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WORKSHOP ON URBAN MICRO-FARMING AND HIV-AIDS Johannesburg Cape Town, South Africa 15-26 August 2005

Urban Micro-Farming and HIV/AIDS in Kenya; The KAIPPG Experience

By James Onyango KAIPPG (Kenya AIDS Intervention Prevention Project Group) Kakamega

July 2005

INTRODUCTION TO KAIPPG AND ITS PROGRAMME KAIPPG is a grassroots service NGO working with marginalized communities in the rural and peri-urban areas of Kenya, founded in 1996. Its mission is to addresses HIV-AIDS problems holistically through linkages with various aspects of community welfare. It attempts to build the capacity of communities to realize their full potentials and bring about positive change. It focuses its work on improving the status of women, children and youth living in the rural and peri-urban areas, through direct support and increased access to knowledge and information about the links between HIV/AIDS and other social concerns such as poverty, agriculture, nutrition, gender and general health. KAIPPG fosters an approach of self-empowering activism, which in turn helps in the development of programs to address the identified community needs. KAIPPG trains people to help themselves and encourages communities to collect, preserve and disseminate indigenous health and agricultural knowledge and techniques. Currently KAIPPG has 12 paid staff, 2 program volunteers and a large team of community-based volunteers. The paid staff include, 4 Nutritional Field Workers attached to the Nutrition and Food Security Project, 2 nurses attached to the community care and support program, 1 Projects Coordinator, 1 Administrator, 1 Accountant, the Chief Executive and 2 support staff. KAIPPG addresses the holistic needs of the HIV/AIDS affected households in rural, urban and peri-urban areas of Kakamega, Kenya through its Nutrition and Food Security Program. This Program was initiated in 2000; initially targeting 240 HIV/AIDS affected rural households. In 2003, the project was scaled up to reach 720 households, including 180 urban and peri-urban communities, particularly slum dwellers. The primary objective of this program is to improve nutritional and economic status and overall food security of rural and peri-urban communities and households made vulnerable due to HIV/AIDS in Kenya. The strategy is to build an innovative and integrated program that holistically addresses the food, nutritional and economic needs of HIV/AIDS affected communities and other vulnerable households in a sustainable way. The project attempts to holistically improve the status of the entire household where the children live; links families with each other, with local and national agencies, healthcare workers, and other "helping" entities so that a web of support and well-being can be established. The current program is serving 720 households enrolled on 24 NFS of 30 beneficiaries each, of which 6 NFS comprising 180 participants have been developed in urban centres. The success of this program is based on proper development of participatory processes that allow involvement of project beneficiaries plus other strategic partners from the time of project conception, planning, implementation and evaluation. To achieve this, the project went through a series of activities as briefly outlined below: Community Mobilization and Nutritional Needs Assessment Activities The project started by stakeholder mapping and mobilization of communities. This was done through field visits and community sensitization workshops. This process helped in identification and sensitization of the community and other stakeholders on the proposed project and define the roles of the various stakeholders The stakeholders identified included community health workers (CHWs), trainer of trainers (TOTs), provincial administration (PA), Ministry of Health (MOH) and Ministry of Agriculture (MOA), NGOs and other Community based organizations (CBOs) within the project area.

KAIPPG conducted 3-day non-residential community sensitization workshops in each targeted project sites. First workshop day focused on making the project known to the community and identifying and familiarizing with possible stakeholders and partners in each project area. Community leaders, MOA extension officers, MOH personnel and the PA were invited to attend. This enabled all stakeholders to identify their roles and assist in the identification of project beneficiaries. Approximately 60 people participated in each of the workshops. Day two focused on conducting the nutritional needs-assessment. The needs assessment helped to determine the common crops grown in the particular areas, the farming resources already available within the groups, the seasonal calendars, establish the community action plans, determine respective roles of each stakeholder and develop the participatory monitoring and evaluation tools. Day three focused on developing criteria for selection of project beneficiaries. Establishment of Nutritional Field Schools (NFS) KAIPPG established 24 community-based non-formal learning centres, called Nutritional Field Schools (NFS) in 24 sites. Of these, 6 project sites comprising 180 participants were developed in urban centres of Busia, Mumias and Kakamega, while 18 sites comprising 540 participants were in rural areas in Bungoma, Teso and Malava/Lugari districts in Western Kenya. Using participatory methodologies, 30 people per site were selected from vulnerable households. The 30 people were organized to comprise one NFS. Priority was given to older orphans; widows, low-income women and older vulnerable children who are PLWHA or HIV/AIDS affected household members. KAIPPG worked closely with its already existing community groups to identify group members from their home-based care beneficiary clients and those already enrolled on our other projects.

Establishment of beneficiary plots and demonstration sites Each member of the NFS donated a small plot (about half acre), from the family land, on which to grow crops. KAIPPG rented small farms for the participants who did not own or have access to the family land, while the multi-storey gardens (sack gardens) were developed for the urban-based clients. The crops to be grown were selected on the basis of their nutritional components, with priority being given to indigenous crops and vegetables. NFS members were then supplied with farm inputs and supplies, and equipment. Certified maize and sorghum seeds, vegetables, and fertilizers were purchased from authorized dealers and supplied to the beneficiaries.

One farm demonstration plot was centrally established on each field school where NFS members met once a week to receive training and share issues of concern and successes. Community members donated the land for the demo plots. Where this was not possible KAIPPG rented the farm from the municipal land. Formal classes were held during the NFS meetings, facilitated by Nutritional Field School facilitators, Ministry of Agriculture Extension Officers and Nutritionists. The facilitators used the demonstration plots to show how to effectively prepare the soil, proper plant spacing, cultivation techniques, pest control, harvesting techniques and dietary intake for OVCs and PLWHA. Training of Vulnerable Households in Nutrition and Food production The participants were taught relevant skills and techniques to enable them acquire the needed nutrition and patient care skills, maximize crop harvest and have the potential to become more economically and socially empowered. The NFS participants who completed the above training and who were able to apply new skills of food/crop production and utilization were linked up to our Information, Communication and Technology project, which trains communities in integration of Information and Communication Technologies in HIV/AIDS prevention, gender and agricultural development. This in turn empowered the project beneficiaries to serve as facilitators in dissemination of information to the new field schools in their catchment areas, as the project further expands. Apart from the weekly meetings, small inter-care group meetings were held to share experiences on counselling, team strengthening and motivation and as a means of relieving stress. When the group members harvested their crops, they donated 5% of their total produce to new groups earmarked for subsequent growing seasons, in order to replicate and expand the project with minimal external inputs. During the weekly formal classes at the demonstration plots, community members were given a chance to ask questions on cross cutting issues, which were then addressed by the NFS facilitators. Condom distribution was also done on demand after every weekly session at the demonstration plots. Stigma reduction Reduction of stigma and raising the status of PLWHA was among the key anticipations of the project. KAIPPG achieved this through: Trainings on the NFS Organization of post-test clubs (PTC) and other community self supporting initiatives. PTC members are NFS participants that have undergone an HIV test and have knowledge of their current status. Its primary aim was to link beneficiaries and provide opportunities for them to share their burdens and experiences. By the close of 2004, 11 PTCs had been formed. Through the PTCs, clients were able to know each other, form strong webs of support and access ARV treatments. KAIPPG developed proposals for the PTCs to seek funding for initiation of their own Income generating projects directly from the National AIDS Control Council (NACC). Facilitation of joint meals with PLWHAS. KAIPPG provided the beneficiaries with food during the NFS classes. This ensured that the process of food preparation, feeding and teamwork was more practical, with the food being bought from the community, prepared as part of the learning process and eaten by all those participating on the NFS classes. Since all beneficiaries were eating together as a group, this reduced stigma. Since food was prepared on the spot and eaten jointly, beneficiaries could not divert the money meant for their food into spending it on other pressing needs at the expense of the food.

Collaboration and Linkage of Clients to health facilities and other support networks In order to ensure that a comprehensive package of care and support services are provided to PLWHA and affected family members, KAIPPG worked with its homebased care volunteers and those trained by other institutions to encourage and motivate NFS participants and reinforce the nutritional training component of the project. CHWs are uniquely positioned to promote compliance with revision of diets geared for the client with opportunistic infections, eating disorders, and certain food intolerance related to HIV/AIDS. NFS members were provided with the opportunity to visit with previously trained NFS members to get a first hand view of the changes made in household dietary regimes as well as the impact the program made on food production and marketing. Apart from linking beneficiaries with each other into a sort of web, KAIPPG created strong linkages with several governmental and non-governmental agencies. CHWs strengthen the linkage of project clients with health facilities for early diagnosis and treatment of infections, such MSF Spain, for ARV access by the clients, hospitals and clinics in the districts of operation for the purpose of facilitating referral of the patients and provision of VCT and ARTs, among other services. KAIPPG also linked up NFS members with K-REP and SMEP-micro-financing organizations, so that members could access resources to start up small businesses and expand crop production. The Kenya Agricultural Research Institute in Busia and Kakamega provide some researched varieties of root crops (such as potatoes and cassava) to our project clients; MOA and MOH provide technical expertise to the whole project. The provincial administration assists with the security of the farm plots and safety of widows and orphan headed plots. These networks facilitated the provision of a complete care continuum to our targeted communities. It is hoped that these networks will further be strengthened as the project progresses in the subsequent phases so that they will survive and be sustained even after the end of the project. RESULTS OBTAINED Improvement of household food security and nutritional status of PLWHAS The project helped the most stigmatised groups (HIV/AIDS-infected and affected) to be self-sufficient in long-term food supply, and to improve the nutritional status of children. This in turn provided them with greater psychosocial empowerment and adaptability. Monitoring information shows that the households are maintaining their improved gardening practices, nutritional habits and methods of caring for PLWHA. In addition longevity of life and a delay in progression from HIV to full blown AIDS, has been observed in 65% of HIV infected individuals who were enrolled on this program. Improvement of household economic sustainability In addition to linkages with micro-financing institutions, households sold other products of their agricultural activities such as animal cakes and margarines, thus generating extra income. This helped to improve both the livelihood of families and their general long-term economic and social standing. Skills development:

The project trained communities in caring for the PLWHA in the home, good nutritional habits, proper knowledge on the importance of VCT and ARV treatments and also in reliable, innovative, and simple methods of food production and processing, record keeping and farm planning. This skill development ensured that the communities were adequately equipped to implement the project on long term basis using their own resource people The organization was successful to prove to the community that through proper farming practices food security can be attained. The plots produced yields, which were approximately 65% to 70% higher than the previous productions. Stigma Reduction and Empowerment of orphan-headed households The project activities made that the urban and peri-urban communities negative attitude towards farming and stigma towards PLWHA began changing. Other benefits and beneficiaries The project had benefited many people, either directly or indirectly. Each of the 720 beneficiaries was from a household of 8 persons on average, totalling to approximately 5,760 beneficiaries. Apart from this, all NFS were open to attendance by other members of the neighbourhoods. An additional 1350 persons not initially registered on the program participated in NFS classes. Local business communities also benefited due to sale of farm equipment and supplies to the project, as were the micro-financing institutions to which the groups were linked. Several local NGOs and Farmers Groups have adopted the nutritional field school model.

LESSONS LEARNT The success or failure of urban agriculture projects that aim to positively influence nutrition and income situation of households affected by HIV-AIDS is dependent on a number of factors, which are presented below. Creating access to Land and water Urban families normally have very restricted access to land and water for food production. In many urban centres open space for agriculture is limited and the faster the urbanisation, the more limited that space becomes. For this reason, the efficient protection of open spaces in inner cities is an important issue. Farming can be done on strips of land at the sides of roads, railways and power lines, as well as along riverbanks and on seasonally flooded land. In most countries, power lines are

situated in non-residential areas and so, in the same way as river banks, the land over which they pass is often used as illegal dumping sites. These strips may be converted for agricultural use. Experiences in Kenya have shown that by creating community gardens in such areas, illegal dumping and squatting on such land can be prevented. Sack gardens can be developed within the inner cities where there is limited space and water. Hand drip irrigation can be used in resource constrained agricultural areas. Overcoming labour constraints: group and livelihood approach HIV-Aids affected households encounter severe restrictions in labour availability for farming (or other productive activities). It is for this reason that organizing people into groups is important. Groups assist in tending each others farms, as it is understood that the failure of one individual within the group would be seen as failure of the whole group. Group activities such as merry-go-rounds can be used to raise funds that can help in meeting the labour and other productive needs of PLWHA. Where the program has trained family and community care givers, these can be used to assist the PLWHA with day to day social chores including tending of the farms. Urban farmers to a large extent have other urban jobs too. This limited their availability and focus on training on the field schools. It is in this context that the program did not restrict itself to agricultural activities but took the whole of the peoples livelihood strategies into account. Most people, who get infected with HIV while residing in urban areas, immigrate to their rural homes during their final time of illness. It is important that during the planning of the program methods that are sensitive to these dynamic processes should be considered. Dealing with rapid change Change is a dominant feature of the urban context for many people, either real or anticipated. The rapid changes in the urban settings can be a major impediment to project sustainability. Housing insecurity, land insecurity, rapid changes in land use, immigration, shifting work opportunities, soaring land prices and an increasing interference of urban political and economical power groups will all have varying implications on the sustainability and long term impacts of the micro-farming program. Availability of high quality but affordable gardening Inputs Access to the necessary inputs for gardening from a local, sustainable source is an important element for successful gardening. Such inputs include seeds, seedlings and saplings, a regular water supply, environmentally friendly soil improvement techniques and pest control, fencing, proper farming tools and capital where needed. Community Participation Involvement and participation of the community in project initiation, design, implementation and evaluation will ensure active participation and ultimate ownership of the project by the beneficiaries. Having two-way channels for information exchange is instrumental for achieving sustainable, improved gardening practices. Self- created local community groups are necessary for creating a voice through which the marginalized can be heard. Technical assistance, demonstration and training Technical support is especially important when new gardening techniques are being promoted such as growing new or increased number of varieties or year-round vegetable production, and when all these have to be linked up with HIV/AIDS care, support and mitigation. Training and other group activities around a central demonstration garden can serve to demonstrate different varieties, hybrids or other

important garden techniques such as composting, use of natural pesticides, year round production, sack gardening and other topics relevant to community needs. Nutrition and HIV/AIDS education within the gardening activity Counselling to change feeding/eating behaviours and adopt positive attitudes for PLWHA is generally an important component of food-based strategies. Similar to understanding the indigenous approach to gardening, an understanding of the cultural context, feeding practices and interaction of drugs with food will guide nutrition education to achieve good health and sustainable behavioural changes. The garden or nursery can also be utilized as a focal point for nutrition education and social marketing to promote increased consumption of micronutrient rich foods. In addition, messages about a variety of other issues that influence nutrient absorption and overall health such as prevention of childhood illness, timing of meals/foods, intake of tea and other factors that inhibit nutrient absorption can be presented to households, HIV/AIDS care givers, orphan guardians, mothers and household members. Broadening from gardening to animal husbandry KAIPPG has begun integrating animal husbandry, fish, bee and mushroom farming, with its home gardening program. This is because of the important success of related pilot activities, as well as the fact that animal foods are a very good source of micronutrients, and that their bioavailability is better than that of micronutrients of cereals and vegetables. Implementing Integrated and multi-stakeholder programs Since agriculture is not a job of choice for most urban dwellers, it is strongly recommended that the program integrates other activities, such as the arts and communication, non-agricultural economic activities, into the program. Involvement of other stakeholders in program implementation will facilitate comprehensive support across a wide spectrum of community needs. Funding for support of the post-test clubs (PTC) should be provided within that of the nutritional activities in order to facilitate effective community mobilization for VCT and ARTs. The PTCs are very effective fora, not only for stigma reduction and PLWHAs economic empowerment, but also for educating people on the importance of VCT and ARTs, including where and how to access these services. This approach will make the program more attractive to all cadres of people - youth, women, men and the elderly- and lead to greater program impact and sustainability. Monitoring and evaluation Monitoring facilitates the identification of problems and the development of solutions based on sharing between the beneficiaries and the program managers. Indicators are dependent on the program objectives and should include some that can be monitored locally. Continued integration of lessons learned from implementation and evaluation efforts is one of the key aspects to the successful scale up of this program. Evaluation and planning should be conducted at key intervals during the program period to improve the program. Follow-up of program clients and involvement of other partners in the monitoring and evaluation framework will ensure that problems are identified and tackled before they get out of hand. Semi-annual Participatory Project Review workshops were held with strategically selected beneficiaries, CHWs and partners, in order to assess the impact of the project. Achievements made during the implementation, challenges and lessons were shared, and action plans for subsequent phases developed. These workshops are normally broad-based so as to share the lessons from other projects of the KAIPPG program as this not only helps in creating synergies, but also to establish

ways and linkages for the communities project sustainability in case of the unavailability of future donor support. Combination of funding sources A project of this nature requires both external sources of finance and reasonable contributions from both the beneficiaries and other local stakeholders. For instance, the overall institutional, administrative and logistical support to this project was provided by KAIPPG, using funding from USAID through Pathfinder International. The farm tools and equipment were donated by WORKAID -a British charity- while the ICTs component of the program was funded through CTA/IICD/IDRC/HIVOS GenARDIS Small Grants Program. On the other hand, the project beneficiaries provided labour and where possible, land. The Kenya Agricultural Research Institute (KARI) provided some certified seeds while MOA and MOH provided technical support. Technology development There is still limitation of local technical knowledge in urban agriculture with no or minimal research having been conducted. More research is needed as well as capacity development for institutions undertaking urban micro farming in the context of HIV/AIDS.