Sustaining Love and Care

A Model of Staff Support for a Grassroots HIV/AIDS

Organization in Tanzania

Leslie Snider, MD, MPH

KIWAKKUKI

ANTARESI2008

Antares Foundation Mission

• “…to improve the quality of humanitarian assistance and overseas development through advice, training and support.”

Antares Model of Support

Factors Underpinning Antares Guidelines

• Stress is inevitable in humanitarian aid work• Staff members, managers and agency are inter-

dependent and all responsible for good stress management practice

• Stress management should be instituted in organizational policy as 1) proactive, 2) routine and 3) responsive measures

• Principles are applicable to everyone with tailored support for national and international staff

Who are the “Staff?”

• International and National NGO Staff– International staff– National staff located elsewhere in country

(South Sudanese staff working in Darfur)– Local staff working in the area where they live– Volunteers

• National staff comprise the majority of staff in international organizations

Adapting our Model to Organizations….

• Working in long-term development

• With stable staff members

• With limited resources

• With their own values, beliefs and ways of understanding and effecting support

• Without access to a professional mental health referral base for all staff

HIV in Tanzania, Kilimanjaro Region

UNAIDS/WHO Epidemiological Fact Sheet on HIV/AIDS and STIs, 2000.

“Kikundi cha Wanawake Kilimanjaro Kupambana na UKIMWI”

Kiwakkuki

Kiwakkuki Background

• Founded in 1990 around the global theme of Women and AIDS

• Formally registered as an NGO in 1995, currently planned for a Trustee

• Goal: To accelerate women’s access to information on HIV and empower them with skills needed to fight HIV and AIDS in their families and communities at large.

Activities

• Empowering women made a big difference in the war against HIV/AIDS in Kilimanjaro

• Broad-based activities:– HIV/AIDS Awareness Raising– Home-based care for PLHA– Support to orphans and other vulnerable

children– Voluntary counseling and testing

40 Staff Members

The Challenge

• Organization began work in Moshi municipality then gradually spiraled out adding volunteers to cover 6 districts

• Membership now stands at 5,064

• 100 groups of volunteers in the region

2,300 Volunteers

The Collaboration

• Volunteers providing critical support in dire conditions which HIV/AIDS has created in their daily context.

• Difficult and distressing work, done in ill-afforded spare time for volunteers who have other family or job responsibilities

• Work for both staff and volunteers is manifestly stressful

• Need for a structure to offer support to the women carrying out this vital role would make a significant contribution to their mission

2004 Assessment Findings

• Tremendous success and growth• Increasing interest from volunteers, but

also increasing numbers of beneficiaries with no end in sight– Fear of the organization in keeping up with

the demands of the pandemic

• Organizational culture, demands of clients and ever-increasing workload conspired to create high stress levels

Culture of Volunteerism: A Double-Edged Sword

• The basis of Kiwakkuki’s success

• Very hard working and dedicated staff who…– Don’t take lunch breaks– Don’t take holidays– Have a poor balance between work and life

duties

Stressors and Supports

• Working conditions• Organizational structure

& management problems• Lack of skills training• Accumulated stress• Lack of personal coping

and perceived support• Lack of communication

(technical & social)• Secondary traumatization

• Religion• Sharing• Singing• Laughing• Friendship

Early Response of the Organization to Staff Members

• Lunch breaks• Holiday schemes• Workplace policy for staff affected by

HIV/AIDS• Salary increase• Family days: opportunity for staff to bring

their family members to learn about HIV/AIDS and the work they do

2008 Assessment: Findings from Work/Life Questionnaires

• Work Assessment:– Good communication among all Kiwakkuki members

is of fundamental importance– Some stress management measures are now in place

(group activities, stress management education, improved available resources such as staff manuals).

– Recommendations from respondents:• Formalize systems (i.e., the method for giving out work)• Improve assistance with travel arrangements• Ongoing stress management training

2008 Assessment: Personal Circumstances

• Kiwakkuki members live in extremely difficult circumstances:– Some living on low income; some with HIV/AIDS– Overwhelming majority experienced or witnessed

extremely traumatic situations

• Challenges working in this social context:– Many beneficiaries with problems too great to address

as a whole.– Large geographic working area, transportation

difficulties– High expectations about the work from the community– Chronic lack of resources

Antares Principles Matrix

• According to each principle…– What are you doing?– What are the gaps/needs?– What is your action?

• Findings:– Need for more education and support, regularly

organized and placed within daily routines– Need policies, systems and resources (manuals, HR

resources, trainers)– Barriers: lack of funds, large # volunteers, difficult

work and travel conditions

Two Streams of Assistance

• Organizational Consultation– According to Antares Principles– Longer-term process– Importance of prioritization

• Inter-Collegial Support– Skills based training– Able to institute rapidly with all members

Stream 1: Organizational Consultation

• Prioritizing Actions!• Exercises and dialogue helped staff to

understand where they had informal (and sometimes formal) measures already in place– Screening: informal assessment of potential

volunteers done through training

• 3 Priority areas: preparation & training, monitoring & ongoing support, end of assignment support

Preparation & Training

• All staff and volunteers need an orientation to Kiwakukki, to clarify expectations and reduce disappointment/rumors about what to expect.

• Opportunities for staff and volunteers to participate in professional development training and conferences within and outside the country were seen as valuable staff support initiatives.

Monitoring & Ongoing Support

• Want to develop a way of monitoring ongoing stresses

• Discussed a mid-assignment briefing or debriefing to be able to identify and address emerging issues

End of Assignment Support

• Particularly important, as staff members express a fair degree of distress when project funding cycles and their positions end.

• Want to improve their exit planning with staff for their life beyond Kiwakkuki. Exit interviews important both for the person and for Kiwakkuki to learn.

• Exit interviews also provide a chance for Kiwakkuki to better understand reasons for reasons for attrition of volunteers in order to develop effective support strategies.

Next steps

• Appointing a key “holder” of the principle for action

• Short time frame to realize some progress (3 months)

• Venue for addressing these issues in ongoing way (every other Friday alternating with “professional literature” day)

Stream 2: Inter-Collegial Support

• Builds upon other natural interventions in place: “talking friend”

• A structured method of peer consultation for problem-solving

• User-friendly method for staff and volunteers at all educational and skill levels

• Opportunity to be together and share• Engages the expertise of the peer group,

building confidence

The 5-Step Method

1. Present the problem (5 minutes)

2. Questioning (10 minutes)

3. Group formulates “the problem” (5 minutes)

-Presenter restates their problem

4. Advice from Group (10 minutes)

5. Presenter Evaluates the Process (5 minutes)

Things to Remember

• Ongoing group of equals (peers/colleagues)• Stick to the time and structure• Everyone takes a turn – mutual learning• Can ask about effect on the person (how they

feel, how they are coping)• Person does not have to accept the advice!• Supportive: Be careful in questioning not to

blame person for the problem or their handling of it.

• Confidentiality!

Follow-On

• Groups should be from the same location in order to continue

• Presenter chosen at the end of the consultation for the next meeting

• Comfortable, quiet and private location must be identified

• Regular meeting time working within members’ time constraints arranged

Lessons

• There is a need for support for local, HIV/AIDS development organizations – staff, volunteers and beneficiaries

• Organizational structures and policies are essential, but should be introduced in achievable, step-wise fashion

• Practical peer support and consultation skills can be rapidly implemented and scaled up

“A dragon was pulling a bear into its terrible

mouth. A courageous man went and rescued the

bear. There are such helpers in the world, who

rush to save anyone who cries out. Like Mercy

itself, they run toward the screaming. And they

can’t be bought off. If you were to ask one of

those, ‘Why did you come

so quickly?’ he or she

would say, ‘Because I

heard your helplessness.’”– Jelalludin Rumi,

13th Century Afghan Poet