainings which will be to ensure that partners CSOs take these into account and incorporate them in their programs of work when feasible.
Facilitating the reporting of stigma and discrimination onto the platform should certainly be a priority for any CSO that works on behalf of PLHIVs and KPs.
Partner CSOs should continue to collaborate with CHRAJ especially in terms of monitoring and expansion of project outcomes.
Lastly, CHRAJ, WAAF and partner CSOs should use this project as a best practice and try to have it replicated in other West African countries as a way to fight stigma and discrimination against PLHIV and KPs.
Conclusion: This project has produced many positive results. 382 individuals made up of PLHIVs and members of KPs were reached with education on fundamental human rights, as well as reminding them of the availability of CHRAJ’s Discrimination Reporting System. The work is however nowhere near done, as messages need to continue to be spread both through the regions in which we have already begun to work and the regions that we have not yet been able to reach.
The poster distribution has also been successful, and will hopefully serve as an active reminder of the fact that resources exist to help those who have been discriminated against. The posters will also discourage discrimination against PLHIVs and KPs because they will serve as a reminder that if they stigmatize or discriminate, they could be reported.
We are also very excited to report that the trainings have been effective in that the rate of people reporting cases onto the Discrimination Reporting System has increased. As of September 2015, 52 cases have been reported, compared to the twenty-two (22) cases that had been reported at the start of the project.
The workshops have also been helpful in that they have led us to identify some new issues related to PLHIVs, KPs, and stigma that we can begin to address as we close this project. We can begin to alert the relevant parties, such as policy makers, program planners, health care workers, and disease control program officers, of these issues in the hopes that we can improve the state of the health care system as well as rights for everyone in Ghana.