SOCIAL MOBILISATION PAPER
‘ASSISTING THE VULNERABLE WITH THEM’
[Condom demonstration by a Himba Red Cross volunteer among fellow community members]
? To develop working partnerships with identified vulnerable communities ? To foster human dignity in all communities by addressing the basic needs of people in
accordance with the fundamental principles of the International Red Cross and Red
? To have well-defined and sustainable programmes with priorities based on identified needs
in vulnerable communities
? To have strong NRCS institutions from the head office right down to the branches
? To strive to make the NRCS financially self-sustainable
Covering an area of 824 269 square kilometres, Namibia lies on the South West Coast of Africa. It shares borders with Angola, Botswana, South Africa, Zambia and Zimbabwe. The entire western side of Namibia borders the Atlantic Ocean. The country is arid with part of it consisting of the Namib Desert along the west coastline and the Kalahari Desert on the Southern and Central Eastern bordering Botswana.
The country experiences periodic and frequent drought. Except for the Northern areas, rainfall is limited, with some areas experiencing as low as one millilitre of rain per year. Perennial rivers are the Zambezi, Kwando, Kavango and Kunene in the Northern borders, while the Orange River forms the Southern border with South Africa.
Except for the northern regions, the soil is of very poor quality making it unsuitable for crop farming. However the country has a rich supply of minerals such as diamonds, gold, tin, lead, copper, silver, uranium, natural gas, gemstones, marine resources and unexplored oil deposits. The country also has a wide variety of wildlife.
Most of Namibia‟s population live in rural areas. The disparity between the rich and the poor in Namibia is very high. With a population of only 2 Million, Namibia is sparsely habituated. This distribution in the population also limits development. The Life expectancy at birth is 43.3 years. The GDP per capita is 6.210 USD meaning that 34.9 percent of the population is living below 1.00 USD per day, while 55.8 % of the population is living below 2.00 per day. The Adult Literacy rate for people who are 15 years old and above is 83.7 %. 80-94 % of the population have access to affordable essential drugs. However 45% of households have to walk 60 minutes to reach a health facility, while for rural areas this could even be more. 77% of the population have access to safe water source while 41% of the population have access to improved sanitation. The Under-five mortality rate is 67 per 1000 live births.
AIDS is the number one cause of death in Namibia contributing to 12.4 % of the deaths and the number of people infected with HIV/AIDS is increasing. AIDS is the fifth cause of death in children. The national HIV/AIDS prevalence rate in Namibia is 22.5%. The percentage of adults living with HIV/AIDS is 21.3 %. Apart from HIV/AIDS, Malaria and TB are other diseases of serious concern. 1.5 out of a 100 000 people are affected by Malaria, while 478 out of 100 000 people suffer from TB.
Namibia Red Cross Society and focus on HIV/AIDS
‘An integrated approach’
Since its establishment by an act of parliament act no 16 of 1991 followed by its recognition by ICRC and then admitted by the International Federation of Red Cross and Red Crescent Societies (Federation) in 1993, NRCS has continued to expand
tremendously in size and capacity to carry out its mandate as a National Humanitarian Organization auxiliary but autonomous to public authorities in the humanitarian spheres. The Constitution of NRCS promulgates the governance and management structures and functions of the National Society. A General Assembly provides governance implementation through governing board and regional committees.
The National Society is in principle committed to building an institution that is financially self-sustainable with strong governance structures, effective and efficient management and capacity to deliver services to the most vulnerable countrywide. The realization of such commitments is being guided by the National Society‟s strategy 2005 including Health Strategy. The above strategies have been developed in line with strategy 2010 of the Federation, ARCHI 2010 and the Ouagadougou Plan of Action as well as National Development strategies.
In line with the ARCHI 2010 – to make a major difference to the health of vulnerable
people in Africa, the National Society guided by the fundamental principles, addresses
basic needs of the most vulnerable. This is done through interventions in Health and Care, Disaster Preparedness and Response, Humanitarian Values and Organizational Development with implementing community-based Programmes in close cooperation with its stakeholders. The NRCS is operating in 7 Regions (Caprivi, Kavango, Kunene, Khomas, Ohangwena, Otjozonjdupa and Karas regions), five of the regions covered are in the northern part of Namibia, where 70% of the population is situated and has lowest human development index
The NRCS has expanded its services considerably with the opening of new Regional Offices namely Khomas, Karas and Otjozondjupa regions in 2003.
HEALTH AND CARE IN THE COMMUNITY
‘HIV/AIDS as a health priority’
In the past 10 years HIV/AIDS has increased tremendously with the overall prevalence rate now at 22.5%, posing a threat on the socio-economic status of the population. In its efforts to reduce transmission and mitigate the impact of HIV/AIDS, the NRCS has scaled up its prevention, care and support and advocacy activities through Home Based care and prevention programmes.
‘Community support and involvement’
Guided by its mission and vision to develop working partnerships with identified vulnerable communities, Namibia Red Cross Society values the improvement and empowerment of communities to live healthier and better lives.
Home Based Care (HBC)
Through the HBC project a network of community support for terminally ill people, their families and AIDS Orphans has been established in most affected regions such as Ohangwena, Khomas, Caprivi and Otjozondjupa.
The identification of the regions was community driven in terms of approval and
selection of volunteers, village and health committees. This was followed by baseline
surveys to determine the magnitude of the problem, and setting up the project structures.
The most vulnerable people as well as project supervisors and facilitators were identified
through community meetings and consultation with traditional leaders.
To date, 119 supervisors, 132 facilitators and 784 care providers were trained throughout
the project. In order to ensure that HIV/AIDS infected and affected have accesses to
physical, psychosocial and material support, the project has established 11 support groups.
Furthermore, 4114 clients were reached and over 10 245 orphans and vulnerable children
NRCS and two National Societies (Botswana and Zambia) have jointly launched a Cross
Border Home Based Care program in Caprivi region where the three countries share a
common border. In total 43 volunteers of which 14 were from Namibia were trained
through this project.
In the Kavango region, which is having the highest number of orphans in Namibia,
NRCS is operating a Drop-in Center for orphans and other vulnerable children. Through
the programme 120 orphans and other vulnerable children were registered of which 80
children are benefiting directly. The children are provided with one meal per day, school
uniforms and school fees exemption forms.
The OVC programme in Okakarara, Otjozondjupa region is a community initiative
managed by volunteers, who through income- generating project e.g. cooking,
needlework are supporting 7 out of 9 registered OVC.
NRCS also plays a complimentary role in advocating for the rights of orphans and
vulnerable children (OVC).
Project Clients OVC Support SuperviFacilitatoCare providers area/region reached registered groups sors rs Ohangwena 3824 +10 000 3 15 96 465 Khomas 133 245 1 63 139 Caprivi 157 0 7 4 36 180 Kavango 0 120 0 0 0 0 Otjozondjupa 0 9 0 19 0 0 Total 4114 +10 365 11 97 132 784
Income generating activities for clients and HBC providers/facilitators
Plans are underway to establish income-generating activities for our clients and HBC
givers. This has been prompted by the need to promote sustainability, social well being
and proper nutrition. Due to the high unemployment rate and ill health, clients do not
have any means to sustain themselves and most of them only rely on the meager AIDS
Grant provided by the Ministry of health and social services. Therefore there is a need to
ensure that the clients and care givers are empowered economically in order to enable them to live longer and continue rendering their services in their communities. Examples of income generating projects are gardening and small-scale businesses. Coca Cola Namibia has pledged to provide capital for small-scale retail businesses to sell their products as well as provide business management training as social responsibility to plough back its profits within the society it operates.
As part of curbing the spread of HIV/AIDS, NRCS is contributing to the improvement of knowledge, attitudes and practices of the community through the following programs: Edutainment, Desert Soul, Namibia Reproductive Health Initiative (NARHI), as well as integration of HIV/AIDS prevention in other activities. The distribution of condoms is integrated in all NRCS programmes.
Edutainment Training Unit
Edutainment Training Unit is a multi-media project established to reduce and prevent the spread of HIV/AIDS through drama, music, traditional songs and puppetry performances. The National Edutainment Unit is responsible for training similar units at regional level. The Edutainment units in 6 regions (Khomas, Kavango, Kunene, Ohangwena and Caprivi) have received training in drama and script writing.
After every performance, a feedback session is held with the community to evaluate the impact of the messages and understanding thereof as well as to give direct feedback on HIV/AIDS concerns. During 2003 the project reached 68002 people countrywide.
Desert Soul project
Desert Soul is a multi-media health and development communication project that focuses on health issues such as HIV/AIDS, TB, Malaria, Gender-based violence as well as Alcohol and substances abuse. The project develops communication campaigns using booklets, television and radio dramas. The overall objective is to promote social behavior change through discussions sparked by the topics addressed and thus mobilizing communities to positive societal norms and practices. The excitement of this project is that it is community driven – in terms of research, deciding on topics to be addressed and
as participants. The aim is to promote ownership of the media products. Programs are also produced in the vernacular languages to ensure maximum reach of rural communities and semi literate people.
A logo and a brand name have been produced through rigorous community consultation and competitions. Among the short listed names “Dessert Soul” was chosen and the logo chosen consists of the Map of Namibia and the Red Cross symbol.
(A quote from a Namibian male on the Desert Soul Logo)
“You know, Namibia is surrounded by two desserts that represent the soul of
Namibia and we are very proud of them and this is what the project is.”
Research on the adaptation of the adult HIV/AIDS booklets was conducted in a form of literature review, stakeholder consultations and Focus Group Discussions among different age groups and sexes in rural and urban areas. Volunteers from Windhoek-based International University of Management and Namibia Red Cross trained staff conducted the research. The booklet would contain topics on stigma, discrimination, the rights of people living with HIV/AIDS and disclosure. The community and stakeholder consultation is to solicit for input on the relevance of the booklet in terms of content, layout, language and illustrations.
For Television, the Namibia Broadcasting Corporation was awarded a tender to produce a children‟s series called „Soul Buddyz.‟ The production content includes topics such as HIV/AIDS, disabilities, violence, safety, negligence and bullying. The 26 episode series is already in post-production stage and is envisaged to go on Air during the second week of September 2004. Community involvement is very high and as participants or interviewees and the children themselves as presenters, having under gone training. The objective is show real-life situation of health issues, especially HIV/AIDS by letting infected and affected people to do the talking instead of talking for them.
The Radio process is also in the process of adapting a 45 episode Radio drama that will be produced in 5 local languages that were chosen based on the HIV/AIDS prevalence rate and vulnerability. Topics to be covered in these episodes include HIV/AIDS, TB, and Depression and Land issues.
Namibia Reproductive Health Initiative project (NARHI)
NARHI project is a community - based programme focusing on the improvement of mother and child health as well as adolescent reproductive health as an entry point to address HIV/AIDS in Kavango and Kunene regions. During the period under review the project trained 388 volunteers to reach 49 227 people through information dissemination and awareness campaigns. Communities are given information and training in areas such as hygienic and healthy traditional birth as well as family planning to help women to live healthier lives and to reduce maternal morbidity. Remarkable impact on the lives of the targeted groups such as improved discipline among adolescents, increased attendance of women for mother and child services and increased number of people using family planning services has been noted.
Voluntary Counseling and Testing (VCT)
Namibia Red Cross in partnership with Social Marketing Association has opened a VCT (New Start) center in Katima Mulilo in 2003. The main purpose of the center is to increase access to VCT services to the community. As an entry point to HIV/AIDS prevention and referrals for care and support services for people living with HIV/AIDS (PLWHA).Since the inception, the center received 279 clients out of which 93 (33.3%)
tested HIV positive. The VCT is envisaged to go a long way in eradicating stigma and encouraging people to know their status in order to improve their health.
Water and Sanitation Project
Water and sanitation related diseases, despite being preventable, remain one of the most significant child health problems in Namibia. NRCS water and sanitation project in Kunene is aimed at reducing morbidity and mortality due to water and sanitation related diseases among children. The communities are actively involved as they have to take ownership of the water points and maintenance thereof. The training and maintenance is done in partnership with the Ministry of Agriculture, Water and Rural Development.
The Water and Sanitation Project is found in the Kunene area in Opuwo district. This area is habituated by nomadic Himba people who have kept their strong cultural practices including dressing despite the revolution of civilization. The project has so far installed 27 water pumps benefiting more than 450 homesteads in 27 villages. 202 volunteers in 41 villages were trained in hand pumps maintenance as well health promotion skills.
According to internal evaluation conducted within the project area, more than 86% of trained Health Promotion volunteers were actively conducting health education activities within their villages. 27% of people interviewed have reported a reduction in water and sanitation related diseases. On average 80% of people interviewed within project area are knowledgeable about water and sanitation diseases regarding its causes, preventions and correct ways of treating and managing of diseases.
The role played by women in the Water and Sanitation Project is a milestone towards eradicating gender stereotyping. In the Ovahimba community that is bound by strong cultural norms, women were perceived as being unequal to male counterparts and of lower status. As in most cultures, women are perceived as only child bearers and caretakers for homes and families. The Water and Sanitation Project in the Kunene Region has helped to cut the barriers in cultural practices that inhibit the empowerment of women. Through this project, Himba women have become active partners in the maintenance of water points and as beneficiaries as well as volunteers in promoting health and sanitation campaigns within their communities.
The recurrent droughts due to late or minimal rainfall have been one of the most life threatening phenomena to vulnerable rural communities in Namibia for the past decades. Last year alone, the country experienced a severe drought that affected more than 64000 people in the Northern part of the country. This has led to the government declaring an emergency appeal for assistance to affected communities particularly in the Ohangwena, Kavango, Otjozondjupa and Caprivi regions respectively. HIV/AIDS is also a major problem in most of these regions that are mostly rural.
The situation in Caprivi region was further aggravated by a devastating flood disaster that affected more then 12000 people in the Kabbe and Katima Rural Constituencies. At 43%, Caprivi region has the highest prevalence of HIV/ AIDS in Namibia.
The NRCS Disaster Management department with two sectors namely Disaster preparedness and Disaster response is aimed at reducing vulnerability of communities through the designing and implementation of appropriate responsive Programmes and mitigation activities.
The Department has been involved in various disaster management interventions where it successfully alleviated human suffering e.g. Drought relief interventions in Kunene in 1992- 1994, managing of Osire refugee camp in 1999 to 2001 and the recent floods operation in Kabbe and Katima rural Constituencies in Caprivi Region in June 2003. Continued support from the Federation has improved capacity of the Disaster Management Department and consequently contributed significantly to the achievements attained by the NRCS.
As part of disaster preparedness activities, a 5 year Action Plan was developed. The Action Plan is aimed at building the prevention and preparedness capacities of communities in disaster prone areas by strengthening systems at regional and community level. Emergency Management Unit (EMU) and Regional Management Unit (REMU) are multi sectoral Emergency structures that are coordinated by the Office of the Prime Minister at National level and Regional Governors at Regional level. The representation of NRCS at either structure has been an advantage and enabling factor to disaster management interventions to issues affecting the country as a whole. Additionally the National Society has contributed to Disaster Management issues within Southern Africa with 7 of its staff trained as members of the Regional Disaster Response Team (RDRT) for Southern Africa.
The Namibia Red Cross Society also has a First Aid department that also serves as a self-sustaining unit of the organization. Its objective is to build capacity of communities and other institutions in life-saving skills, while at the same time generate income by conducting some of its activities on commercial basis and selling First Aid kits to corporate entities and government institutions.
From January 2004 to date, 10 first aid courses were conducted. During the past year, 981 people graduated in First Aid courses of which 614 (62%) people graduated in Basic First Aid and 322 (32%) graduated in Mining First Aid. A number of Instructors in have also been trained under the First Aid Programme.
In May 2003 heavy rainfall alongside the Zambezi River caused the river to burst its banks sending floodwaters in the Caprivi Region, in the far north-east of Namibia bordering Zambia, Zimbabwe, Angola and Botswana. The floods submerged 22 villages and left more than 12,000 people homeless in the Kabbe and Katima rural constituencies.
In response to the Government appeal to assist the flood victims, the NRCS immediately mobilised its partners through the Federation and conducted an assessment that was followed by swift relief intervention by a Regional Disaster Response team comprised of members from sister National Societies of Zimbabwe, Zambia and Botswana. The relief operation that lasted for three weeks was aimed at improving the lives of vulnerable people affected by the flood through the provision of basic health services, water, sanitation and hygiene needs. Approximately 9000 people in 2000 households were provided with non food relief items including 24000 water purification tablets, 118 jerry cans, 1758 mosquito nets, 1542 blankets and 752 washing detergents. Additionally 48 NRCS volunteers received training on Health Promotion skills on water-borne diseases and hygiene behaviors.
Succeeding the relief operation, a review was conducted by a Federation representative to assess the impact of the relief intervention and to develop a long-term action plan. The assessment has confirmed that the relief operation has averted possible suffering of people due to the floods but has expressed a need for rehabilitation of effects of the floods particularly in the area of food security, water and sanitation and capacity building.
Humanitarian values - Information Dissemination
Activities in the Information Department are geared towards the promotion and dissemination of the Movement Fundamental principles and promotion of humanitarian values through information dissemination and advocacy Programmes. All activities re integrated in all Programmes nationwide. People reached through these activities have themselves contributed to influencing community behavior change on the essence of respect for life, human dignity. This based on the ideal that the NRCS as a voluntary humanitarian organization aims to prevent and alleviate suffering without discrimination on the basis of nationality, gender, race, religious beliefs, class or political opinion. In order for the Department to effectively ensure its services 5 Regional Managers and some HQ staff and 150 volunteers received training in communication skills, designing & presentation tools as well as reporting. The improved capacity of staff and volunteers particularly at community level as sense of ownership of the NRCS ideals as well as producing quality information materials especially on HIV/AIDS.
Organization Development (OD)
The increase of humanitarian needs in Namibia raises high anticipation from the public for NRCS to deliver more services in the communities. In order to effectively respond to the needs of the community, the National Society continues to improve its own organizational capacity. Governance structures at regional level are strengthened and
empowered. The capacity of staff and volunteers has been improved and contributed to the quality service delivery attained by the National Society.
Self-assessment activities carried out during the period under review have created urgency for the National Society to further improve its organizational structure, governance and management as well as employing capacity building strategies. Furthermore, as a way to scaling up humanitarian activities particularly in addressing the scourge of HIV/AIDS and other humanitarian needs, an appeal was launched through the Federation. Gender and age aspects are taken into consideration by ensuring that the most marginalized benefit and actively participate in the humanitarian activities.
NRCS‟s greatest challenges continue to be the improvement of the governance structure management systems, capacity building of staff and volunteers, establishment of NRCS presence through out the country and the alignment of Programmes with defined needs and priorities of most vulnerable groups in a sustainable manner.
Financial constraints in some projects hindered the progress on implementation as planned. Despite better coordination mechanisms in place, roll out plans especially in Anti-retroviral Treatment activities need to be accelerated to reach most vulnerable at grassroots level.
Social assistance remains the only source of nutrition for many vulnerable people and the Red Cross the only haven for such provisions. However unless funding is sustained, the hundreds of hungry people, HIV positive people (and especially HIV positive mothers who cannot breast feed their babies) who daily come at the Society to get food, will suffer.
MEASURING SUCCESS - ‘Complex but possible challenges’
The NRCS has continued to fight against issues that hinder progress in addressing HIV/AIDS such as Stigma and Discrimination, ignorance etc. To strengthen our messages, networks and alliances have been established with other Organizations under the same course, such as PLWHA, Home based care, Treatment and Voluntary Counseling and Testing. The Government has also modified its policies on HIV/AIDS by not only declaring the disease as an economical and social problem to the nation but most importantly to roll-out Anti-retroviral treatment to State hospitals. This ensured that the drugs are accessible even to the most vulnerable and poor who cannot afford to visit Private Doctors where the drugs were previously only accessed. However the numbers of people on Treatment is still small.