MALAWI: Scaling up the COPE Program

The Community Options for Protection and Empowerment program (COPE) is committed to mobilizing sustainable community-based and owned solutions to HIV/AIDS in Malawi. In the first phase of COPE (COPE I), the program undertook a broad range of interventions in nine villages near the town of Mangochi, Malawi. A joint review determined that although most of the interventions were producing positive results, the cost per beneficiary was too high to implement the staff-intensive approach at a larger scale. Another observation was that the continuation of COPE staff-initiated activities by community volunteers would be questionable once COPE staff moved on to work in another part of the District.

Taking the issue of scale (and sustainability) into account, COPE staff took a different approach in the Namwera area of the District during the remaining eight months of COPE I. Staff size was reduced from 20 to 9. The focus of the 9 remaining staff shifted from addressing problems at the community level to mobilizing and building the capacities of the community to address their own problems. COPE used its resources to breathe life into a structure of area- and village-level committees that had been devised by the National AIDS Control Program and UNICEF in 1994 but which did not function in most of the country. Staff management reconceptualized the role of COPE field staff, shifting away from direct implementation toward community mobilization. New field staff assembled and participated in a week-long training to prepare them for their revised roles.

The central responsibility of the community mobilizer-the new name that COPE field staff chose for their role at the end of the retraining-was to catalyze and train community members to undertake tasks that strengthen family and community capacities to care for orphans and other vulnerable community members. Each of the six COPE community mobilizers who were to work in the Namwera area were assigned several villages. In each village, the community mobilizer worked through existing structures and institutions and through newly organized village AIDS Committees. COPE I also supported the development of the community level Namwera AIDS Coordinating Committee (NACC). The NACC brought together talented and committed government health, community development and education personnel; business people; and representatives of religious groups to help mobilized communities, particularly village AIDS Committees, against the impact of HIV/AIDS.

In another effort to address the growing scale of the HIV/AIDS problem in Malawi by reaching greater coverage, Phase II of COPE started at the district level-reviving, sensitizing and mobilizing District AIDS Coordinating Committees to take the lead in mobilizing community and village AIDS Committees.

As COPE II seeks to make an impact over a much wider geographic area by working at a district level, efforts to lead and mobilize community and village AIDS Committees became a particular challenge. It will be perhaps the most difficult test of whether this model can be a cost-effective and sustainable way of addressing the impacts of HIV/AIDS on a greater scale.

Mobilization at the district level is more difficult than at the area and village levels because the geographic scope of responsibility is much larger, members are further removed from problems, and ownership and sense of responsibility is more difficult to achieve in the face of extensive need. Also, distances to reach affected villages are large, and transportation is often problematic. Moreover, community-owned and managed responses mobilized through the district, community, and village AIDS Committee structure are not a package that can be replicated and expanded just by increasing the resources dedicated to it. It is an empowering process that must develop from a sense of responsibility for addressing the problem and a sense of ownership of the response.

The challenges to come to scale while retaining quality and impact are many. The field office's strategy was to slow down expansion of COPE II while the essential processes of COPE's program success were refined and documented. Steps taken include:

• Documenting the community mobilization process. COPE worked with a full-time Peace Corp volunteer who helped key staff in the field develop a Manual on COPE Implementation. While it is recognized that the community mobilization process should be responsive to community needs, the Manual will provide guidance as to the key steps, lessons learned and overall process utilized by COPE at the community, district and national levels.
• Refining and packaging curriculum designs. COPE's Training for Transformation for District Level mobilization as well as Technical Sub-Committee training design for Home-based care; Orphans; Youth; and High-Risk Technical Sub-Committees are being developed with assistance from a consultant with curriculum design expertise and input from staff who designed the original training. These training manuals will complement the Manual on COPE Implementation.
• Defining and simplifying monitoring and evaluation systems. Monitoring and evaluation systems need to be better defined and simplified so that they can more easily track program impact at both the community and district levels and contribute to regional and/or national level monitoring of future impact.
• Operations research for proving effectiveness. Outside assistance from technical agencies skilled in operations research are assisting COPE to explore essential questions on program impact, including sustainability and cost-effectiveness.
• Program critique/sharing lessons with external partners. COPE staff has organized a lessons learned/best practices workshop amongst programs in the southern Africa region working on similar prevention-to-care community outreach models.