First stage: choice of activities
Activities developed at the pilot site, which assures a well
defined geographical responsibility, were based on the three pillars of the
strategy of communication for behavioural change combined to life skills:
namely risk and vulnerability mapping, behavioural analysis, and integrated
communication plan, on one hand, and promotion of the use of condom,
orientation for
Risk and
vulnerability
mapping
Life skills
Behavioural
analysis
Integrated
communication
plan
Figure 7 : 3 pillars of the strategy of
communication
counselling, HIV voluntary test, and, curative care and
professional insertion on the other
hand. These activities have been chosen depending on their
capacity to create
confidence in the youth population.
Second stage: study of identified problems
The quantitative knowledge of problems considered as priority
ones was acquired at three levels:
1. The identification and assessment of problems by youths
themselves ( meetings at the level of the LIP and the health club, risk and
vulnerability mapping, behavioural analysis , integrated micro communication
plan, social and health census).
2. The exchange between the youths and their supervisors on
the problems thus identified (Task Force meetings, restitution of vulnerability
and risk mapping, behavioural analysis, integrated micro communication plan,
health census).
3.
The members of the Executive Educative Team study at their
turn the problems rose by the youths or noticed by themselves during
supervisions and other visits on the field (Executive Educative Team
meetings).
·:. The management tools have been developed to allow
the collection, analysis, conservation and dissemination of data collected as
activities were implemented.
Third stage: research and application of solutions
The three levels instituted at the second stage, for a
systematic study of problems depending on priorities, have been used for the
research and application of rational solutions, specific to priority problems
identified and studied at the two previous stages. The information thus
collected have been used as they were made available, to progressively
rationalise the organisation of activities and to gradually developed basic
socio-educative services more specific to the pilot site ( meetings of the LIP
and health clubs, risk and vulnerability mapping restitution, behavioural
analysis, integrated micro communication plan, socio sanitary census).
iv. Progressive rationalisation of the internal
functioning of socio-educative structures of
the pilot site.
For practical and feasibility reasons, the application of new
approaches in the new structures has been given privilege over the internal
rationalisation of the functioning of previously existing structures. It did
not appear appropriate, at the risk of raising new needs for which the project
could not afford, to create new services, introduce new methods or techniques
without a previous study of their applicability, use and profitability in the
ongoing functioning of the previously existing socio-educative structures.
Methods and techniques that can enable the best coverage of
needs felt by the youths at the level of the pilot site have led the
organisation and functioning of the LIP and the «CIEE» + Implantation
and functionality criteria of the LIP and the «CIEE»
+ Choice of activities depending on problems considered as
priorities (Risk and
Vulnerability Mapping, Behavioural Analysis, Integrated
Communication Plan, Census,
Voluntary Screening Centre, distribution of condoms). + Meetings
of functional units
The « CIEE », the 30 LIP, and 30 health clubs have
been organised on the basis of promotional, preventive, curative or
socio-professional reinsertion functions to be fulfilled by the programme
around the following hypothesis of work:
·
:. The health club developed in the pilot experience is a
structure of participation. It is at this level that the integration of
«health» preoccupations of youth population in the comprehensive
package representing their global preoccupations is accepted as the basic
element on which the concept of participation is based.
· :. The interaction between the LIP and the health club
enables the coordination among different socio-educative structures in charge
of other preoccupations of youth populations and that interact with the health
action.
·
:. The LIP/ « CIEE » works as a global social
animation structure for the youths. The LIP, at the level of the communication
area, and the «CIEE» at the level of the whole council, are
structures of coordination and orientation of the inter sector action.
v. Promotion of the young peer educators as other human
resources of the population.
Given that human resources are limited, a policy of promoting
education by the peers has been conceived at the pilot site. This policy has
been based on a maximal delegation of tasks. Two convergent ways have been
used:
·
:. the standardisation of methods and techniques to make them
accessible to the young peer educators;
· :. the continuous training to upgrade their
competences.
The standardisation has been considered as part of the
rationalisation of activities while associating the peer educator in the
framework of their continuous training for the techniques that they have an
experience on.
The rise of the peer educators' competence was done in view of
a responsibility commitment based on an active training oriented towards
problems which they were facing. The 6 members of the Executive Educative Team
at the level of the « CIEE », the 30 SPE with 10 PE each at the level
of the LIP were pooled into teams corresponding to functional
service units sharing common objectives of work. 6 SPE represent
their peers in the Executive Educative Team. Each group meets regularly
following a well defined calendar. The aim of these meetings is to make
everyone become aware of the common objectives and individual responsibility in
their realisation, to define the assessment criteria and to evaluate the work
in a critical way in order to get to necessary improvements.
The situation study brought out the usefulness of reviewing
the knowledge necessary to understand certain problems and provided to each
team subjects to treat in a more systematic way. The holding of meetings
allowed informing peer educators bit by bit on general aspects of the project
to make them understand the framework in which they work so that they act as
intermediaries with youth population.
In this policy of promoting education by the peers, tasks were
delegated to the youths and their supervisors from the local population,
without a formal training, and ready to volunteer. Among the supervisors and
the youths trained through learning by doing, certain highly motivated and
skilled individuals emerged, being stimulated by the social function to
perform.
III. LIMITS OF THE PILOT EXPERIENCE
The notion of pilot site needs a double purpose, that of
providing services and that of research. Right from the beginning, a clear
definition of needs both of competent human and financial resources lacked. The
pilot experience has been conceived under the sole aspect of offering services
to the youth population using volunteers and not executive permanent paid
personnel for functions they exercise.
The NGO «Ambassade Chrétienne», partner in
charge of executing the pilot project, did not have own human and financial
resources. They depended entirely on the technical support and the financial
contribution of UNICEF to the extent that if these means could have not been
provided, they would have led to the collapse of the project.
The ministry of health which was in charge of the project at
the beginning was not in charge of the youth. It is in the course of the
execution of the project that the ministries in charge of the youth have been
implicated.
More over, the fact that at the UNICEF, there was no
substantial provision of means for the pilot experience delayed the development
process of different strategic and operational axes. The time allowed to
conduct such an experience ought not to have been restricted to the duration of
the annual cooperation action plan also.
The question of financing has not been taken into account as an
important development axis of the pilot experience of creating a district socio
educative service.
IV. RESULTS
The question we asked ourselves at the end of the 2007 annual
plan of action putting an end to the 2002 - 2007 programme cycle of cooperation
between the Central Africa Republic and UNICEF was to know whether the
replication of the health district model into a socio educative district and
its integration in a larger district socio economic system permitted to reach
the determined objectives.
(a).The study of conditions and organisation - management
methods of the integrated,
continuous and global responsibility to take in charge
risk and vulnerability of the
youths to STI/HIV/AIDS with their full and active
participation.
The same as for the health district, the notion of socio
educative district fulfilling the three essential dimensions. [13]
The spatial and demographic dimension
Notions of :
health map
target population
zone of geographic responsibility population coverage
Reference scale District health authority Health institution
Figure 8 : the spatial and demographic
dimension
The population has been well defined, living in a well limited
geographical area, the third district of Bangui, corresponding to an
administrative area. This dimension of the model has permitted to repeat at new
expenditures, the notions of area of responsibility, socio health map oriented
towards the risk mapping of the youth to HIV/AIDS, target population ( youths
of 10 - 24 years old) and of social, health and educative population coverage.
However, the major obstacle has consisted in having a unique social, health and
educative authority in
charge. The fact that the urban council district, considered
in the national health organisation as a health district, does not have a
health district head did not enable to put in place this control unit formally.
This notion of socio educative authority in charge of the structures of the non
formal educative system does not exist in the CAR, or if it does, is not
applied.
We did our utmost to make the third urban council of Bangui an
« area of responsibility » of a number of social, health and
educative institutions that accept to coordinate taking in charge health
problems of all youths aged 10 - 24 living there, whether they were already
using the services of those social, health and educative institutions or
not.
In fact, without an exact knowledge of youth population to
cover, of the area for which the local socio sanitary and educative system
accepts certain responsibilities, one did not know how: + to establish a full
social, health and educative coverage : how many youths of 10 - 24
years old one is in charge of ? What effort still to be made in
order to cover all youth
population through information, education and counselling,
treatment or activities of
diverse nature?
+ to conceive a realistic planning : how to evaluate needs,
which priorities, which volume of activities to foresee, which conditions of
implementation to envisage?
+ to undertake an evaluation of services : which common bases
(denominators) to take into account when one measures activities and results ?
What social, health and educative information system to put in place to collect
pertinent data and, in particular, succeed to get access to individuals
belonging to the target population?
+ to favour the community participation : with which authorities
one should dialogue, with which groups of the « civil society »,
which youths in which quarters, till which geographical limits?
+ to put in place the inter sector collaboration : with which
services ? Implicating which leaders? Mobilising which actors? Till which
physical limits?
The five elements above have been for us important arguments
used to make the district socio educative site match the youth population and a
given geographical area, that of the third urban council of Bangui. Throughout
the process the high importance of the social, health and educative coverage
should be noticed.
Demand
CBC
Real
Needs
In fact, the knowledge of the youth population by the district
socio educative system have enabled not to answer passively to the need
Offer of
Participation Rationalisation
Service
felt
Needs
of information, education and counselling, treatment and services
deriving from the youths. But it has enabled to be «pro-active»
and to look for means to make needs
demand and offer meet.
Figure 9 : Needs, demand and offer
AS
P
P
P
The management dimension
Notions of :
Formal and informal authority community participation
inter sector action
supervision and control
P = Population; AS = sectors other than health
Figure 10 : The management dimension
It is the management and authority functions. At the pilot
site, these functions have been exercised in an informal and functional way by
the Executive Educative Team without any socio educative and health authority.
The members of this team have achieved activities of supervision. The logistics
and the financial management being exercised by the supervising
NGO. This managerial dimension of the model has enabled to
re-examine the notions of formal and functional authority, supervision and
control, community participation and of dynamisation of the inter sector
action.
|
The technical dimension
|
Notions of :
+ users' circuit
+ delegation of tasks
+ scales of services
+ reference and counter reference
|
|
Figure 1 1 : The technical dimension
It deals with organisation functions regarding activities of
information, education and counselling the young people, treatment and
services. It has enabled to re-evaluate for the urban pilot site the notions of
circuit of the young people as users, scales of socio - educative and health
services, then the relation between them, delegation or decentralisation of
competences and technology, or of reference and counter reference system of the
youths asking for services (whether they are ill or not) also.
At the end of the year 2007, to scrutiny, the adequacy much
sought after becomes evident between this model and the functions assigned to
the mastery of a coherent and performing health district and socio educative
space. Conceived this way, we wanted the socio-educative district as well as
the health district to be more than a tool for Information, Education and
Counselling (IEC) organisation, treatment or socio-educative and health
services. It has become a pertinent entity where diverse actors concerned by
the field of the youth health can envisage to collaborate efficiently and act
at the adequate level.
|
Différent
actors
|
Différent relations et Différent
interactions Functions
|
Youth association and vulnerabe groups
Pool of the
young peer
educators
Inter sector
Team
CA
Youth
information
center
HC
Youth Healh
club Center
LIP
Social
sector
HC
LIP
School
CA2
HIV voluntar y testing centre
Communication area (peripheral planning unit)
Coordination and orientation structure of the young peer
educators
Youth dialogue and
participation structure
Figure 12: model of organisation, management and animation an
integrated district socioeducative service
(b) The second objective dealt with the exploitation of
information collected in view of
the documentation of the pilot experience.
Right from the beginning of the pilot site development
different activities have been shared into « projects ». This
repartition was done essentially in accordance with the two fundamental
approaches of public health: the vertical approach (strategies of action
answering a problem - diverse methodologies)5 and horizontal
approach (organisation and rationalisation of services)6.
So, reproducing and adapting the organisation of the local
health information system, given
the vocation of the pilot site that is to
say with a dual aim namely « service delivery to
youths » and
« research », it has been put in place methods and techniques of
collection,
5 Projets symboliséd by figures
6 Projets symbolised by a set of three letters
analysis and conservation of information. These different
«projects» have been shared among different members of the Executive
Educative Team at the level of the pilot site.
A system of classified sheets in a folder of each project
enables to follow its evolution and make a report about its progress. Each
project is followed and documented in terms of: (see picture below).
> General principle (GP)
> Empirical decision (ED)
> Administrative instruction (AI) > Operational Instruction
(OI)
> Evaluation analysis (EA) > Evaluation instruction (EI)
> Evaluation monitoring(EM) > Basic data (BD)
> System (SYS)
> Progress report (PR)
This type of organisation has been conceived much more for the
management and follow up of the pilot experience and less for the organisation
of everyday routine of the members of the Executive Educative Team. This
responsibility was devoted much to the technical assistance assured by UNICEF.
This has enabled to conceive and elaborate tools for the management and follow
up of the development of the organisation and functioning of a normal site
offering socio educative and health services to a given population (see pilot
site documents
entitled «système d'information local -
SIL»).
The application of the planning method based on Performance
Evaluation and Review (PERT) has enabled to piece together activities and
events that has contributed to the realisation of the specific objectives of
the pilot experience as shown in the figure 13 below.
B-1 F-3 E-3 J-3
A-1
K-1
5 8 1 1
2
C-1
D-1 H-2 L-1 N-3
R-1
3
6 9 1 1 1
End
Start
1
I-3 G-3 M-3 O-1
7 1 1
4 3
P-12
Q-12
Figure 13 : PERT of the structural and
functional organisation of the socio-educative district service
Path
1 2 5 8 11 14 16
A-B-F-E-K-J: 1M + 1M + 3M + 3M + 3M + 1M = 12 months
Path
1 3 6 9 12 15 16
B-D-H-L-N-R: 1M + 1M + 2M + 1M + 3M + 1M = 9 months
Path
1 4 7 10 13 16
I-G-M-0-P: 3M + 3M + 3M + 1M + 12M = 22
months
1 16
Q 12 M = 12 months
Path
Notes: Circles = Events; Arrows and letters = Activities;
Numbers = Time in month, Double arrows = the critical path, or how long it
should take to complete the project.
Following the PERT, multiple activities developed at the pilot
site are for some independent because they can be performed simultaneously;
others are dependent because one activity might be completed before the next
activity can begin. PERT is more appropriate the activities follow both
dependent and independent series of each other. Key PERT components are
activities, events, periods/time, the critical path and if possible the cost
[13].
The critical path determines the length of time take to
complete a project by determining how long each activity will take. In our
case, it is shown by the double line in Figure 13. 18 activities /events have
been followed for the realisation of the specific objectives of the project for
the structural and functional organisation socio-educative district service:
The Youths Centre for Information, Education and Counselling (YCIEC), the
Executive Educative Team (EET), the Supervisor Peer Educators (SPE), the Peer
Educators (PE), the Local Information Pool (LIP) and Health Clubs (HC):
A. Discussion with partners implicated (1 month)
B. Choice of the place of location of the CIEC (1 month)
C. Identification and training of the EET (1 month)
D. Identification and training of the 30 SPE (1 month)
E. Division of the site into communication areas and their
development (3 months)
F. Settlement and equipment of the CIEC (3 months)
G. Risk and vulnerability mapping (3 months)
H. Identification and training of 10 PE by each SPE (2
months)
I. Organisation and structuring of the EET team work (3
months)
J. Structural and functional organisation of the CIEC (3
months)
K. Preparation and Official opening of CIEC (1 months)
L. Implementation and organisation of the LIP (1 month)
M. Carrying out of the behavioural analysis and acquisition of
life skills (3 months)
N. Organisation and structuring of health clubs (dialogue
structure) 1 by communication area (3 months)
O. Elaboration of integrated communication micro plans by
peer educators in each communication area and the integrated communication plan
of the whole pilot site by members of the EET (1 month)
P. Implementation of micro plans of action in each communication
area by peer educators and of the plan of action of the site by members of the
EET(12 months)
Q. Supervision of the implementation of micro plans of action in
communication areas by the EET and the SPE (12 months)
R. Evaluation of integrated communication micro plans and of the
integrated plan of the site (1 month)
The estimative duration for each activity /event has been
determined (A-1, B-1, F-3, E-3, J-3, K-1, C-1, D-1, H-2, L-1, N-3 R-1, I-3,
G-3, M-3, O-1, P-12 and Q-12 the same as the sequence of realisation of
different tasks: (A is completed before B can begin, E before H, H before J and
so on... Q is an independent activity).
Management tools have enabled to get both better organisation
and follow up of services offered (service aim) and better knowledge of
priority problems and their solutions (research aim). Three categories of tools
have been conceived:
+ At operational level
Management tools are connected to the established socio
educative system which comprises two essential elements:
The basic socio educative service represented by the
LIP in this case considered as the functional unit of the pilot site
of IEC delivery in a dynamic interaction with the youth population of the
communication area covered represented by the health club.
A that level, management tools conceived enable:
· manage the problems of any youth (individually);
· manage the LIP in terms of minimum package of activities
to carry out;
· manage relations between the LIP and the youth
/population
Central reference unit: the CIEC where management tools
are used to:
· manage the CIEC in terms of structural and functional
organisation of a service offering a minimum package of activities to the youth
population of the whole pilot site ;
· manage relations among elements of the urban council
socio educative system (LIP and CIEC)
+ At the research level
The elaborated management tools enable to undertake research,
follow up and evaluation that is to say, to improve the delivery of socio
educative services by bringing new knowledge.
+ At the strategic level
Management tools enable to pile useful information and
dispatch them to the institution concerned and to give an orientation to the
general policy of planning, norms and procedures connected to the IEC delivery
to the youth population of the urban council.
(c) Bringing useful information to the authorities
concerned for the generalisation of the
model to the whole country.
Through out the pilot site development process, ministries
implicated in the prevention and reduction of HIV/AIDS youth vulnerability to
have been engaged in the framework of the cooperation programme between the CAR
and UNICEF. Thus, the ministry of public health assured at the beginning the
supervision and coordination of the project through the National Committee of
AIDS Control (Direction Nationale de lutte contre le SIDA - DNLS);
the ministry of youth has replaced the ministry of public
health ; the ministry of national education has intervened for the educational
part and the ministry of social affairs for social matters.
In each ministry, excepted that of social affairs, a
management team composed of three executives chosen by the minister assure the
technical support and the administrative management of the project following
the plan of action of the cooperation between the CAR and UNICEF.
A supervising committee made of representatives of each
management team to which the NGO «Ambassade Chrétienne», main
partner and responsible of the execution of the project and other youth
associations have been associated, assuring the global coordination of the
project. Since the youths are the target population, the presidency of the
committee, initially assured by the «DNLS» has been transferred to
the general Directorate of the Youth of the ministry of youth.
The implication right from the beginning, of executives of the
ministries in charge of the youths and the ministry of health has been of great
importance in the endorsement of the joint responsibility by those ministries
and UNICEF for the development of the pilot project. Factors that have
conditioned the development, the structural and functional organisation of the
district socio educative site in the third urban council by replication of the
health district model based on primary health care can be divided into three
main categories:
· Conceptual factors
· Political factors
· Factors connected to resources
1. C onceptual factors
The concept of reproduction and the reproductively character
can be understood in the
philosophical and global sense as a number of
institutional conditions. We will use it in a
more specific sense that is the measure in which a project
provides a certain number of precise answers to some problems, depending on
approaches that can be repeated elsewhere. It is not so much the conditions in
which these answers have been supplied that are important but the approaches
followed.
In the framework of the pilot experience of the third district
of Bangui, it has been established, right from the beginning, the
reproductively of concepts and methods as one of the justifications of the
action and the research.
Although the initial aim of the project was to study the
organisation of specific interventions in matter of prevention and reduction of
youth vulnerability to HIV/AIDS, this has been oriented towards how to assure
to the youth population of the third district the best service possible in
relation to available resources.
The CAR should be able to gain from this intervention
information and necessary material to define at national level, a policy and a
plan for promoting the youth health in general and for preventing HIV/AIDS
among them in particular. The constant preoccupation during the whole process
in view of its generalisation has been to draw conclusions for approaches
adopted and disseminate them.
The project has remained above all a project of health
promotion, even if other fields have been revealed important too. The
enlargement of the field of action to other fields of development such as the
socio economic re-insertion has just been envisaged with the active
participation of youths only. By limiting itself to the field of health
considered in a more global socio educative framework, the project has been
able to provide a certain number of precise answers regarding the organisation
of socio educative services in an administrative district corresponding to an
urban health district.
The concept of health district based on primary health care
that used to serve then as reference model was well understood. It has been
applied and extended to the district socio educative site where health has been
a sector with a very high technical component7.
From a conceptual point of view thus, to analyse the results
of the pilot experience, we have got to make use of the
«modelisation» of a district socio educative system, by conceiving it
in its merest form adapted to the health district system. It is a question of a
district socio educative system with two levels - a socio educative central
unit of reference (the CIEC) and socio educative peripheral units called Local
Information Pools (LIP). The model comprises three replicable dimensions: the
spatial and demographic dimension, the managerial dimension and the technical
dimension.
The conformity of the project to the national Policy of HIV/AIDS
control has been an important factor of success. The reference to the national
policy, legal arrangements, and other institutions that make its environment
has enabled the endorsement by the national authorities as well as actors on
the field of the project. There has been a very high mobilisation both at the
local and national level. The ministries of public health, youth, social
affairs and national education have accompanied the whole pilot site process of
development. The President of the Republic
Mr BOZIZE (see picture) and all the members of
government have visited the Youth Centre for
Information, Education and Councelling (YCIEC)
or «CIEE» in French).
2. Political factors
7 The health district versus the district socio educative site
roughly speaking can be defined as the functional unit of decentralisation of
the socio educative organisation for a well defined population. Its optimal
height and complexity in a given situation are the result of two opposed
requirements: it should be large enough to enable a certain concentration of
human and technical resources. But it should equally be small enough so as to
establish a communication with the population and a participation of
communities. In other words, the scale economy and the search of a bottom -up
planning must be reconciled to make treatment more pertinent in order to match
priorities. (ibidem, pp.7-8).
The position of leadership obtained by the HIV/AIDS programme
in the preparation of the (5th African Development Forum (ADF V) held in
November 2006 in Ethiopia, and in the organisation of the Youth National Forum
in December of the same year has led to the official adoption of the model and
the recommendation (by the authorities) of its generalisation to the whole
country.
3. Economic factors
To make the project less vulnerable, the following elements have
been taken into account: + the project has been based on principles of
simplicity and complexity,
+ realistic rather than global and integrated,
+ successive stages of realisation have been well defined and
are connected rather than being bound to be realised simultaneously,
+ by taking available resources as limit, the project has
prevented itself from the danger of realising a piece of academic bravery,
+ to concretise this will, several decisions have been taken:
the intervention unit of the project is the national planning unit of health
services that is the district, here the administrative district. The
development of the infrastructure is done with the volunteer personnel
available and by calling to the community participation for possible
improvements. The LIPs are managed by the youths themselves trained through
learning by doing.
4. The financing of the project.
In the present socio economic conditions of the CAR, featured
by the stagnation of the socio educative budget, that of health in particular
and the degradation of the purchasing power of the population, it was difficult
to make all the services of the pilot site finance by the state. It was also
unrealistic to expect the populations to finance the project by themselves. The
idea
right from the beginning has been to show that it was possible
to reproduce at low cost a taking in charge system of the prevention and
reduction of HIV/AIDS youth vulnerability by a socio educative service
following the organisation model of the health district.
Therefore, international aid has been considered as a
necessary solidarity to assure minimum services to the youth population so that
this aid should not create new needs. No new technique has been introduced
without its use being proved through a discussion within the team.
However, the question of financing should be discussed in a
further study in order to get the estimate of the investment cost and
functioning of district socio educative site offring services of information,
education and counselling to the youths in matter of prevention and reduction
of their vulnerability to HIV/AIDS.
V. OPPORTUNITIES OF REPLICATION
As mentioned above, we understand by replication the ability
for a project to provide answers to a problem following approaches that can be
repeated elsewhere and not the reproduction of all elements of the project.
Certain actions are dictated and highly influenced by the local context and
should not certainly be reproduced exactly as those undertaken somewhere else.
This is why, for example, standard instructions of risk and vulnerability
mapping and behavioural analysis are made to answer problems of the youth
population of the third urban council with means available locally. Repeating
them as such somewhere else would lead to inconsistencies and inefficiency.
What is replicable in this case is not the final product, but rather the
methodology of its elaboration and standard instructions for the young peer
educators.
However, and whatever the value of approaches, channels of
communication that enable to assure the dissemination of the experience must be
used.
a) The teaching of HIV/AIDS in schools
Teaching is an important mean for disseminating ideas.
Unfortunately, during the experimental stage of the model, it was not envisaged
to introduce the teaching of HIV/AIDS in school milieu of the fundamental level
2 following new approaches of life skills combined to the communication for
behavioural change as it was the case for fundamental level 1. However, the
consideration of the CIEC («CIEE» in French) in the national policy
of the youth, could bring to the teaching of youth animation in the framework
of the future National Center of Youth and Sports (NCYS, in French CNJS)
concrete field elements, by reinforcing the credibility of the education by
showing that ideas defended are achievable.
However, activities of prevention and reduction of youth
vulnerability to HIV/AIDS have
been introduced as extracurricular
activities. We have tried to complement and compensate
this lack of education by publications notably the description
of methods followed (example: the promotion of the young peer educator) or the
dissemination of key ideas such as the district socio educative service.
The presentation of the CIEC model («CIEE» in
French) at the «Ecole de Santé Publique de l'Université
Libre de Bruxelles» (School of Public Health of the Free University of
Brussels) in June - August 2006 has been an important stage as channel of
replication that should be maintained under a given form. The pilot site being
in itself a replication of the experience lived in Cameroon, it is as such a
good opportunity to test, improve and disseminate the methodologies
developed.
b) The training of national executives
At the end of the experimental period in 2007, although short
(24 months), the pilot site of the third urban council of Bangui has been
oriented as demonstration and reference site for the whole country. Therefore,
it has been planned to make it a training centre for national executives of the
ministries of youth and of national education. The contribution of national
executives of the CAR to the implementation of the project has been and will
continue to be an opportunity of training on the field and acquisition of an
important expertise.
c) To test approaches and methods
Very quickly, testing methods developed in the third urban
council of Bangui in-of- school and in the divisions (rural areas and emergency
in 2007) have got the double advantage of studying not only the replication,
but the acceptability of the methods in- school also and equally in the rural
milieu. Moreover, the approaches and methods applied at the pilot site are
themselves a replication of what has been developed in Douala in Cameroon.
d) Necessary conditions for replication
Definitely, the pilot experience of Bangui has enabled to define
three necessary conditions to the replication of these approaches:
The first observation that has been made is that it is
very difficult to seize the essence of an approach when one has not witnessed
all its beginning.
The replication in the school milieu of Bangui and division
(rural areas in 2007) has been indispensable to the understanding of the origin
of an instruction and its evolution in order to be able to remove anything
particular in it, but to understand its «raison d'être» also
before adapting it correctly to a different environment.
The second observation is connected to the difficulty
to interpret an approach and to the difficulty to discriminate the importance
of the detail. We have seen both at the pilot site of the third district and in
the school milieu that these difficulties have led to blocks and deviations.
The third observation made indicates that the methods
that have been the most easily adopted are those that corresponded to the
expressed needs both in the third urban council of Bangui and in the school
milieu. It has been generally a matter of fields in which there were questions
on how to operate. For example, the nationalisation of the organisation and
functioning of the Youths Centre for Information, Education and Counselling
YCIEC (»CIEE» in French), the risk and vulnerability mapping, the
behavioural analysis and the integrated communication plan. This observation
underlines the necessity of introducing as priority the methods that answer the
demand of people interested. In fact, the comprehension is easy if we answer a
problem rather than if we want to test a theoretical hypothesis.
VI. CONCLUSIONS AND GENERAL COMMENTS
The main weakness of the national socio educative and health
system in general, and in particular of the non formal education in the CAR as
in many developing countries lays in the absence of an adequate model of the
organisation of non formal education, out of the school system. The word model
is understood here in the sense of the reference organisational structure in
relation to which diverse variations are defined.
The structures of the ministry of youth in the CAR are
distinguished nowadays by the existence of official youth services badly
equipped without maintenance and very often not functioning on one hand, and by
the desperate efforts deployed to create, despite everything, new structures
that do not answer national realities on the other. The model of organisation
of youth socio educative and health services, as a mirage, continues to raise
hope and important expenditures with in most of the cases disappointing
results. We are totally in front of a poverty of the non formal education. This
poverty is not only linked to the present economic climate that is to say
linked to the lack of personnel and adequate infrastructure, poor supply,
equipment and management conditions of youth socio educative and health
services, but to the failure of the adaptation of the model inherited from the
colonial period also. There is a deeper vacuum, a conceptual vacuum.
In this documentation, we have described an organisation model
of information, education and counselling of the youths in the framework of
HIV/AIDS control but from a sector other than health while borrowing from the
latter the simple organisation model of two complementary scales in which all
curative and preventive activities are integrated, which is adapted to socio
economic conditions of the third urban council of Bangui. This model could then
fill an important conceptual vacuum.
In the poor functioning conditions of youth services, many
supervisors of the youths and policy makers think that, the improvement of
services should pass through the progressive rehabilitation of existing
structures as resources are made available. Such an approach although a bit
easy, still has many inconveniencies, the most important of them being the
difficulty to make the youth population and the personnel of youth animation
perceive that socio educative services for the promotion of the youths do not
mean « earning a bit more» but changing the nature of services.
It is preferable to define the model of basic socio educative
services that we want to settle in the area. The interest is that we start from
a clear reference obliging each time to justify possible variants.
The analysis of the use of this simple system shows that it is
satisfactory and enables to take efficiently in charge the problems of
prevention and reduction of youth vulnerability to HIV/AIDS both in and out of
the reference service, the CIEC (»CIEE» in French). However, the main
constraints must be taken into account and two of them influence the
application of the model in the CAR:
> the important degradation of the country economic
possibilities that make it more and more dependent on foreign aid for the
financing of its socio educative and health services.
> the lack of competent human resources to assure the
spreading and implementation of the model.
The simple model described offers to the CAR one conceptual
framework of planning, organisation and implantation of non formal socio
educative structures playing a role in the care of youth problems notably the
prevention and reduction of their vulnerability to HIV/AIDS.
The existence of the model presents many advantages:
a) A framework for international assistance
By making this model adopted in the whole CAR, a framework
has been created in which actions and resources can be driven giving them a
great coherence to the planning of the non formal socio educative action.
b) A framework for national coordination
The existence of the functional model in town as well as in
the rural milieu will create coherence not only for foreign donors but for
various actors in the country also. The model, by highlighting the functions of
each scale, will enable to reach a better coordination among actors. They feel
more concerned by the youth population health which they are responsible of in
the framework of a policy (for the promotion of the youth, of health).
c) Moderator effect on certain constraints.
A weakness of the realisation of care in CAR is the lack,
after having divided the country into health districts, of a coherent national
plan that defines stages of realisation of this model, one health district
after another, in some words a national «pre-plan». For the youth non
formal socio educative sector, there is no «pre-plan» too. The latter
could offer a flexible reference framework that could enable to decide
depending on pre-established criteria rather than on diverse pressures.
It should be unrealistic to think that the existence of a
conceptual model lifts the constraints to the realisation of the National
Health Development Plan based on the policy of primary health care for the
health sector. However a conceptual model gives a better base to get to more
relational solutions in a given political context. As the experience of the
pilot site of the third urban council of Bangui shows it, this model, by
filling a conceptual vacuum creates a framework in which political options of
the country are concretised and enables to avoid that the organisation of non
formal socio educative services are turned into a Babel tower.
Moreover, there is good reason to underline here that the
participation of the population that of the young people in particular, is
raised as the corner stone of the successful completion of the project. The
socio educative and health structures animated by the young people (CIEC, LIP,
Health club) have enabled to undertake activities at the community level, to
give an orientation and to coordinate the inter sector action at basic level.
However, even if it has been demonstrated that it was possible to develop
activities of prevention and reduction of youth, vulnerability to HIV/AIDS with
their full and active participation, it is also true that if the other socio
educative sectors that should provide answers to problems which the youths are
facing are not organised in the same perspective, an important link in the
chain could lack and then the objectives targeted will be far from being
reached.
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