Community power: Making all the difference
At the Alliance, we have a theory about to make a difference in the world. We believe the community has the power to tackle HIV if they are recognised and supported to do so. Community mobilisation is essential to end AIDS.
As an alliance of national, civil society organisations (known as Linking Organisations), we have supported community mobilisation in response to the HIV epidemic for 20 years. We work in the knowledge that communities are critical to the success of the HIV response. We work alongside communities, community-based organisations and networks to ensure there is equitable access to effective HIV prevention, treatment and care for all those who need it.
We work through the realisation of human rights; the empowerment of people living with HIV and other affected people; by demanding political accountability; and strengthening community and health systems. Overall, our assumptions are based on the belief that communities have the power to tackle HIV if recognised and supported to do so and that some civil society capacity and resources exist at both local (community) and national levels.
The benefits of our approach are evident - to us and others we work with - on a daily basis but how do we prove this with evidence? Community action is notoriously difficult to quantify and measure.
“What is emerging is a rich and fascinating record of community action and empowerment at a grassroots level.”
— Researcher, LSE
Measuring the success of community action
In June 2011, The Lancet published the Investment Framework for HIV and AIDS, which recognised community mobilisation as one of 11 ‘critical social enablers’ in the response to HIV. The critical role of communities was not news to us, or to many other community actors or local government institutions, but it had rarely been described so prominently as a ‘critical’ ingredient for effective health programming.
The Investment Framework provided a catalyst for the need to better understand community mobilisation. It also underlined the fact that it is vital for those involved in the HIV response to better articulate the role and added value that civil society brings in improving health outcomes. As such, it gave us the impetus we needed to be much clearer about the Alliance’s own theory of change. That is the logical sequence of changes that are required to achieve the desired outcomes of our work, and our assumptions about how and why that sequence of change might come about.
Working with others to confirm our theory of change
In late 2012 the Alliance asked the London School of Economics and Political Science (LSE) to examine and document the role of community mobilisation across Alliance HIV programming. The research team interviewed 39 people from Alliance Linking Organisations, implementing partners, networks, the international secretariat in the UK and regional offices.
During the process, the lead researcher said, “What is emerging is a rich and fascinating record of community action and empowerment at a grassroots level”.
In 2013 the World Bank concluded a three-year evaluation of the impact of the community response to HIV and AIDS. This large-scale research included country studies in Burkina Faso, India, Kenya, Lesotho, Nigeria, Senegal, South Africa and Zimbabwe and provides strong evidence in support of our theory of change.
Based on both of these pieces of work, we learnt that the premise on which the Alliance was founded 20 years ago - that community mobilisation is an essential means to end AIDS - is more relevant today than ever. The LSE research found that the greatest resources of the Alliance are the community activists and community workers who are often members and groups affected by HIV and AIDS. The World Bank research highlighted that investments in communities have produced significant results including improved knowledge and behaviour, and increased use of health services, and even decreased HIV incidence.
The LSE research identified five common short-term results, which commonly happen as a result of our interventions.
- Peers are engaged to deliver services: this approach typically involves training community members to deliver community based services. For example, people living with HIV were trained as Network Support Agents in Uganda, to increase demand for a variety of HIV services.
- Community members take leading roles in programmes: this approach goes beyond a common peer approach to include supporting participation in decision making and in more ambitious roles to plan and implement programming. For example, employing people who use drugs and training them as peer outreach counsellors.
- Programmes respond to community priorities: this includes targeting people and interventions that will have the greatest impact on the state of the HIV epidemic. An HIV programme focused on treatment adherence, for example, can fail if an individual’s poverty needs are ignored.
- Community and social capital are enhanced: this includes bringing people together and creating a community in environments where people living with HIV and those most affected by HIV may previously have been isolated. Many activities depend on individuals gathering in the same physical space (e.g. self help groups), and the office of a community-based organisation is often used for this purpose.
- Communities are socially and politically mobilised: this includes both collaborative and adversarial approaches to political mobilisation, but the aim of both is to tackle stigma, discrimination and criminalisation in order to improve access to health services. You can download the PDF about our theory of change here.