MUNICIPAL COUNCIL OF VIHIGA LOCAL GOVERNMENT ASSOCIATION ACCELERATING DECENTRALISED RESPONSE TO HIV/AIDS HIV/AIDS WORKPLACE POLICY Prepared by: Vihiga Secretariat P.O. Box 370, MARAGOLI – KENYA TEL: 51209 Email: firstname.lastname@example.org December 2008 24 Table of contents Acknowledgement 1. Introduction and Background 2. Brief about Vihiga 3. Situational Analysis of HIV/AIDS in LG Work Place 3.1 Gaps and Barriers to HIV/AIDS interventions in work places 3.1.1. Openness/denial 3.1.2. Intefration of HIV/AIDS mainstreaming HIV/AIDS Departments 3.1.3 Resource Mobilization and Allocation 3.1.4. Social – Cultural Practices 3.1.5. Poverty 3.1.6. Insurgency and Migration 4.0 HIV/AIDS Work place Program 4.1. Developing an HIV/AIDS Policy in Workplaces of Local Governments 4.2 Integrating Work place HIV/AIDS Program in LG plans 4.2.1 Coordination and management 4.2.2. Awareness Raising and Prevention 4.2.3. Healthy and Safe Work Environment 4.2.4. Equal Treatment and Anti-Discrimination Measures 4.2.5 Care and Support 4.2.6 Medical Care and Associated Costs 4.2.7. Counselling Services 4.2.8. Creating an open and accepting environment 4.2.9. Confidentiality 4.3. Implementation of the Program 4.4 Getting Started 5.0 HIV/AIDS work place program and policy at Vihiga 5.1. Conclusion Annex 1 2 23 Acronyms AMICAALL Alliance of Mayor’s initiative for community Action on AIDS at the Local Level ART Anti-Retroviral Therapy CBO’s Community Based Organizations HIV/AIDS Human Immune Deficiency Virus/Acquired immuno deficiency Syndrome NGO’S Non Governmental Organization PMTCT Prevention of Mother to Child Transmission (of HIV) VCT Voluntary Counselling and Testing WHO World Health Organization FPO HIV/AIDS Focal Point Officers LG Local Governments M&E Monitoring and Evaluation MoLG Ministry of Local Government PLWHA People living with AIDS PHA People having AIDS SCE Self Coordinating Entity MCV – Municipal Council of Vihiga MHAC Municipal HIV/AIDS Committee CPDA – Christian Partners Development Agency 3 22 Acknowledgement HIV/AIDS Workplace program and Policy at Municipal Municipal Council of Vihiga would like to thank all organizations and Council of Vihiga individuals who contributed towards the development if this Municipal Council of Vihiga policy at the Secretariat is as above in document. most of the areas identified. However, Municipal Council of Vihiga has ensured the following: We acknowledge the contribution of the Aphia II Western, CPDA, Availability of condoms in the strategic areas Public Health and Local Government leaders both political and Appointed one staff member to be the focal person on technical. We appreciate all those managers and workers in the HIV/AIDS activities different workplaces for sharing their ideas with us and ensuring the Attends HIV/AIDS related for a and programs enrichment of the document with information that we may not have Is the secretariat for the self coordinating entity, (SCE) of the easily come across. decentralized response of HIV/AIDS Participates actively in HIV/AIDS national partnership We however wish to thank, in a special way the Ministry of Health for committee meetings. providing the necessary technical assistance to support both the study and the development of this document. Conclusion Kenya has taken bold steps in the fight against HIV/AIDS, led by His We also pay tribute to all our development partners in scaling up Excellency the President. The Local Authority have supported the HIV/AIDS response in Vihiga by supporting efforts in all manner struggle in various ways. The significant contribution of Municipal possible to fight the scourge. We will forever be grateful for their Council of Vihiga is to coordinate the efforts of the council and to help commitment to resource mobilization and strategic planning by Local invigorate their interventions. Government in the decentralized response to HIV/AIDS. Accelerating the decentralized response to HIV/AIDS is timely and is the logical step to ensure a sustainable response for HIV/AIDS prevention at the grassroots. Municipal Council of Vihiga commitment is to lead by example in the struggle. Lesley Khayadi TOWN CLERK MUNICIPAL COUNCIL OF VIHIGA 4 21 a) Monitoring and Review 1. Introduction and background Management shall establish a monitoring and evaluation This document gives the policy of the Municipal Council of Vihiga to mechanism of the program based on agreed indicators. enhance and expedite the intervention by Local Government in the There shall be a bi-annual review of implementation to address fight against HIV/AIDS in Vihiga. It is intended to give the attainment of goals and objectives. stakeholders insight into the role of Local Government in this regard and the mechanism for co-coordinating the Local Government within Getting started the mandate and structure of their Association. The key issue in this LA must seek to benefit from additional funding from Government document is to address the challenges posed by HIV/AIDS at the and other agencies for example the global fund, President Bush Association and to ensure a conducive HIV/AIDS work place program Initiative e.t.c. and policy both at LG and as developed by member LA 2.Brief about LA 1. Consultations with local government workers and key LA consists of all the Local Government of Vihiga and their affiliate stakeholders to build consensus based on local state of the organizations and professional bodies. epidemic 2. Establish a task force-committee to carry out situational Council Profile analysis, on LA capacity and Finances e.t.c. Local Government to provide technical support. PROFILE 3. Conduct a situation and Impact analysis of HIV/AIDS in the Municipal Council of Vihiga was formed by amalgamation of former locality Trading Centres i.e. Majengo, Mbale, Chavakali and Mudete which formed 4. Assess the impact of HIV/AIDS on the functioning of the LA the Vihiga Urban Council in 1981. It was elevated to a Town Council in 5. Identify some preliminary priority areas e.g. Policy 1986 and into a Full Municipality in 1991 vide gazette Notice No. 500/1990. 6. Approval of policy framework by established committee and The Municipality covers an area of 78 Sq. KM. It has 6 Electoral Wards management namely:- 7. The Task Force Committee undertakes further research and Chavakali, Lyaduywa, Izava, Wamuluma, Central Maragoli and North Maragoli. respectively. develops program goals and specific objectives, place for activities and a budget for identified/approved activities. POPULATION 8. Integration of program into existing organization and personnel The 1999 census gave the total population as follows: policies (healthy policy, grievance, harassment, equal opportunities e.t.c) and revision of these policies to bring them MUNICIPAL POPULATION BY LOCATION (1999) in line with HIV workplace program. LOCATION MALES FEMALES TOTAL 9. Establishment of monitoring indicators and systems CENTRAL MARAGOLI 12,885 14,562 27,447 10. Implementation of awareness-raising and prevention WAMULUMA 8,954 10,508 19,462 components of the program commences (at least at the level of IZAVA NORTH 6,305 7,368 13,673 resource planning, training and budgeting) LYADUYWA 7,305 8,757 16,062 11. Commence implementation of other parts of the program NORTH MARAGOLI 10,160 11,934 22,094 12. Review and revision of program as appropriate CHAVAKALI 7,963 8,732 16,695 13. Adoption by the full council committee meeting. TOTAL 53,572 61,861 115,433 20 5 Water And Sanitation Access to benefits shall not be pegged to declaration of one’s The Municipality falls under the Lake Victoria North Water Services status. Board, and water provision is undertaken by the Amatsi Water Management shall assist staff, who feel so, to disclose his/her Company which serves Chavakali and Mbale towns only. status in the presence of a counselor or a doctor. The information shall be kept confidential. Water is sourced from River Lunyerere. However the supply is inadequate as the company uses a single pumping unit with a capacity Implementation of the program of 900M3, whereas demand is pegged at 2000M3. The company b) HIV/AIDS Task Force Committees: Council HIV/AIDS requires additional pumps and upgrading of the KPLC transformer to Committee and Locational HIV/AIDS Committee right upto the increase pumping capacity lower level shall be established. c) Shared Responsibility: Responsibility for implementation of the Waste Management different elements of the program will be shared across the A) Solid Waste Management staff, and the community including CBOs, NGOs. The council has one tractor which it uses to serve major market areas d) Training /Capacity Building by collecting solid waste deposited at designated dumping sites. - Staff shall be trained in the implementation of the program However this is not 100% effective and we require garbage trucks, and - Training on the general needs of people living with HIV/AIDS dustbins. We operate a dumping site at Lunyerere area that requires and their caregivers shall be carried out upgrading and provision of waste recycling facilities. - Information and training shall be provided to all irrespective of gender, race, nature of employment and sexual orientation. We hope to be able to incorporate sorting of waste into plastics Such information and training shall be integrated into existing (recyclable, non-recyclable), organic, paper, e.t.c. as an Income education and human resources policies and program as well as Generating Activity for the youth. occupational safety and anti-discrimination strategies. - Staff training on HIV/AIDS shall take place during paid B) Liquid Waste Management working hours and attendance by all staff including senior staff shall be treated as part of work obligations. This poses a major challenge to the municipality as most households use pit-latrines. The municipality requires a Sewage Treatment Works e) Resource Mobilization as a matter of urgency. Management shall be encouraged to develop resource mobilization plans and activities e.g. identify opportunities for volunteers to off Currently a number of premises use septic tanks which require set costs, e.g.: introduction of a volunteer/trainee of internship frequent emptying. There is the added danger of polluting water program as back-up support and delegation sources as the residents rely on springs and shallow wells. Management shall hold donor conferences with development partners with a view to mobilize resources Management shall ensure that the HIV/AIDS strategic plan is integrated into the core function of the council and that there is an annual budget line for HIV/AIDS activities. 6 19 The LA shall provide information to all staff on where HIV- In 2007 Municipal Council of Vihiga carried out a study and came up related advice, with the following findings: counseling and referral could be found outside the work Institutional capacity to address HIV/AIDS environment Leadership in all departments is committed to the fight against LA shall identify a suitable staff member from whom staff can HIV/AIDS seek confidential advice, counseling and referral on HIV – There is established Municipal HIV/AIDS Committees related matters. Adequate time and training shall be provided (MHAC). These are good implementation structures for to that individual to enable her/him to fulfill these functions responses considered effective in the fight against HIV?AIDS adequately. through the partnership structure, a system of health service Creating an open and accepting environment institutions and CBOs. However, coverage of services for surveillance, treatment of Ols, STI and TB management, IEC, Extended sick leave and/or compassionate leave: existing condom promotion, VCT and others is still limited. Many are provisions shall be reviewed and revised as necessary to take yet to benefit from PMTCT and ARV therapy. account of the situation of staff infected and/or affected by There are Municipal HIV/AIDS Focal Persons who coordinate HIV/AIDS. all HIV/AIDS related activities. These are technical persons Shall include flexible working hours and time off for under the office of the Town Clerk. counseling and medical appointments, part-time and return to Duplication of activities is very common and at times the local work arrangements. administration through relevant departments in some locations HIV/AIDS Status shall not, under any circumstances, be used does not actively supervise the work of lower structures, nor as a basis for termination of employment. Staff with HIV- coordinate programs of CBOs and other organizations involved related illness shall be enabled to continue in employment so in HIV/AIDS work at the grass roots. long as they are fit for available, appropriate work. In case of termination of employment due to extended illness, Sensitization in the HIV/AIDS response staff with HIV/AIDS shall be accorded similar benefits and Most of the people are aware of preventive measures through ongoing conditions to termination due to other serious illness. IEC strategies in all communities. Sensitization about HIV/AIDS has become multi-sectoral; Confidentiality implemented by all departments of Municipal council, NGOs and All employees shall have a right to confidentiality on their CBOs, too have taken up the task of sensitizing communities including medical information. LA officials in their areas of operation. A staff member’s HIV status shall always be treated as The most common source from which people receive information and confidential sensitization about HIV/AIDS include the mass media, mainly radio, An employee who divulges information about the HIV status formal assemblies by local community leaders and other officially of a staff member, without that member’s consent shall be designated persons, visits by agents of government and NGOs. subject to disciplinary action. The relevant part of the Actors in HIV/AIDS work have found FM stations to be an effective disciplinary procedures under the existing personnel policy medium of communication in form of short adverts and talk shows. It shall be amended accordingly. is almost impossible to ignore the messages since they are played on each station quite frequently. 18 7 Media houses are very active in as far as dissemination of HIV/AID Local governments shall provide health packages that can messages on mainly prevention and control as well as treatment is prolong/improve lives of PHA. concerned The workplace management in collaboaration with mininstry A common approach for scaling up sensitization in different social of Local Government shall review their health policies to demographic and special population groups is the setting up of a ensure that all critical/terminal illnesses are adequately covered network of peer educators. in order to uphold the principle of equity and non- Drama groups have been formed within the communities to further the discrimination and avoid a situation whereby people with work of sensitization about HIV/AIDS. HIV/AIDS become subject to resentment and increased stigma The process of learning and sharing is reinforced by grapevine on the grounds of ‘favoritism’ within the health policy. communication channels already existing in almost every community Counselling Services HIV/AIDS POLICY IN LA - Management shall create an open and accepting environment for That a clear workplace policy on HIV/AIDS was conspicuously counseling affected and infected at work. lacking in most local government and where there are a few on - Management shall ensure provision of an effective and suitable provision of drugs , the implementation was poor. counseling service to accompany the treatment. That although the Decentralization Policy empowers local governments at the various levels to enact and enforce by-laws and Medical Care and Associated Costs ordinances to ensure development in their areas, and now to enforce The benefits shall include but will not be limited to access to HIV/AIDS interventions e.g. in limiting events and circumstances that ARV treatment, as well as the costs of treating opportunistic are unsafe, especially to the youth, LA have not been sufficiently infections. empowered to/have not taken the initiative to enact these laws. LA shall enlist the services of professional medical personnel in the administration of ARVs and provide information to staff HIV/AIDS has resulted into: on possible access points for ARVs within the different 1. A risk of reduced productivity, with possible decline on returns program and operational areas. to investment, which may negatively impact on investor Proper sensitization and education about the use of and dangers confidence. of misuse of the drugs shall be provided. Employees shall take 2. Loss of revenue from such would be investments full responsibility for ensuring adherence to medial direction. 3. Loss of skilled workers. Absenteeism together with the entry into the labor market of orphaned children, who have to Counselling Services support themselves, may lower both the average working age LA shall encourage voluntary confidential counseling and and the skill level. testing 4. Conflicts at workplaces that result from stigmatization and Counselling shall include, pre and post-test counseling to equip discrimination of PLWAs can lead to declining morale and recipients with problem solving tips and skills. hence consequent collapse. Staff shall be given the option to choose where to access 5. Threat of social stability. Aggravating social inequality counseling services, within the workplace management or other 6. Impoverishment counseling service providers. 7. Threat to productivity due to absenteeism, loss of skills, higher 17 employment benefits 8 Post exposure prophylaxis (PEP) for staff exposed to the risk of 8. Hiring replacement workers HIV infection, through accident or sexual assault, whether in 9. High costs of treatment and funerals the workplace or elsewhere. 10. Retraining of workers Provision of counseling and reasonable paid time off for staff 11. Provision of family pensions. following occupational or other exposure STI Management The workplace represents an ideal form for tackling the epidemic Encouragement of healthy lifestyles e.g. dietary information. because it is a place where diverse groups of people come together on regular basis and have existing structures and facilities that can used for prevention, care and support programs. Equal Treatment and Ant-Discrimination Measures LA shall ensure: In response to the above findings, Municipal Council Vihiga has Nurturing of positive attitudes within the workplace through decided to carry out the following activities: training and awareness rising. That Pre-employment medical tests should not include an Facilitate LA to enact clearly defined non-discriminatory HIV/AIDS HIV/AIDS test policies/by-laws and ordinances to protect the rights of all individuals. That indirect screening questions in verbal or written form are Advocate for and conduct training and equipping of work place peer not included in interviews. educators with all the relevant skills to sensitize, counsel and make That an individuals HIV status does not affect recruitment referrals so as to increase awareness levels about HIV/AIDS at the choices and/or promotion prospects and/or other work workplaces. opportunities, such as transfers, training and travel (unless Encourage mobilization of resources locally through establishment of there are clear health grounds for doing so). budget lines for HIV/AIDS activities to cater for treatment and care That discrimination and/or harassment of staff on the grounds needs of PLWA of their HIV status will be treated as a disciplinary matter and Ensure provision of correct information about HIV/AIDS, home based the relevant part of the existing personnel policy will be care, VCT, PMTCT and ART, care for orphans and PLWAs from the amended accordingly. workplaces both in the formal and informal sector. On Disclosure, a person should be encouraged to inform Oversee the development of a mechanism to facilitate the his/her supervisor about his/her HIV/AIDS status when no establishment and coordination of workplace HIV/AIDS longer able to perform assigned duties, or where he/she so programs/policies in the council. desires. On benefits: HIV/AIDS person is entitled to equal benefits Objective, expected outputs and outcomes with the uninfected employee. Enhance the capacity of local governments and local actors to coordinate HIV/AIDS issues at the decentralized level and to address Care and Support policy and other interventions. Medical care and associated costs The benefits shall include access to ARV treatment, as well as the costs of treating opportunistic infections 9 16 Expected Outputs: Carrying out of impact assessments as need be so as to inform Institutional capacity for leadership and coalition building to strategic planning and establish cost of the epidemic on LA respond to HIV/AIDS strengthened at national and resources. decentralized levels. Constant review of employee benefits, and a skills succession Coordination, partnership and networking for HIV/AIDS plan as part of HR Development. response at various levels enhanced Regular review and monitoring of the policy/Program Information generation and dissemination among various Data Collection and analysis to monitor trends stakeholders at various levels improved. Communication of any information on amendments, e.t.c. to Resource mobilization and utilization for HIV/AIDS response workers enhanced Policy and by-laws/ordinances on OVC and for the work place Awareness Raising and Prevention produced LA shall ensure: A Monitoring and Evaluation Plan and Reports produced Awareness raising through ongoing continuous, regularly updated jointly by the implementing agencies. information dissemination, and education about HIV/AIDS, basic facts Reports from meetings, policy and planning sessions, on transmission, prevalence rates, national/international policies, workshops, policies, newsletter, bronchures, fliers and a employment rights and current, treatment, care and support options documentary produced. Distribution of media materials e.g. brochures, leaflets e.t.c. to all staff members and their families. Dissemination materials shall be Expected Outcomes adapted/translated as appropriate to reflect diversity in terms of staff Strengthen coalition among the organizations i.e. NGOs, position culture, religion e.t.c. ministry of local Government e.t.c. Peer education within areas of work by trained educators Drivers should be provided with a minimum First Aid Kit To empower local leaders on HIV/AIDS programming, Involvement of PLWHA in the design and provision of awareness workplace policy, dissemination of information on the raising as a means of combating stigma. interventions on OVC e.t.c. Involvement of cultural and religious leaders in fighting stigma and raising awareness on HIV/AIDS. LA shall regulate activities of GAPS AND BARRIERS TO HIV/AIDS INTERVENTIONS IN traditional healers in the management and treatment of HIV/AIDS. WORKPLACES Openness/Denial Healthy and Safe Work Environment The national response to HIV/AIDS has been a policy of openness and LA shall ensure: political commitment. Although wrong attitudes like prejudice, stigma, Access to barrier methods which provides protection against denial and discrimination are still mildly prevalent and may hinder infection. eg. Free access to male and female condoms and openness about HIV/AIDS among workers, a lot has been attained. updated information on storage, use and disposal. This encourages the leadership to address any issues of apathy and Provision of first aid kits with protective gear in case of suppress this. The most affected are the elite or senior staff who fear accidents e.g. gloves, syringes and needless, and helmets for exposure and still fear to speak out unlike in the rural setting where motorcycle riders. many now go for VCT services. 10 15 There is also insufficient treatment facilities for AIDS related Integrating Workplace HIV/AIDS Program in Council plans infections and this too is a major hindrance to openness. The lack of A Workplace HIV/AIDS program outlines how all the different free (or subsidized) treatment largely contributes to unwillingness to elements within the policy will be translated into practice at the attend VCT services by majority of the urban workforce. workplace. Key elements of an HIV/AIDS workplace program INTEGRATION OF HIV/AIDS /MAINSTREAMING HIV/AIDS include: IN DEPARTMENTS An impact assessment of HIV and AIDS on the organization The existence of HIV/AIDS strategic plans does not mean that they HIV/AIDS awareness programs have been integrated into District Development Plans (DDP) Voluntary HIV testing and counseling programs Organizations carrying out health related work have made attempts to HIV/AIDS education and training include HIV/AIDS strategies in their programs, including caring for Condom availability and distribution the sick, provision of medical care and nutritional support. There is Encouraging health treatment for STDs need to integrate HIV/AIDS at the workplace in all aspects of local Universal infection control procedures including post exposure government operations. prophylaxis Mainstreaming has been steadily taking root as many now understand Creating an open and accepting environment how this can be implemented. Treatment of opportunistic infections for all PLHA staff Counseling and other forms of psycho-social support for RESOURCE MOBILIZATION AND ALLOCATION affected stakeholders and their families LA have taken the initiative to mobilize resources for HIV/AIDS and ART and referral of patients/Clients for further management the allocation made towards HIV/AIDS intervention has been Management evaluation and review of the program. minimal, if at all. Availability of funds would support the establishment of policies, awareness raising programs, treatment and The Municipal Council of Vihiga Workplace Program shall focus on care and putting in place facilities like information bronchures, the following: condoms and gloves. The resource envelop is limited but LA is trying her best to commit even more resources to HIV/AIDS, in close Coordination and Management collaboration with other NGOs. LA shall ensure: Existence of an HIV/AIDS Focal Point Person, (FPO) with SOCIAL CULTURAL PRACTICES clearly defined roles and duties LA should have a clear policy on the above. Cultural practices may be Establishment of the HIV/AIDS Task Forces and Partnership positive; while others are risky and can increase or encourage HIV Committees at the District, (DAT), Locational level, sub- infection to an individual. A database on these cultural practices locational and village levels e.t.c. for implementation and should be made. Cultural practices that predispose or increase the risk coordination of programs. of infection with HIV in urban (as well as rural) areas include: Provision of regular progress reports to Executive Committees and Top Management Infidelity among married persons (if it does happen) That pledge by LA on commitment to demonstrate its role in Boyfriend-girlfriend affairs; fight against HIV/AIDS is made and implemented Sexual harassment (sex demanded as a precondition to Commitment on conducting annual review of implementation recruitment and promotion) of the policy and the changing needs as per epidemic. Denial 14 11 6. promotion of increase in household incomes Circumcision – sharing a knife 7. Reduction of violence against women and children. Widow inheritance Unsafe sex and Developing an HIV/AIDS Policy in Workplaces of Prostitution as form of earning income. Municipal Council of Vihiga. HIV/AIDS Workplace Program Communities are in dire need for strong Local Authority response to An HIV/AIDS Policy is a written document that sets out an the struggle against HIV/AIDS, especially at the community level. organization’s position and practices as they relate to HIV/AIDS. LA should set an example of best practice and caring for its members. LAs should express their determination in supporting the fight against Core Principles that cannot be omitted in an HIV/AIDS policy HIV/AIDS in all its functioning, with emphasis on mainstreaming. include: Key stages of developing an HIV/AIDS strategy in guiding Local None discrimination in employment related to HIV status e.g. Authority (Municipal Council of Vihiga). career opportunities Principles of equality and equity must be adhered to Discussing and analyzing the HIV/AIDS problem Continuation of employment regardless of HIV status Identification of core values and guiding principles for LA Confidentiality (council) Responsibility Identification of priority areas for action as well as roles and Inclusion and human dignity responsibilities Healthy and safe work environment Compilation of indicators to monitor success Gender equality as the basis of interventions for prevention and Resource identification, mobilization, allocation and coping. utilization. VCT and non screening for employment or recruitment or promotion Key future areas of strategic policy interventions by Municipal Recognition of the importance of social dialogue, consultation Council of Vihiga. with employees and their representatives in developing and implementing policy 1. Provision of foster care or childcare institutions for orphans Recognition of the need for programs of prevention, care and and other vulnerable children support as the basis for addressing the epidemic in the 2. Review of social welfare policies with a view to address issues workplace raised by HIV/AIDS e.g. age to access grants Accessing employees to ART (Free where possible) 3. Care for PHA and the terminally ill, at home or in institutions 4. Decreasing locally raised revenue, and ability to afford LA The Commitment of the Council should be demonstrated by the services e.g. water, sanitation, refuse. commitments of both financial and human resources to develop, 5. Poor school attendance due to failure to pay school fees and implement and sustain the program. children becoming care takers of the ill, and emergence of FPO should be established and their roles clearly outlined. child providers The policy must be translated into practice. 12 13 The Municipal Council of Vihiga has six elected councilors and two nominated ones. Council establishment stands at 65 staff. The CEO of the council is in town Clerk, who handled administrative issues of the council. The Civic wing is headed by the Mayor. This is the arm that makes the policy of the council.