Memoire Online - Model of organisation and functioning sseb

IN COLLABORATION WITH THE MINISTRY OF YOUTH, SPORTS, ARTS AND
CULTURE AND NGO «AMBASSADE CHRETIENNE»

No	TITLE	PAGES
	PREFACE	3
	ACKNOWLEDGMENT	7
	LIST OF ABBREVIATIONS	8
	LIST OF FIGURES	9
I	INTRODUCTION	10
I.1.	PROBLEMS	10	I.2.
FRAMEWORK OF THE CONCEPT	10	I.3.
DESCRIPTION OF THE CONTEXT	12
II.	GLOBAL APPROACH OF RISK PREVENTION PROBLEMS AND VULNERABILITY OF THE YOUTH TO STI / HIV-AIDS IN THE THIRD SUBDIVISION OF BANGUI : OBJECTIVES AND PROCESS	14
II.1.	OBJECTIVES	14		II.2.
PROCESS	14
III.	LIMITS OF THE PILOT EXPERIENCE	25
I.V.	RESULTS	26
V.	OPPORTUNITIES OF REPLICATION	41
V.I	CONCLUSIONS AND GENERAL COMMENTS	44
V.II	BIBLIOGRAPHY	48

It is with deep gratitude and total admiration of all people who gave a contribution to the realization of this completely new pilot experience under the technical guidance of the consultant Jeanne d'Arc Kengne, namely the members of the Executive Educative Team, the young Supervising Peer Educators of the pilot site and the Pastor Ambassador of the NGO «Ambassade Chrétienne» that I write the preface of this book. Since I took office at the Bangui Unicef Bureau in the Central African Republic, in the month of March 2005, I have been dreaming of this most creative application of my professional life and my knowledge of the organization of district socio-sanitary services based on the system of primary health care, then reproducing and adapting this model in a sector other than health notably the socioeducative sector.

I was given an opportunity when it was assigned to me as one of the major tasks to develop in the third district of Bangui a pilot experience for prevention and reduction of risk and vulnerability of the youth to STI / HIV/AIDS with their participation, to provide documentary resources for this experience in view of making recommendations for the generalization of the model to the whole country.

It was a mission to be entrusted to a research and training institution in public health that would put at the disposal of the project a team of experts for the development of such a pilot experience. However, this was not the case. I thought it was judicious to fetch for services of an individual, a person having experienced the idea being studied, able to assure such a technical assistance while being member and supervisor of the team responsible for the project at the same time, and moreover, to get the target populations benefiting from the project involved as an indispensable resource for its realization.

Right from the beginning, the problems of this pilot experience have been focussed on the framework of the agreement to bear medical costs of the populations in a participative approach having reached a level where health structures are facing the fact that people's preoccupations for their health are expressed in relation to their other preoccupations for a certain well-being.

The approach implemented in the development, organization, management and follow up of the project was based on a simple assertion: «beginning from problems met at the level of health services / youth population interface - discussing these problems with the youth - and, from these problems thus mentioned (common place problems, local and / or isolated ones, but truly felt) entering into bargain with existing structures in order to «coordinate» the intersectorial action.»

The receptiveness and enthusiasm that the approaches developed in this experience have given rise to are quite above our expectations and can be considered with good reason as the true success of the model. After eighteen months, the highest authorities of the country (The Presidency of the Republic and the government) have adopted the model and have decided of its generalization to the whole country.

Approaches developed in the course of this pilot experience have confirmed, to us, two fundamental hypotheses of work in relation to the participation of the population in the framework of integrating health system as socio-economic sub-system in the political and administrative jurisdiction (district, subdivision, council ...):

+ the integration of health preoccupations of the population in a complete package representing its global preoccupations is accepted as basic element on which the concept of participation rests

+ whatever the structures taking in charge the other preoccupations of the populations, whatever their concepts, their objectives or their methods, the type of interface they create at the level of the populations, they influence these populations in one way or the other and then, directly or indirectly, interact with the sanitary action.

The pilot experience in the third district of Bangui went beyond our expectations; not only the work and contribution of the consultant enabled to show that it was possible to repeat and adapt the sanitary district model based on the primary health care system in the socioeducative sector, but in addition, it gave another base of the approach in the development and organization, management and animation of major strategic axes of a programme for fighting against HIV/AIDS in accordance to the vision of the Medium Term Strategic Plan (MTSP) 2006-2009 of Unicef.

Indeed the 4 Ps « la prise en charge pédiatrique » (the agreement to bear medical costs in paediatrics), « la prevention de la transmission mère-enfant du VIH » (the prevention of mother -child transmission of HIV), « la prévention primaire chez les adolescents / jeunes » (the primary prevention with adolescents /the youth) and « la prise en charge des orphelins et autres enfants rendus vulnérables par le fait du SIDA » (the agreement to bear medical costs of orphans and other children made vulnerable due to AIDS) have started to be discussed in an integrated way rather than vertical. The model of the communication strategy for HIV/AIDS interventions based on the three pillars (risk mapping, behavioural analysis and communication integrated plan) combined to life skills being the federal element of the organization of the agreement to bear medical costs of the 4 Ps.

The primary prevention with adolescents / the youth is stressed in this model as the pivotal
and corner stone for the aspects of prevention in the matter of fight against HIV/AIDS by the

fact that it opens a gateway towards the parent/mother - child transmission prevention and its corollary the paediatric AIDS, for the youth themselves are future parents or they become parents too early (mother daughters / unmarried young mothers), towards the agreement to bear medical costs of «OEV: Orphelins et Enfants Vulnérables» (orphans and vulnerable children, children: in the street, children soldiers ...) for they have a good knowledge of families having lost one or two parents and are often the more concerned. The youth aged 10 to 24 make more than 40 % of the population in the Central African Republic. Among pregnant women, those aged 15 to 24 have the highest rate of infection to HIV/AIDS.

I dare hope that the youth and their educators first, members of the executive staff of ministries in charge of the youth and other ministerial departments, leaders of national and international NGOs / Associations, agencies of bilateral and multilateral cooperation as well as those of the united nations system will find in this handbook a guide for an integrated and participative approach of the prevention and reduction of risk and vulnerability of the populations to HIV/AIDS in general and the youth in particular.

Already, the youths of the pilot site are taking part to international meetings and conferences to disseminate their experience and are receiving other youths from other sites and countries (Burkina Faso) for training and experience sharing visits.

We couldn't have reached this stage of the work if UNICEF Bangui hadn't accepted to entirely sponsor my consultation to carry out this pilot experience. In this light we give special thanks to Dr FOUMBI Joseph the former Resident Representative of UNICEF Bangui who without backsliding gave us the technical support needed.

We expressed our sincere gratitude to Dr N'SAMBUKA BADIBANGA of the UNICEF HIV/AIDS programme for his technical, scientific guidance and coaching during all the steps of my course, to Dr Jean MACQ of the Public Health School at the free University of Brussels (Ecole de Santé Publique de l'Université Libre de Bruxelles) for cordial collaboration, availability and advice despite his multiple occupations.

We are equally very indebted towards the representatives of the ministries in charge of the youth and public health in the CAR, the NGO «Ambassade Chrétienne» and in particular the supervising peer educators, not forgetting the members of the Executive Educative Team for their cordial cooperation that has led to the success of this experience.

We also express our gratitude and acknowledgement to the members of «Association Culturelle Mission de la Re-Création» (ACMR), in particular Jules Aigard NANFANG and Glory MOUKIA for their suggestions, dialogue, translation and review of this handbook.

Our special thanks also go to our family members especially my parents Mr and Mrs TAKAM Jean Marie in Yaoundé, and to my junior sisters Noëlle Makouo and Josiane Koutsing for their moral support during hard times.

We finally thank all the young peer educators of C.A.R who have voluntarily and spontaneously accepted to sacrifice a little bit of their time in order to contribute to the development of this pilot experience.

Special thanks to all the executive board of the Madison University for the patience, devotion and particular attention that they have shown through out the learning process.

Figure 1	:	Management diagram: global approach of health problems in the development framework
Figure 2	:	Administrative map of the city of Bangui
Figure 3	:	Administrative map of the third subdivision of Bangui
Figure 4	:	Illustration of the organisation and functioning of socio- educative services offered to the youth in the third district of Bangui
Figure 5	:	System working as an integrated complete package with possibility of a dynamic interface with the youths population
Figure 6	:	Scheme of the Development activities
Figure 7	:	3 pillars of the strategy of communication
Figure 8	:	The spatial and demographic dimension
Figure 9	:	Needs, demand and supply
Figure 10	:	The Managerial dimension
Figure 11	:	The technical dimension
Figure 12	:	Model of organisation, management and animation of an integrated district socio-educative service
Figure 13	:	PERT of the structural and functional organisation of the socio educative district service

I - INTRODUCTION

In the plan of action for the 2005 - 2007 cooperation programme between the Central African Republic and UNICEF, it was proposed to develop in the third local council of Bangui a pilot experience for prevention and reduction of the youth vulnerability to HIV-AIDS with their participation, to document the experience in view of formulating recommendations for the generalisation of the pattern in the whole country. The project was intended to be a pilot site, and that implied a dual purpose: