Memoire Online - Model of organisation and functioning sseb

In order to develop the pilot experience in the third district of Bangui, activities undertaken or strategies used for information, education, and counselling in matter of prevention and reduction of youth vulnerability to STI/HIV/AIDS have been considered in certain cases as part of a more extended district socio-educative system and in others as specific sub-systems.

In this pilot experience, the analysis of basic socio-educative structures and their constitutive elements showed that socio-educative services were not structured in a system but were made of a number of sub-systems not working as a complete package ; there was no coordination among them and services offered to the youths were scattered (Figure 4).

1. socio-educative services

2. target population

Figure 4 : Illustration of the organisation and functioning of socio-educative services offered to the youths in the third district of Bangui.

Consequently, a more efficient, effective and coordinated structuration [11] was envisaged in basic socio-educative services - health centre, youth club, social action sector, school, HIV voluntary testing centre, youth friendly centre (CIEE in French) - organized in a system in such a way that there are possibilities of creating a dynamic interface with the youths (figure5).

1. socio-educative services

2. target population

Figure 5 : System functioning as an integrated comprehensive package with possibility of a dynamic interface with youths population.

The LIP (Local Information Pool) would serve as element of permanent interaction with the youths (figure 4) represented in different structures of dialogue settled in the district which

are health clubs. This system will have to function as an integrated comprehensive package³ offering information, education and monitoring services (IEM or IEE in French) as a whole to the youths with their full participation. It will be called « socio-educative district system » made of basic socio-educative and referral services.

The approach followed relies on the replication of the model of health district system based on primary health care. This model is indeed the pertinent entity where various actors concerned by health domain can envisage collaborating efficiently and acting to the adequate scale [12]. The approach followed is systemic where the health district is conceived not as a standard and catch-all modality of service organisation, but as a model to adapt to circumstances, without forgetting the aim of a health service in the urban context.

Thus, the model of health district has three essential dimensions [12]. The first is spatial and demographic. It is the definition of a precise population, living in a defined geographical zone, corresponding or not to an administrative zone, on which the health authority is responsible. This dimension of the model enables to introduce the notions of zone of responsibility, health map, target population, and population coverage.

The second dimension concerns the management and authority functions. Exercised by the health authority, they range from supervision activities and logistics to the financial management. This managerial dimension⁴ of the model enables to re-examine the notions of formal and functional authority, supervision and control, community participation, and enabling of the inter sector action.

3 An integrated system of health is a system where elements are organized, tidy and coordinated in view of common objectives: in our case, it is the agreement to bear medical costs of problems related to prevention and reduction of youth vulnerability to HIV/AIDS in the third district of Bangui

4 Management Functions, Chapter 1, page 11, Management Fundamentals, Concepts-Applications-Skill Development. Robert N.Lussier, Ph.D., Springfield College, Springfield, Massachusetts, 2000 South -Western College Publishing, a division of Thomson Learning.

The third dimension deals with organisation functions concerning treatment, services and activities. This technical dimension re-evaluates for the area the notions of users' circuit, services' scales and relations among them, delegation or decentralisation of competences and technology, or of reference system and counter reference system of patients also.

The model of health district can be applied to the urban context of the 3rd district without losing its coherence or abandoning its end: the effective coverage of the population by Primary Health Care. [4]

The replication stages of the development and organisation of such a system in a more extended socio-educative system are described in documents of general policy, organisation, management, animation and training designed during this pilot experience. Five strategic and operational axes have been followed:

To develop the various fields of activity of the pilot site, an Executive Educative Team essentially made of volunteers identified and chosen by the NGO «Ambassade Chrétienne» has been put in place. Its members perform this social function without any remuneration other than that of their habitual functions.

The Executive Educative Team exercising both technical and administrative functions matching the profile of a social animator: teacher, communicator, health professional, youth and animation councillor, and management specialist.

The essential function of this team is the supervision of the young supervising peer educators responsible of the organisation, management and animation of the communication area (LIP, Health clubs). The structuration in team and the work organisation have been a constant priority during the whole process.

Communication channels have been created to enable the participation of everyone to the making of decisions

, tasks sharing, team spirit (responsibility in the group), and the evaluation of activities through active research

from opinions of the others (meetings, folder for the circulation of documents, calendar of activities, supervision notebook, etc).

Decisions were turned into « instructions » preventing the member of the Executive Educative Team in charge of their application of the pattern and the evaluation deadline. This has led to the setting of a local information system containing management tools for the organisation and functioning of the pilot site and a standard supervision kit.

The global approach for the development of the coverage was carried out at two levels: 1. Settlement of a basic socio-educative service

The council has been divided into 30 geographical units called communication areas (CA), corresponding as much as possible to quarters following the administrative structure (division). Each communication area is under the responsibility of a young supervisor peer educator (SPE) and hosts a local information pool (LIP), a potential space made up of 10 young peer educators and a health club (HC) which pools representatives of youth association (ASS) and vulnerable groups (VG) identified (street children, loose girls, etc...).

In order to raise awareness for an individual search of solutions to their problems, the social animation of youths is realised throughout the health clubs considered as participation structures.

The local information pool has been organised structurally and functionally to serve as interface between the participation and dialogue structure of the youth (health club) and the basic socio-educative services.

The analysis/observation of the interaction between the local information pool (LIP) and the health club on one hand, and the local information pool (LIP) and the basic socio-educative structures on the other, depending on the problem to solve, has permitted the understanding : + of conditions to observe for the settlement of coordination and orientation mechanisms of

+ of each structure in terms of objectives to meet and minimum package of activities to to

+ of the technical, material and financial necessary support related to the needs of youths.

Given the huge size of communication areas, alternative approaches have not as yet been

developed to complement the coverage of the youth sub-urban populations living at very

long distance from the local information pool (LIP): mobile services of peer educators

2. Establishment and rationalisation of the organisation and functioning of a central structure as a Reference Information, Education and Counselling Centre for basic socio-educative services. The Reference Information, Education and Counselling Centre (Centre d' Information, d'Education, et d'Ecoute des jeunes / CIEE in French) has been developed and organised as a reference structure for the information, education and counselling of youths in connection to the 30 local information pools. The space organisation within the CIEE has been done taking into account the needs in information and education (meeting room, library, video room), the needs in management and follow -up of activities (office of the Executive Educative Team),

1st stage				2nd stage			3rd stage
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the needs in management and follow-up of the equipment, materials and furniture (store), the needs in the counselling of youths (counselling room), the needs in management and follow up of activities in the 30 communication areas by the young supervisor peer educators (SPE room), and the needs in training (conference room).

The functionality criteria, the composition, the localisation and a standard kit of educative and didactic material for each socio-educative structure («CIEE», LIP, and Health Club) have been defined.

From the needs felt by youth population and with their full and active participation, three complementary and simultaneous stages have been followed in the development of activities:

Figure 6 : Scheme of the development of activities
	Transfer

Model of organisation and functioning sseb

II.2. PROCESS