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The Positive Outcome of Pulling Young Girls from Vulnerability

According to PEPFAR, “Every day, around 1,000 adolescent girls and young women are infected with HIV. Girls account for 74% of new HIV infections among adolescents in sub-Saharan Africa”. This realization has increased the need to focus on protecting Adolescent Girls and Young Women (AGYW). As poverty is a major factor that places women in vulnerable positions, thus making them susceptible to risky behavior that can lead to HIV infection, USAID-funded HIFASS-LOPIN 3 project has incorporated Adolescent Girls and Young Women (AGYW) in its current implementation of the Orphans and Vulnerable Children Program, in order to provide young girls with the opportunity for grooming in goal setting, self-esteem, HIV prevention and management, care of their bodies, self-sufficiency, making good choices and generally becoming better individuals who will ultimately lead great lives.

Rachael Okon, a 20 year old resident of Calabar South Local Government Area of Cross River State, one of the Local Government Areas with the highest HIV prevalence in the state grew up in a challenging environment. Her mother passed on when she was about 15 years old and her father had to stop working after an accident, depending on his share of family income which is insufficient. Hailing from a large family with seven children, despite her big dreams, Rachael was unable to further her education after secondary school. She started living with and helping her older sister, who was also trying to stand on her feet by selling. She took up menial jobs in two shops successively, wondering where she would get funds to move forward and be all she dreamt she could be. This was before she came in contact with the HIFASS-LOPIN 3 project and was registered under the Adolescent Girls and Young Women program in 2016.

She was trained extensively in tailoring and empowered with items for business start-up – a sewing machine, a weaving machine, a pair of scissors and a sewing kit. As a hardworking young girl who has learnt to be confident, Rachael went on to rent a shop for business in one of the markets in Calabar Municipality Local Government Area and is now making enough money to take care of herself and save for the future. Her designs are unique and neatly done and she is patronized by passersby who are thrilled by her displayed work as well as people referred by customers.

For someone who initially doubted the program, Rachael stands as a good ambassador. She says “it is worth every while. Before, I wasn’t really sure of what I wanted but then I was given a chance, I was given an opportunity to focus on something”.

Rachael has truly focused on tailoring, she is confident and her business is growing. In addition to sewing, she sells fabric. This gives her extra income and she saves funds daily with a savings group and sends specific amounts to the bank. She has also begun giving her shop a facelift from her proceeds, as the initially bare-floored space now has a rug on it and is ornamented with mannequins displaying various designs. She hopes to be a great designer someday.

This is one of over 200 AGYWs trained in skills acquisition and empowered for business start-up. This program has pulled these young women from vulnerability, from a state of hopelessness to one of great hope. They can now stand on their own and not succumb to the pressure of lack by engaging in risky acts that can lead to contraction of HIV/AIDS. For those who are positive, they can take good care of themselves so that their treatment will not be inhibited. It shows clearly the effect of helping others see that they can become what they admire, that they don’t need to do away with their dreams but hold fast to them. For Rachael, her dreams have come true.

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The Effectiveness of a ‘Paradigm Shift’ in Contrast to ‘Handouts’ for Sustainable Development Interventions

As is popularly said, it is better to teach a man how to fish than give him fish to eat when he is hungry. A lot of vulnerable members of our local communities expect a handout “fish” which will neither satisfy them nor reproduce itself for future consumption. This vulnerability or the feeling of helplessness increases the risk of contracting HIV/AIDS, as young people in desperate situations can accept as low as N500 ($1.4) cash or a meal worth N300 ($0.8) in exchange for sex; and in most cases, unprotected sex.

In line with achieving the UNAIDS 95-95-95 goal which is aimed at ending the HIV/AIDS epidemic by year 2030, the HIFASS-LOPIN3 project funded by PEPFAR through USAID, incorporates enlightenment and informal education which are able to create paradigm shifts, in interventions to vulnerable populations for HIV prevention and management, in their focal areas which are PEPFAR listed geographical areas with high HIV/AIDS prevalence.

A perfect example is Elizabeth Emmanuel Asuquo, the second of six children, who had to live with her aunt from the age of six along with another sibling. Her parents, a security man and a petty trader, could not cope with their care. Her aunt saw her through primary and secondary school education but could not go further, so she was back to a place of helplessness, armed with insecurity and low self-esteem for a downward spiral.

She was enrolled into the Adolescent Girls and Young Women group in Calabar South Local Government Area of Cross River State, manned by Rhemacare Development Initiative, the sub-granted organization working in that community and her mindset was changed with peer sessions where her self-esteem was boosted and she learnt about HIV prevention, food hygiene, how to refuse sexual advances and other areas that have built her to face her world squarely in spite of all she has been through. Her enrolment for skills acquisition in hairdressing and receipt of hair dryers (standing and hand-held), a 4-in-one roller set and other items for business start-up have empowered Elizabeth to be self-sufficient.

A handout would have provided temporary relief for Elizabeth, but this intervention has established her permanently. She sees herself differently, has established her business and can cater for herself and contribute to bringing her entire family out of vulnerability. With proceeds from her growing business, she rented a shop in her locality where she attends to customers regularly and now has an apprentice who paid to be trained in hairdressing. In the locally acceptable term, she is now a ‘Madam’. She contributes financially in her aunt’s house where she lives and to fee payment for her younger ones with her parents. She also saves either 3,000 or 4,000 naira every month and is glad with her achievement.

According to her, “I had a passion for hairdressing but I was always thinking, when will that time come, where will I go? … I was angry with myself…. Now I can take good care of myself, I can mingle with people….” Concerning her aunt, she said  “now I’m independent and also got my aunty relieved of too much responsibilities….”

Elizabeth has set a pace for many like her and as a current trainer, she is in a good place to teach her apprentice beyond hairdressing, but also the life skills she has learnt so far from the AGYW program. She is an ambassador in her own sphere, pointing people in the direction of hope and showing that HIV/AIDS can truly be eradicated by 2030, first with a paradigm shift.

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Nigeria has the highest TB burden in Africa and ranks 6th globally

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Each Year, March 24 is set aside to commemorate the World Tuberculosis (TB) Day to raise public awareness about the devastating social, economic and health impact of tuberculosis. Despite significant progress over the last decades, TB remains the world’s deadliest infectious killer and require acceleration of efforts to end the TB epidemic globally and in Nigeria.

Each day, nearly 4500 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. Global efforts to combat TB have saved an estimated 54 million lives since the year 2000 and reduced the TB mortality rate by 42%. To accelerate the TB response in countries to reach targets – Heads of State came together and made strong commitments to end TB at the first-ever UN High Level Meeting in September 2018 in New York.

The theme of World TB Day 2019 – ‘It’s time’ will ensure all that all stakeholders including political leaders are reminded of the commitments made and the timely need for actions to Scale up access to prevention and treatment, funding, human rights and accountability to end TB in Nigeria.

At the Pre-press briefing held in Abuja on Thursday, 14th March 2019, US-CDC representative in Nigeria, Dr. Bethrand Odume released the statistics with the theme “It’s time!” and slogan “To end TB in Nigeria (keep the promise! Find TB! Treat TB)”. Odume said the estimated cost was expected to be raised by the government, communities, private sector, international donors and individuals. He lamented that most of the funding for the disease comes from foreign donors, adding that it was unacceptable and should be discouraged.

He said: “To control TB in Nigeria, the sum of N147 billion has been estimated. N35 billon of that amount which is about 24 per cent has been met. To be very sincere, over time, there has been an increase in funding within the national TB programme and government has actually come up to rise to its responsibilities but the gap of 75 per cent still remains. No fewer than 18 people are reported to die as a result of the ailment every hour, thereby ranking Nigeria the sixth globally with nine per cent rate and the first in Africa after India and Indonesia which are at 26 and 11 per cent rate respectively.”

“We are looking at how to come about filling this gap. For this approach, the government must be there. One missing gap in Nigeria is that the private sector is not really coming up and that is where the Stop TB partnership in Nigeria comes in,” he said

National Coordinator of the National Tuberculosis and Leprosy Control Programme of the Federal ministry of Health, Dr Adebola Lawanson who was represented by senior programme officer, NTBLCP, Mr. Emperor Ubochioma said Nigeria has the highest TB burden in Africa and ranks 6th globally. Till date, tuberculosis is estimated to kill 18 Nigerians every hour. Forty-seven Nigerians develop active TB every hour, with seven of them being children.

She said persistent cough for two or more weeks could be TB and any affected person should see a healthcare provider. Dr Lawanson said diagnosis and treatment, including tuberculosis drugs, are available free of charge in all Directly Observed Treatment (DOTS) centres nationwide and that the disease is curable.

As the country joins the rest of the world to commemorate this year’s World TB day today, it behoves on government at all levels, stakeholders, as well as the general public to accelerate efforts in tackling the disease.  This is in line with the theme of this year’s commemoration of the day ‘It’s time to end TB’.

It is time to find and treat every TB case, address all concerns related to the disease and end it for good in Nigeria.

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Economic empowerment brings about a complete turnaround for vulnerable families

Nkechinyere lost her shop where she sold food items and fairly used bags to a fire outbreak in Port-Harcourt. In spite of the maternal drive to be strong for her children, she had to move to her husband’s village in Anambra State when her health deteriorated and she was too weak to meet basic needs, she became dependent.

Her husband left her and his family, was no longer as supportive as he was in providing for her and the children. When the ill-treatment became unbearable, she relocated to her home town, Owutu, a local community in Afikpo South LGA of Ebonyi state, to live with her own family, a community where they are predominantly peasant farmers. This was where her children were enrolled, based on vulnerability, into the PEPFAR funded HIFASS-LOPIN 3 project, through WOCHAD, a Community Based Organization, working in the area.  At the time, she became very thin, weak and unable to move around. Her oldest daughter Onyechinyere was saddled with the burden of fending for the family. Nkechinyere tested positive for HIV along with two of her children and they were referred for treatment.

Nkechi did not need hand-outs which would satisfy her temporarily, she needed a source of income that would take her back to a state of independence. She also needed a support system to pull her through her trying time. HIFASS-LOPIN 3 provided a support system by introducing her to the Caregivers’ forum where they discuss issues surrounding health, nutrition, parenting, education and other issues that would benefit them; then gave her a seed grant to start a trade. Her daughter, Onyechinyere was introduced to the Adolescent Girls and Young Women (AGYW) club where she learnt to set goals, value and protect herself, the use the word ‘No’. She was trained in hairdressing and received materials to start up her own business – hair dryer, hair wash basin, generator and other items needed for a hair salon.

Nkechinyere’s Caregivers’ forum started a SILC (Savings and Internal Lending Community) group after they all received Financial Literacy training. In the group, they are able to save money regularly and share out at specific times. They also give out loans among themselves from the purse to improve their businesses.

With her seed grant Nkechinyere began selling tomatoes and pepper. Initially, she sold from a sheet spread on the ground, but now has a shed in the market. She has also added pumpkin leaves and Okro to her merchandise. Her daughter, Onyechinyere, went into partnership with someone to get a shop where she makes hair and fixes hair extensions. She also participates in peer education through AGYW (Adolescent Girls and Young Women) meetings and has learnt to set life goals, protect herself and say ‘No’. Nkechinyere and the children who are reactive are all adhering to treatment.

In her words, Nkechinyere is grateful “… for saving my life and entire household from death, empowering me to be able to carter for my children through the LOPIN-3 program. I will encourage other positive caregivers to join the SILC group and to face their positive status with a positive attitude”.  Her daughter Onyechinyere is grateful to the American people for “remembering Nigerian young girls”.

This is one less vulnerable household in the community as income from the mother is supplemented by that from the daughter. All the children, apart from Onyechinyere who is now a hairdresser, are in school and are feeding regularly. This makes them less likely to participate in risky behavior, more hopeful for a better future and eager to help others. Nkechinyere says “I will encourage other positive caregivers to join the SILC group and to face their positive status with a positive attitude”.

 

Disclaimer: This success story was made possible by the kind support from the American people delivered through the U.S. Agency for International Development (USAID). The contents are the responsibility of Health Initiatives for Safety and Stability in Africa (HIFASS) and do not necessarily reflect the opinion of USAID or the U.S. Government.

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Vulnerability to Stability

Stella Ukah is a widow saddled with the responsibility of caring for her 3 children. She tried farming but was still unable to meet basic needs, only one of her children was enrolled in school because of the required demands which she could not meet.

HIFASS-LOPIN 3 (Health Initiatives for Safety and Stability in Africa – Local OVC Partners in Nigeria Region 3) project funded by PEPFAR through USAID enrolled Stella’s household based on their level of vulnerability through Destiny Daughters Initiative of Nigeria, a Community Based Organization, and placed her in a Caregivers group where issues affecting vulnerable households are discussed. She received training in nutrition, education, and other areas; but most importantly was in a group where people who were striving to get out of vulnerability, like her, met. There, she was encouraged to begin a business and started making and selling Akara, a local staple. She was selling regularly but did not have enough funds to buy in bulk. Her customers were dissatisfied because she could not meet the growing demand. Stella needed reassurance that everything could turn out right and that was exactly what she got from the Caregivers’ Forum.

After they were trained in Financial literacy, her Caregivers forum formed a SILC (Savings and Internal Lending Community) group where they save money regularly and share at stipulated times. They also give out loans among themselves for important activities. She received a seed grant from the project with which she boosted her business enabling her produce more Akara balls, sufficient for her customers.  At the moment she sells pap, bread, milk, milo and other items along with Akara so people have options of accompaniments with their Akara.

She is glad to say she now travels all the way to Enugu, a neighboring state, to buy Beans and Corn, the grains needed for her trade, in bags. She also saves money with her SILC group and on her own. All her children are enrolled in school and she is happy with her current state, hoping to keep improving with time. She says in pidgin “the time when then support me to do the akara, I dey help my children dey help myself. The last time, if you see me you no go remember me.” This means that with the support she received, she can now take care of herself and her children, adding that she looks different from how she did some time back.

 

Disclaimer: This success story was made possible by the kind support from the American people delivered through the U.S. Agency for International Development (USAID). The contents are the responsibility of Health Initiatives for Safety and Stability in Africa (HIFASS) and do not necessarily reflect the opinion of USAID or the U.S. Government.

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From Support Group to Cooperative Society: The Otu Oganiru SILC Group

Vulnerability in most rural communities is like drowning in a pool with no life guard in place. This is because in general, rural communities are relatively poor with families striving to care for their own, so supporting someone else is quite a task, except with support from wealthy families which is often not widespread.

One of the components of the PEPFAR funded HIFASS-LOPIN 3 project intervention is encouraging enrolled households to join sustainable structures which will help them during the period of the intervention and afterwards. One of such structures is the Savings and Internal Lending Community (SILC) group. Before these groups are formed, members receive financial literacy training, which is rare in rural communities where residents are rarely empowered intellectually and education is low, making the rural folk unable to think of creative ways to improve their economic value. The SILC groups discuss ways of improving their livelihoods and save money weekly which they share out at stipulated times after they have given out loans from it and collected interest for a period. After doing this for a while, these thinkers from Otu Oganiru (meaning Association for Progress) SILC group sought a way to ensure their contributions increased so that ultimately, they would have more income. To this end, they decided to start farming.

They took their case to some members of the community and a particular family which is wealthy supported them with 2 plots of land for their cause. They live in a friendly community where people are allowed to go into any farm and collect cassava stems from double-stemmed plants, that was how they got the stems for planting and began farming.

The secretary of this group is Jude C. Ajah, a young and active man who is not yet married. Though he has no children of his own and is not an enrolled caregiver, he supports vulnerable children in the community with clothing and school fees at different times. He joined the SILC group for savings but with his enlightenment, he helps keep records and mobilizes the members, grouping them to work on the farm at different times. For the group, he says a lot of their members make Fufu (cassava paste) and instead of buying cassava from the market at exorbitant rates would buy at reduced rates from their farm, then they will have income for the general purse and decide on a sharing plan. The most exciting thing is he said “we decided to register the group into a cooperative, we have our bye-laws….” He explained that they have everything they need for a cooperative including the number of people.

The selflessness displayed by this young man has helped the group tremendously and the caregivers are happy, they are hopeful for a better future for themselves and their children.

 

Disclaimer: This success story was made possible by the kind support from the American people delivered through the U.S. Agency for International Development (USAID). The contents are the responsibility of Health Initiatives for Safety and Stability in Africa (HIFASS) and do not necessarily reflect the opinion of USAID or the U.S. Government.

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Tracking an Index Case Helps Locate a Demoralized Vulnerable Household for Intervention

An area of health management that still needs great attention in Nigeria is the Psychological aspect. People go for medical treatment with other burdens that can either be relieved or aggravated based on the care they receive, just like Mr. Archibong, who knew his status and received treatment at a local health facility till he was informed that his prescription of Antirethroviral drugs could not be refilled unless he had a CD4 count test, for which he had to pay N3,000.00. At the time, he did not have the required amount. Confused, distraught and demoralized, he stopped treatment and sought other options instead, till happenstance brought his family under the HIFASS-LOPIN 3 project radar.

His 12-year-old son was hawking snacks in their neighborhood and walked into a HIV Testing Service (HTS) venue where a HIFASS-LOPIN 3 (a project funded by PEPFAR through USAID) community outreach was taking place. The outreach was hosted by one of the Community Based Organizations (CBO) sub-granted by HIFASS-LOPIN 3, Neighbourhood Care-Well Foundation (NCF). His son tested positive and was followed up as an index case, so his family could be tested. A few days later, the parents and other siblings were tested, and both parents along with the 12-year-old index case were the only positive cases recorded in the family. The boy was still not aware of his status.

During counselling, Mr. Archibong disclosed that he had previously been treated for Tuberculosis (TB) but had stopped receiving Antirethroviral drugs for about two years. At the initial visits, he could barely walk and said he lacked strength to keep up with his laundry business which he wanted to continue at home because he was ejected from his shop when he could not pay for it. His wife who worked with him at the time, stayed home to help him, as he became physically dependent. They looked to friends and relatives for basic needs. Also, he was encouraged to disclose his son’s status to him and eventually, with proper counselling, he told the boy.

Both parents and their son have now been linked to trusted facilities where their prescriptions are refilled regularly. They have received adequate training in relevant areas like financial literacy, education, nutrition, gender norms and a lot more. They have also received nutritional support in the form of food items – rice, beans, plantain, seasoning. The project supported Mr. Archibong with a seed grant of N40,000 which he put into his business. He has resumed laundry services and also now sells bread. His wife was also empowered with another seed grant of N40,000.00 and she now runs a hairdressing business.

Since the husband resumed treatment, he has regained strength and is back to his regular activities. So his wife is free to run her own business. The most fascinating part of their story is the fact that they learnt how to make ‘Tom Brown’, a highly nutritious meal made from soybeans, groundnut and either corn, millet or guinea corn, at a food demonstration held in HIFASS-LOPIN 3 office, Calabar. Positive households are usually encouraged to take it because it contains the body’s required nutrients and is high in energy. Mr. Archibong now consumes it regularly with his family and they sell it as well to people in their community, educating them of its advantages.

Also, he attends caregivers’ meetings regularly, where they discuss relevant information regarding care for themselves and their families and is the secretary of Nka Uforo (meaning Prosperity group), a Savings and Internal Lending Community (SILC) formed after caregivers were trained in financial literacy. He is ecstatic about the whole experience and has this to say “…I was sick, but now I am strong, at least I’m going back to my laundry business, combining with the bread business…. I am made to understand it is the American people that sponsored the program, so I want to say a big thanks. I want to say that you guys have helped me to stand…. I may not have ability to reward you all, but I believe that God will reward you all. I want to say thank you very much”.

 

 

Disclaimer: This success story was made possible by the kind support from the American people delivered through the U.S. Agency for International Development (USAID). The contents are the responsibility of Health Initiatives for Safety and Stability in Africa (HIFASS) and do not necessarily reflect the opinion of USAID or the U.S. Government.