Participatory evaluation of counselling, medical and social services of The AIDS Support Organization (TASO) in Uganda.

The AIDS Support Organization (TASO) is an indigenous non-governmental organization (NGO) of HIV-infected and affected people in Uganda. TASO provides counselling, social support, medical and nursing care for opportunistic infections at 7 centres affiliated to district hospitals in Uganda. Between 1993 and 1994, the services provided by TASO were evaluated through a participatory approach between staff and clients. TASO counselling services helped clients and their families to cope with HIV and AIDS, with 90.4% of clients revealing their serostatus, and 57.2% reporting consistent use of condoms in the past 3 months. TASO was also the main source of medical care for clients with opportunistic infections in the last 6 months (63.8%). As a result of counselling, over half of the clients (56.9%) made plans for the future and 51.3% wished to make wills. There was a high level of acceptance of people living with HIV/AIDS (PWAs) by families (79%) and the community (76%). Care was provided to PWAs at home mainly by women (86.2%). TASO has demonstrated that individuals and their families are able to live positively with HIV/AIDS. Through counselling, medical care and material support to clients and their families, TASO has effected change in people's attitudes, knowledge and lifestyles. In particular, TASO has demonstrated a strong capacity to overcome four problems that haunt AIDS care in most places: (1) revealing one's HIV-serostatus to relevant others; (2) accepting PWAs in family and community; (3) seeking early treatment; and (4) combining prevention and care. In general, TASO has shown that specialized services to meet AIDS care needs can be added to existing health services at district levels. As a result of the participatory evaluation, a well-accepted monitoring system was established.

PIP: The AIDS Support Organization (TASO) is an indigenous nongovernmental organization of HIV-infected and affected people in Uganda. The organization provides counseling, social support, and medical and nursing care for opportunistic infections at seven centers affiliated with district hospitals in Uganda. TASO's services were evaluated during 1993-94 via a participatory approach involving staff and clients. The organization's counseling services helped clients and their families to cope with HIV and AIDS, with 90.4% of clients revealing their serostatus, and 57.2% reporting the consistent use of condoms during the preceding 3 months. TASO was the main source of medical care for clients with opportunistic infections during the preceding 6 months. As a result of counseling, 56.9% of clients made plans for the future and 51.3% wished to make wills. The evaluation further found a high level of acceptance of people with HIV/AIDS (PWA) by families (79%) and the community (76%). Women provided 86.2% of in-home care to PWA. TASO's experience demonstrates that individuals and their families can live positively with HIV/AIDS and that specialized AIDS care services can be readily added to existing health services at the district level.

The training process in community-based health care in Saradidi, Kenya.

Community health workers from a community-based health development programme in Saradidi, Kenya, were trained beginning in 1980, using participatory training. Training was considered high priority by the community. The process of training was geared to local problems, perceptions, situations and resources. The content of training was based on perceived health problems in the community and on responsibilities agreed upon by the health workers. Training was done in or near the villages where the participants were living and working. Concrete actions that could be taken to solve local problems were emphasized. The trainers were people who understood local problems, lived in Saradidi and were known to the trainees. Community leaders and members participated in the training as did some community health workers after completing their training. Evaluation indicated significant changes in the trainees' knowledge practices and behaviour.

Between science and common science. Nonformal education for village health workers in Kenya.

PIP: To help the 50,000 people living in Saradidi improve their community, the Anglican Church of the Province of Kenya of originally organized a health project in 1979 as the cornerstone of an extensive rural development effort to reach people through parish and congregational committees. The Saradidi Health Program intended to reduce the high rates of infant and child mortality and morbidity by directly involving the community in the provision of its own health care and the improvement of its quality of life. Each village elected its own health and development commitee and later selected volunteers to work in the community. Training was given to those selected to organize teir communities for the health program--the Nyamrerwa or Village Health Helpers (VHHS). Their task was not simply to provide information about appropriate health practices, but the much more difficult 1 of spanning the 2 worlds of medical science and traditional beliefs and practices. Over the course of several years, the experience at Saradidi proved that these 2 worlds need not be in competition. They could be complementary provided that the VHHS were capable of integrating their newly-acquired knowledge with the common sense of centuries-old practice. An evaluation of the program has shown that the VHHS have now begun to accoomplish their task of influencing the practices and changing the attitudes of the people in Saradidi. The nonformal approach is effective because it involves the whole community in the process of promoting good health. The VHHS act as a catalyst, bringing together useful information and practices from the outside and making them part of the community's own information and practices.^ieng