Nazarene Compassionate Ministries Inc. (NCMI) will rapidly scale up its HIV/AIDS prevention services in

Ethiopia using faith-based and community-based networks of churches, mosques and schools.

The NPI abstinence, be faithful (AB) project promotes primary and secondary abstinence until marriage

among youths, faithfulness among married couples and reduction of sexual coercion and abuse. The AB

prevention program follows the successful peer education model developed by Food for the Hungry and

successfully implemented with track one ABY PEPFAR funding with Fayyaa Integrated Development

Association (FIDA) as a subpartner. The model involves youth-to-youth (Y2Y) groups of 14 leader youth

(LY) per group led by trained promoters who provide ongoing training for the LY to lead their peers in

additional groups of 14 through 12 months of training and discussion of Choose Life, a curriculum

developed by World Relief with supplemental enhancements provided from Food for the Hungry (FHI). This

program promotes a positive approach to abstinence and uses barrier analysis and behavior change

communication methods to identify and overcome barriers to abstinence and faithfulness. In addition,

married couples will attend small group (5-6 couples) discussions on the weekends. Trained co-promoters

will moderate the discussion on a voluntary basis. This activity uses the Faithfulness manual produced by

Food for the Hungry International.

The program will promote abstinence among youths, youth leaders, and leader youths primarily through

church youth groups and secondary schools through participatory education and behavior change

communication techniques. Using an integrated approach, a variety of creative methodologies will be used

to reinforce abstinence and faithfulness messages, including videos, school events, sporting events, drama,

and music. Parents/guardians will also receive prevention training and will be encouraged to support the

commitment of their children in remaining abstinent and to serve as co-promoters for the Y2Y groups.

The program will make significant progress in FY08 toward end of project targets by utilizing the

multiplication effect of the Y2Y training model in training promoters for ongoing training of groups of leader

youth, who will in turn train their peers in small groups. In FY08, the partnership will reach 68,691

individuals with direct AB promotion through AB training.

Couples will be encouraged to remain faithful by attending faithfulness classes, primarily in church-based

training events, and discordant couples will be encouraged to protect the uninfected spouse through correct

usage of condoms. Volunteer co-promoters will receive monthly incentives to enable them reach the clients

and reduce volunteer burnout.

NCMI will work through its lead agency, FIDA, operating in partnership with sub-recipients Justice for All-

Prison Fellowship Ethiopia (JFA-PFE). FIDA is already working in Ethiopia under a PEPFAR AB grant

through a Track 1 subgrant from Food for the Hungry International Ethiopia. This ongoing alliance under the

New Partners Initiative (NPI) provides prevention programs through abstinence and be-faithful (AB)

messages and training reaching 68,691 youths and adults in FY08. Individuals practicing unsafe sex will be

counseled on safe sex and referred for condoms to health institutions and other service outlets. Moreover,

motivational interviewing will be conducted with these beneficiaries to encourage behavior change. NCMI

will also work and share experiences from project activities and exchange best practices with Samaritan's

Purse and other partners working on AB.

The NPI AB project serves youths aged 10-26 and married couples. The targets will be reached through

schools, churches, mosques and youth associations. In addition, youth prisoners will be accessed through

prison officials, who are at the same time co-promoters for AB messages.

For ongoing quality assurance of the AB program, NCMI is placing a high priority on strengthening

monitoring and evaluation systems for the AB program in FY08. Posttests will be given to the youth after

every three sessions to ensure that youth are retaining the AB messages. The youth leaders are expected

to score 70% in their posttests, and those who fail to score the minimum result will be advised to attend

make up sessions. The tests will be prepared centrally and sent to the project sites. Quality improvement

and verification checklists will be used in activities such as trainings and counseling sessions to ensure the

quality of the service provision.

The project design seeks to ensure sustainability by building ownership from within at the local community

level and at the local nongovernmental organization (NGO) level. All project activities are designed to

encourage independence and self-governance in the planning, design, implementation of outputs, and

outcomes. Communities will be empowered for decision-making on harmful practices addressing risky

behaviors, male norms, to increase gender equity in AB program and reducing violence and coercion. This

local ownership and involvement will begin with focus group discussions among all community stakeholders

that are conducted in preparation of initiating a training cohort in each new geographic location. The role of

the NGO partners is to build the capacity of communities to do their own direct service with the skills and

knowledge gained during their trainings in an effective and quality manner. The faith-based organizations

networks are essential to the ongoing sustainability of the program as the local faith-based organizations

have a long term commitment to their local communities. The targeted training of church and mosque

leaders and utilization of key youth leaders, volunteers and promoters from church youth groups and

schools will enable the program to continue beyond the initial investment under NPI.

New Partner Initiative

Nazarene Compassionate Ministries, Inc. (NCMI) is rapidly scaling up palliative care services in Ethiopia

through community-based organizations (CBO), indigenous nongovernmental organizations (NGO), faith-

based organizations (FBO), and prisons. NCMI will work through its lead agency, Fayyaa Integrated

Development Association (FIDA), operating in partnership with sub-grantee Justice for All-Prison

Fellowship Ethiopia (JFA-PFE). This ongoing alliance under the New Partners Initiative (NPI) will provide

palliative care to 388 people living with HIV/AIDS (PLWH) through home-based and prisonbased care

services in FY 2008. The NPI palliative care project aims to improve the quality of life for PLWH through

alleviation of their suffering, thereby reducing the burden for the family and other caregivers with a holistic

approach to palliative care, providing quality care to respond to physical, psychosocial, social,and spiritual

needs. Moreover motivational interviews will be conducted with these beneficiaries to encourage behavior

change.

The palliative care activities include: food support, medical support training, and support to caregivers,

spiritual counseling and promotion of positive living, establishing support groups, identifying and referring for

STI, and TB treatments, promoting disclosure, end-of-life planning and bereavement counseling.

These home-based care (HBC)activities will be provided through a team of district nurses and volunteers

trained and certified in home- and community-based care for PLWH. Each team comprises a minimum of

five volunteers and a nurse. As part of a holistic approach to palliative care,children of PLWH will be

supported in school material, fee and uniforms.

FIDA will work with local community leaders, faith-based organizations, and community-based organizations

to deploy, train, and supervise volunteer HBC providers. Volunteers and caregivers will receive HBC kits to

help them look after the clients. For motivation, volunteers will receive monthly incentives to enable them

reach the clients and reduce volunteer burnout.

Training will be given to spiritual leaders to deal with emotional and psychosocial issues of both infected

and affected people. FIDA will also strengthen community-based support groups, community mobilization,

and PLWH leadership development to reduce stigma and strengthen affected households and communities.

FIDA will train caregivers to provide ongoing care and prevention messages for PLWH in HBC settings to

help them maintain safe sexual practices. To reduce diarrheal morbidity and mortality, FIDA will educate

PLWH and their families on safe water and personal hygiene, including education on home water treatment.

In addition, needy patients will be given monthly food and hygiene support and will be linked to community

support groups for sustaining the support. The home-based care activities will be strongly linked to health

centers and hospitals. Through training of prison officials and peer volunteers in ten prisons in six regions,

prison-based care, food, nutrition, and ART adherence counseling will be delivered to prisoners living with

HIV/AIDS. To facilitate ART referral from prisons, JFA-PFE will work with Columbia University-based

organizations.

In five districts throughout Oromiya and SNNP regions, FIDA will promote ART adherence and compliance.

HBC volunteers will receive basic training on ART referrals and adherence counseling. To facilitate referral

services in each health institution, key persons will be identified to coordinate the referral process. In

addition to counseling and referral, FIDA will cover monthly transport costs for those who do not have

access for ART services. In order to promote project sustainability, identification of potential community

resources and support will be conducted. FIDA will also encourage sustainability by strengthening

community HIV committees through capacity-building efforts, including training on resource mobilization,

leadership, and financial management. In addition, FIDA will advocate for the mainstreaming of care and

support activities for PLWH in the existing community support organizations and social networks to ensure

sustainability of project activities beyond the project period.

NCMI will do mapping on palliative care services for connecting to wraparound services with PEPFAR

partners. In case one or both parents die, children of PLWH will be identified by local HIV committee and

will be referred to FIDA's OVC project and linkages to wraparound services provided by the World Food

Program and Family Health International, or other community resources such as food security, education,

skills development, and economic self-sufficiency. Individuals practicing unsafe sex will be counseled on

safe sex and referred to health institutions for voluntary counseling and testing and condoms. PLWH will be

referred to service outlets such as ART and PMTCT. Through partnership with JFA-PEE, NCMI will link to

activities with Colombia University partners and Ministry of Health to facilitate palliative care and ART

referral for PLWH prisoners.

The NPI palliative care project serves PLWH in five districts in two regions through counseling and HBC.

Those needy PLWH will be supported with food, transport, and hygiene products. Children of PLWH will be

supported with school materials, fees, and uniforms. The local HIV committees will identify the needy PLWH

to be targeted by palliative care project activities in their communities. The project benefits the most

disadvantaged segment of the population including prisoners. PLWH prisoners in ten prisons in six regions

will identified in collaboration with prisons' health officials and local health institutions.

The emphasis areas for the palliative care project include promoting gender equity and capacity building of

local organizations. To promote gender equity an equal number of men and women will benefit from the

project. In addition the project addresses women's vulnerability to AIDS in all prevention activities. The

capacity of local organizations will build and strengthen the community HIV committee through training on

resource mobilization, leadership, and financial management will be rendered. Wraparound programs

include referral for TB treatment; economic strengthening and education through provision of vocational

training for self and other employment; and household food security through gardening activities.

Through the New Partners Initiative, NCMI and Fayyaa Integrated Development Association (FIDA) will

strengthen care and support for orphans and vulnerable children through community mobilization and by

strengthening a referral network with other service providers. NCMI's OVC care model features a

comprehensive approach to supporting orphans and vulnerable children and their caregivers through a

range of support services, including education, vocational training, economic strengthening, legal protection,

shelter, nutrition, and psychosocial support and referral linkages. NCMI and FIDA are committed to

coordinated care for OVC based on working with community committees and other service providers to

assess and prioritize the needs of each beneficiary. At least 1,340 OVC will be served throughout the

Somali (Jijiga and Kebribaya), South Nation and Nationalities Peoples (SNPP) (Chuko, Wondo Genet,

Hager Selam and Daye), and Oromiya regions (Jimma zone at Gomma and Sokoru, Illubabor zone at Metu

and Bedele). NCMI and its lead partner, FIDA, will work through existing structures of the community,

government, faith and community based organizations to enable comprehensive service provision to OVC

and their families.

Each activity will be planned to meet age, developmental, and gender considerations of OVC. For example,

mobilizing communities, construction of new houses and maintenance of the existing ones will be one of the

services to improve the living condition of OVC and their caregivers with emphasis on prioritizing child

headed and female headed households. The local government will provide land and the community will

contribute in labor and local building materials. School-aged OVC will get educational support (stationery,

uniform, and tutorial class) and older OVC will get vocational and skill training based on their individualized

need and also supported with the appropriate working tools and materials. Community committees will be

trained on child rights and how to advocate for the legal protection of OVC and take action on implementing

existing child polices. The committees, volunteer home based OVC visitors and OVC field workers will be

trained on the social and emotional needs of OVC and they will provide psychosocial support to OVC and

caregivers. Referral linkages with other service providers will be strengthened to achieve coordination of

care. The technical and managerial capacity of the indigenous community organizations and community

committees will be strengthened or expanded to mobilize local community resources at each project site.

NCIM and FIDA have data from previous year of experience that show how their approach or model

improves the living conditions of OVC and their family on a sustainable basis. For example, past experience

with this approach resulted in 1,218 OVC accessing education and all being able to stay in school.

Ongoing monitoring and supervision will be conducted to track improvements in child status and capacity of

communities and families to care for OVC. The monitoring data will be used to make program refinements

that lead to reinforcing local communities managing on their own.

The PEPFAR OVC Guidance and the Standards of Services for OVC in Ethiopia will be used to inform

planning, implementation, and monitoring of the program. NCMI and FIDA will participate in the monthly

meetings of the Ethiopia OVC partners' group and will network with other PEPFAR partners to increase

harmonization and maximize use of resources. This includes exchanges on successful practices in applying

service standards to reach more children and achieve shared outcomes agreed upon by all OVC partners.

NCMI will integrate its PEPFAR activities to provide a continuum of support to OVC and their families. NCMI

and FIDA will use and augment mapping data on child and family related services from Save the Children

(PC3) and other sources to facilitate referrals and coordination of care. Services or resources relating to the

range of HIV/AIDS and child social service needs will be covered. Special emphasis will be placed on

increasing coordination with households receiving palliative care and expanding linkages with clinical

services. NCMI will organize meetings and form partnerships with other service providers at the local level

and from multiple sectors to share planning opportunities, increase coordination and avoid duplications.

NCMI will provide a list of OVC beneficiaries to other service providers and use a referral form. At the end of

each month NCMI will obtain formal reporting from each of the referral partners to check whether the

referred OVC received the required service or not. NCMI and its local partners will also undertake day-to-

day monitoring of the referral process. NCMI will coordinate with WFP for food and nutrition service to OVC,

as well as with schools for education of OVC. Through organizing small-scale IGA activities 178 OVC will be

provided food and nutritional support. In the Oromiya region, NCMI will seek to coordinate with the PMI to

secure services to OVC and their families.

The OVC project is implemented in Oromiya, SNPP, and Somali regions. NCMI will implement the project in

six project sites. One thousand three hundred and forty needy OVC and 670 caregivers will receive support

through this OVC project. Once the targeted population is identified through community committees, various

identified needs will be addressed through direct service provision and the leveraging of other resources.

Services will be provided based on a number of factors, including severity and priority needs, interest in

receiving support, gender, and age and development of the beneficiaries. Religious leaders, teachers, and

local business-people such as local traders and hotel owners and will be involved as part of the community

mobilization effort and to strengthen community resources.

Gender equity will be addressed by reaching boys and girls through different interventions and giving

special emphasis to the conditions or contexts that increase the vulnerability of girls. For example,

sensitivity training on gender-based violence. Local organization capacity building will be emphasized to

sustain the OVC program in the community by providing various technical and managerial capacity building

trainings for these organizations and local committees. The goal is for communities to be in a better position

to manage and sustain their efforts by mobilizing local resources and reducing the need for external

assistance over time. Involving these local organizations from the inception of the project and during project

implementation, monitoring and evaluation will help them to maintain coordinated care for OVC and their

families.