Content

Proposals in 2013

These are the proposals that German-supported health and social protection programmes submitted for publication in 2013. 


For 2013, the BMZ task force health selected two proposals for documentation: 

  • Occupational health and safety approach in the second largest shipyard in Bangladesh; and the
  • Policy dialogue for social health insurance reform in Mongolia.

The proposal from Namibia, Philipp Mwetu, came third in the task force's ranking and it was recommended to make it a priority candidate for documentation in 2014.

The proposals were discussed and voted on during an online event on 18 February 2013.

Watch the recording of the event (Duration: 01:27 hrs; Java required) and read below the proposals of the selection round 2013. We welcome your feedback at the end of the page.

A triple win situ­a­tion in Bangladesh: Healthy workers, healthy communities, healthy business

  • Alternative working title: Opening the door to better health in Bangladesh: Occupational Health & Safety is the key

Why should this approach be documented in the German Health Practice Collection?

The 2010 MDG review positions non-communicable diseases (NCD), including occupational health and safety (OHS), as a core de­vel­op­ment issue requiring urgent action in the post 2015 de­vel­op­ment framework. Omission of NCD indicators in the MDGs has been a barrier to securing donor funding for NCDs and occupational health interventions. Many donors exclusively fund the health priorities contained within the MDGs. However, 2.2 million people die yearly as a result of occupational accidents or work-related diseases (estimate In­ter­na­tional Labour Organization, ILO). By comparison, according to the WHO, only about 287.000 women die from pregnancy- or childbirth-related complications around the world every year. Especially in Bangladesh, an emerging manufacturing and export powerhouse for western markets, the OHS fatalities and accidents are staggering. Victims of workplace accidents and their families are prone to catastrophic health expenditures and risk being pushed into pov­er­ty. That is why innovative OHS models in de­vel­op­ing coun­tries, such as the Western Marine Shipyard (WMShL) example in Bangladesh, are critical to address the rising burden of NCDs.

The OHS intervention at WMShL goes beyond health only. It is in line with the GIZ core competence product of private sector de­vel­op­ment, and has synergies with other GIZ supported economic de­vel­op­ment and employment programmes in Bangladesh. Examples are the Promotion of Social & Environmental Standards in the Industry (PSES) project, and GIZ IS. It is also a clear-cut example of a de­vel­op­ment partnership (PPP) where public and private partners join forces to realize a project that is profitable for business partners and has a de­vel­op­ment benefit in a de­vel­op­ing coun­try.

Furthermore, with the growing influence of Corporate Social Responsibility (CSR) and the foreign buyers’ perception of domestic work practices means that for example shipyards have to adopt global standards in the areas of health and safety of their employees, the en­vi­ron­ment, and all the actors in its en­vi­ron­ment, in order to compete on the global markets. The collaboration between GIZ, WMShL and the Ministry of Health and Family Welfare (MOHFW) has demonstrated how this can be done.

WMShL is the second largest player in Bangladesh’s booming shipbuilding business.  Their core business is constructing and exporting customized ocean-going vessels for the in­ter­na­tional market. In Bangladesh, the export earnings from ships, boats and floating structures were worth $46.2 million in 2010-11 (Bangladesh Export Promotion Bureau), mainly for the German, Dutch and Danish markets. According to an estimate of the Government of Bangladesh, it will contribute 4 to 5 % of the national gross domestic product by 2015 and would become a $ 2 billion industry in five years’ time (BBC, 24 August, 2012) Furthermore this sector has potential to create 1 million jobs in addition.

In line with the laws and principles as stipulated in the In­ter­na­tional Labour Organization’s Constitution, GIZ has supported WMShL to implement a holistic quality management approach towards OHS, which promotes the rights and involvement of all members of the workplace. This system has been designed to engage the workplace to perform on-going tasks and functions, track hazards and incidents and highlight the overall OHS performance over time. The system is maintained and managed by the shipyard. The shipyard has employed one on-site OHS advisor who supervises 24 safety advisors. Their work underpinned by rigorous performance monitoring and policies to provide strategic direction to the management and OHS programme management team.

Due to the measures introduced under this partnership, the injury rate of the 3000 workers at the shipyard has dropped by 99% from the baseline data, i.e. from more than 1000 to less than 10 per month. As a result of the effective establishment of a comprehensive occupational and safety system, the shipyard has now acquired OHSAS 18001, the world’s most recognized OHS management systems standard. WMS is one of the few companies, and the first shipyard in Bangladesh to obtain this. It has also acquired ISO 14001, an internationally recognized standard for environmental management of businesses. Their efforts on how to reduce environmental waste have to a better understanding how the company uses materials, and manages energy. This in turn has reduced operational costs and has improved efficiency. By acquiring these in­ter­na­tional certifications potential trade barriers have been removed.

The partnership covers more aspects. It has not only resulted in significant improvements in the health and safety of shipyard workers, but also better health for com­mu­ni­ty members. Through a Public Private Partnership (PPP) between WMShL and the MOHFW, a newly established health center at the shipyard not only provides health services to the workers, but also to the health needs of approximately 25.000 people in the surrounding com­mu­ni­ty. In line with national policy and practice, it provides family planning and maternal and child health services, including immunizations. Over the last year and half, more than 11.000 patients have visited the health facility.

What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner coun­try’s popu­la­tion?

The WMShL intervention is a component of the Multi-Sectoral HIV/AIDS project. This project will end on December 31 2012. As one of the few examples in Bangladesh of a collaboration in OHS which has led to in­ter­na­tional certifications, it has significant potential to be scaled up to other business sectors such as the rapidly expanding garment sector and leather industry. Following a devastating fire at a large garment factory on November 24 2012, in which at least 112 workers died, the debate on workplace issues such as OHS and workers’ rights has intensified. In the wake of the tragedy, foreign consumers and buyers are critically eying Bangladesh’s private sector and its services. Recognizing that poor workplace conditions and practices have potential to seriously tarnish the name of Bangladesh as a manufacturing hub, the gov­ern­ment has now acknowledged the need to enact legislation to reform the labour law and mainstream OHS in workplaces. WMShL is one of the few best practice examples in OHS in Bangladesh, and it has internationally recognized certificates to prove it. At this critical moment, the policies and frameworks developed within the WMShL collaboration have significant potential to contribute meaningfully to the national occupational health policies for Bangladesh.

'A triple win situation' at a glance

Improving quality and access to health services: Support to the reform of the social health insurance in Mongolia

Why should this approach be documented in the German Health Practice Collection?

Despite the existence of a social health insurance system, insured are paying an increasing amount out of their own pockets in order to receive adequate treatment for health care services. The health associated financial risks are therefore rising and the acceptance of the social health insurance system is diminishing. In order to address this issue a comprehensive capacity de­vel­op­ment approach has been implemented with the goal of strengthening the health care system by improving operational capabilities of institutions of the social health insurance system and quality of care on a sus­tain­able basis. The approach focused from the outset on individual and organizational capacities as well as on network and system de­vel­op­ment. At the same time it ensured participation of a wide range of stakeholders and alignment with national strategies. Subsequently, this resulted in strong empowerment of the corresponding partners for independent further de­vel­op­ment and institutional learning and led to high ownership of implemented activities, building the basis for long term sustainability. Due to the fact that the approach is based on the general capacity de­vel­op­ment model, transferability to other contexts is feasible. Gender-sensitivity of the approach has been assured by e.g. conducting gender-differentiated surveys and stressing gender issues in discussions on the improvement of quality and access to health care services. Furthermore, as the only active project in the social health insurance sector, the approach could strongly contribute to raising the profile of the German-Mongolian De­vel­op­ment Co­op­er­a­tion.

What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner coun­try’s popu­la­tion?

Project implementation started in January 2011 and is implemented at national level. As social health insurance is compulsory by the Mongolian law, the approach covers the whole popu­la­tion.

In the area of strengthening the management and organizational capacity of the social health insurance institution, a basis for continuous improvement of the functionality of the institution has been established as shown by the following outputs and outcomes:

Based on an organizational assessment the social health insurance institution developed with support from the project and through a wide participatory approach a business de­vel­op­ment plan in order to describe the midterm de­vel­op­ment strategy of the social health insurance for 2012-2016 in practical detail. The document has been approved by the National Social Insurance Council and represents the first comprehensive strategic document in health insurance history in Mongolia. Within the framework of the mid-term strategic plan, a human resource de­vel­op­ment program for the social health insurance institution has been designed, including a training package developed by a working group of the Social Insurance General Office with facilitation and support from the project. Training implementation will be carried out nationwide in 2013. Additionally, the number of staff carrying out the activities of the health insurance nationwide has increased by 68% since project inception, exceeding the project indicator of 60% by 2013.

In the area of improved quality and access of the social health insurance services for the insured, a mechanism for quality control of the services of health service providers has been agreed upon by responsible norm-giving institutions and put into practice in selected hospitals as shown by the following outputs and outcomes:

In line with the mid-term strategic plan, a continuous quality improvement program of health services for insured developed by the social health insurance institution with support from the project was approved by the relevant authorities. As part of the program, training packages have been designed and implemented nationwide first by the project and then by a working group within the Social Insurance General Office. As a result of the quality improvement program, the number of clinical guidelines and standards in hospitals has increased by around 25%. Additionally, the program involved the renewal of the contract format between the Social Insurance General Office and health care providers, which has been approved by the Health Insurance Sub-council. In the amended contract format, new instruments and methods like peer review, claim check and patient satisfaction surveys, were incorporated. The regulation on peer review was approved by the official order of the relevant authority and the new contract format has been implemented in four selected hospitals. Consequently, the workload of health inspectors responsible for these hospitals decreased by 40-50% and constructive collaboration and open discussions between stakeholders could be established. The Social Insurance General Office also improved availability and access to information on social health insurance for the insured and institutions of civil society by e.g. the establishment of a hotline and conducting nationwide social marketing activities based on a social marketing program that has been developed in collaboration with the project.

In the area of strengthening the social dialogue and consensus among social health insurance stakeholders, relevant civil society organizations participate actively in strengthening the social dialogue as shown by the following outputs and outcomes:

As a consequence of empowerment of relevant stakeholders due to capacity de­vel­op­ment activities of the project, a program to strengthen the social dialogue among social health insurance stakeholders has been initiated by the Trade Union and Employers’ Association. For this purpose a working group has been established by the Employers’ Association. Both, the Trade Union and Employers’ Association, carry out individual and joint activities on social health insurance related issues facilitated by the project. They also publicly confessed to integrate elements supporting the social dialogue into their activity plan. The inclusion of these stakeholders in planning and decision making processes contributed to a trans­pa­rent and efficient management of insurance premiums and public funds. Furthermore, public discussions on social health insurance could be triggered through publishing corresponding newspaper articles.

In the area of facilitating reforms to improve the legal and institutional framework of the social health insurance system the following outputs and outcomes could be achieved:

A draft law on the comprehensive reform of the social health insurance could be formulated with the technical assistance of the project and is now being discussed in the parliament. Additionally, initiated by the project,  a long-term policy paper on social health insurance using a participatory approach is being developed by a multi-stakeholder working group established by the Ministry of Population De­vel­op­ment and Social Protection and the Ministry of Health. The process is facilitated by the project in collaboration with the "Providing for Health" sector initiative. An integrated draft of the policy paper was presented at the national forum on Social Insurance Reform with 250 participants and met with a wide response in local media. The final policy paper will form the basis for future legislation and stakeholder coordination in the area of social health insurance.

Overall, as a consequence of successful project implementation the department for social health insurance strengthened its position within the Social Insurance General Office and Ministry of Population De­vel­op­ment and Social Protection. By facilitating the de­vel­op­ment of several key documents the project could add to im­por­tant milestones regarding optimization of structures, processes, human resource management and interaction with the civil society. Furthermore, the project activities significantly contributed to sensitization of stakeholders, recognition of the relevance of the social health insurance and willingness of decision makers to implement fundamental processes of change. Importantly, all achievements were accomplished with only little financial means in a relatively short period of time, proofing high effectiveness and efficiency of the approach.

'Improving quality and access to health services' at a glance

Applicants

Reform of the social health insurance in Mongolia
Werner Kosemund, Portfoliomanager GIZ Office, Ulaanbaatar
Deutsche Ge­sell­schaft für In­ter­na­ti­o­nale Zu­sam­men­ar­beit (GIZ) GmbH
werner.kosemund@giz.de
+976 7011 5340

Urtnasan Tsetsegmaa
Director General Social Insurance General Office (SIGO)
Ministry of Population De­vel­op­ment and Social Protection (MoPDSP), Mongolia
urtnasan.ts@ndaatgal.mn
+976 9911 3392

Philip Wetu: A multimedia and multi-channel approach to HIV awareness in Namibia

Why should this approach be documented in the German Health Practice Collection?

The drama "Three and a Half Lives of Philip Wetu" follows the life of a young, attractive IT professional in Windhoek and his multiple relationships with women. The story focuses on relationships against the background of HIV prevention. It illustrates the risks in multiple concurrent partnerships and entering a sexual network. By actively involving the audience in the decision-making process, "Philip Wetu" invites for lively, personalized discussions, which are guided by trained facilitators. The choice of a male as the lead character emphasizes the importance of men’s involvement in successful HIV prevention. The "Three and a Half Lives of Philip Wetu" has found application in various contexts throughout Namibia and the region and is therefore an excellent example to be included in the German Health Practice Collection.

The concept of Philip Wetu has been developed according to the Namibian context of high HIV prevalence and associated topics such as multiple and concurrent partnerships, gender, condom use, HIV testing and others. Numerous focus group discussions and stakeholder meetings have been held to develop the characters of the story and thereby ensured that target groups (students, workers, etc.) can identify with them and the situations they find themselves in. The story represents the real life of Namibians. It is therefore not ‘them’ who are at risk, who have the problems, but it is actually us, the people around us, our friends, the men and women that are admired for their lifestyles.

The story of Philip Wetu has been published in two different formats, a film and a comic, whereas the latter has been issued in weekly episodes in the local newspaper "The Namibian" as well as in comic book form.

Both formats have laid great emphasis on interactive approaches. Using a unique format, the film stops at pivotal points in Philip’s life allowing the audience to choose the direction Philip should take, each leading to different outcomes. Whether to do an HIV test or not; whether to tell his long term partner about an affair or not. The film is shown in facilitated settings to encourage constructive discussions and ensure active participation to create awareness about gender roles, HIV testing and treatment and so on. When the movie was broadcast on national TV, the audience was able to vote per SMS on Philip’s decision, followed by studio discussions with experts.

The comic is divided into 13 episodes each ending with Philip Wetu asking an open question to the reader. The participatory approach was continued for the comic as well. In the newspaper format, readers had the opportunity to respond via SMS and Facebook and could thereby also win a meeting with the main actor. The comic book version is also designed for a facilitated setting as each episode is accompanied by educational guidance notes to encourage discussions after each episode.

Several stakeholders have been involved in the de­vel­op­ment and roll out of the "Three and a half lives of Philip Wetu". The creation of the story and its characters has been supported by the NGO NawaLife, the Goethe Center and funding from USAID/PEFAR. The main partner organisation is Positive Vibes, an innovative HIV and AIDS communication initiative based in Namibia, which trains facilitators for the movie and can also be requested to facilitate screenings. The media NGO Steps for the Future, based in South Africa, is the partner for distributing the comic throughout the Southern African region and also offers training on the usage. For the of the comic book, the programme partnered with teaching students from the University of Namibia for the de­vel­op­ment of the educational guidance notes as well as with the Namibian Institute for Educational De­vel­op­ment (NIED). NIED included the comic book on the resource literature list for its life skills subject and 2000 copies of the book will distributed to schools in Namibia.

What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner coun­try’s popu­la­tion?

A broad based marketing and distribution strategy ensured that the movie and the comic reached a wide audience both regionally and nationally. Public sector institutions, a wide range of NGOs, the University of Namibia and the Polytechnic, workplaces, National TV and Steps for the Future acted as multipliers. The film has been shown in facilitated way all over the coun­try and has also been distributed by Steps for the Future in the Southern African region. In 2009 Approximately 1000 Namibians had taken part in a facilitated screening of the Life Choices film. Moreover, there are now 130 qualified trainer equipped with manuals and films. In the Year 2012 800 copies were distributed to and trainers were trained in Botswana, Lesotho, Zimbabwe, Zambia, South Africa and Malawi. The comic has been published in the national newspaper the Namibian in 13 episodes (one per week). 2000 copies of the comic book will be distributed to schools all over Namibia.

Qualitative interviews were conducted with partner organisations and beneficiaries (i. e. ministries). The movie received an overwhelmingly positive feedback from the audience in all reported screenings and was especially well received by young people. This also provided valuable input for improvement of the implementation. Suggestions were to translate the movie into other languages, train more facilitators especially for remote regions and do multiple day screenings to reach more individuals.

Further data is available on text messages received and Facebook interactions for the newspaper edition. Many individuals used this way to privately way to share their stories and thus could be given advise and/or referred to counsellors.

'Philip Wetu' at a glance

Applicants

GIZ Multisectoral HIV and AIDS Response Project
P.O. Box 8016
Windhoek, Namibia
Luise Haunit, Technical Advisor
Email: Luise.haunit@giz.de
Tel.: +264 61 402 697
Fax: +264 61 231541

Positive Vibes
Casper Erichsen
Pasteur Str 49
Windhoek, Namibia
Email: casper@positivevibes.org
Tel.: +264 (0) 81-239 2675
Fax: +264 (0) 61 62262376

The role of com­mu­ni­ty participation within the Regional Funds for Health Promotion in Cameroon

Why should this approach be documented in the German Health Practice Collection?

Initiatives on com­mu­ni­ty participation in health aren’t new in the African Region (cfr. Mali and others) where they play a role in the primary health care but the implementation on such a high level regarding the ownership of drugs distribution seems to be quit unique.

For almost 25 years the former GTZ (now GIZ) is involved in the Regional Funds for Health Promotion (French;FRPS) in three out of the ten regions in Cameroon. In the beginning, these Funds had to ensure a better liberation of essential drugs for the popu­la­tion in the North West, the South West and the Littoral Region. To obtain this objective, a strong collaboration between the Ministry of Public Health (through the Regional Delegation of Public Health), the Dialogue Structures (com­mu­ni­ty participation) and the Financial and Technical Partners was established which resulted in the creation of these three Regional Funds for Health Promotion.

Since 2010, the Cameroonian Government requested the German Co­op­er­a­tion (and their partners in the Sector Wide Approach unit in the Health Programme; AFD, KfW and WB) to extend this approach also to the seven other regions in the coun­try. The innovation of this concept is that the popu­la­tion, through the dialogue structures (starting on grass roots level in the com­mu­ni­ty health centres, through the district level in the district hospitals, up to the Regional level in the FRPS) are involved in decision making on health issues and that they have a hand in how profits of this mechanism are reinvested in the health issues of their region.

Special attention was given to the gender aspect ensuring that especially women were encouraged to run at these elections for the dialogue structures as they are usually the ones that have to deal with health issues in the family.  On a regional level, elected representatives of the com­mu­ni­ty are part of the management team of the Regional Funds for Health Promotion (FRPS). This way of organizing the governance of health promotion services and, more importantly, this way of ensuring the availability of drugs at the local level is pretty unique on the African continent.

Seen the fact that the FRPS have become a coordinating Regional mechanism that, beside the management and distribution of drugs, together with the Regional Delegations invest in other health programs such as a hospital maintenance unit, a Regional cell for mutual health schemes and others, the social protection profile of this approach is also evident.

The FRPS buys currently the essential drugs -on a central level- at the CENAME which is a governmental institution (French; CEntral NAtional d’approvisionnement en MEdicaments et consomables) and ensures on Regional level the management and distribution of these drugs to service delivery points (health centres, hospitals). With the profit made by carrying out this service, the FRPS ensure a sus­tain­able mechanism that has a trans­pa­rent way of management as the accountancy (gains, investments, reserves…) are discussed in the three monthly management committees where com­mu­ni­ty representatives take part. Prices, at which the drugs can be sold in districts and health centres, are fixed by the central level and it is this revenue that ensures the “income” of the FRPS and its sustainability. The legal status of the FRPS as a Public Investment Group, soon to be ratified by the Prime Minister’s office of Cameroon, ensures also a solid basis for the future.

What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner coun­try’s popu­la­tion

The three existing Funds have every three months a “management committee” and once a year a general assembly. In these management committees, as well as in the GA’s, the turnover of drugs management, and how it should be reinvested in health initiatives, is discussed. Best evidence of the functioning of this initiative is here as the General Assembly of the FRPS discusses on how profits are reinvested in healthcare in the Regions. These reports and decisions are available.

The advantage and the force for the Regional popu­la­tion of the FRPS, in comparison with the other Regions where the management of drugs is done by a so called CAPR (Centre d’Approvisionnement Pharmaceutique Régional), is the fact that the FRPS deliver the drugs to the hospitals and to the health centres since the vehicles are the property of the FRPS. In most other regions, the Service Delivery Points have to collect the drugs themselves from the Region and with no transport ensured, this causes many problems.

There is also a so called “solidarity mechanism” meaning that the price of the drugs is kept the same everywhere within the FRPS Regions. There are no added extra’s for transport costs to remote areas, something you often see in the other Regions. This is a mechanism that improves accessibility to drugs for the poorest popu­la­tion far away from the Regional capitals and distribution centres.

Already these two mechanisms ensure a better availability of drugs and a better access for the popu­la­tion towards essential drugs in the FRPS Regions. The fact that the Ministry of public health requested the German Co­op­er­a­tion to help and install also FRPS in the other seven Regions of the coun­try is also a good good indicator that the approach does work and ensures access for the popu­la­tion to essential drugs. Fact that first the dialogue structures are “re-boosted” from the grass root level (“comité Sanitaire” in health centres) through the district hospitals (with the comité Sanitaire du district”) to the Regional level to ensure that we have a trans­pa­rent and good trained com­mu­ni­ty participation before installing the new FRPS is a logical and essential step. You can imagine that also on grassroots and district-level these COSA’s and COSADI’s follow closely drug distribution and availability for the popu­la­tion as this has an impact on their means.

Meanwhile, the turnover of this mechanism (money that is paid by the popu­la­tion to buy drugs) is reinvested in other health issues in the Region such as support to health scheme initiatives, hospital maintenance initiatives support to Performance Based Finance initiatives and on. In that way, representatives of the popu­la­tion have a decision making role -and therefor ownership- in what happens with “their own money”.  A point of attention is that the national drugstore (CENAME) knows, on a regular base, stock outs. In the CENAME, there’s no com­mu­ni­ty participation as this a purely governmental institution.  As the FRPS are obliged to buy their drugs here, it means also that they are confronted with this same problem. To resolve this, we added in the new convention (that will give a legal status to the FRPS), the article stipulating that in case of the unavailability of a drug in central level (CENAME), the manager can -72 hours after his request- buy the drugs through another authorised dealer ensuring the access of this drugs for the popu­la­tion in their Region.

We have studies available

  • On the state of dialogue structures before our interventions and after our interventions.
  • On the impact for the popu­la­tion.
  • On the availability of MEGs (Medicaments Essentielles Générique) in the Regions WITH a FRPS and others with a CAPR structure.
  • The most recent study is the one conducted by the CDC where the FRPS are one of the 500 objects studied on the de­vel­op­ment of evidence based recommendations and their results should be published in the upcoming months. The preliminary results on this study on the systematic review on effectiveness and costs of strategies to improve health worker performance in low and middle income coun­tries is however available.

In the Reports of the existing FRPS, the investments of the turn-overs of these FRPS are clearly stated. The GIP convention (to be ratified soon by the prime ministers’ office) has the signature of the Minister of Public Health for the governmental part, from the German Ambassador representing the Financial and Technical Partners and from the com­mu­ni­ty representative of the Region and this convention will be used as a basis to create other FRPS.

'Community participation within the Regional Funds for Health Promotion' at a glance

Applicants

GIZ Cameroon, Programme Germano-Camerounais de Santé/VIH-SIDA (PGCSS)
Marc Ramaekers, Technical Advisor FRPS
Email: marc.ramaekers@giz.de
Tel.: +237 76971260

Ministry of Public health of Cameroon
Dr. Sa’a, director health promotion
Email: dr_saa2005@yahoo.fr
Tel.: +237 77741704

Healing through the Arts: How Applied Theatre and Drama and Drama Therapy can heal trauma and create awareness around HIV and AIDS

Why should this approach be documented in the German Health Practice Collection?

a) Drama for Life (DFL) is the only applied drama programme in the world that examines how drama can become an effective process that moves beyond a dialogue of binaries; how drama can engage the whole person as an agent of his or her own destiny within a social context driven by cultural, national and global forces; how drama can enhance intrapersonal and interpersonal  awareness about critical health, human rights, social justice and environmental issues; how drama can develop a reflective practitioner who isn’t afraid to ‘look from the outside’ and to simultaneously ‘look from the inside’; and how drama can foster a humanity that is founded in principles of service to com­mu­ni­ty, empathic leadership and creative and compassionate engagement in learning.

In five short years Drama for Life has grown into an in­ter­na­tional academic, research and training programme that spans across Africa and abroad with alumni, academic and non-governmental partners. Through applied drama Drama for Life engages future leaders in the field to become artists who understand the ethical and contextual issues related to drama that is used as a learning method; drama that shapes research; and drama that can be used to bring about social behaviour change around HIV and Aids.

Drama for Life is the only programme that offers degrees in Drama Therapy in Africa and currently is Africa’s leader in an interdisciplinary and integrated approach to Applied Drama, Arts Education and Drama Therapy.

b) The multi-sector HIV&AIDS prevention programme of the German De­vel­op­ment Co­op­er­a­tion contributes to a joint approach to reduce HIV incidence and therefore to strengthen the social stability of South Africa.

The objective on programme level is to achieve that vulnerable popu­la­tion groups increasingly make use of adequate service and support measures of HIV prevention offered by all sectors involved. The programme aims at enhancing HIV/AIDS-prevention and fighting the disease in a multi-stakeholder approach.

The target groups are those popu­la­tion subgroups that are most affected by HIV&AIDS – people who are exposed to a high risk of getting infected and/or who suffer most the consequences of the epidemic .

Drama for Life forms part of GIZ South Africa’s strategy to support NGOs active in the field of HIV&AIDS prevention in the de­vel­op­ment of innovative intervention approaches to fight stigma in the form of youth de­vel­op­ment and com­mu­ni­ty dialogues. Drama for Life serves a large student com­mu­ni­ty that is considered an HIV risk group in South Africa.

c) Drama for Life officially piloted in 2008 with the first enrollment of 29 scholars from 9 African coun­tries. In the beginning of the programme, DFL only hosted an academic programme. In the last 4 years, Drama for Life has grown to a unit at Wits University that hosts an academic programme,a research programme and 8 projects that impact different communities in South Africa. Through its unique study package, as well as its unique projects, DFL has managed to establish its own brand that gets recognized in Africa and parts of Europe, Canada and the US and attracts oustanding practitioners and academics in the field of Applied Theatre and Drama to attend DFL events, conferences, festivals etc. DFL alumni successfully work as DFL practitioners in their home coun­tries implementing applied drama and theatre strategies they have learned at DFL.The programme already has been approached by other African universities who would like to implement the academic programme at their institutions.

In 4 short years Drama for Life has qualified over 80 scholars from 15 different African coun­tries that use, teach and transfer the skills of applied theatre and drama to other African coun­tries.

Currently more than 25% of Drama for Life alumni work in universities across the continent; more than 45% are now in senior management positions; more than 32% have gone onto Masters and PhD studies in public health, popu­la­tion de­vel­op­ment, education, migration studies, drama therapy, applied drama, theatre directing and performance studies; more than 20% have won further scholarships and awards for further study and or participation in national and, or in­ter­na­tional programmes; more than 93% have engaged as consultants offering training to organisations and projects that are engaged in serious health, social and de­vel­op­ment issues, and more than 70% avow that they are still deeply rooted in the art of theatre-making.

DFL is hosted at Wits University. Wits makes major infrastructural contributions to the programme, reducing financial, space and administrative pressure. DFL is fully administered and audited by the Wits Financial systems and all other support systems. Annually DFL organizes a fundraising event, the money raised goes into the sustainability plan of the organisation. DFL has made substantial funding applications to the National Lottery, EU and other sources. DFL is given an academic budget that includes some staffing. Besides GIZ funding, the programme is currently supported by:

  • The Goethe Institut
  • Business and Arts South Africa (BASA)
  • The National Arts Council (NAC)
  • The National Research Foundation (NRF)
  • The President’s Emergency Plan for Aids
  • Relief (Pepfar)
  • Rand Merchant Bank
  • Oppenheimer Memorial Trust
  • Ford Foundation
  • Flow Communications
  • Open Society Initiative of Southern Africa
  • (OSISA)
  • Wits Transformation Office
  • Wits Student De­vel­op­ment and
  • Leadership Unit (SLDU)
  • Wits Counselling and Careers De­vel­op­ment Unit (CCDU)

What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner coun­try’s popu­la­tion?

List all internal monitoring and evaluation reports, external evaluations and other studies that provide evidence for the effectiveness of this approach. Also, please explain how long this approach has been implemented and to what level/coverage it has been scaled up.

A self evaluation academic progress report is written by each scholar at the end of every semester. Within the other project activities, project teams and committees that report to a central DfL structure/working group ensure that project plans are effectively implemented. A Monitoring and Evaluation Committee, comprising of lecturers and students has been put in place to undertake the process of data collection and analysis. Quarterly and annual progress reports are made available to donors and sponsors in the required formats and are also used for decision-making purposes in the improvement of the programme. Monitoring of progress in home coun­tries are tracked through the project’s mentoring system and a quarterly progress reporting structure for the students. The model used for evaluation is a ‘Logic Model’. External evaluators are engaged for specific projects.       

'Healing through the Arts' at a glance

Applicants

Drama for Life
Miriam Behrendt, GIZ Junior Advisor
Drama for Life, Wits University
Email: Miriam.Behrendt@giz.de / Miriam.Behrendt@wits.ac.za
Tel.: +27 11 71 74 733

Drama for Life
Warren Nebe
Director
Email: Warren.Nebe@wits.ac.za
Tel.: +27 11 71 74 729
Fax: +27 73 671 2500

Rolling out public sector workplace programmes in councils in Tanzania

Why should this approach be documented in the German Health Practice Collection?

Since 2007 the Tanzanian German Program to Support Health with Health Focus as sub-contractor, supported ten Tanzanian ministries and gov­ern­ment institutions in implementing HIV workplace programmes for their employees. It was found par­tic­u­lar­ly challenging to address the 250,000 public servants employed in the coun­try’s periphery.

To reach the public sector workforce in the rural and remote parts of the coun­try a rights-based council-level campaign approach was taken from July 2009 on.

Cross sector one-day seminars were held with public servants at ward level. The seminars combine the dissemination of comprehensive bio-medical, psychosocial and legal HIV information and offer on-site VCT services.

The rights based seminar program refers to the “Circular No 2 on non-discrimination and support for HIV-positive public employees”, the “Guidelines for managing HIV and AIDS in the public service”, the “Code of ethics and conduct for public service” and the “Prevention of corruption act”. The latter is used to broach the issue of sexual harassment in the workplace. The program highlights public servants’ personal rights, their duties and responsibilities. It offers comprehensive information on HIV and STIs, demonstration and practice (on models) of correct condom use and it provides the opportunity to test for HIV.

The innovation lies in the initiation of a multi-dimensional social process at com­mu­ni­ty level. There is individual empowerment through the promotion of personal rights, through the transfer of concrete HIV and STIs knowledge and skills in correct use of condoms as well as through reduced barriers to HIV testing.

On the other hand the public servants, being resource persons in their communities, learn to communicate about sexuality and HIV. They become a critical mass for fighting stigma and discrimination, for advising other com­mu­ni­ty members on HIV, and for supporting and organising joint action against HIV at com­mu­ni­ty level.

It is a process that fosters power in people for use in their own lives, their communities, and in their society by learning to act on HIV and AIDS.

In implementing this rights based intervention(s) a structural approach was taken advocating firstly for the buy-in of the Regional Administrative Secretaries (RAS). The RAS facilitated the coordination with the councils. At council level the modus operandi was agreed upon and translated into roll-out plans to the ward level.

The strategy contributes to the MDG 6 and is based on in­ter­na­tional recommendations such as the ILO /2010): Recommendations concerning HIV and AIDS in the World of Work (No. 200), as well as on BMZ and GIZ policy papers, recommendations respectively guidelines:

  • BMZ (2009): Sector Strategy (187): German de­vel­op­ment policy in the health sector (chapter 4)
  • BMZ(2012): Decade of German support to workplace health
  • GIZ (2011): Guidelines for Driver Health Management.pdf
  • GIZ (2011): Integrated Health Management at the Workplace.pdf
  • GIZ HIV-Arbeitsplatzprogramm

Transferability: As mentioned earlier a rights based approach was taken to address the HIV problem in public sector workplaces in the periphery of Tanzania (Circular No 2 on non-discrimination and support for HIV-positive public employees, the Guidelines for managing HIV and AIDS in the public service, the Code of ethics and conduct for public service). Most African coun­tries have adopted similar legislation and issued comparable policies and guidelines. Apart from the approach, there are similarities with regards to the administrative system (division into regions/provinces, districts and sub districts) and central and local gov­ern­ment structures.

Participation and empowerment: Comprehensive capacity de­vel­op­ment through

  • Participatory curriculum de­vel­op­ment for council-level seminars (with experienced lecturers/tutors from the Tanzania Public Service College - TPSC);
  • ToTs building training capacity of TPSC and the Local Government Training Institute (LGTI) in Hombolo;
  • En­gage­ment of regional and council administration (regional administrative secretariats and council management teams) for in kind contributions (venue, allocation of a gov­ern­ment official for information/mobilisation of participants, a car and driver, fuel, generator and snacks and refreshments for participants).
  • Empowerment of public servants through information about their rights and duties, passing on of comprehensive knowledge on HIV and STI prevention and treatment and the provision of on site HIV testing and counselling opportunities.

Gender sensitivity: Seminar curriculum includes discussion of gender roles and stereotypes as well as sexual harassment in the public workplace.

Sustainability: Existing Tanzanian policies, guidelines and legislation are disseminated and implemented. The capacity of national training institutions for public servants (Tanzanian Public Service College and Local Government Training Institute) was developed. The TPSC receives already requests for further seminars from ministries and agencies. Assessments show that public servants pass on their new knowledge in their communities and encourage family and friend to test for HIV.

What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner coun­try’s popu­la­tion?

The rights based district campaign approach was first tested in 2009 and rolled out from 2009 – 2012. It has so far covered 3 Regional Administrative Secretariat (RAS) Offices and 18 Councils (in Tanga, Mtwara, Lindi). A total of 18,917 public servants participated  (about 70% of the targeted workforce) in the seminars (10,353 (55%) men and 8,564 (45%) women). 10,343 public servants were tested for HIV and counselled (54.7% of participants,  53.7% of men-55.9% of women). 412 (4.0%) were found HIV positive (men: 3.0% and women: 5.1%).

'Workplace programmes in Tanzania's councils' at a glance

Applicants

Tanzania German Programme to Support Health (TGPSH)
Inge Baumgarten, Programme Manager,
Email: inge.baumgarten@giz.de
Tel.: +255 22 2122044/66

Health Focus GmbH
Gerlinde Reiprich, Technical Backstopper
Email: reiprich@health-focus.de
Tel.: +49-331-2000 70

Fidelis Owenya, Team Leader
Email: fowenya@yahoo.com
Tel.: +255-784300104

BMZ glossary

Close window

 

Share page