Development and the HIV Epidemic: A forward-looking evaluation of the approach of the UNDP HIV and Development Programme

CASE STUDY 2: THE PARTNERSHIP BETWEEN THE SALVATION ARMY AND THE HIV AND DEVELOPMENT PROGRAMME

"Sharing experiences means extra space for mutual growth"  

Introduction

Not all organisational interactions are healthy C those of the UN system and non-government organisations can bring to mind situations of awkwardness, tension, competition and exclusion.

Occasionally that is not so - the reflections of conversations, key events, key lessons learnt through organisational sharing of the UNDP HIV and Development Programme (New York) and the Salvation Army International Headquarters (IHQ) (through the IHQ technical assistance team) recall a healthy experience of mutual learning expressed through:

*Informal discussion.

*Regional and national co-operation with a focus on local programming.

*Participation of the Salvation Army in UNDP formal processes, e.g. SPR.

*Participation of UNDP in Salvation Army processes, e.g. International conference on HIV, Leysin, July 1991; participatory evaluation of the work of the international technical assistance team, Ottawa, Canada, September 1992.

The values that underscore co-operation need to be identified not only because they are crucial to organisational collaboration, but because mutual learning is essential for an effective response to the HIV epidemic. No longer do communities and organisations have the luxury of time to "play games", to be "territorial": the problem is too big for all of us combined, let alone any organisation trying to do it alone.

The values for effective co-operation include a willingness to share, to listen, to learn from the other, to be enabled in personal and organisational development because of the influence of the other, to be secure in sharing, to recognise the common foundation of sensitivity to the personal and community voice of suffering and of the search for hope, the need for a commitment to an ethic of care, and to a belief that change is possible. These values are expressed and developed in a context of belonging rather than separateness. They are the cement which holds together the foundations of programme development at local, regional and international levels. Complementing these values are the use of key concepts which include the link of care to prevention, and community involvement in social change.

How have values been shared, concepts formed, and programmes developed in more effective ways because of the co-operation between the two international organisations?

1. Zambia 1988

Picture the Chikankata AIDS team, frantically integrating daily work with evening planning and late night writing, entertaining, hosting, being hospitable to constant visitors, all of whom seemed to want to come at the weekends because that was when they had spare time!

Occasionally the visitor was not ordinary, but somehow communicated an insight.

Such a visitor was Elizabeth Reid (of UNDP). She came as an analyst, as a human being, as a person enmeshed in the emotions associated with the impact of the virus on a person and a family. She seemed to see something different, and what was so implicit to the implementing team was named by her.

She saw that the person with HIV had been placed fairly and squarely in the middle of circles of concern C that the person mattered and yet the person was in relationship with others.

She saw an attempt to articulate, at that stage, the link between the care of a person and the positive motivation towards protection and prevention by and in affected others.

 The key values observed appeared to be: 

(1) Care is necessary for human dignity, encouragement and development. 

(2) Care links with motivation of affected others towards prevention and positive development through change. 

(3) Programme implementors don't have to be interventionists but can be participants. 

(4) Outside experts need to live the rhetoric C they need to sit with others, listen, absorb, sense, reflect, and learn. 

These values were the basis of the Chikankata program, characterised by the word "integration". 

This concept of integration implied the interlinkage of many disciplines; the community voice was linked with the national voice in policy development; and, in a most basic sense, the integration of a care process with a prevention response came from within the motivation and initiative of people rather than relying primarily on external interventions (which were popular at the time).

2. London 1990 

Ian Campbell, appointed by the Salvation Army to be Medical Adviser to the Salvation Army, finds his way to London and, within the first few days of arriving in February 1990, is in contact with "the network". 

One early link was with UNDP New York, out of respect for relationship, as well as the felt need in Ian to find out what was going on internationally and to strengthen the process of international linkage of the Salvation Army.

The values and concepts expressed by the Salvation Army at that time with respect to AIDS had been more clearly articulated as "transferable concepts" C care linked to prevention; community related to belonging; change relating to attitudes, behaviours and environment; decentralised approaches embracing the notion of teamwork and linked to sustainability; the search for and discovery of hope; normalization meaning the realistic recognition of living with HIV/AIDS; and others.

A facilitator group had formed to develop programme and concept transfer internationally through the Salvation Army system.

Elizabeth Reid and Mina Mauerstein-Bail (of UNDP) together encouraged the identity that was being expressed by the Salvation Army. In a visit to the Salvation Army International Headquarters, including an interaction with the Commissioner, Bramwell Tillsley (second in command of the Salvation Army internationally), the statement was made by Elizabeth Reid that, "It is not our job to shape you in the UNDP image but to affirm you in your own identity, as the best way to help the international response to AIDS."

The values expressed by UNDP included the following: 

* Unity in diversity - but a common belief that social change is possible. 

* Respectful affirmation that religious belief is the key to effective living in many people's lives and in the identity of many faith organisations. 

One key concept was inter-organisational sharing as a means of strengthening identity and performance. This has been the foundation for informal and formal interaction since 1990. 

3. Leysin, Switzerland, July 1991

By agreement of the General, the first Salvation Army international conference on AIDS was held. This proved to be a catalytic event to a sequence of programme design, support and evaluation, and organisational sharing. This sharing is currently inclusive of 30 countries, with 50 community-based programmes still emerging, some of which can still be directly related to the Leysin conference.

A key feature of conference programme design, by the international technical assistance team, was the inclusion of other organisations to underscore the value of mutual learning.

The values expressed by the Salvation Army and by UNDP (represented by Mr Wally N'Dow, then the UNDP Resident Representative from Central African Republic, subsequently in Tanzania, and now the Assistant Secretary-General of HABITAT, and Secretary-General for the HABITAT II Conference, June 1996) were that inclusiveness is valuable, and that inclusiveness is of direct benefit to work because of its influence on programme planning and development.

Wally N'Dow, a Muslim, was stimulated by the conference, and clearly felt that he belonged. An indicator was seen at the conclusion when he gathered everybody together, holding hands, and led the group in a song. He felt free to share his own faith background with another faith-based organisation. The common ground was of response, in a spirit of service and facilitation, to the intrusion of HIV/AIDS. The common vision was the opportunity for community development, change, and hope.

 4. Senegal, November 1991

Informal Consultation on Behavioural Change. Through a process of interlinkage between the UK NGO/AIDS Consortium, the Salvation Army, Save the Children (UK) and UNDP (New York), a reflection happened on the process of behaviour change. An influential and succinct statement on behaviour change emerged as the product of the work of 16 local programme teams, and of a facilitation process formed by inter-organisational sharing. This was in itself an indicator of successful sharing of values and concepts, and was ahead of its time because so many unusual boundaries were crossed.

The meeting in Senegal seemed to have that quality of reaching out into the future. A significant shift was felt in development of consensus about the concept of "community".

The Salvation Army view for some time had been that people are interconnected in relationships in community C people are "autonomous" and yet that does not mean that they work alone. Their decisions are influenced by others and the intricacy of the community process for seemingly simple actions should never be underestimated. Apart from a statement on the influences on behaviour change, this was another major outcome of the Senegal meeting, but it was subtle in that the connection between the person and community relationship had already been discerned mutually by UNDP and the Salvation Army. Perhaps it was more distinctively observed by Elizabeth (of UNDP) at the meeting, particularly through informal conversation in lunch hour times and after hours with people such as Roy Mwilu and Noerine Kaleeba. The meeting formed the environment for productive healthy mutual strengthening of learning, particularly the interconnection between community belonging and change.

 5. Other connections

In betwen these "major events", informal visits to New York, warm connections at regional and international meetings continued ...

6. Washington, June 1992

The US Congressional Forum on HIV/AIDS. An opportunity for influencing US policy on funding? A time for talking between people belonging to organisations? Politics?

Ian (of the Salvation Army) presented on "Care and traditional values in relation to responses to AIDS and HIV", with reference to the Chikankata Hospital experience of connecting care to prevention. Elizabeth spoke on "contracts" between people C using a different language but reinforcing the shared values and concepts contained in the former conversations and experiences. She spoke movingly of contracts between persons, men and women, communities and nations, linking this to development, positive change and hope.

The key value affirmed was that people develop through relationships, not by power and conflict. The key concept strengthened, which is crucial to effective programme development, was that people in the intimacy of their relationships need to respond as relational beings and as people in groups, as well as being persons functioning as individuals.

7. Berlin, July 1993

"HIV/AIDS and Military Populations", a UNDP supported initiative, examined creatively the role of military populations in responding to and perpetuating the epidemic.

Another type of "military" C the "Salvation Army" C was creatively incorporated by Elizabeth Reid and Mina Mauerstein-Bail (of UNDP), probably as an effort on their part to increase the representation of values and concepts that go beyond the prevailing images associated with military populations.

Instead of seeing military populations as isolated units, the reality is that they connect to civilian populations in times of war and peace, through sexual activity, and through family and community life. The meeting did not ignore the accentuation of the risk environment provided by military populations in times of instability and civil war.

The key value shared indirectly and directly was that people in "groups" are actually not isolated in those groups C in this sense "targeted interventions" need to be very strategic and linked to the recognition that people in groups are also in other relationships.

The key concept underscored by this exploration of linkage to the wider community was that people who define themselves as being within a very select community or group are actually a sub-group of a wider community.

This is crucial to effective programme development because it is clear that through targeted interventions alone, marginalisation often increases for people who are commercial sex workers, truck drivers, youth, military people, religious people, etc. It is still commonly the case that targeted interventions are named as the only practical way forward. Even if other strategies are named, there is often a tendency to rely on targeted interventions as the priority, and in isolation from other relationships, because this appears to be easier.

8. Community Response

After Ian's visit to Zambia, Zimbabwe, Uganda and Kenya in May 1994, the emerging distress felt within families and communities impacted Ian (of the Salvation Army) with a sense of urgency that there needed to be a definitive reflection on processes of behaviour change. He wrote about this to Elizabeth (see letter).

Elizabeth responded to Ian's letter with her own letter - there was evidence of an instinctive perception of the real issue, beyond the words, of personal family and community impact that was way ahead of anyone's ability to name (see letter).

A key value being expressed was, "We do not know what we think we know." The epidemic teaches us that it is impossible to say that we have arrived, and that the best we can do is to share together, looking at relationship variables, real people, real experiences, real behaviours. This will give some opportunity to stretch out to touch the meanings associated with the epidemic, most of which are felt non-verbally and often missed by most people.

9. Regional inclusion

The Salvation Army international team co-ordinated a series of regional workshops focused on "concept analysis", beginning in November 1993 in Zambia (for Africa), September 1994 in the Philippines (for East Asia and the Pacific), Bangladesh in February 1995 (for South Asia) and Bolivia in August 1995 (for Latin America).

With each of these workshops, it was possible for UNDP (New York) to allocate a small funding grant to support the work of the international team which, in most cases, was the catalyst to other organisations giving funding sufficient to meet the needs (e.g. a $5,000 grant for the meeting in the Philippines stimulated other donors to provide the rest of the funding amounting to $75,000). Perhaps of more significance was the inclusion of people from other organisations and locations.

For example, the inclusion of people from Bulgaria, Poland and Russia (2 from each location, representing national and non-government responses) proved to be a major creative element stressing the process of inclusion at a meeting attended by people responding to AIDS and HIV from villages in Papua New Guinea, from the Marshall Islands, and from Salvation Army administration levels in other countries of the region.

But the conceptual foundations of care, community, change, hope and sustainability were shared effectively, across culture and language, and so it was possible to find convergence as well as to acknowledge divergence. The programme development culture of eastern Europe superficially appeared to jar with the ethos of the meeting; and yet the necessary struggle to find common ground was probably key to accelerated learning by all the participants.

Of significance was the recognition of the value of spirituality and faith in motivating people to respond, within organisations, to the challenges of the epidemic. There is a strong faith tradition in Eastern Europe and in South-East Asia. This congruency, itself a reflection of the congruency of respectful recognition of identity between the Salvation Army International Headquarters and UNDP New York, was a strengthening feature of the meeting.

Madu Balu Nath, of the UNDP HIV & Development project in Delhi, acknowledged similar values in her participation in the Bangladesh meeting. She spoke of the need to work from the inside out, of participation with community spirit, and of listening to community voices as a means of guidance in the response to the epidemic.

For example, Juan Jacobo Hernández of Colectivo Sol was able to say, at a moment of crisis and creative development involving a former Salvation Army officer who is HIV positive and who was also a participant, "The Church has AIDS. The Salvation Army has AIDS. Thank you God." He prefaced his comment by saying he had never prayed before.

Around this time Elizabeth began to speak of the need for a gathering of religious leaders and the Salvation Army team is supportive of that approach, willing to participate and facilitate C a future challenge.

It is a sobering thought to recognise that the intimacy of life is expressed through relationship, which in turn is expressed sexually, emotionally, and through the exploration of the meaning of 'soul' which finds its expression in various forms of prayer.

There is a language of hope forming C based, for example, on the acknowledgment of the need for intimacy and health of relationship; and of terrible loss that is not just happening now but awareness as to the awful knowledge that the past and the future are being lost in the present. This is loss of community memory. Yet hope is yearned for, sensed, claimed, and expressed in the poorest of circumstances. People feel it in caring with each other; in working together for change now; in simply being able to talk in new ways; and in still believing in a future, unseen and unfelt, yet it is there.

10. National and local interaction

The horror and hope of Rwanda is unmatched. In April 1995, it was possible for the International Salvation Army team to support the Salvation Army work in development through agriculture, health and pastoral care by advising on how that work could be interlinked with response to HIV and AIDS.

It was recognised that HIV/AIDS is an entry point to the fragility and capacity of life and this is no more true anywhere than in Rwanda which is searching for its "soul" through the visible process of reconciliation.

As in other countries, a visit to the UNDP office, encouraged through correspondence from Mina Mauerstein-Bail to the UNDP Resident Representative in Kigali (as had happened previously with Bangladesh, Uganda, etc.), paved the way for mature interactive mutual learning between the two organisations, ... at country level.

The values represented included recognition of the role of an international structure to help facilitate within the organisation so as to make it receptive to the "stranger" at the doorway. Cultivation of a spirit of inclusion and mutual learning was the service of UNDP, New York, and the result was affirmation in the mind of the Salvation Army team in Rwanda that HIV/AIDS is a development and reconciliation issue.

Summary

Inter-organisational sharing is not just about sharing information and holding on to personal identity no matter what C effectiveness is determined by shared values, that embrace respect; affirmation of the other identity given that it is founded in genuine compassion, and a capacity for strategic action embracing both care and change; a culture of mutual learning, of facilitation, of service, of listening in to community voices, of sitting within the suffering without ever believing it is possible to provide for it entirely; and participation in the search for hope. These values are crucial to the "common ground" of conceptual reflection for effective program development.

The key concepts for the Salvation Army include the inter-linkage of care to prevention, belief that change is possible, community as circles of belonging and participation; sustainability depending on the interlinkage of the person in community to care and prevention. Hope is related to all these factors.

There is an obvious congruencey with UNDP's ongoing exploration and reflection on conceptual foundations. Different language may be used, but there are nevertheless similar foundations.

These are based, perhaps for both organisations, in a mixture of organisational identity, experience, instinct, and the personal values of those involved. These are related to personality, character and experience, yet they alone do not provide a common ground for learning C it is their linkage to conceptual definition and, in turn, to patterns of action that helps draw the organisations together informally and formally in a continuing exploration of the unknown, the unfelt and the unseen.

Perhaps the most powerful, positive, interlinking factor is the mutual recognition that the epidemic has outstripped us in its negative impact. There is a curiously powerful common background for people of the Salvation Army International Headquarters technical assistance team and the people involved in HIV and Development, New York C experiences of suffering, of participation, of positive change; and a capacity for conceptual reflection indivisibly linked to these experiences. These are the elements that are most important to forming the common ground that is essential for effective organisational sharing.

This Case Study was prepared by Captain Dr. Ian Campbell and Alison Rader of the Salvation Army, HIV and Health Programme Development Team.