HP+’s capacity strengthening activities in three regions in Burkina Faso are part of efforts to increase the rate of COVID-19 vaccination. At the grassroots level, HP+ conducted advocacy activities with more than 800 community and religious leaders to facilitate their engagement in the promotion of COVID-19 vaccination. These leaders adapted HP+’s tailored messages to drive behavior change. In the Center, Hauts-Bassins, and Centre-Nord regions, vaccination coverage increased from 1.6, 4.3, and 1.5 percent in December 2021, respectively, to 5.1, 15.5, and 6.2 percent after campaigns in January 2022. At the governmental level, HP+ helped organize workshops in the three regions where more than 50 regional health directorate staff and 86 health district staff were briefed in COVID-19 vaccine logistics and management as well as communication and key messages for the population. HP+ also supported the organization of 19 district-level advocacy meetings in the three regions. The national Ministry of Health is planning to implement HP+’s approach in other regions of the country as part of its vaccination rollout.
To capture and share the positive impact of health policy implementation, HP+ uses storytelling featuring local partners through film. On January 25, HP+ hosted a virtual watch party that featured a short film—“Why Policy Matters: Strengthening Family Planning Services for Guatemala's Indigenous People”—about Guatemala's National Contraceptive Security Commission (CNAA) and a network of local, multisector subcommittees helping to improve access to family planning services and commodities, especially to meet need among rural and Indigenous communities. The discussion featured representatives from the Reproductive Health Program of the Ministry of Health, the CNAA’s Observatory on Reproductive Health, and a community-based logistics coordinator for medicine. Similarly, on January 13, HP+ held a watch party for "Messages of Hope: Reaching Boys and Men with HIV and AIDS Information," followed by an interactive panel discussion with representatives from Malawi’s National AIDS Commission, the Evangelical Christian and Qadria Muslim associations, and the Chikwawa District Health Office. The short film documents how the Faith and Community Initiative in eight Malawi districts worked with religious leaders to engage previously hard-to-reach men and boys. The religious leaders incorporated “Messages of Hope”—accurate HIV messages that correspond with religious texts from the Bible or Qu'ran—into their sermons and day-to-day community engagement work. This effort is helping dispel myths and misconceptions about HIV, fight stigma, and increase willingness to access HIV services and treatment. View the full Why Policy Matters series.
On November 22, 2021, Malawi’s Minister of Health, the Honourable Khumbize Chiponda Kandondo, visited Quadria Muslim Association of Malawi (QMAM) in Machinga district to see the role religious leaders play in response to the HIV pandemic. QMAM, a recipient of PEPFAR funds through HP+ grants under the Faith and Community Initiative (FCI), organized an event to showcase the efforts that both Muslim and Christian religious leaders have been making to ensure that men and boys have access to HIV services in the district. These efforts include distribution of HIV oral self-test kits, reporting to respective health centers, and the use of HP+’s Messages of Hope booklets and facilitation manual as well as child protection policy booklets. The lively event featured dances that the minister joined in, music, and plays on HIV testing and adherence to treatment, as well as a sermon on preventing sexual violence against children. In her remarks, the minister praised the FCI program, lauded the role that QMAM, the Machinga District Health Office, sheikhs, and other partners are playing in reaching men and boys, and appreciated the collaboration between Muslims and Christians. Impressed by the event, the minister asked that some of the Muslim volunteers join a World AIDS Day event to showcase their intervention while HP+ supported the Zikiri dance group to travel to the event to perform songs that incorporate Messages of Hope.
In Malawi, HP+ has found powerful catalysts for change not just among typical stakeholder groups but in plain sight in villages, small organizations, churches, and mosques. In a series of blogs, staff describe working with individuals who, armed with facts and coaching, are able to effect change for individuals and society. An Act of Faith: Malawi Leaders Tackle HIV, published in Science Speaks, tells how religious leaders helped increase the uptake of HIV services. Sharing Information, Saving Lives: Noble Calling relates how, in just over a year, religious leaders and 632 volunteers living with HIV have brought nearly 4,000 people back to HIV care—a crucial step toward reaching epidemic control. The Power of the Pack tells the story of a group of determined women who were trained to be strong advocates to improve sexual and reproductive health policies for women and girls. The women are determined to pass on their experience, contacts, and know-how to the next generation to help deliver on commitments in Malawi’s Family Planning 2030 agenda.
A radio station based in Kenya’s southeastern coast recently hosted a live family planning discussion between a Muslim leader and a local Kilifi County government official. HP+ helped arrange for the interviews and discussed key talking points with the presenters. The discussion on Lulu FM between Muslim leader Ustadh Rashid and Kilifi County reproductive health coordinator Ken Miriti highlighted collaborative efforts between the county government and religious leaders to promote uniform messaging for family planning among interfaith communities in Kilifi. Kilifi County has among the lowest modern contraceptive uptake rates in Kenya and religion and cultural issues were identified in the county’s costed implementation plan as key contributing factors. Faith leaders in the area use different avenues to address existing myths and misconceptions about family planning through the lens of religious norms and beliefs. HP+ has fostered joint accountability between the county government and faith leaders from Christian and Muslim communities to implement family planning interventions. Throughout the COVID-19 pandemic, HP+ has supported this strong network of interfaith leaders from Christian and Muslim communities in Kilifi County to be more involved with family planning. HP+ will continue to support the Department of Health to engage with more leaders from established faith networks, to sensitize them on family planning, and enlist them as family planning champions in their communities.
HIV services for men and boys are getting a boost in Malawi through the efforts of teen clubs and a church-based support group. With the support of HP+, the Evangelical Association of Malawi is reaching out to teens in Phalombe and Nkhotakota districts with psychosocial counseling, nutritional support, assistance with treatment adherence, and viral load monitoring. Since July 2020, the Faith and Communities Initiative effort has reached 662 men and boys and 82 teen members with nutritional support. The teen clubs have promoted access to early viral load testing among boys living with HIV at Kapiri Health Centre, where 148 members have accessed viral load monitoring services.
Malawi religious leaders are using dance to reach men and boys with messages of hope on HIV testing, treatment, and adherence. In May, the Quadria Muslim Association of Malawi (QMAM), with support from the U.S. President’s Emergency Plan for AIDS Relief and HP+, organized a dance event at Traditional Authority Chamba that attracted 2,500 people and distributed 197 HIV self-test kits. The traditional dances, called Zikiri dances, are performed as a competition by young men in praise of Allah. As part of their grant activities, QMAM integrated HIV messages of hope into their praise songs to help create demand for HIV services.
Several local media outlets in Malawi have reported on evidence-based HIV programming implemented by faith-based organizations. HP+ is providing these organizations funding from the U.S. President’s Emergency Plan on AIDS Relief as well as technical and organizational development assistance. The project conducts outreach, provides counseling, and carries out advocacy around HIV, with a focus on reaching men and boys with messages of hope and information about HIV. The religious organizations are shifting social norms by reducing stigma and increasing acceptance of discussing HIV in faith settings. They are providing HIV self-test kits and linking individuals to health facilities to support them to know their status and, if positive, to start and stay on treatment. Media coverage of the role of faith communities in HIV programming in Malawi will increase awareness of the important role the faith community plays in the HIV response. This coverage is expected to increase local confidence in the ability of faith leaders to contribute to the HIV response, bolstering strong collaboration between faith communities and the health system.
Community and faith leaders have come together in Kilifi County, Kenya, to craft uniform, consistent messaging in support of family planning. At a workshop in February convened by HP+, the leaders developed messages they will use to advance family planning in their communities through their respective forums. One message, for example, posed the question: Did you know that family planning is not against our faith? The goal of the campaign is to foster a better understanding of family planning and address misconceptions that impede its uptake. The hybrid physical/virtual workshop was an outgrowth of an action plan developed with HP+ support during a workshop in November 2019. The activity is intended to encourage demand for family planning services and to address Kilifi County’s all-method contraceptive prevalence rate of 38 percent, lower than Kenya’s national rate of 58 percent.
Using skills gained in HP+-led training sessions, a Malawi sheik is among the 30 religious leaders active in their communities promoting HIV treatment and prevention. The two-day sessions in Dwangwa and Nkhotakota.in August 2020 focused on the promotion of HIV testing and counselling, HIV treatment services, and treatment adherence. Sheiks have been promoting these messages among their faith community, with a particular emphasis on reaching men and boys. Sheik Muhamad Abdul from Dwangwa’s main mosque has referred 30 men and boys for HIV testing and supported three people in restarting antiretroviral therapy (ART) after one year of discontinuing. The messages promote HIV testing, ART initiation and ART adherence. This work is being supported by PEPFAR’s Faith and Communities Initiative (FCI) and implemented by HP+ with six local faith organizations in Malawi.
In Mali, where faith leaders wield significant influence over sociocultural and health matters, the decision of these leaders to speak publicly about ways to end gender-based violence (GBV) is a monumental step. Since committing in early 2020 to join HP+ and other stakeholders in advocating against GBV and promoting a national GBV law, these leaders—both Muslim and Christian, male and female—have formulated faith-specific talking points and are sharing them with their communities. Along with advocating for passage of the law, this public discussion is a critical step in combating GBV in Mali, where 4,617 incidents were recorded in 2019 alone.
In Malawi’s Chikwawa district, faith healers have been discouraging community members living with HIV from taking antiretroviral therapy (ART). Concerned that this may lead to ART defaults and increased death, religious mother body PECHANOMA facilitated a dialogue with other leaders in July, with HP+ support, to reinforce their role in emphasizing accurate messaging around HIV and COVID-19 and the importance of continuity in ART for people living with HIV. The leaders committed to continue disseminating accurate HIV messaging in their communities by holding meetings with religious and local leaders, disseminating radio and TV messages, and using mobile vans with loudspeaker systems.
HP+ is strengthening relationships between communities of faith, health facilities, and district governments in Malawi to support the country’s HIV response. The project is supporting six Religious Mother Bodies (RMBs) to implement PEPFAR’s Faith and Community Initiative, which aims to rapidly increase the proportion of men and boys living with HIV to access testing and treatment. The RMBs and PEPFAR clinical partners are working together to establish how faith leaders and health facilities can coordinate to increase male access to services, including coordinating with eight district governments to establish working relationships and obtain buy-in and guidance on geographic targeting for their activities.
Mali’s Alliance of Muslim and Christian Religious Leaders has expanded their organizational by-laws to include working against gender-based violence (GBV), an important step forward for a country where faith leaders have significant influence over sociocultural practices that impact health. According to Mali’s 2018 Demographic Health Survey, 45% of women ages 15-49 have experienced violence. Following an orientation by HP+ on the types and prevalence of GBV in Mali, the faith leaders felt compelled to act. With the modified by-laws, the alliance joins forces with the National Program to Abandon GBV and other stakeholders to revive efforts to advance a law to combat GBV in Mali.
HP+ has demonstrated its value to USAID Eswatini in facilitating the transitioning of two local organizations from subs to primes. During March and April 2019, HP+ supported USAID Eswatini to assess the landscape of local organizations working in the HIV sector with regard to their institutional and technical capacity. HP+ conducted organizational capacity assessments (OCAs) with 11 local non-governmental organizations (NGOs) and faith-based organizations (FBOs) and provided recommendations to USAID on organizations exhibiting strong capacity that could be transitioned to primes with some further preparation. HP+ was recently notified of USAID Eswatini’s desire to transition two of the more highly ranked organizations to primes and will be drawing on HP+’s assessment findings and materials in lieu of doing NUPAS with the current subs. World Vision Eswatini is a current sub to Pact and has HIV expertise in OVC, economic strengthening, youth, key populations, and the HIV care continuum. Young Heroes is also a sub to Pact and is known for its work in OVC and youth, although it has expanded into additional HIV sub-areas as the organization has grown.
Malawi's population is one of the fastest-growing in Africa, placing great strain on its health system, environment, and economy—hindering the country's ability to meet its development goals. To address unmet need for family planning services and the needs of adolescent girls and young women at all levels, HP+ is coordinating across multiple sectors including engaging traditional and religious leaders and communities. Christian Connections for International Health (CCIH) published a story this week about a family in Malawi helped by the Evangelical Association of Malawi, under an HP+ supported activity. The account of a family receiving marriage and birth-spacing counseling after a family tragedy, demonstrates how engagement with community leaders on family planning messaging helped on family mend and achieve financial security.
In late July, close to 100 traditional and religious leaders hailing from 10 West African nations gathered in Burkina Faso to share experiences and renew commitments in implementing innovative strategies to take advantage of the region’s demographic dividend—the accelerated economic growth that can result from changes in the age structure of a population. Among the nine-point pledge announced by the religious leaders is a commitment to advocate with their peers for the acceptance of family planning through use of methods that conform with their values and a commitment to fostering dialogue between couples on reproductive health issues. The forum, organized with support from the USAID-funded Health Policy Plus (HP+) project, “Reaping the Demographic Dividend: Religious and Traditional Leaders Get Committed,” held July 24-26 in Ouagadougou, was attended by the President of Burkina Faso, Roch Marc Christian Kaboré; the Mossi Emperor, Moogho Naaba Baongho; and the U.S. Ambassador to Burkina Faso, Andrew Young. HP+ plans to support the implementation and monitoring of action plans developed during the regional meeting.
An article describing a University of North Carolina (UNC) study and co-authored by Health Policy Plus Malawi country director, Olive Mtema, was published this month in the International Journal of Gynecology & Obstetrics. The article, “Effect of family planning interventions on couple years of protection in Malawi,” features USAID-funded work by the Health Policy Project (HPP) to sensitize religious leaders and their congregations on the benefits of family planning, and address barriers to family planning related to religious beliefs. This work was part of the community mobilization and demand generation aspect of a package of services delivered to two intervention sites as part of a quasi-experimental study conducted by the University of North Carolina (UNC) Project-Malawi. The full package of interventions delivered to study sites included community mobilization and demand generation for family planning, and training and mentoring of health providers in LARC insertion. The study found that uptake of family planning methods, particularly long-acting reversible contraceptives (LARC), increased following implementation of the package of family planning interventions.