Focus Area 4 aims to support schools and viable community organisations in the sustainable long-term roll-out of quality youth HIV prevention and risk behaviour reduction programmes targeting youths as a priority population in line with the prevention efforts of the HIV and AIDS and STI Strategic Plan for South Africa (2007-2011).
Funds allocated to this focus area amount to R15m, 10% of the total project funds, and 100% of funds in this priority area, all of which are directed to GOLD.
Focus Area 4: HIV/AIDS
R (m's)
R (m's) to Dec 2010
% of Total
R’s to date/R’s total
GOLD
15
9.41
10
62.7
Table: SEEDS Consortium Focus Area 412
The review of activities and performance of GOLD in the focus area of HIV/AIDS continues the structure of previous sections of the MTR, with section one presenting a narrative of the results of the Management Survey and section 2 the results of the Survey of Beneficiaries.
SECTION ONE: FOCUS AREA 4
This section presents a review of the progress and activities of GOLD in the WC, compiled from interview extracts/direct speech garnered from 6 semi-structured in-depth interviews conducted with four directors/project managers/facilitators from GOLD WC and three GOLD IO project directors/managers. Clarifications on key themes were drawn from extracts and data from GOLD annual and quarterly reports, published and unpublished documents shared with us, including formal evaluations and site reports, and on-line resources etc.
WESTERN CAPE GENERATION OF LEADERS DISCOVERED (GOLD) PEER EDUCATION ROLL-OUT PROJECT: GOLD PEER EDUCATION DEVELOPMENT AGENCY
The SEEDS programme rolls-out the GOLD Peer Education (PE) Programme in underprivileged communities in the Western Cape “encouraging behaviour change and support amongst the youth, including those in and out of school, and to empower school-going peer-leaders to become positive role models and agents of community change.”
Supportive of the National HIV and AIDS Strategic Plan (2007-2011) the project goals are threefold: building social capital for sustainable community development in South Africa; mitigating the negative impact of inadequate education and HIV/ AIDS on youth, vulnerable children, families & communities; and, reducing risk behaviour and the number of new HIV infections in youth by developing social norms that encourage them to protect their health and their futures.
The programme follows a youth leadership and risk behaviour prevention model:
“The GOLD model is playing a pivotal role in building social capital in communities, in supporting education in difficult circumstances, and in developing a generation of young emerging leaders and character to contribute to positive changes in their schools and communities. At the heart of the GOLD model is the belief that the message giver is the strongest message. Adolescent peer educators, who demonstrate leadership potential, are equipped and supported by skilled facilitators to fulfil four specific roles at varying levels of responsibility for both their peers and younger children. These roles are: role-modelling, education, recognition and referral of youth in need of additional help, and community upliftment.”
The primary objective is to reduce youth risk behaviour, thereby bringing about a decrease in the rate of new HIV infections among youth aged ten to twenty four years in the Western Cape. GOLD follows a behaviour-change cascade methodology: identifying youth leaders in peer groups recruited and their talents channelled positively on strategic tasks:
“Behaviour change through exertion of positive peer pressure”
“We recruit ‘naughty boys’ as ‘peer leaders’ because we can channel their leadership qualities positively”
“Peer education harnessing peer pressure and influence over their peers for positive measurable change”
This WC GOLD project is part of a larger GOLD initiative begun in 2004. In December 2006 the implementation of GOLD Peer Education in South Africa and Botswana was awarded the Commonwealth Education Good Practice Award for helping education in difficult circumstances. This award was judged amongst applications from 52 countries. The Western Cape GOLD Programme played a significant role in contributing to the winning of the award and should receive much of the credit for this achievement.
GOLD developed its Peer Education (PE) Model “using a participatory process and drew on best practice global research together with the learnings of several pioneering NGOs who had been piloting peer education in South Africa for several years.” As a result, the GOLD Agency and GOLD WC were confident in the SEEDS project of their capabilities in delivering a “quality, flexible, effective and sustainable peer education programme in the context of the schools and needy communities we would be working within.”
With SEEDS support, GOLD carefully works hand-in-hand with strong community-based organisations (implementing organisations) to deliver GOLD peer education programmes in their communities. GOLD trains and mentors implementing organisations to work intensively with groups of peer educators over a period of three years. Peer educators also have an optional two-year post-school opportunity for further skills development and peer education activities. GOLD provides part funding for these programmes through sub-grants, but implementing organisations are encouraged to develop their own sustainable funding streams to contribute to their programme costs. Working with implementing organizations and facilitators means GOLD can increase the ‘reach’ of GOLD peer education to cover more and more young people (peers) each year. This is a key advantage of the design of the GOLD peer education model:
“Peer Educators receive intensive training over three/four years in a range of issues including self-development, presentation and facilitation, sexual and reproductive health including HIV/AIDS, leadership, group work, community development, communication skills, project management, research, advocacy and child rights, and mentoring. Each peer educator is provided with a lifetime toolkit of skills, leadership development, and a connection to future opportunities to continue to contribute to taking the province forward. A character of integrity and strength is formed in each one of these young leaders who will in turn each measurably impact 9 peers and children to adopt positive and purpose driven social norms through multiple activities and face to face support. The emphasis is on practical experiential learning and skills development and each peer educator has specific practical ‘outputs’ that they have to meet each year as they progress through the relevant programme. This is where large numbers of youth or peers are effectively reached by the peer educator.”
The project’s target audiences are staff from implementing organisations, school educators if working in schools, and youth. Staffs of implementing organisations include community leaders that are adult programme managers and out of school facilitators that work with adolescents in areas with high incidence of HIV; high prevalence of HIV and AIDS; high numbers of orphans and vulnerable children (OVC); lack of adult role models; and high incidence of youth risky behaviour. The intended youth beneficiaries are adolescent leaders and their peers between the ages of ten and twenty four in and out of schools.
In the GOLD Model, trained GOLD peer facilitator’s work in schools or community institutions implementing the GOLD programme on behalf of recruited local community development organisations (Implementing Organisations -IOs) who are critical ‘gateways’ to the local community/neighbourhood and important sites of learning:
“We collaborate with viable community based organisations in the sustainable roll out of youth peer education programmes in alignment to GOLD model thereby empowering youth opinion leaders as positive role models and agents of change”
“Working with communities and CBOs who are the experts in one geographic area”
“Our IO’s, such as Izandla Zethembo in Gugulethu, are very important learning areas for GOLD. In this case, we documented findings that working with out-of-school youth is critical to assisting positive impact on school-going youth in the same communities and that the school cannot be seen in isolation to the community”
Within schools, educators are important to the success of GOLD’s programmes “as their roles in supporting peer educators in the school system is key to peer educators reaching peers at schools.’ However, educators, or for that matter, school participation for the GOLD programme is not critical to success since peer influence, not formal training, is the core of the programme and this can occur as much within as beyond a formal institution:
“Sometimes after midnight our PE’s are at work when they are out with their peers and here we really see ‘youth influencing youth’.”
“Sometimes PE’s get calls in the middle of the night from peers in trouble.”
IO-employed peer facilitators (many former peer educators themselves) in the age range 20 to 30 years, target and work with young people in and out of school to realise their responsibilities as Africa’s “future pioneers” or next generation leaders. They encourage them to “speak out” on issues of HIV/AIDS, provide social support to peers in the context of poor and marginal communities, develop life vision and purpose in the face of drugs, alcohol, gangs, early pregnancy, gender violence, family violence etc, and focus on completing schooling, study, make positive career decisions and enhance opportunities for future life-long learning. GOLD is a wide-ranging and long-term intervention looking to develop strategic changes in reduction of youth risk behaviours/HIV infections, communities supporting families and youth (caring behaviour, access to social support, health and security), and developing social capital for social development. This means that the GOLD model is and its cost-effectiveness shown after many years:
“Peer education programmes are often criticised for being too intensive or expensive. But if you want ownership of decisions in the absence of families, it has been shown that young people listen to young people. We see peer educators as a significant asset. They are leaders, not chosen because they are good, but because they are leaders. The ultimate sustainability of GOLD peer education will be measured by the long term social and economic contribution of the thousands of youth who have passed through our programme. In the future we look forward to measuring the increase in employability and linkages to future opportunities of the young people who are already being developed as leaders and positive role models within their schools and communities and will continue to influence every sector of society. We believe that the return on investment will continue for decades to come. Our strategy is to go deep with a few individual so that that tipping point in social capital can take its own form in every sector of society but that kind of impact you are not going to see in a 4 year project period”
In contrast with other SEEDS organisations “Academic performance is not our main focus but is one of the many outcomes we measure.”
The numbers of IO’s and PE’s involved with the WC GOLD programme have dropped considerably since SEEDS project inception: in 2009 GOLD in WC had 14 IOs and 4845 PEs; in 2010 8 IO’s with 3,700 PEs; and in 2011, there were 5 IOs(two in Somerset West, two in Gugulethu/Khayelitsha, 1 in Kraaifontein) with 1337 PE’s.
From the outset GOLD’s assumptions for the success of the project in the WC were two-fold, namely “that viable community organisations working with youth exist and are able to implement the GOLD programme in the identified priority geographic locations’, and ‘that the WCED and WCDOH continue to endorse the GOLD programme as a needed HIV/AIDS intervention in schools and their communities.”
As it turns out, the rapid loss of traction by GOLD in ‘certain (but not all) priority geographic locations’ is in most respects traceable to the ‘lack of viable community organisations to work with’, not because they are unwilling to implement the GOLD programme which continues to be seen as the ‘gold standard’ for peer to peer HIV counselling programmes or even the intrinsic weaknesses of the small community organisations which elected to work with GOLD. Rather, the lack of IO’s to work with according to GOLD is a consequence of Government revising its Global Funded Peer Education Programme to exclude GOLD’s implementing partners.
This had a major impact on the GOLD programme largely due to the fact that GOLD implementing partners had been funded in part over the long term by the WCED and WCDOH respectively. When the funding ceased with the revised programme, this meant reduced sites for GOLD as SEEDS funds became the main source of funding without the initially assumed cost share from Government to enable “more reach for less”. GOLD IO’s as well as other NGO’s working in schools were forced to withdraw from schools to make room for the Government’s revised programme and this led to many GOLD programmes having to reduce their footprint and convert to being community-based from having been school-based.
For GOLD’s IO’s, the experience has been a sobering one; some have dropped out of programme; others have not. The experience ironically resulted in positive reflection on the programme’s many relative strengths and a growing sense of collective responsibility and buy-in from IO’s :
“Our partners no longer have the naïve belief that they can or should rely entirely on the Government; just as easily they know they can be let down, and out in the cold but they know that we stood by them.”
“In the meetings which followed our IO’s emerged with improved sense of being part of f a family – it made us more loyal to each. As some visitor noted 'meetings are family time for you guys'.”
“Now our IO’s are saying we believe in GOLD – its unified us, IO’s still using us are reporting on time and are so committed we can say that many things have changed positively.”
There is little doubt however that the circumstances are still less than ideal for GOLD in the WC :
“The stakeholder stuff more tricky: when working with teachers it’s great to have the Department working with us.”
“When working with youth, school is still the best context to access youth the majority of the time. NGOs are better positioned, got more time on their hand than teachers have on their hands to address some of the social issues that are critical to good learning. Education could be impacted significantly if the relationship between govt was working well.”
The negative impact of the DoH Global Fund tender process and the subsequent need to shift programmes from School to Community based has meant that the first 6 months of 2011 have presented both GOLD and their IO’s with many challenges. However in GOLD’s own words:
“The WC Community of practice has emerged stronger than ever.”
A further learning is that no matter what happens government is still the key stakeholder and change in a democracy is inevitable and necessary:
“What NGOs can do is to think about how to make programmes more and more robust. Part of this is accreditation, getting programmes and training such as for curriculum advisors endorsed internally in government.”
Reflecting on the whole experience is painful:
“To be honest the WC has been the hardest, most difficult place to work, honestly. For political reasons, school based programmes with proven impact have been halted by a decision by Government to start completely afresh with new leadership, funding and so on. It broke people’s hearts; principals, teachers were crying.”
GOLD has the sense that the province’s approach is short-sighted since in the WC GOLD programme the government had a recognised world-class peer education programme that was the envy of other countries, let alone SA’s own provinces, and with it Government would be in a position to reach many more youth than with the new school-based model:
‘In WC such a pity, WC has destroyed an amazing community of practice, which was just beginning to gain some maturity, depth, impact. Department just sat indoors and weren’t willing to listen [to us]’
“We had an MOU with PDE and PHD and a great relationship. But whole department’s are no longer there. Organisational memory is now gone.”
A further consideration is that the provincial government failed to appreciate the positive role that partnership with a best practice organisation can play in developing and trialling new ways of working and new delivery models:
“If there is genuine collaboration and Government and civil society work together, government needs innovative best practice organisations that might not be able to take things to scale but can inform strategies for scale that might never be best practice but inspired by best practice.”
“What government can come with is actually some guidance for us on where to streamline, what to focus on, what their actual needs are but not if there is no partnership and little conversation.”
Turning to considerations of the impact of the project, it is important to acknowledge that whilst the scale of the project impact in the WC has undoubtedly being significantly diminished for reasons just discussed, the GOLD Programme and the administration thereof appears not to have suffered:
“GOLD’s rigorous approach to quality is widely acknowledged”
“We’ve had criticism and praise: we’ve been criticised for being too long-term, too intense, too many assignments, too much reporting; we have been praised for being futuristic, sustainable, long term approach, and strong M&E – but we have not been criticised for not being attentive to our performance.”
“Our ME outcomes are built around behaviour change/our curriculum: not around social capital and potential for scale-ability. We show using proximal distal outcomes that our programme does increase peer educators knowledge of HIV and AIDS, their ability to access health services, testing etc. We compile Outcomes Reports for sites annually. These evaluation questions arise all the time and we approach them very systemically using educator performance on the Programme; we developed the use of Strategic Charts – that records what peers talked about to each other; we compile “Most-significant-change” stories from peers to reach other peers.”
“In many ways our indirect influence is often more important for example ‘Seeing the changes in peers has brought the change.’ You hear (these stories) all the time.”
“I don’t believe that we really capture the most important success stories which are sometimes based on a simple chance conversation.”
Reduction in HIV/AIDS risk behaviours? “Can’t say it is thus, but there is a decline, and though our footprint now smaller than it was... we do see changes in young people.”
In the past year, in summary, the key project challenges have been:
PDH tender process and resultant exclusion of very successful GOLD programmes at certain schools, resulting in the forced exit of PEs from programme.
WCED lack of communication and cooperation
Managing the exit strategy with 2 IO’s, initiated owing to WCDOH declaration that the GOLD programme cannot be implemented at all in Global Funded schools
Facilitator retrenchment, attrition and disappointment
PE attrition and disappointment
Financial strain on many IOs and their staff
Tension between GOLD programmatic minimum standards and reality on the ground in many of the WC IOs in the current changing landscape
Conversion of many sites from School Based to Community Based
As a member of the SEEDS consortium, GOLD derived benefit from the flexibility shown by the SEEDS management in supporting the organisation through the period of provincial restructuring. However, GOLD has no partnerships or collaboration with any of the SEEDS partners:
“It’s been good but due to our specific focus, we have complimented the core education partners but our diversity has meant that our service offerings remain separate. With ELRU and EMEP we have met formally regarding collaboration and have plans for structured initiatives of collaboration in the remainder of the project period. There has been a lot of amazing informal sharing, but at this point we have not collaborated in a way that you could measure outcomes as yet however on a macro level all of these initiatives have worked within the WC affecting provincial issues - I think that was a strategic decision of RNE to bring best practice organisations together to add strategic value to the major areas of need in the province’s education system and collaboration at this level has been successful.”
There seems to be no lack of opportunity given geographical and programme overlaps for example with EMEP nor is there an objection in principle on the part of GOLD. In GOLD’s own words:
“We are looking at how components of the GOLD curriculum can be used within all aspects of the SEEDS project and SEEDS have supported this to be reworked for this purpose. We will launch this in 2012 for the consortium and other future organisations that can benefit. We have presented this to the consortium in early 2011 and feedback was positive. .”
“We are coming from the informal education sector angle – peer to peer informal education in HIV and AIDS and life skills, but in the [SEEDS] meetings people coming from the formal [education sector] angle. We are doing something quite different than the other partners but together we are addressing the ‘whole’. It’s still difficult making collaboration a priority when we are all busy meeting our agreed objectives.”
GOLD suggests however that these difficulties could be overcome with the consortium now agreeing to jointly draft a budget for joint initiative for 2012:
“The consortium now could budget for some concrete linkages – this could enhance our outcomes as a whole, our systemic impact.”
“If people could genuinely submit a budget to kick-start collaborative initiatives for 2012, and it gets ratified, and people are held accountable, I think you would be amazed.”
SECTION 2: FOCUS AREA 4
A two-page questionnaire was designed and customised for GOLD. The questionnaire was customised for the peer facilitators/educators and learners on the GOLD programme. The questions included self-assessments of levels of satisfaction with different aspects of the project, including ways in which it might be enhanced. The instruments also checked for awareness of other distinct components of SEEDS. A systematic random sample of participants was selected to complete the questionnaire. The realised sample size was 192, consisting of 11 peer facilitators and 181 peer educators (learners). The number of respondents is listed in Table 1.
Table : Number of respondents from each of the SEEDS component projects
A large number (181) of peer educators responded to the survey. Almost two-thirds are females; about seven out of ten participate in sport and/or other activities; and almost all are satisfied with their study progress and lives as a whole. Conversely, most of the GPEP facilitators are males in their 20s. However, similarly to the learners, most participate in sport or other extra-mural activities and all are satisfied with their studies and their lives.
Table : Characteristics of participants in the Peer Education programme
Facilitators
Learners
Number of respondents
11
181
Male : Female ratio
73:27
37:63
Age range
23-29
12-20
Plays Sport
75%
71%
Music/cultural activity
88%
75%
Religious group
75%
68%
Other club
50%
54%
Very satisfied or satisfied with study progress
100%
96%
Very satisfied or satisfied with life as a whole
100%
89%
Although the majority of learners and educators who had participated in the GOLD programme strongly agreed that they had enjoyed their participation, the proportion of strong agreement was higher amongst educators (91%) than learners (77%).
Table : “I have enjoyed participation in the programme” (% in peer education programme)
Programme
Strongly agree
Agree
Not sure or Disagree
GOLD Learners
77
19
4
GOLD Facilitators
91
9
0
The vast majority of learners (94%), and all of the facilitators, who participated said that the programme had made them more aware of the importance of peer education. Similarly, 91% of learners and 100% of facilitators had become more confident in peer education since their participation in the GPEP. Most learners (83%) and all facilitators said that the material covered in the GPEP is relevant to promoting their skills as a peer educator or facilitator of peer educators, respectively.
Almost two-thirds (65%) of learners and 100% of facilitators indicated that they had made use of the support materials frequently since participating in the GPEP. Most (learners 86%; facilitators 100%) also said that the methods demonstrated are extremely helpful in their work with their peers. The majority (91%) of facilitators and more than three-quarters (77%) of learners have regular contact with other peer facilitators or peer educators respectively.
Visits to the school or centre by GOLD facilitators are seen to be helpful by 89% of learners and all educators. Although all facilitators perceive that the management at their schools is fully supportive of the GPEP, this is the perception of only two-thirds (67%) of learner peer educators. Sizeable proportions of both learners (33%) and facilitators (44%) are of the view that people at their schools who are not involved in the GOLD programme feel “left out”. Training session times have been most suitable to 85% of learners and all facilitators; as have training session venues to 73% of learners and all facilitators. All facilitators (100%) and most learners (90%) say that they enjoy peer education more since attending the GPEP training sessions.
From the perspective of facilitators, some of the most positive consequences of participation in the GPEP were seen to be:
“The amount of lives we have helped and touched”;
“The opportunity to transform lives
The views of learners exuded confidence in the skills they had acquired:
“it feels like I can take over the world and make it great”;
“it makes me happy”;
“I feel good”;
“it is because as young people we stay away from drugs”;
“getting confidence and getting leadership skills”;
“I feel more aware of what happens in life around me”;
“I have become more confident and find it easy to interact with my peers”;
“I feel that I am able to share my feelings with my peers”;
“I am aware of many things like peer pressure and I know how to handle those things”;
“I am very good at communicating with people who need help”.
Most facilitators said nothing should be changed, with a few making suggestions like:
“Provide some refreshments for the kids cause we meet after school”;
“Make the classes more interactive friendly, projector and power point”.
Many learners said that nothing should be changed, with a substantial number indicating the need for more engagement with the GPRP. A few of the comments included:
“nothing, I love the programme but we might have to get together more often”;
“everything still great”;
“there should be more sessions”;
“time spent on participation”;
“as daar meer tyd in dit gesit word”;
“time spent on participation I want more time to be added”;
“we only have one camp, there were supposed to be two camps“;
“be more detailed in outside trips for strict parents”;
“there is nothing I can change because everything that is here helps fully or it’s useful to me”.
