Daniel Yirga Molla-Coffee Plantaion Development
Coffee Plantation Development Enterprise is a government-owned company engaged in producing and selling coffee mainly for export. The enterprise consists of three plantations, based in Oromia, South and Gambella regions and is in the position of having a large number of people living and working in the same area which brings its own mix of social issues.
I have been with the Oromia based plantation for six years and I am currently the Head of Health Services. My background is Master of Public Health (MPH) preceded by Bsc degree in Health Care Management and Diploma in comprehensive nursing. I am based at the head office in Jimma Town.
There are seven farms within the plantation with more than 4,200 permanent workers and 4,000 temporary workers. There are also occasional workers during harvest time. At that time, there are more than 12,000 workers in total. Everyone who works on the plantation lives there too and there are 5,200 householders and more than 24,000 people altogether (including families). Health services are one of the basic services provided and each farm within this plantation has its own clinic. There are eight clinics in total, including the head office clinic.
In the late 1990s and beginning of this decade HIV/AIDS cases in the community were very pronounced. There were many people dying and clinic records showed an increase in people getting treated for HIV related infections and an increase in the number of deaths attributable to AIDS.
Therefore at this time, an HIV/AIDS program was put in place which focused on awareness creation and condom distribution. This program continued until very recently but it was inconsistent, varying in strength from farm to farm, with poor coverage and results.
A new approach
In order to strengthen the prevention program with a more tailored approach, and as a result of extensive research for my recent Masters in General Public Health into disease prevention measures, we found out about the Community Directed approach (CDa) and implemented this approach in mid-2008.
The CDa is a newly adopted disease prevention approach which was first used by the World Health Organization (WHO) for the Onchocerciasis control program. It is said to be a third generation disease prevention approach as it is a timely, innovative and cost-effective strategy compared to institution and community based approaches. The approach has made it possible to empower communities with their own interventions into their health programs. The approach requires a minimum of 65% treatment coverage and compliance for 12 to 15 years, something that institution and community based approaches had not been able to achieve.
The World Health Organization (WHO) recently called the Community Directed approach the best innovative public health finding and recommended it for other disease prevention and health promotion areas. It is particularly effective in areas where there is poor leadership commitment and poor health structures.
In this regard, this is the first project of its kind in Ethiopia outside of its use for the onchocerciasis control program.
Special features of Community Directed approach include:
· Complete ownership of the program by the community. The community leads the health interventions with reasonable technical and logistic support.
· Communities themselves appoint accountable local health agents called Community Directed Health Agents (CDHA) from people amongst themselves. CDHAs are trained volunteers that facilitate program activities and their recruitment is based on levels of literacy, volunteerism and acceptance by the community with due emphasis given to issues of confidentiality (in the case of HIV/AIDS prevention program).
· The community also collectively decides how, when and where the activities will take place, for example like convenient and acceptable methods of condom distribution within the community.
· The community is empowered to undertake the monitoring and evaluation of the program.
Support and partnerships
The Coffee Plantation Development Enterprise is wholly supportive of this program and the budget comes in large part from the enterprise. A recurring budget of 50,000 birr has already been allocated by the enterprise for this year’s activities while the remaining cost is expected to be covered by other donors like partner NGOs.
The enterprise has already said that if this approach is successful, and it is looking that way, it should be extended to the other two plantations. It has already aided awareness-raising amongst management and labor unions.
As most activities are being sourced by the community, NGOs such as OSSA provide assistance together with Jimma University which is providing support for the research aspect of the project.
There are four partners involved in managing the program – the community, NGOs, the Labor Union and the enterprise. They are all helping to run the program and, at the plantation level, have formed a managing board, called Community Directed HIV/AIDS Prevention Council. Each of the seven farms, which are under the plantation, has its own sub-council. The budget is managed by the HIV/AIDS councils.
Activities to date (in the first three months of the project period) include:
· The entire plantation community has been organized into unit communities (UC) with on average 58 households in each. 90 UCs have already been organized. One awareness creation meeting in each UC was undertaken so a total of 90 meetings to inform community members about general features of the new approach and to conduct CDHAs selection have taken place.
· All the selected CDHAs have been given the first three days training (which will regularly be continued every three months for three year project period) on general awareness about HIV/AIDS and starting activities of the new approach, together with OSSA.
· In addition, small groups of seven people (the ‘community leading group’) have been organized within each of the 90 UCs and they are expected to plan and organize activities. These seven people are from a range of different sections in the community; three religious leaders, one woman, two youths and one elderly person. They work with the CDHAs on activities.
· CDHAs have collected and updated basic community data.
· Determination of education sessions, IEC material and condom distribution schemes with quantity estimation, as part of planning, was conducted by all community leading groups and CDHAs.
· Regular peer education sessions with distribution of IEC materials have been started.
· Ongoing collection and constant distribution of condoms through agreed upon distribution methods have also been started by CDHAs.
The next planned activities in the coming quarters are establishing Regularly Organized Coffee Ceremony (ROCC) programs and Community Conversation (CC) sessions. But in later phases of the project, CDHAs plan to conduct HCT (HIV Counseling and Testing) and distribute ART drugs.
The entire community benefits, the enterprise benefits because of improved productivity. Other communities and the general public will benefit after the research is published with best practice and learnings.
The enterprise is very positive about the program and would like to extend it from HIV/AIDS to other social and environmental issues. We are also seeing full community participation from service provision to consumption, sustainability and access and adherence.
The program is still in its early phase and we are expecting the first data on the pilot program at the end of 2009, but to date, the signs have been extremely promising that this is the way forward and we are hoping that other companies, through our association with the Ethiopian Business Coalition Against HIV/AIDS (EBCA), will learn from our experiences.
Our plan in the future is to expand the approach to other health programs such as malaria, water and sanitation and reproductive health. Together with HIV/AIDS, these are the priority social and health issues of the plantation communities.
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