promoting excellence in training - unaids

Promoting excellence in training

The Regional AIDS TrainingNetwork (RATN)

UNAIDSCase Study

June 2001

UNAIDS Best Practice Collection

© Joint United Nations Programme on HIV/AIDS(UNAIDS) 2001.

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UNAIDS/01.31E (English original, June 2001)ISBN 92-9173-076-9

UNAIDS – 20 avenue Appia – 1211 Geneva 27 – Switzerland Telephone: (+41 22) 791 46 51 – Fax: (+41 22) 791 41 87 e-mail: [email protected] – Internet: http://www.unaids.org

Cover photo: Health worker in a community-based care project in Botswana assists an AIDS patient.

© UNAIDS/Giacomo Pirozzi

Promotingexcellencein training



The Regional AIDSTraining Network (RATN)

UNAIDS case study

U N A I D S B E S T P R A C T I C E C O L L E C T I O N

ContentsAcronyms 5

Acknowledgements 6

Executive summary 9

Background 18

HIV/AIDS in sub-Saharan Africa 18

The founding of the Regional AIDS Training Network (RATN) 19

Key functions of the RATN headquarters 25

Staffing overview 25

Collaboration with Partner Institutions (PIs) 27

RATN and the promotion of training 28

Information dissemination 30

Key activities of RATN 33

Course development 33

Expert committees 35

Course delivery 37

Monitoring and evaluation 40

Long-term follow-up and evaluation 41

Impact on the employing organization and the community 43

Building the RATN network 48

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RATN achievements 50

High level of satisfaction with RATN courses 50

Raising the standard of training in the region 51

Raising the profile of training in East and Southern Africa (ESA) 52

Improving collaboration and communication between Partner Institutions (PIs) 53

Challenges 55

Course delivery 55

Network-building 57

Strengthening collaboration between Partner Institutions (PIs) 59

Funding 60

Lessons learned 62

Lessons learned about training 62

Lessons learned about collaborating and networking 64

Appendix 1: RATN Partner Institutions 66

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Contents

Acronyms

CIDA Canadian International DevelopmentAgency

ESA East and Southern AfricaPIs Partner InstitutionsRATN Regional AIDS Training NetworkSTDs Sexually Transmitted DiseasesTASO The Aids Support OrganizationTOT Train the TrainerTORs Terms of ReferenceUNAIDS Joint United Nations Programme on

HIV/AIDSWHO World Health Organization

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Acknowledgements

Since its founding less than four years ago, the RATN project has incurredsubstantial “debts of gratitude” to those organizations and individuals whohelped nurture the idea of a regional training network, brought it intobeing, sustained it and helped guide its future. It is impossible to name allthose to whom we owe thanks. Nevertheless, there are some whose contri-butions have been particularly noteworthy.

A special thanks to our funders, especially the Canadian InternationalDevelopment Agency (CIDA) and the World Bank, who supported RATNfrom the outset. We’d also like to thank those supporters who are helpingus expand our vision, scope of work and activities. They are: the Academyfor Education Development (AED), Swedish International DevelopmentAgency (SIDA), Flemish Inter-University Council (VLIR), the Joint UnitedNations Programme on HIV/AIDS (UNAIDS), United Nations Children’sFund (UNICEF), the Population Council, Family Health International,University of Washington, USAID, the World Health Organization (WHO)and the Health Resources and Services Administration (HRSA).

We’d like to express our deepest gratitude to the Universities of Nairobi andManitoba, particularly to those key individuals who were instrumental ingetting RATN up and running: Hannington Pamba (Nairobi), JeckoniahNdinya-Achola (Nairobi), Allan Ronald (Manitoba), Stephen Moses(Manitoba), and Frank Plummer (Manitoba).

RATN has benefited immeasurably from the skills, commitment and pro-fessionalism of its management team and advisers. We would like toacknowledge the special contributions of Anastasia Ndiritu, JacquelineMakokha, Purity Nyamu and Roselyn Kareithi, Stan Benjamin and the lateDavid Fish.

Acknowledgements

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Our final and most heartfelt thanks to the staff and trainers of the RATNPartner Institutions, whose belief in and generous support for RATN havebeen so essential to getting us to where we are today.

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Dr Job BwayoCo-director, RATNChair, Department of Medical MicrobiologyUniversity of Nairobi

Dr Larry GelmonCo-director, RATNVisiting Lecturer, University of NairobiAssistant Professor, University of Manitoba

Bruce Waring and Larry Gelmon wrote this case study,which was commissioned by UNAIDS. Olusoji Adeyi wasthe responsible staff member at UNAIDS. Laura Bordencontributed comments to early drafts of the document.

The impacts of HIV and AIDS onany given sector of society are

multiple and complex. No government, organiza-tion or individual involved in HIV/AIDS preven-tion, care, treatment and support activities has allof the skills, knowledge, and experience to be opti-mally effective without some form of basic oradditional training. This training may range fromSTD control, counselling, testing and communitycare to behaviour change, managing and planning.Providing quality courses and other trainingopportunities is a tried and tested way of increas-ing the effectiveness and productivity of manage-ment, workers and volunteers in the workplace.

In early 1994, the Universities of Nairobi (Kenya)and Manitoba (Canada) assessed the HIV/AIDS-related training needs in the Eastern and SouthernAfrican (ESA) Region. The study demonstrated thatdecision-makers, mid-level managers and trainersthroughout the region felt inadequately preparedto address the growing challenges of HIV/AIDS.While acknowledging that training was required,the assessment highlighted that training needs var-ied from country to country.

Out of these results and further discussion in theregion the idea developed to form a network oftraining institutions and to this end the RegionalAIDS Training Network (RATN) project was

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Executive summary

Introduction and background

founded in 1997. Its goal was to provide skillstraining, upgrading, extension services and techni-cal assistance in the ESA region to health andallied workers in the HIV/AIDS/STDs field. RATN’saim is to increase the capacity of HIV/AIDS/STDprogrammes there to mount effective treatmentand prevention strategies so as to reduce theimpact of the epidemic.

In its mission, RATN has defined its key roles as:a) developing and presenting new training cours-es through Partner Institutions (PIs) that respondto perceived needs in the region and b) facilitatinga process that will lead to establishing a formalnetwork of training institutions governed by itsmembers.

Partner Institutions (PIs) is the namegiven to the organizations that

have agreed to work with the RATN project ondeveloping and providing courses as well as form-ing a formal network of training organizations inthe ESA region. There are currently 17 RATN PIs.

In collaboration with PIs, RATN has developedcourses providing skills training in the followingareas: counselling, counselling supervision, syn-dromic management of STDs, community care ofHIV/AIDS, communication and behaviour change,adult education/training of trainers, advocacy, pol-icy & planning of HIV/AIDS, laboratory manage-ment, STD supervisor training and adolescent

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Executive summary

Focus on training

counselling & research. To date, over 50 trainingcourses have been delivered through RATN PIs,and nearly 700 students from 21 African countrieshave been trained.

RATN courses are aimed not at so-called “front-line workers” but at trainers and managers of pro-grammes. The idea behind these training of train-ers (TOT) courses is that the students will take theirnew-found knowledge and apply it to improvingthe quality of training given to their own and otherinstitutions as well as individuals interested intraining issues in their home countries.

Focus on network building The purpose of the RATN project then is to build aformal network of organizations involved in train-ing in the HIV/AIDS field. To date much progresshas been made and RATN PIs are generally active-ly engaged in networking (i.e. collaborating, com-municating and sharing information).

RATN achievements

Since its beginnings less than four years ago, RATN’sachievements have been notable. They include:

High level of satisfaction with RATN courses Follow-up studies of RATN course alumni demon-strate that the alumni and their employing organ-ization are highly satisfied with the courses. Onealumni follow-up study from the counselling andcommunity care courses offered by RATN and itsPIs indicated that over 80% of the respondentsimproved their operational skills in the workplace,

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and a substantial percentage commented onincreased levels of confidence and interpersonalskills with clients.

Raising the standard of training in the region RATN has begun to have a major impact on rais-ing the standard for training in the ESA region.The use of expert committees to define minimaland optimal training components of new RATNcourses has helped them gain a reputation for set-ting new, improved training standards.

Raising the profile of training in ESA RATN and its PIs are collaborating to raise aware-ness among decision-makers and donors of thevalue of quality training. Using the results of itsmonitoring and evaluation activities, RATN candemonstrate the short- and long-term results andbenefits of its courses.

Improving collaboration and communicationbetween Partner Institutions (PIs) RATN has had some success in breaking the rela-tive isolation that exists in the ESA region amongtraining organizations in the HIV/AIDS field, par-ticularly those offering training in counselling andcommunity care.

Challenges

RATN and its PIs have faced a number of chal-lenges in working toward their goals, among them:

Course delivery The following are the greatest challenges in this area:

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Executive summary

• Selection of course participants: RATN and thePIs have carefully defined admission require-ments for each course and closely vetted courseapplication forms. Nevertheless, some alumnihave been disappointed in the level of knowl-edge of other course participants and the nega-tive impact this had had on their learning expe-rience.

• Funding of course participants: Some fundershave criticized RATN for using operationalfunds to directly support scholarships for courseparticipants. RATN acknowledges that in anideal situation it would not have to do so.However, the realities of regional economics-course delivery costs as well as the inability ofmost individuals and AIDS service organiza-tions to pay for training-mean that RATN mustunderwrite a certain amount of training costs,at least for the near future.

• Post-course support: RATN alumni have indi-cated the need for post-course support to helpthem fully utilize the knowledge they havegained. RATN and its PIs are currently explor-ing cost-effective strategies to respond to thisexpressed requirement.

Network-building While much progress has been made in establish-ing a formal network and RATN PIs are, to vary-ing degrees, actively engaged in the process ofnetworking, many project stakeholders expectedthat more progress would have been made bynow. To address this concern, a network develop-

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ment committee has been given a mandate toexplore options for establishing a formal network,a governance structure for the network, and atimeline for setting up the network as a distinctlegal entity.

Strengthening collaboration between PartnerInstitutions (PIs) RATN has achieved some success in encouragingcollaboration between its PIs, particularly betweenthose PIs that are offering courses in the same area(i.e. counselling and community care). However, ithas been less successful in promoting collaborationbetween PIs that offer courses in disparate areas.

Funding One of RATN’s major challenges is funding. Thereare two aspects to this concern. The first involvesaccessing adequate resources to cover RATN’splanned activities and the second further diversify-ing its funding base.

Lessons learned

Since its inception, the RATN project has under-taken a number of lessons learned exercises.

Lessons learned about training

1. Conducting a needs assessment study is a cru-cial first step in developing intervention pro-grammes. Using needs assessment data in pro-gramme planning helps ensure that interven-tions are relevant to actual needs. Suchprogrammes are likely to attract support from

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Executive summary

different stakeholders. The needs assessmentstudy that was conducted prior to the RATNproject’s development yielded information thathelped guarantee that the project was appropri-ate to needs of the ESA region, and has con-tributed to RATN’s success at fund-raising.

2. Developing an ongoing resource for identifyingemerging needs is a way of maintaining rele-vance. Expert committees have been essential tomaking sure that the RATN courses are relevantand have also assisted in raising the standardfor training in the ESA region.

3. RATN courses have been adapted to suit the needsof the ESA region, which has contributed to mak-ing them relevant and popular. This practice hassignificantly reduced the number of courses thatare not context compliant, hitherto a commontrend, especially with courses from the first world.

4. Creating and encouraging a culture of excellencein course content and delivery among PIs hasmade a significant impact in several areas. It hasheightened awareness of the need for qualitytraining; created a demand for the courses beingoffered and rapidly made RATN and its partnersacknowledged regional advisers on best practicesin training.

5. The practice of feeding back the results of mon-itoring and evaluation exercises into pro-grammes and activities ensures continuousquality control and improvement of courses andtraining.

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6. Follow-up studies to evaluate the impact oftraining on alumni and their employing organ-izations are critical. The data from the studieshelp document the course’s impact and thisinformation can be used to improve subsequentones. Such data also verify the effectiveness ofthe training offered.

Lessons learned about collaborating and networking

1. PIs (members) are more likely to contribute todeveloping a network if the “value added” oftheir participation is clear. It is essential to cre-ate frequent opportunities for PIs to reflect onhow their organizations are benefiting fromtheir participation to keep them motivated.

2. It is important for PIs in a network to havedirect contact with one another and not tobecome overly reliant on secretariat staff tofacilitate communications.

3. Their involvement in the governance of the RATNproject has given PIs a sense of project ownershipand enhanced their commitment to achieving aformal network of training institutions.

4. Building a formal network will not be achievedsimply by engaging in networking activities likeinformation-sharing and promoting collabora-tion. Such activities are vital in creating a senseof working for a common goal but they will notin themselves give members a sense that thenetwork belongs to them. Building a formal

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Executive summary

network requires resources and a concrete planas to how to establish and sustain it.

5. Investing in communication vehicles such asthe RATN member newsletter and the RATNweb site has been an effective way to keep PIsinformed of vital information and resources.The newsletter and the web site have alsohelped to improve the public profile of RATNand PI projects along with that of their courses,throughout the ESA region.

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Nowhere has the impact ofHIV/AIDS been more devastating

than in sub-Saharan Africa. All but unknown ageneration ago, today it poses the foremost threatto development in the region. By any measure, andat all levels, its impact is simply staggering.

Given these realities, African governments, commu-nities, and their partners must act now to preventfurther HIV infections, and to care for and supportthe millions of people already infected and affected.An expanded response must include greater invest-ment in training to help those in a position to act —both inside and outside of government— to keep upwith the ever-increasing demands of what is prov-ing to be one of the most complex, persistent anddeadliest pandemics in recorded history.

Expanding the response includes the importanttask of sharing lessons learned. This paper wasconceived as a way to share valuable lessons forthose individuals and institutions interested in net-work-building and training issues. To that end, thispaper addresses the following topics and keyissues: • Key functions of the Regional AIDS Training

Network (RATN) headquarters• RATN key activities• RATN achievements• Challenges and lessons learned

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BackgroundBackground

HIV/AIDS in sub-Saharan Africa

The Regional AIDS TrainingNetwork has its origin in the long-

standing research collaboration between theUniversities of Nairobi (Kenya) and Manitoba(Canada) in the area of sexually transmitted dis-eases (STDs). The two universities began workingtogether on STD research and training in the late1970s. By the early 1980s they had partnered withthe Universities of Washington in the United Statesand Ghent in Belgium to establish the CollaborativeCentre for Research and Training in STDs. In thelate 1980s, the World Health Organization (WHO)designated the Centre a “Centre of Excellence” andthe Centre accepted WHO’s invitation to become a“WHO Collaborating Centre.”

In addition to landmark work in the natural histo-ry and epidemiology of STDs, in 1985 researchersat the Collaborative Centre were the first to dis-cover HIV in Kenya. Subsequently, theCollaborative Centre’s research and training focusexpanded to include the new virus. Furtherresearch elicited the now well-established linkagesbetween STDs and HIV acquisition/transmission,the dynamics of mother-to-child transmission and,more recently, evidence of associations withbreast-feeding and the presence in some people ofresistance to infection.

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The founding of theRegional AIDS TrainingNetwork (RATN)

By the late 1980s and the early 1990s HIV wasfirmly established and growing in most ESA coun-tries. The demand for training in STD/HIV preven-tion, control and treatment at the collaborativecentre also increased during this time, with grow-ing requests from all over the region for trainingopportunities. However, the Collaborating Centrehad extremely limited capacity to keep up with thedemand for training.

In considering various options to provide qualitySTD/HIV training, officials from the Universities ofNairobi and Manitoba, along with their colleaguesfrom the Centre, discussed the changing nature ofHIV/AIDS in the region and how to address thespreading epidemic effectively. As the epidemicmatured, the multifaceted nature and impact of thevirus became increasingly apparent. It became clearthat any strategy to prevent the further spread ofHIV and to mitigate its impact would have toexpand beyond the prevention, control and treat-ment of STDs.

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Background

The RATN works closely with TheCollaborative Centre for Research andTraining in STDs to meet women’sneeds. Visitors from the Centre accom-pany peer educators on a home visit totalk about STDs and HIV/AIDS. Credit:STD/HIV/AIDS project of the Universityof Nairobi /WHO Collaborating Centre.

This led to the idea of creating a regional centre topromote excellence in training in a range of areasrelated to HIV prevention and mitigation of itsimpact. To obtain donor support for a trainingcentre, the universities knew that they had to backup their observations on training needs withempirical data. To that end, funds were obtainedto conduct a needs assessment study in the ESAregion in early 1994. The nine-country studyincluded interviews with key informants and focusgroup discussions with health and allied workerswho were viewed as potential trainees. The studydemonstrated that decision-makers, mid-levelmanagers and trainers throughout the region feltinadequately prepared to address the growingchallenges of HIV/AIDS, that training wasacknowledged as a need and that the needs variedby country.

The study also revealed a pattern of isolation withrespect to training. While various organizationsthroughout the region offered high-quality train-ing courses, many had little knowledge of similarcourses offered by organizations in other coun-tries. Most institutions offered country-levelcourses rather than drawing participants fromaround the region. Furthermore, the study foundthat organizations working in the same field butin different countries did not explore opportuni-ties for sharing training ideas, course content andmaterials. This was the result of deeply held beliefsthat countries and institutions in the region hadlittle to learn from one another because of sup-posed cultural and linguistic differences or varia-tions in local history of the epidemic.

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From these results and further discussion in theregion came the idea to form a network of train-ing institutions instead of a training centre. Thenetworking model replaced the concept of thetraining centre model because it offered some dis-tinct advantages:

• Under the training centre model all trainingwould have happened in one location, whilethrough the networking model, training wouldhappen wherever the training institution waslocated or wished to provide the course.

• Considerable start-up costs were associatedwith the training centre model including con-structing or renting a building(s) to house thetraining centre. The networking model neededonly office space to house a secretariat.

• The networking model was considered moresustainable, assuming that the organizationsinvolved would be more prepared to contributefinancial and human resources to creating anetwork in which they had ownership ratherthan to a training centre that could be per-ceived as belonging to somebody else.

The RATN project began in 1997 with the aim ofestablishing a regional network of training insti-tutions to provide skills training, upgrading,extension services and technical assistance tohealth and allied workers in the field ofHIV/AIDS/STDs in the ESA. RATN’s goal is toincrease the capacity of HIV/AIDS/STD pro-grammes to mount effective treatment and pre-vention strategies and, ultimately, to reduce theepidemic’s impact in the region.

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Background

To achieve its purpose, RATN has assumed the fol-lowing tasks:• identifying and collaborating with high-quality

training institutions in ESA to present regionaltraining courses;

• developing and presenting new training cours-es through PIs in response to perceived and feltneeds in the region;

• providing resources so that existing trainingprogrammes can reach a wider audience;

• developing a regional network of technicalexpertise through convening meetings/work-shops, publishing documents, improving com-munication linkages, and liaising with institu-tions and donors;

• serving as a resource for others to identifytraining institutions, trainers and consultants inthe region;

• acting as a focal point for discussions on train-ing issues;

• advocating for training resources at the region-al and international level and

• facilitating the establishment of a formal net-work of training institutions to be governed byits members.

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A peer leader demonstrates how to use a condom toa group of attentive listeners. Credit: STD/HIV/AIDSproject of the University of Nairobi /WHOCollaborating Centre.

Offering high-quality courses andother training opportunities is aproven means of increasing theeffectiveness and productivity ofmanagement, workers and volunteersin the workplace. The impacts ofHIV/AIDS on any given sector of soci-ety and the economy are multipleand complex. All organizations andindividuals involved in HIV/AIDS pre-vention, care, treatment and supportactivities can benefit from basic oradditional training, whether it be STDcontrol, counselling and testing,community care, behaviour change,or managing and planning. In thedynamic field of HIV/AIDS work newdevelopments are constantly beingreported. Keeping up with these

developments is vital. Trainingensures that individuals and organi-zations in a broad spectrum of areasstay informed of emerging knowl-edge, new techniques and approach-es, recognized good practices andhow to apply them effectively.

Almost 20 years of living with the HIVvirus has also underscored that thestress of working in the HIV/AIDSfield can lead to high rates of turn-over and burnout. When people leavegovernment or other organizationsworking in HIV/AIDS, or change jobs,training is needed to give new peoplethe skills and confidence to do theirjobs well and to help keep the organ-izations with whom they work effec-tive, innovative and committed.Sending employees on training cours-es to upgrade their knowledge andskills is also a proven antidote againstburnout. One underlying factor lead-ing to burnout is the stress of feelingill-equipped to perform responsibili-ties as well as expected. In manyinstances employees or volunteerslack the knowledge and skills to meetperformance expectations but qualitytraining helps them to function moreeffectively in many situations and canrelieve them of this stress.

Background

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Box 1: Why training?

RATN secretariat staff pose for a picture at the Network offices inNairobi. Credit: Regional AIDS Training Network.

The RATN project is managed by asecretariat located on the grounds

of the College of Health Sciences at the Universityof Nairobi in Kenya. The secretariat primarily facil-itates the development of the project’s work planand its effective implementation. The projectemploys two co-directors, a project manager, twoprogramme coordinators and a few support staff.

The co-directors represent the two main projectpartners—the Universities of Nairobi and Manitoba.The co-directors serve as the project’s senior man-agers and together are responsible for overall proj-

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RATN Partner Institutions (PIs)

The organizations working with the RATN proj-ect on developing and providing courses andcreating a formal network of training organiza-tions in ESA are known as Partner Institutions(PIs). There are currently 17 RATN PIs:• Centre for African Family Studies (CAFS),

Nairobi, Kenya• Connect Institute of Systemic Therapy,

Harare, Zimbabwe• Eastern and Southern Africa Management

Institute (ESAMI), Arusha, United Republicof Tanzania

• Family Aids Caring Trust (FACT), Mutare,Zimbabwe

• Genitourinary Centre, Harare, Zimbabwe• Health Economics and HIV/AIDS Research

Division (HEARD), University of Natal,Durban, South Africa

• KARA Counselling and Training TrustLimited, Lusaka, Zambia

• Kenyan Association of ProfessionalCounsellors (KAPC), Nairobi, Kenya

• Malawi Institute of Management (MIM),Lilongwe, Malawi

• Mildmay International, Kampala, Uganda• Project Support Group, University of

Zimbabwe, Harare, Zimbabwe• Salvation Army Chikankata Health Services,

Chikankata, Zambia• School of Public Health, Nelson Mandela

College of Medicine, University of Natal,South Africa

• South Africa Institute for Medical Research(SAIMR), Johannesburg, South Africa

• The AIDS Service Organization (TASO),Kampala, Uganda

• The United Republic of Tanzania GenderNetwork Programme (TGNP), Dar esSalaam, United Republic of Tanzania

• University of Nairobi, Nairobi, Kenya

Key functions of theRATN headquarters

Staffing overview

ect operations. These duties include: strategic plan-ning; project monitoring and evaluation; fund-raising; liaison with and reporting to donors andthe Kenyan Ministry of Health; and maintaininglinks with PIs and other leading regional and inter-national HIV/AIDS organizations.

The project manager is responsible for projectadministration, financial management and report-ing, and human resource management.

The course coordinator has overall responsibilityfor developing and delivering courses. This encom-passes liasing with PIs to develop, schedule, mon-itor and evaluate courses, organize expert commit-tee meetings and follow up with course alumni.

The network coordinator is responsible for creatinga formal network of training institutions and pro-vides services to RATN members. This includessupporting the Network Development Committee,marketing courses, developing the RATN web site,producing and distributing the RATN newsletter,and liaising and maintaining linkages with otherregional AIDS and STD networks.

The RATN co-directors, project manager and pro-gramme coordinators are supported by a smallnumber of full- and part-time staff, including aresource centre librarian, a data entry clerk and aninformation officer. Additionally, the secretariatemploys consultants on an as-needed basis forspecial assignments.

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Key functions of the RATN headquarters

The RATN secretariat’s collaborativerole with the PIs involves cooper-

ating in the following key areas:• course development • course delivery• monitoring and evaluation• long-term follow-up• network-building

This collaboration is described more fully in thesection on the key activities of RATN (see page 33).The RATN secretariat and PIs also collaborate inproject planning, workshops, advocacy and coursemarketing, as described below.

Project planning In collaboration with PIs the RATN secretariat pro-duces an annual activity plan to achieve the pro-ject’s goal and objectives. The secretariat requeststhat PIs make comments and suggestions duringthe planning process. The steering committee,which has representatives from the PIs as well asthe Universities of Nairobi and Manitoba, donors,and other interested parties, adopts the final workplan.

Workshops Occasionally, the RATN Secretariat and the PIswork together on developing and implementing

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Collaborationwith RATN – the Partners’experience

When asked why they value their participa-tion in RATN, PIs responded:RATN has helped us raise our profile as atraining organization. We have benefited from our partnershipwith RATN in many ways. RATN has, forexample, provided us with an opportunity toshare and review course curricula andexchange information and materials withRATN and other PIs around the region.Through RATN, my organization has had thequalitative aspects of its courses reviewedby other PIs and the RATN Secretariat. Thisfree of charge “peer review” has resulted inimproved quality, delivery and effective-ness/relevance of our courses.I find the information posted on the RATNweb site to be very useful, in particular theworkshop reports and the training informa-tion.RATN has given us many more opportunitiesto share information and interact with otherinstitutions than we had before joining.The partnership has enabled the programmeto delve into new [training] areas that wehad not thought of offering at a regionallevel.Staff members have been trained in variouscourses through RATN…this has improved ourservice delivery in the communities we areserving. Exposure to other environments hashelped to review some of our systems [and]our monitoring skills have been enhanced.My organization gets a lot of benefit fromits participation in RATN, including the mar-keting of our courses, staff development,friendship and networking with others inthe region.Our participation in RATN gives us a region-al—as opposed to local—overview of what ishappening to fight AIDS.

Collaboration with PartnerInstitutions (PIs)

workshops to advance RATN’s work. Workshops onmonitoring and evaluation, advocacy and market-ing have been held to develop strategies for imple-mentation by both the secretariat and the PIs, andother PI workshops are planned on specific areas ofinterest.

Advocacy RATN and the PIs are committed to raising aware-ness of the need for and the availability of qualitytraining in the region. This concern for advocacyas collaborative effort is explained more specifical-ly in the section on RATN and the promotion oftraining (see below).

Course marketing The RATN secretariat and PIs both play a role inmarketing RATN-affiliated courses. The secretariatproduces a course calendar and distributes it to amailing list of potential clients and donors; thecalendar is also posted on the RATN web site andupdated in the quarterly newsletter. PIs receive theRATN newsletter for distribution and also promoteRATN courses in their respective newsletters.

One of RATN’s chief roles is toimprove the variety and quality of

training in the region. This enables people toaddress the challenges of the HIV/AIDS epidemic.The most obvious way that RATN tries to accom-

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RATN and the promotion of training

plish this is by collaborating with PIs to develop,deliver and improve the quality of training cours-es. A less apparent way in which RATN and its PIsperform this role is through advocacy.

For organizations and individuals in the front linesof the response to the epidemic the need for effec-tive training is clear. However, in the experience ofRATN and its PIs the need to invest in training isstill undervalued by most decision-makers. The1994 training needs assessment study identifiedsignificant gaps between the stated need for train-ing in certain areas and available courses. Thelong-term follow-up and evaluation of coursealumni and their supervisors from counselling andcommunity care of HIV/AIDS courses showed thatmany decision-makers do not give much thoughtto the quality, efficiency or utility of the availabletraining as long as it is held.

For example, the evaluation found that manydecision-makers made little or no effort to discusswith trainees the quality of the training receivedor to explore with them the impact and implica-tions of their new knowledge and skills for theindividual or the organization. Furthermore, manydecision-makers did not provide the necessarysupport for trainees to utilize their new knowledgeand skills, which is essential if training is to makea difference.

Training champions If individuals in a position to allocate resources forHIV/AIDS do not grasp the need for quality train-ing and for ensuring that the trainees’ acquisition

29

of new knowledge and skills is supported, thentraining needs a champion.

Since its inception the RATN project and its PIshave taken on this role with some notable achieve-ments. Representatives from RATN have beeninvited to meetings as a voice for the training sec-tor and the RATN model has been referred to inmajor policy documents as an example that shouldand could be replicated in other regions. Given theimportance of raising the profile of training in theESA region, RATN and its PIs will continue todevote time and resources to “championing” oradvocating for training. They are currently exam-ining the best strategies for accomplishing this.

Another key function of the RATNsecretariat is to compile and dis-

seminate information relevant to the needs of thePIs and the RATN project itself. RATN achieves thisby producing a newsletter, supporting a web site,creating marketing courses, developing and main-taining a resource centre and facilitating electron-ic networking between PIs.

RATN newsletter The quarterly RATN newsletter provides informa-tion on RATN committee meetings, workshops,events, member news and other developments inHIV/AIDS-related training. The newsletter is dis-tributed to over 2000 readers, including PIs, coursealumni, donors, potential trainees and course

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Information dissemination

sponsors, which encompass government depart-ments, local and international nongovernmentalorganizations (NGOs), and multilateral organiza-tions throughout the region.

RATN web site – www.ratn.org Launched in 1999, the RATN web site currentlyfeatures the course calendar and timetable, currentand back editions of the RATN newsletter, recentworkshop reports and two searchable databases.The alumni database contains valuable informa-tion on all the trainees who have taken RATNcourses and the resource centre database containsan index of available materials. Both databases areregularly updated. It is to be hoped that the website will be further upgraded in the coming monthsto include links to PI web sites and other AIDSresource centres and networks.

Resource centre The RATN secretariat houses a small resource cen-tre whose collection focuses on subjects related tothe prevention, care, treatment and support ofHIV/AIDS, training and evaluation. Members mayborrow from the centre’s collection and are keptinformed of latest additions.

Electronic networking The RATN secretariat promotes the use of electron-ic mail to PIs as a method of communicating withthe secretariat and one another. It also encouragesPIs to use the Internet to access information andresources related to HIV/AIDS and/or training. Thesecretariat is currently seeking funds to ensure

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access to electronic mail and the Internet for allPIs. There have been rapid advances in telecom-munications capabilities in the region even in thefew years since RATN was founded, and it contin-ues to monitor recent developments so that the lat-est technology can be utilized to maintain andimprove communications between PIs and with thesecretariat.

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One of RATN’s main roles is toidentify and establish linkages

with training institutions and through them todesign, develop and deliver short courses targetedat middle-level workers, managers and trainers inthe ESA region. In collaboration with PIs, RATNhas created courses providing skills training in thefollowing areas: counselling, counselling supervi-sion, syndromic management of STDs, communitycare of HIV/AIDS, communication and behaviourchange, adult education/training of trainers, advo-cacy, policy & planning of HIV/AIDS, laboratorymanagement, STD supervisor training and adoles-cent counselling & research. RATN courses areaimed at trainers and programme managers.Training of trainers (TOT) courses are built on theidea that the students will take their new-foundknowledge and apply it toward improving thequality of training given by their own and otherinstitutions in their home countries.

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Key activities of RATN

Course development

Box 2: RATN Courses delivered up to December 2000

Topic Training Institute Location Times held

Counselling KAPC Nairobi 8Counselling KARA Lusaka 8Counselling CONNECT Harare 6Counselling supervision KARA Lusaka 1STD managers EU Nairobi 1Community care HIV Salvation Army Chikankata 6Community care HIV FACT Mutare 2Community care HIV TASO Kampala 3

Communication behaviour MIM Nairobi/Lilongwe 3Adult education ESAMI Arusha 4Policy & planning U of Natal Durban 3STD management GU Centre Harare 2Adolescent interventions KAPC Nairobi 1Research methods University of Nairobi Nairobi 2Lab management SAIMR Johannesburg 1Advocacy skills CAFS Nairobi 3

During 2001 RATN and its PIs plan to deliver new courses entitled:Utilization of research results; Interventions against mother-to-childtransmission; Palliative care; Programme management and administration;HIV and gender issues; and HIV intervention in the workplace.

A participant speaksto delegates duringthe RATN HIV in theWorkplace Interven-tion Meeting, held inNairobi in January2001. The meeting,which brought to-gether private-sec-tor stakeholders to

outline interventions and needs, served as the basis for a new course.Credit: Regional AIDS Training Network.

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Where do students comefrom ?

As the table below shows, from November1997 to December 2000 students came fromcountries throughout the region to attendRATN courses.

Country No. of Students

ANGOLA 1BOTSWANA 20BURUNDI 2ERITREA 1ETHIOPIA 23GAMBIA 1KENYA 131LESOTHO 2MALAWI 77MAURITIUS 1 MOZAMBIQUE 12NAMIBIA 38NIGERIA 10RWANDA 7SOUTH AFRICA 44SUDAN 2 SWAZILAND 35UNITED REPUBLICOF TANZANIA 36UGANDA 58ZAMBIA 128ZIMBABWE 63

Total of 21 countries 692 students


The promotion of excellence is acore principle underlying RATN’s

philosophy of course development. To further this,RATN has instituted a process that involves the useof expert committees. For most new coursesoffered under the auspices of RATN, the coursecoordinator convenes an expert committee. This isdone by canvassing PIs, donors, and other selectedindividuals and organizations/institutions to iden-tify individuals recognized for their knowledge,skills and experience in a given subject area aswell as trainers recognized for their exceptionalskills and experience. Nominees receive a letterpresenting the committee’s terms of reference(TORs) and inviting them to attend a three- to five-day meeting, which usually takes the form of afacilitator-led workshop. The TORs of any givenexpert committee typically include the following:• Identify the optimal components of a training

programme, including modules on TOT or man-agerial courses that need to be added to thebasic curriculum.

• Develop the minimum criteria for an acceptablecourse curriculum.

• Identify training institutions in the region thatare conducting high-quality training courses inthe subject matter under discussion.

• Identify gaps in existing courses and suggestways to enhance them.

• Identify courses that are needed but not cur-rently offered.

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Expert committees

The first meeting of any expertcommittee tackles at least thefirst three or four of these TORs.In most cases courses are deliv-ered by at least one or two insti-tutions within a year of the meet-ing.

Expert committee follow-upmeetings are usually convenedevery two years to review cours-

es, paying particular attention to the student eval-uations collected. Recommendations are made tothe training institutions on modifications toimprove their courses. Committee members alsoidentify emerging trends and new issues, commenton how they might influence course content, rec-ommend refinements to courses and select newcourses that need to be developed.

Similarly, the Community Care of HIV ExpertCommittee meeting in October 1997 identified atraining syllabus. This course is now deliveredthrough three PIs in the region: TASO (Uganda),Salvation Army Chikankata (Zambia) and FACT(Zimbabwe). A follow-up meeting in October 1999reviewed these courses, and new course areas wereproposed for development. The community caregroup met again in September 2000 to developthese courses further, especially in the areas of car-ing for the carers and palliative care. A course ofpalliative care is due to be held in Uganda in 2001.

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Expert committees in action

The first expert committee meeting incounselling was held in March 1997. Themeeting identified a training syllabus fora counselling TOT course, and three insti-tutions (Kenyan Association of Profes-sional Counsellors (KAPC) Nairobi, KARACounselling and Training Trust Limited,Lusaka, and Connect Institute of Sys-temic Therapy, Harare) subsequentlybegan to deliver this course. A follow-upcounselling meeting in April 1999reviewed these courses and recommend-ed new counselling courses. Consequent-ly, “Counselling supervisor training” and“Counselling adolescents” courses werelaunched in 2000.


Successful participants of theCounselling course, offered byRATN in collaboration with theKenya Association of ProfessionalCounsellors (KAPC). The four-week course is experiential andtheoretical. Credit: Regional AIDSTraining Network.

Since KAPC delivered the firstRATN-sponsored course in late

1997, more than 50 training courses have beengiven through PIs, and almost 700 students from 21African countries have been trained. RATN coursesare held in locations throughout the ESA region,primarily in the city, town, or rural location of thePI that is giving the course. Most courses are resi-dential, with room and board included in the tuitioncosts, and are of two to five weeks’ duration.

RATN courses primarily employ local trainers affil-iated with the PI, although in some instances train-ers from other institutions or from outside the ESAregion have been used. From the outset RATN hasbeen conscious of the need to ensure a gender bal-ance among course participants. To date there hasbeen an almost equal number of women and men

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RATN expert committee meetings: 1997-2000

Date Held CourseFebruary 1997 STD managementMarch 1997 Counselling (1st Meeting)April 1999 Counselling (2nd Meeting)May 1997 Research methodsOctober 1997 Community care of HIV (1st Meeting)October 1999 Community care of HIV (2nd Meeting)October 2000 Community care of HIV (3rd Meeting)December 1998 STD supervisionApril 1999 Mother-to-child transmission (MTCT)February 2000 Greater involvement of people living with HIV/AIDS (GIPA)January 2001 HIV interventions in the workplace

Course delivery

attending RATN courses, with women predominat-ing slightly. Similarly, RATN consciously tries toensure that students selected to attend the coursescome from as many of the countries in the ESAregion as possible. Every RATN course offered hashad students from a minimum of three ESA coun-tries. The RATN secretariat and the PIs work close-ly together reviewing the application forms foreach course, trying to the achieve a balance ofgenders, skills and regional representation fromthe pool of available applicants.

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Here are some of the comments thatRATN alumni have made about thecourses’ impact on themselves and theirorganizations, clients and communities.

“The training built confidence in mebecause when I am performing my duty,I feel I am doing the right thing.”

“I am now able to handle the youth whoseek help from our clinic. Since training Idon’t refer them.”

“I used to be against these animalscalled condoms. But now I advocate forcondom use to my congregation, … Ieven distribute them.”

“Before training, I concentrated moreon the HIV victims, but after the train-ing, I realized that the families are evenmore affected. The skills I acquiredhelped me to help families.”

“ [The training] has helped me to involvethe community… they feel they are partand parcel of the programme. We thinktogether, we plan together, we evaluatetogether.”

“Yes, the organization has changed itspractices as a result of the course…I amthe one who is directly involved in plan-ning for training for instance, implement-ing and evaluating. My boss… approveswhat I am really planning. So… most ofthe things that I learnt from the trainingare directly implemented.”

“One thing which we have influenced isthe availability of a doctor out there inthe community. This is a result of what Isaw during my training… a doctor nowwho actually goes out in the communityto take care of the patients right awaythere in the village. This is an idea whichwas brought from the training that Iattended.”

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Participants at the RATN Counselling course heldannually in collaboration with the KenyaAssociation of Professional Counsellors (KAPC).Credit: Regional AIDS Training Network.

Box 3: Reports from students: the impact of course delivery

From the outset, RATN recognizedthat the key to its success and the

ability to recognize success when it happened, wasin developing a rigorous and detailed system ofmonitoring and evaluation. To evaluate courses,each RATN course participant completes a stan-dardized evaluation form at the end of his or hercourse. Student evaluations are collated and sharedwith the PI responsible for the course so it canmake any necessary adjustment to content ortraining methods. The evaluation results are alsoused as resource materials by the expert commit-tees described above.

The utility of the post-course evaluations is partic-ularly evident when more than one RATN PI offerssimilar courses at different times. The post-courseevaluation data allow for a comparative analysisbetween the courses offered by the separate PIs.The comparative analysis results are shared witheach of the PIs and expert committees, who usethem to improve course content and trainingmethods. A RATN evaluation performed in the fallof 1999 by the Canadian InternationalDevelopment Agency cited RATN’s practice of per-forming a comparative analysis of post-courseevaluation data from similar courses as “an inno-vative approach” to monitoring and controlling thequality and content of training courses.

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Monitoring and evaluation

In 2000, with funding from UNAIDSand cooperation with the PIs, RATN

conducted a follow-up study of course alumni andtheir supervisors from counselling and communitycare of HIV/AIDS courses. The study assessedwhether the courses have had any impact or influ-ence on: i) the participant and his/her professionalskills; and ii) on the employing organization andthe community. The evaluation exercise was alsoused to share the results with others who mightwish to learn from the RATN model. The studymethodology, findings, and impact of the findingson RATN are summarized below.

Study methodology and toolsA convenience sample was used in this study. Thetarget populations were the alumni who had com-pleted their course at least six months previouslyand their supervisors. The study sought to inter-view all traceable alumni and their supervisors andto conduct focus group discussions with availablealumni. A total of 90 alumni and 74 of their super-visors from 5 countries (Kenya, Malawi, Uganda,Zambia and Zimbabwe) were interviewed. These 90alumni represent a 61.2% rate out of the possibletotal (ranging from an 85.2% follow-up rate inUganda to 37.9% in Zimbabwe). The alumni wereemployed by a variety of organizations, including

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Long-term follow-up andevaluation

government institutions, NGOs and universities.Among the respondents, 71% came from capitalcities while 29% were from other smaller towns.Major findings of the study are presented below.

Impact on the course participantsand their professional skills

Perceived relevance of courses • Alumni found that the skills they learned in

the course were relevant to their current job.Over 62% reported transferability of skills totheir work situation as the most useful courseattribute.

• A substantial percentage of participating alum-ni from both the counselling and communitycare courses cited increased levels of confidenceand interpersonal skills with clients.

Enhancement of skills • Over 81% of the alumni reported having

improved their operational skills in the work-place. Counselling alumni reported strength-ened counselling skills and community carealumni reported improved provision of commu-nity care services.

• Thirty-six per cent of alumni reported their jobresponsibilities changed as a result of courseattendance. Those alumni whose responsibili-ties changed indicated that additional dutieswere assigned or duties changed because thecourse had improved their knowledge and skillsand they were more competent in handling cer-tain issues, especially those related to

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HIV/AIDS. In some cases, job responsibilitieschanged because the course participant initiat-ed new programmes after attending the train-ing course.

Influence on peers • The majority of alumni (97.8%) reported having

shared the course outcome with members oftheir organization. The information was sharedwith the immediate supervisor (78% of cases),with colleagues (91.2%) and less frequently withpolicy-makers/planners.

• As alumni returned to their jobs and communi-ties, they shared the knowledge they acquiredduring the course. Of the alumni, 45.1% report-ed utilizing the knowledge and skills from thecourse to initiate in-service training pro-grammes, to organize formal training pro-grammes (35.2%) and to influence policy for-mulation (27.5%).

Influence on the alumni’sorganization • Supervisors of course alumni indicated that

courses offered very relevant training that ben-efited their organization and identified a rangeof benefits, including improved services toclients, initiation of new client services,

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Impact on the employingorganization and thecommunity

strengthened staff capacity, improved monitor-ing and evaluation, and better fund utilization.

• Some focus group discussion participants statedthat their organizations received recognitionand legitimization as a result of improved com-munity services provided by trained alumni.

Increased networking • RATN courses play an important role in

strengthening networking among course partic-ipants. Over 85% of alumni indicated that theyhave been exchanging information with fellowparticipants and 78% were communicating withothers working in similar fields.

• Focus group discussions clearly indicated thatgreater and stronger collaboration betweenorganizations developed as a result of individ-ual connections established during the train-ing courses. One participant summarized theeffect thus: “We have broadened our collabo-ration and networking and we no longer workin isolation.”

• At the organizational level, networking orincreased collaboration has taken the form ofexchanging information and course materials,holding joint seminars, exchanging coursefacilitators, inviting guest speakers to forums,and holding formal and informal meetings

The need for post-training support Results from focus group discussions and the sur-vey indicated that alumni require support fromtheir colleagues, supervisors, planners and policy-makers to make the best use of the skills gained

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during training. Alumni reported feeling con-strained by the lack of follow-up support for fur-ther networking, learning, and supervision aftercompleting RATN training courses. Alumni desiredfollow-up meetings where they could “share expe-riences” and “seek help when problems arise”.

Impact of study findings on RATN The study findings have already had a majorimpact on RATN’s development and future direc-tion. The findings demonstrate that the trainingcourses in counselling and community care haveproduced positive results for the alumni and theorganizations with whom they work, and suggestthat the clients and communities served by coursealumni also benefit from the alumni’s enhancedperformance. These results are important in them-selves because in a “results-oriented” fundingmilieu they represent measurable “outcomes”,which are crucial to demonstrating to donors andtheir constituencies the effectiveness of training.Moreover, these results will be a persuasive toolwhen RATN and its PIs advocate on behalf oftraining in the region.

While the follow-up study results have strength-ened RATN’s and the PIs’ appreciation for measur-ing the impact of training courses this also pres-ents a clear challenge. Follow-up studies areexpensive and time-consuming for the PIs and theRATN secretariat. Financial and human resourcesare scarce for such studies. Undertaking additionalfollow-up studies means that RATN and the PIswill have to divert funds currently earmarked forcourse development and course delivery or raise

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additional funds. Alternatively, the existing fol-low-up study methodology could be modified tomake it more cost-effective and time-efficient forRATN secretariat staff and the PIs.

RATN and the PIs are currently examining all ofthe options for future monitoring and evaluationactivities, including follow-up studies, and willcome to a joint position in early 2001.

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Box 4: Summary of key findings of the long-term,follow-up study on the impact of counselling andcommunity care courses

• The relevance of knowledge and skills imparted through the training courses isessential for their application at the organizational level. Transferability ofskills to work situations was reported by 62.3% of the alumni as the most use-ful course attribute.

• A prime objective of the collaboration in the regional courses is to assist par-ticipants in improving skills that may lead to enhanced quality of services. Over81% of respondents reported that the courses helped them to improve theiroperational skills in the workplace.

• For the effects of training to be felt at the organizational level, disseminationof the course outcome by the alumni within their organization must happen.Supervisors confirmed that over 90% of those who attended RATN courses hadshared knowledge and skills gained from the course within the organization.

• Supervisors recognized the benefit of the training to their organizations. Over87% indicated that the training has improved service to clients and over 83%noted that it strengthened the capacity of their organization’s staff.

• Attendance in RATN courses improved networking among course alumni. Over87% of alumni indicated that they made new contacts as a result of the coursethey attended.

• Alumni indicated the need for some form of post-training support to helpensure that they are able to fully apply the skills and knowledge they learnedduring the course.

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RATN is as much about network-building as about course delivery.

Over the past three years the RATN secretariat andPIs have taken numerous steps to establish a for-mal network. Major milestones in the network’shistory are:• hiring a network coordinator in the RATN sec-

retariat;• drafting the network strategy paper;• facilitating meetings and opportunities for PIs,

donors and other key stakeholders to commenton the draft networking strategy and otheraspects of network development;

• obtaining a legal opinion on the network’soptions for its structure and incorporation;

• setting up a network development committeeand giving it a mandate to propose strategiesfor a sustainable, self-governing network and

• informing donors and potential donors of theintent to formalize the network.

While a formal network has yet to be achieved, itis inaccurate to conclude that RATN PIs have notrealized the benefits of “networking” or do not feelpart of a network. Although a formal network wasnot established when the Canadian InternationalDevelopment Agency (CIDA) conducted its 1999mid-project review, PIs reported feeling part of aregional network in which they could make con-tacts with colleagues in other countries. They alsoreported benefits to their programmes as a result ofcollaborating through RATN.

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Building the RATN network

For PIs, the networking benefits are most apparentamong those institutions that offer courses in thesame subject area. For example, the CIDA evalua-tion documented that three PIs initially consideredthemselves competitors because each offers coun-selling courses, but they now frequently communi-cate about course content and training and haveattended each other’s courses. Indeed, these threeinstitutions are now looking at collaborating todevelop and deliver courses.

Further evidence of RATN’s networking influenceand added value in the region comes from the pro-fessional associations and sub-networks that it hashelped spawn. Malawian alumni from variousRATN counselling courses formed the MalawianAssociation of Counsellors. Similarly, RATN alum-ni and counselling PIs also initiated the East andSouthern Africa Counselling Association (ESACA).Each of these associations has successfully attract-ed funding from donors who were partly influ-enced by their alliance with RATN.

In late 1999, UNAIDS requested and funded RATNto help establish an independent network of organ-izations involved in delivering community careservices—the Community Care Resource Network(CCN). A CCN interim steering committee, includ-ing NGO representatives and RATN PIs, has beenset up and a short-term plan has been made for thenetwork’s development. RATN has been given amandate to hire, assist and supervise the networkcoordinator. RATN’s support role in CCN’s devel-opment is expected to evolve as the networkmatures.

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One of RATN’s main objectives inscheduling and sponsoring

regional courses is to assist participants in devel-oping and refining skills to improve services deliv-ery to the community. The follow-up study ofalumni and their employing organizations in theareas of counselling and community care showedthat over 80% of the alumni improved their oper-ational skills in the workplace, and a substantialpercentage cited increased levels of confidence andinterpersonal skills with clients. RATN is proudthat alumni report high levels of satisfaction withthe courses.

Moreover, 36% of alumni in the study reportedthat their job responsibilities had changed as aresult of the course they attended. Those alumniwho changed responsibilities said that they hadbeen assigned additional duties, or that dutieschanged because they had improved knowledgeand skills through the course and were more com-petent in handling certain issues, especially thoserelated to HIV/AIDS. In some cases job responsibil-ities changed because new programmes initiated asa result of the alumni’s attending the course wereincorporated.

The impact on the alumni of RATN courses otherthan counselling and community care has not yetbeen studied and documented to the same extent.

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RATN achievements

High level of satisfactionwith RATN courses

However, the evaluation forms filled out by courseparticipants following the completion of othercourses routinely indicate a high approval rating.This preliminary evidence suggests that the highlevel of satisfaction with the training is not exclu-sive to counselling and community care alumni.

RATN believes that it has begun tohave a significant impact on rais-

ing the standard of the region’s training in the areaof HIV/AIDS. Using expert committees to defineminimal and optimal training components incourse content has doubtless helped RATN’s repu-tation for setting new, improved training stan-dards, although this has not yet been scientificallydocumented. However, donors, alumni and seniormanagers of RATN PIs and other training institu-tions have noted that RATN courses are setting the“gold standard” for course content and training.RATN may have a future role in increasing the pro-fessionalization of training in the region. Thismight include establishing standards or accredita-tion boards, or other strategies to control andmaintain training course quality along with train-er and trainee qualifications.

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Raising the standard oftraining in the region

RATN believes donors and otherdecision-makers in the ESA region

undervalue the importance of training. This may bebecause it is hard to prove that training has a directand positive impact. Without clear evidence of itseffectiveness, donors and others, within and outsideof government, are reluctant to allocate it scarceresources. However, RATN strongly believes thatthe benefits of training can be demonstrated inboth the short and long term, especially if a rigor-ous system of monitoring and evaluation is imple-mented and maintained. Participants evaluate allRATN courses and the results are shared with thetraining institution and expert committees, who usethem to improve content and training methods. Inaddition, the long-term follow-up with coursealumni and their employers assessed course impacton the trainee, the employing organizations and thecommunity. This empirical evidence, demonstratingthe training’s significance and effectiveness, helpsRATN and its PIs advocate for it more effectivelyand for the institutions committed to training.

Finally, RATN has helped raise awareness of train-ing courses and issues in the region through theservices it offers. The RATN newsletter, web siteand resource centre contain a wealth of easilyaccessible information on a variety of HIV/AIDS

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RATN achievements

Raising the profile oftraining in East andSouthern Africa (ESA)

and training issues. PIs, donors and alumni haveinformed RATN that they appreciate the informa-tion and resources on HIV/AIDS and trainingissues that it provides.

The 1994 needs assessment surveyfound that many organizations in

countries throughout the region offered high-qual-ity training courses in a variety of areas related toSTDs/HIV/AIDS. However, these entities had littleknowledge of similar organizations in other coun-tries and what courses they offered. RATN has hadsome success in breaking the relative isolation thatexists among the region’s organizations training inHIV/AIDS, particularly those offering training incounselling and community care. Prior to RATN’sinception in late 1997, the RATN PIs offeringcourses in counselling in Kenya, Zambia andZimbabwe had minimal contact. By participatingin the RATN network and its activities, senior staffmembers from each organization have come toknow the content and the strengths and weakness-es of their respective courses and training methods,and have sat together on the same expert commit-tees. Each organization reports that its exposure tothe others has helped it improve its course content,training methods, and knowledge of recent theo-retical and applied developments in counselling.

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Improving collaboration andcommunication betweenPartner Institutions (PIs)

RATN has also become a “focal point” in the regionfor advice and information on training and relatedissues. WHO, USAID, UNAIDS and other multilat-eral and bilateral donors have either referredorganizations to or contacted RATN in the past twoyears to seek information and ideas about trainingissues or to ask for contributions to policy docu-ments. The WHO Regional Office for Africa recent-ly approached RATN to seek its collaboration on aninitiative to establish training standards for coun-selling in the region. RATN has attended severaldonor meetings at which training issues have beendiscussed and, in early 2000, assisted UNAIDS inorganizing an international consultation on GIPA(Greater Involvement of People Living withHIV/AIDS), using this as an occasion to add train-ing issues to the meeting’s agenda.

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RATN achievements

The RATN secretariat and the PIshave faced evolving challenges in

delivering quality training courses. Certain minorchallenges are typical for any new initiative and toa greater or lesser extent have been addressed.Others have yet to be resolved. The following threechallenges are currently of the greatest concern.

Selection of course participants In some post-course evaluations, participantsexpressed disappointment with their classmates’level of knowledge and said this had a negativeimpact on the course. The respondents felt that thepresence of one or more participant with insuffi-cient background knowledge compromised theirlearning experience. This has occurred despiteRATN’s and the PIs’ stringent admission require-ments to each course and their careful, collabora-

tive vetting of application forms.RATN and the PIs are continuing toexamine ways in which they canimprove the admissions process, tomake it more efficient and toensure that the course accepts thosepeople who are best qualified toparticipate.

Funding courseparticipants In RATN’s first two years of opera-tions a significant amount of its

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Challenges

Course delivery

Training of trainers (TOT) is fundamental to reducing theimpact of STD/HIV/AIDS. RATN considers TOT a core train-ing area and offers courses for facilitators/trainers.Credit: Regional AIDS Training Network.

operational funds were earmarked for scholarshipsto make sure that some qualified applicants couldreceive financial sponsorship to attend RATN cours-es. This resulted in many courses being supportedwhich otherwise would not have been given for lackof sufficient enrolment. However, the practice wasunsustainable, primarily because of RATN’s limitedresources and the overwhelming demand for addi-tional courses and network-building activities.

Some donors believe that RATN should not fundscholarships directly. However, the reality ofregional economics—course delivery costs, theinability of individuals and most AIDS serviceorganizations to pay for training—suggests that ifRATN’s PIs provide training that is worth while,then some of the training costs should be under-written, at least in the near term. RATN and the PIsare exploring other options for securing scholar-ship funds for RATN-affiliated courses, includingjoint fund raising for this purpose.

Post-course support A major finding of the long-term, follow-up studywas that course alumni stated they needed RATNand the PIs to offer some form of post-course sup-port such as meetings or conferences. RATN andthe PIs would like to provide meaningful, post-course support to alumni and are currently dis-cussing what services would be most cost-effec-tive. Clearly, providing airfare for people to attendmeetings, refresher courses and class reunions inthe region is not a long-term option. It is hopedthat the increasing access to e-mail and theInternet will be the most viable strategy.

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Challenges

The RATN project’s primary purposeis to build a network of organiza-

tions that are involved in HIV/AIDS training. Todate there has been much progress in establishinga formal network and RATN PIs are activelyengaged in this effort. However, some PIs, donorsand RATN secretariat members expected that moreprogress towards developing a formal networkwould have been made by now. Concern over thisslow rate of progress was first raised by PIs andwas later emphasized in the 1999 CIDA mid-termRATN project evaluation. Responding to PI con-cerns and the evaluator’s comments, the RATN sec-retariat has acted to put the project’s network-building back on track.

In April 2000, RATN hosted a consultation with PIsto examine the constraints in developing a formalnetwork and a networking strategy paper and torecommend how to overcome them. It was recom-mended to launch a network development commit-tee (NDC) to explore options for establishing a for-mal network, a governance structure to the net-work and a timeline for setting up the network asa distinct, legal entity. The RATN project’s steeringand executive committees approved this recom-mendation. By January 2001, the NDC had mettwice more to work out its terms of reference andto develop and implement its work plan.

Another obstacle to establishing a formal networkis the diverse organizational structures of the

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Network-building

RATN PIs. RATN PIs include universities, private-sector training institutes, research institutes, anSTD laboratory, small and large NGOs, and reli-gious organizations (see Box 2). When the PIs firstmet face-to-face to discuss forming a network,they were concerned that they were just too differ-ent—in their missions, modes of operation anddecision-making processes—to work effectivelywith each other and to build a network. This struc-tural problem remains, but most RATN PIs haveconcluded that the discomfort in collaboratingwith such different types of organizations is out-weighed by the benefits of belonging to the net-work and their respective commitment to raisingthe quality and availability of HIV/AIDS-relatedtraining in the ESA region.

Developing a formal network was partly hamperedby some PIs’ distrust of one another at the outsetof the RATN programme. Some saw others as com-petitors and were reluctant to discuss or shareinformation, particularly specific informationabout course content and training methods.However, this perception gradually changed asthey realized that more could be gained throughsharing information and through other forms ofcollaboration than by remaining outside the RATNnetwork. Moreover, early in RATN’s developmentthe huge need for training throughout the regionbecame evident to most PIs. They realized thatRATN collaboration would not reduce demand fortheir training services.

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Challenges

RATN has had some success inencouraging collaboration between

its PIs, particularly between those that offer cours-es in the same area. It has been less successful inpromoting collaboration between PIs offeringcourses in disparate areas. This can be explainedpartly by the absence of similar courses or subjectmatter about which to communicate to one anoth-er—PIs may all be working in the AIDS field, butthey do not always speak the same technical lan-guage. The dissimilar nature of the organizationscomprising the RATN PIs has contributed to thedifficulties in developing a modus operandi for col-laboration.

RATN has begun to explore strategies to increasecollaboration between all members, includingrecruiting new PIs in specific areas, involving dif-ferent kinds of PIs in RATN committees or otherevents, and encouraging dialogue between mem-bers on common matters. This effort encompassesadvocacy for training, training issues and issuesrelated to monitoring and follow-up with coursealumni. The RATN secretariat actively encouragesPIs to contact one another directly (as opposed tousing secretariat staff as an intermediary) and isexploring the idea of hosting an “electronic forum”on training issues.

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Strengthening collaborationbetween Partner Institutions (PIs)

One of RATN’s major challenges is funding—accessing adequate

resources for planned activities and further diver-sifying its funding base. RATN’s ambitious agendahas been constrained by inadequate financialresources. Ideally, it would like to have sufficientfunds to maintain the base of courses that alreadyexist, to develop and pilot new training courses inresponse to the constantly expanding demand,while at the same time continuing to build a for-mal network. The rising costs of travel and com-munication in the region means that none of theseactivities will become cheaper over time. RATN hashad to prioritize its activities, making difficultdecisions to postpone activities considered impor-tant or slowing the pace of progress towardsachieving its objectives. The need remains great,there is no shortage of ideas for new courses, andit is frustrating that the enthusiasm amongst part-ners for delivering courses and developing the net-work must be thwarted sometimes by lack offunds.

Initially, the RATN depended on CIDA for almost80% of its total funding but increasingly, RATNhas diversified funding sources. CIDA now pro-vides about 60% of the funding, and a number ofother donors are funding specific activities withinthe RATN programme. Nevertheless, the effort tosecure additional funding has been considerable,taking up a major portion of the co-director’s time,and lessons have been learned on the length of

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Challenges

Funding

time it takes to secure any funding, whether it be asmall, one-time donation, or a major, multi-yeargrant. In addition, the vagaries and changingstrategies of most donor agencies means thatfundraising must remain a continuous activity,even when short-term funding seems assured.

RATN is actively addressing this concern and willcontinue to do so in the coming years, using anincreased collaboration with PIs as one strategy tosecure not only international, but also regional andnational funds.

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Although still in its infancy, anumber lessons have been

learned about the RATN project. No single organ-ization or experience can provide all the answersfor those who are seeking to provide better-quali-ty training, or raise awareness of the need forhigher quality training in their community, coun-try or region. Nonetheless, RATN and its PIs werehonoured when UNAIDS requested their coopera-tion in preparing this case study. RATN shares thebelief that its story is worth telling, and hopes thatthe reader will value the challenges, successes,mistakes and lessons learned described in thisdocument.

1. Conducting a needs assessment study is a cru-cial first step in developing programmes orinterventions. Using needs assessment data inprogramme planning helps to ensure the rele-vance of interventions to actual needs. Relevantprogrammes are likely to attract support fromdifferent stakeholders. The needs assessmentstudy conducted before the RATN project wasdeveloped yielded information that helped toguarantee that it was relevant and appropriateto regional needs. This has contributed toRATN’s success at fund raising.

2. Developing an ongoing resource, such as theuse of expert committees, for identifying

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Lessons learned

Lessons learned abouttraining

emerging needs is a way to maintain relevanceand assure RATN course quality. Expert com-mittees have also helped to raise the standardfor training in the ESA region.

3. RATN courses have been adapted to suit theneeds of the ESA region and this has assisted inmaking them relevant and popular. This prac-tice has significantly reduced the incidences ofcourses that are not context compliant, hithertoa common trend, especially with courses fromthe first world.

3. Creating and encouraging a culture of excel-lence in course content and delivery amongstPIs has raised awareness of the need for qualitytraining, created a demand for the courses beingoffered, and rapidly made RATN and its part-ners acknowledged regional advisers on bestpractices in training.

5. The practice of feeding back the results of mon-itoring and evaluation exercises into pro-grammes and activities guarantees continuousquality control and improvement of courses andtraining.

6. Follow-up studies to evaluate the impact oftraining on alumni and their employing organ-izations are critical. The findings help documentthe course’s impact, which can be used toimprove subsequent courses. Such data alsodemonstrate the training’s effectiveness andthis information can be used to show the effec-tiveness and utility of training in general.

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1. PIs (members) are more likely to contribute tothe network’s development if their participationoffers clear “value added”. To stay motivated, PIsneed frequent opportunities to reflect on whattheir organization gains through participating.

2. PIs in a network need direct contact with oneanother and should not rely primarily on secre-tariat staff to facilitate communications.

3. Involving PIs in the RATN governance hasgiven them a sense of ownership and hasimproved their commitment to establishing aformal network of training institutions.

4. Building a formal network will not happenmerely by encouraging or engaging in network-ing activities like information-sharing and pro-moting collaboration. Such activities are impor-tant in creating a sense of working for a com-mon purpose, but do not give members a sensethat the network belongs to them. Building aformal network takes resources and a concreteplan for establishing and sustaining it.

5. Investing in communication vehicles such asthe RATN member newsletter and the RATNweb site has proven effective in keeping PIsinformed of vital information and resources.

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Lessons learned

Lessons learned aboutcollaborating andnetworking

The newsletter and web site have also helped toraise the public profile of the RATN project andits PIs as well as that of the courses they offer,throughout the region.

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Centre for Family Studies (CAFS)Nairobi, KenyaThe Centre for African Family Studies (CAFS) is anAfrican institution dedicated to strengthening thecapabilities of sub-Saharan African organizationsworking in family planning and related reproduc-tive health services. To achieve its mission, it con-ducts courses and provides research and consul-tancy services from strategically located bases inEast and West Africa.

Connect Institute of Systemic Therapy Harare, ZimbabweConnect is a Zimbabwean welfare organizationstaffed by professional counsellors and trainersoffering counselling, training and consultancyservices to the community.

Eastern and Southern African Management Institute(ESAMI)Arusha, United Republic of TanzaniaThe Eastern and Southern African ManagementInstitute (ESAMI) is an intergovernmental manage-ment development institution dedicated to improv-ing managerial performance and effectivenessthrough research, training, and consultancy. Itserves governments, parastatals and the privatesector of 19 member countries in East andSouthern Africa.

Family AIDS Caring Trust (FACT) Mutare, ZimbabweFACT is a Christian-based organization workingwith various communities to provide HIV pre-

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Appendix:RATN Partner Institutions

vention programmes, training and care for thewhole person. FACT is committed to the expan-sion and improvement of training programmes atall levels.

Genitourinary CentreHarare, ZimbabweThe Genitourinary Centre is part of the City HealthDepartment of Harare. Created specifically to groupthe services and training aspects of STDs/HIV carein one institution, it has developed numerous train-ing courses for Zimbabwean health workers.

Health Economics and HIV/AIDS Research Division(HEARD), University of NatalDurban, South AfricaHEARD was formed as a separate division of theUniversity of Natal in early 1998 to emphasize theUniversity’s ongoing and expanding commitmentto the fight against AIDS.

KARA Counselling and Training Trust Limited Lusaka, ZambiaKara Counselling and Training Trust is a registeredcharity established in 1989. Its mission is to pro-mote psychological awareness and to providecounselling and other related services that respondto current needs of human development in Zambia.KARA’s objectives include the promotion of behav-iour change for HIV/AIDS prevention, the provi-sion of psychological counselling services forHIV/AIDS-related problems and the promotion ofthe principles of community-based care and sup-port for those living with HIV/AIDS. It also pro-vides professional training and capacity-building.

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Kenyan Association of Professional Counsellors (KAPC)Nairobi, KenyaKAPC’s mission is to facilitate the creation of asocial climate where society, communities, organi-zations, families or individuals can consider theopportunities of change. The KAPC offers threecategories of membership: for the general public;for recognition by KAPC as a counsellor; and forrecognition as counsellor-trainers. It offers coursesleading to certificates, higher diplomas and an MAin counselling studies in collaboration with theUniversity of Durham.

Malawi Institute of ManagementLilongwe, MalawiThe Malawi Institute of Management (MIM) spe-cializes in management training, consultancy andresearch. It aims to enhance the professional com-petence of individual managers and chief execu-tives and contributes to the strengthening of theorganizations in which they work. MIM specializesin business management, economics and projectmanagement, financial management, organiza-tional behaviour, human resource managementand information technology.

Mildmay InternationalKampala, UgandaMildmay International operates a comprehensivetraining and education programme on all aspectsof holistic HIV/AIDS care and management tohelp key workers manage the AIDS situation intheir country more effectively. Audiences for thetraining include health and social care profes-sionals, people who work with children (including

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Appendix: RATN PIs

teachers, youth workers and parents), governmentofficials, people living with HIV/AIDS, their fam-ilies and carers, and managers of health carefacilities.

Project Support GroupHarare, ZimbabweThe Project Support Group began in 1986 and hasgrown into a regional non-profit organization/trust,with branches in South Africa, Zambia andZimbabwe, and a close academic affiliation with theUniversity of Zimbabwe Psychology Department.The Project Support Group assists ministry, district,municipal, mission hospital and NGO partners todevelop targeted AIDS programmes.

Salvation Army Chikankata Health ServicesChikankata, ZambiaChikankata Health Services focuses on the holisticcare of patients through the most appropriateinterventions, the ongoing creation of sustainablepartnerships with people and communities whoare also striving for health and development anddeveloping the potential in people who will serveZambia’s need for health and capacity-building.

School of Public Health, University of NatalDurban, South AfricaThe School of Public Health is the formerDepartment of Community Health at the College ofMedicine, recently renamed the Nelson MandelaCollege of Medicine. It primarily teaches under-graduate and graduate students, although itincreasingly provides in-service training to groupsin South Africa and the region.

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South African Institute for Medical Research (SAIMR)Johannesburg, South AfricaThe South African Institute for Medical Research,an institute of the University of Witswatersrand, isalso a centre for training in laboratory andresearch skills and is a national laboratory refer-ence centre for Southern Africa and neighbouringcountries.

The Aids Support Organization (TASO)Kampala, UgandaTASO is an NGO that contributes to the process ofrestoring hope and improving the quality of life ofpersons and communities affected by HIV. TASOoffers counselling, medical care, training, capaci-ty-building and advocacy services and promotespositive attitudes towards people with AIDS andtheir families.

The United Republic of Tanzania Gender NetworkingProgramme (TGNP)Dar es Salaam, United Republic of Tanzania.The Tanzanian Gender Networking Programme(TGNP) is a non-partisan, non-denominational andnongovernmental civil society organization thatpromotes gender equality and equity in the UnitedRepublic of Tanzania. TGNP activities includetraining, capacity-building, outreach, informationgeneration and dissemination, activism, lobbyingand advocacy.

University of Nairobi, WHO Collaborating CentreNairobi, KenyaThe University of Nairobi/University of Manitobahave been involved in research and training in the

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Appendix: RATN PIs

field of STDs and AIDS since the 1970s. TheSTD/AIDS Research and Training Unit at theUniversity of Nairobi College of Health Scienceshas been designated as a collaborating centre byWHO, and has become recognized as a centre ofexcellence. The Centre’s programme has, in recentyears, expanded to include a considerable role inimplementing AIDS and STD control interventionprogrammes and operational research. The Centrehas been increasingly called upon to provide train-ing in STDs/HIV to health sector personnel fromthe region, and the Centre has played an importantrole in training young African and internationalscientists.

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The Joint United Nations Programme on HIV/AIDS (UNAIDS) is the leading advocatefor global action on HIV/AIDS. It brings together seven UN agencies in a commoneffort to fight the epidemic: the United Nations Children’s Fund (UNICEF), the UnitedNations Development Programme (UNDP), the United Nations Population Fund(UNFPA), the United Nations International Drug Control Programme (UNDCP), theUnited Nations Educational, Scientific and Cultural Organization (UNESCO), theWorld Health Organization (WHO) and the World Bank.

UNAIDS both mobilizes the responses to the epidemic of its seven cosponsoringorganizations and supplements these efforts with special initiatives. Its purpose isto lead and assist an expansion of the international response to HIV on all fronts:medical, public health, social, economic, cultural, political and human rights.UNAIDS works with a broad range of partners – governmental and NGO, business,scientific and lay to share knowledge, skills and best practice across boundaries.

Joint United Nations Programme on HIV/AIDS (UNAIDS)

20 avenue Appia, 1211 Geneva 27, SwitzerlandTel. (+4122) 791 46 51 – Fax (+4122) 791 41 87

e-mail: [email protected] – Internet: http://www.unaids.org$ 10.00

No government, organization or individual involved in HIV/AIDSprevention has all the skills, knowledge, and experience to be optimallyeffective without some form of basic or additional training. Since itscreation in 1997, the Regional AIDS Training Network (RATN) hasprovided skills training and upgrading, extension services and technicalassistance in East and Southern Africa to health and allied workers inthe field of HIV/AIDS and other STDs. This publication describes howRATN develops and presents new training courses throughcollaboration with Partner Institutions around the region andsimultaneously works to establish a formal network of traininginstitutions which is governed by its members.

promoting excellence in training - unaids

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