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FOR
BOTSWANA BEHAVIOR CHANGE PROJECT
PHASE II
Submitted by:
Jeffrey W. Williams
Executive Director
Partners To The World
October 25, 2009
Introduction and Background
Partners To The World (PTW) is a 501(c) organization established for the purpose
mobilizing individuals and organizations to address the HIV/AIDS crisis in Sub-Saharan
Africa with aggressive and creative solutions based upon recent evidence that behavior
change interventions are essential to the fight against new HIV infections. It is clear that
sole dependence on condom social marketing and other risk reduction interventions have
been unsuccessful in reducing new infections. For reasons outlined in our strategy
document dated December 1, 2008, we concluded that Botswana is the best country in
Sub-Saharan Africa to prove the case for behavior change and risk avoidance as a critical
and essential ingredient in the fight against new infections.
PTW efforts to assist Botswana in reducing new HIV infections began more than six
years ago as the result of a few short term mission trips sponsored by Johnson Ferry
Baptist Church. Initial projects were conducted in partnership with indigenous churches
in the northern part of the country. Phase I of this project began three years ago when a
major partnership was developed with a large church in the capitol city of Gaborone. The
objectives of Phase I were to (1) launch a “life skills” peer-mentoring program in the
senior secondary schools, (2) begin engaging churches in the effort to reduce HIV
infections and (3) strongly encourage the government to implement behavior change and
risk avoidance interventions. As a result of this partnership, a “life skills” program for
Botswana’s public schools was developed and a pilot was approved by the Ministry of
Education for a small number of senior secondary schools in 2006.
This program, known as Face the Nation (FtN), was very well received by both students
and school administrators. It is a “peer-mentoring program” that enlists University of
Botswana undergraduate students who are trained in a specially designed, intensive
training program for five weeks to prepare them for five weeks of teaching in the senior
secondary schools. The program was developed by, and is currently operated by Open
Baptist Church (OBC) in Gaborone. In 2007, the Ministry of Education requested that
OBC expand the program to all 35 senior secondary schools in Botswana, and FtN has
operational in all senior secondary schools for three years. During this time, more than
400 university students and 100,000 senior secondary students have participated. More
importantly, nearly 35,000 students have committed to a lifestyle of abstinence prior to
marriage. In addition, approximately 50 churches have participated in supporting the FtN
program. This is an important first step in drawing the churches and FBO’s to engage
more aggressively in the fight against new infections.
As a result of the success of the Face the Nation program, other opportunities to assist
and influence government programs and policies arose. During the last three years, in an
attempt to push for the use of behavior change interventions, numerous meetings have
been held with government officials and documents exchanged, and Partners To The
World has developed a comprehensive and integrated “evidenced-based” strategy for
reducing new HIV infections in Botswana. At the request of the Ministry of Health, PTW
has also developed a companion implementation plan for this strategy. In addition,
PTW’s Executive Director, Jeffrey W. Williams, has established good relationships with
key Government officials in both the Ministry of Health and the National AIDS
Coordinating Agency. Mr. Williams has had substantial interaction with two former
Presidents of the country, and has made presentations to Members of Parliament and,
more recently, to the National AIDS Council at the invitation of the Council’s Chairman,
Former President Festus G. Mogae.
As has been the case in most of Sub-Saharan Africa, Botswana has for some time relied
on condoms as the primary tool in attempting to reduce new HIV infections. Billboards
and other promotional efforts centered almost entirely on social condom marketing. This
began to change approximately two years ago as recent evidence supporting the need to
rely more on behavior change and risk avoidance interventions began to gain traction.
PTW has invested heavily in encouraging key Botswana Government officials to place
far more emphasis on risk avoidance. In addition to the documents and presentations
made by PTW, HIV infection experts such as Edward C. Green, PhD and Dr. Norman
Hearst, MD, MPH have supported the push for greater emphasis on risk elimination.
Their prior work coupled with their periodic advice and participation has been an
invaluable part of PTW’s efforts. Dr. Green and Mr. Williams have made a number of
joint visits to Botswana and have collaborated on a number of presentations over the last
three years.
In the last few years, Mr. Williams has made 13 trips to Botswana and spent nearly 150
days on the ground, many of them in long meetings with the government officials most
responsible for the policies and programs targeting reduction of new HIV infections. In
addition, Mr. Williams has led numerous teams to Botswana for the purpose of
mobilizing the churches there to more directly engage in the fight against new infections.
Much of the work with the churches has been accomplished through a network of
ministries and NGO’s brought together by PTW for this very purpose into a group known
as Close Connections. This group has accounted for more than 200 individuals traveling
to Botswana to work with various churches. It has also accounted for $1,400,000 of
funding for various projects. While PTW and its Close Connections partners will
continue the effort to empower Botswana’s churches to play a greater role in restoring
traditional values that drive the behavior of citizens, the work with the government has
reached a critical junction and needs increased attention in order to achieve
implementation of the complete strategy. PTW believes that Phase I objectives have been
achieved (see Table 1 at the end of this section) and it is time to expand its efforts with
the Botswana Government. Therefore, PTW is seeking funding to support its expanded
efforts with the government and to move to Phase II with one primary objective: assist
the government in designing aggressive plans for behavior change interventions that will
significantly drive down the infection rate. Once this phase is completed, Phase III will
follow with one primary objective: assist the government in rapidly and effectively
implementing these interventions. PTW and its Close Connection partners will continue
efforts to strengthen and engage the country’s churches and FBO’s. All of the funds
required for these tasks will be funded through designated gifts from Close Connection
partners.
TABLE 1
PHASE I RESULTS
Objectives_______________________ Results____________________________
3. Strongly encourage government to design (1) PTW developed and presented a potential
and implement behavior change (risk evidence-based strategy in 2008
avoidance) interventions based upon (2) At the request of the Ministry of Health,
the most recent evidence. PTW developed a general implementation
plan in 2009
(3) PTW developed an evidence and values-
based plan to address President Khama’s
concern for the declining morals/values
(4) Mr. Williams presented this plan to the
National AIDS Council in May of 2009
(5) Botswana launches its first behavior
change campaign in March of 2009
(6) Small, high-level committee formed in
August, 2009 to determine which PTW
recommendations to adopt
Current Situation
The Botswana Government now has a clear desire to formulate and implement behavior
change interventions. Substantial evidence of this is found in many recent government
planning documents and other published materials. It is also evident from the interaction
PTW has had with a large number of key government officials. More importantly, action
has already begun with the launching of the MCP campaign known as “Break the Chain”,
and $60,000,000 has been budgeted for behavior change interventions over the next three
years. This program is the first nationwide effort to change the risky behaviors of those
involved in multiple and concurrent sexual partnerships that have been demonstrated to
be the major driver of new infections in the heterosexual populations of Sub-Saharan
Africa. This developed amid growing disillusionment with the standard package of “best
practices” Botswana had been led by USAID, UNAIDS, the EU, and other major donors
to implement. Former President Mogae is a prime example of a great African leader in
AIDS who is now keenly interested in behavior change interventions. The importance of
his support going forward cannot be overstated.
In addition, the Ministry of Health, with the substantial participation of both PTW and a
broad cross-section of the country’s religious leaders, has just completed a strategy for
mobilizing the churches and FBO’s of the country nationwide. Mr. Williams has met
several times with these key religious leaders and is actively involved in the planning for
implementing this strategy nationwide. PTW has submitted specific potential themes and
materials designed to grab and maintain public attention. PTW has also produced and
submitted a series of sample TV spots supporting the potential themes and emphasizing
the importance of specific behaviors in avoiding infection.
Funding Request
This request for funding is to support continued efforts with the government during the
next phase (Phase II) of PTW’s work in achieving the first objective set forth in the
Introduction: “Assist the government in designing aggressive plans for behavior change
interventions that will significantly drive down the infection rate.” Phase II covers the
next 12 months. The key tasks relating to PTW’s government efforts that must be
accomplished in Phase II are listed in Exhibit 1. The number of trips that are anticipated
to accomplish these tasks are also listed by task. Exhibit 2A contains the requested
funding for the government related tasks based upon PTW’s experience over the last
three years. Exhibit 2B displays the tasks and anticipated expenditures for all Phase II
work, including work done outside the government. Exhibit 3 lays out the tasks for Phase
II as well as the anticipated tasks of Phase III in a timeline. A summary explanation of
each government related task included in Phase II and the funding requested for each task
are outlined in the next section. Projected travel expenses total $40,000 and the total
requested funding for other project expenses, including the per diem costs for those
participating, is $94,000. Therefore, the total requested funding is $134,000. As shown in
Exhibit 2B, the total projected expenditures during Phase II for all tasks, both
government and non-government related are $577,000. All funding other than the
amounts requested for government related tasks will be provided by PTW and its Close
Connections partners.
Explanation of PHASE II Tasks and Expenses
This task will likely require multiple trips to Botswana with significant communications,
desk work, and administrative support at PTW’s offices in Atlanta. It will also require
periodic assistance form Dr. Green and Dr. Hearst. In addition, Mr. Williams will need to
personally stay in contact with both Chairman Molomo and individual committee
members to be sure a high level of understanding about the recommendations is achieved.
This interaction will also be required to push for decisions on how the desired actions
could be integrated into government policies, programs and specific interventions. During
this task it is anticipated that this process will require the additional expertise and
technical support of experts such as Edward C. Green and Dr. Norman Hearst to:
1. supply the committee with the supporting evidence about the risk levels of
various behaviors (risk reduction vs. risk avoidance)
2. make specific recommendations about the messages that will best encourage
the desired behaviors without creating “mixed messages”
3. assist in setting the relative priorities of key actions to be taken next
4. identifying ways to monitor and measure the effectiveness of the selected
interventions
5. recommend what critical information needs to be understood by various
constituencies involved in the implementation and operation of the chosen
interventions
6. continue to share the evidence with any officials not yet sufficiently convinced
on the need for specific behavior change interventions to assure the maximum
support for the selected interventions
7. assist the committee in obtaining the support of the full National AIDS
Council (and President Khama’s Cabinet if necessary)
8. recommend ways to effectively engage local indigenous leaders (such as
chiefs) in the process, based following up upon
9. recent studies conducted by Dr. Green in conjunction with the Ubuntu
Institute. Chiefs, religious leaders and traditional healers all have similar ideas
about the need to initiate a values-based program to change (or maintain)
moral or “correct” sexual behavior. It is time for them to become much more
involved in AIDS prevention. All have been marginalized from the process.
They are almost never mentioned in national AIDS plans, and if they are, it is
in passing only.(see Ubuntu Report, attached)
In order to properly fund this task, funding is requested for reasonable “per diem” fees as
well as travel and other out-of-pocket expenses for all those participating in this task. It
is anticipated that approximately 7 trips may be required (4 for Williams, 2 for Green, 1
for Hearst). Based upon the number of trips anticipated and the support required while
working here at home, per diem estimates are based upon the following number of days
spent on this project by individual:
In developing the funding request for this task, a cost of $4,000 per trip was used to cover
travel, hotel and food costs. An average length trip was assumed to be 10 days. A per
diem cost of $500 per day was used for two reasons: (1) it is the minimum per diem
typically charged by those involved and, (2) it is the typical per diem the Botswana
Government covers when they pay for this type of assistance, and we need to lay the
groundwork for their participation in covering the expenses associated with this effort.
Both the Ministry of Health and the Ministry of Education have requested a proposal
outlining how PTW might be instrumental in developing and operating a high-quality
training institute designed to comprehensively train all senior and junior secondary
school guidance counselors (approximately 250) in teaching a broad life skills program
on a year-round basis. This training program would also include training these guidance
counselors to counsel students on issues related to STD’s and HIV issues. The
development of such an institute would greatly advance the public school system’s ability
to execute behavior change interventions at a much higher level of quality and
consistency. There are currently approximately 210 junior secondary schools and 40
senior secondary schools, each with at least one guidance counselor. It is a critical time to
move on this initiative for five reasons:
1. The Ministries of Health and Education, having seen the positive impact of the
short-term peer mentoring program (FtN), are now wanting to move to yet
another level. They have spent significant efforts outlining potential desired
topics to be covered and are now looking for a way to implement this type of
training in a consistent and high-quality way.
2. There is currently an opportunity to engage Consortium for Global Education
(CGE) and its 40-plus member U.S. colleges and universities in the process of
developing and operating such an institute. Mr. Williams met several times with
CGE’s Executive Director, Dr. Carolyn Bishop, to assess CGE’s level of
interest. Both Dr. Bishop and CGE’s Executive Committee have expressed
strong interest in participating. CGE is currently operating a training program
in China for public school teachers that results in granting certification to the
government that teaches are proficient in their ability to teach English. It is
anticipated that a similar certification program would be implemented in
Botswana. It is interesting to note that earlier this year, CGE’s Executive
Committee voted to seek a project in Africa.
3. By training the public school guidance counselors to conduct year-long life
skills training, the effort to address the HIV problem with the captive audience
of young people in the schools could be expanded in two ways: (1) to a year
long effort in senior secondary schools. This represents an expansion of several
magnitudes and is critical in reaching the youth with behavior change messages
and supporting evidence..
4. It would lay substantial groundwork for integrating a web-based e-learning
system (such as Red Leaf) to enable rapid develop and dissemination of
behavior change messages as part of the life skills lessons taught by the
guidance counselors. This technology could be used to rapidly develop lessons,
measurement tools and reports to monitor results. It would greatly enhance
consistency and quality in the teaching process and would be used as an
important tool in developing and implementing the training of the guidance
counselors as well.
5. By providing a proposal for a guidance counselor training institute, PTW would
add yet another reason for the government to provide on-going financial support
of PTW to assist in the implementation of programs such as this that are an
integral part of the proposed strategy. Therefore, completion of this task will
likely assist with Task IV (Obtain government funding for PTW to assist in
implementation – Phase III). A profile of CGE can be found in Exhibit 4.
Based upon the number of trips anticipated and the support required for proposal
development, the funding request for this task is:
Funding for management and oversight by PTW are already included in Task A.
CGE will require only per diems for work done in Botswana and will contribute the
additional days of effort and travel costs incurred inside the U.S. that are required
for proposal development . The effort on the U.S. side is anticipated to be at least
14 days of time by Dr. Bishop and at least two Deans of selected member colleges
and/or universities.
TASK C. Conduct pilot of Red Leaf Training System to demonstrate its effectiveness as
a tool for:
Both the Ministry of Education and NAC Chairman Mogae have expressed great interest
in the capabilities and potential of the Red Leaf System. This pilot will be conducted by
loading all five FtN lessons into the Red Leaf System and then using it with several
groups of senior secondary school students not yet exposed to this information. Each
participating student will be asked to take a pre-lesson and post-lesson survey to assess
changes in knowledge and attitude about various behaviors. This pilot will be conducted
in a few selected classrooms in just a few weeks. One of the lessons has already been
loaded onto the system and can be used to demonstrate both the process and the
effectiveness of the system to gain approval for the pilot. Supporting information on Red
Leaf and Mr. Rice can be found in Exhibit 5. Mr. Rice has contributed pro-bono work of
significant value to PTW over the last few years; however, he is unable to cover the costs
of travel for an international effort such as this.
The requested funding for obtaining approval as well as conducting the pilot is:
Funds for management and oversight by PTW are already included in Task A. The only
funding requested for this task is to cover the costs of Mr. Rice’s international travel.
Mr. Rice will contribute the time and additional expense required to tailor the system,
develop the lessons for the pilot, and to plan and execute the pilot. The total cost for this
effort that he and his company are contributing is estimated to be approximately $53,000.
Prior fund raising efforts centered on the operational costs of FtN in order to prove its
value. This has now been accomplished. Funding is now required to continue the broader
effort of assisting the government in designing aggressive plans for behavior change
interventions. Fortunately, all of what was done in Phase I has positioned PTW to request
funding from the government. The Ministry of Health has asked Mr. Williams to
continue to assist them in developing an implementation plan for mobilizing the
country’s churches and FBO’s. As Phase II progresses, it is anticipated that the desire for
continuing PTW involvement will build yielding an opportunity for PTW to obtain
government funding for the latter portion of Phase II or for Phase III. Further, it would be
beneficial for the government to participate in funding PTW efforts in order to
demonstrate its commitment to this effort. Therefore, it is recommended that the
government be told that this next phase (Phase II) is being funded with the desire and
expectation that PTW will be able to obtain funding for Phase III from the Government
of Botswana or one of its financial partners. Given that the effort to obtain government
funding is based upon PTW’s work in Phase I and can be enhanced by continuing to
work with the government on the tasks included in this proposal, there is no incremental
funding request for this task.
Conclusion
PTW believes it is uniquely positioned to continue the efforts begun six years ago. This
belief is supported by:
1. Six years of experience in Botswana learning Botswana’s history and culture.
2. Six years of experience and numerous projects conducted with the churches that
will be a critical conduit for behavior change messages.
3. Three years of experience of interacting with key government officials resulting
in an in-depth knowledge about government plans, processes, and structure.
PTW offers sincere thanks to those who have assisted its efforts in Botswana. Key
contributions have been made by:
PTW strongly believes that success here will spread to many other countries of Sub-
Saharan Africa. The physical and spiritual well-being of many is at stake, and this is a
battle worth fighting. The leaders of Botswana realize this and are now ready to move to
the next step. PTW greatly desires to continue to assist them in achieving what many
believe is not possible, and we pray for your support.
Exhibit 2A
GOVERNMENT TASKS______________________________________________
Close
Task Gerard PTW CGE RedLeaf Connections TOTAL
Task D - - - - - 0
NON-GOVERNMENT TASKS________________________________________
Task
2009
2010 2011
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
Nov Dec
------------------------- PHASE II ----------------------- DELIVERABLES
Make required modifications to gov.
plans based upon changed policies.
Committee review & decisions on PTW recommendations, then
make modifications to Botswana Government Policies
TASK A
Integrate adopted JW recommendations into future plans (schools,
FBO’s, communities, media, workplace)
REQUIRED RESOURCES
Anderson University
Baylor University The Consortium for Global Education (CGE) operates as a
Belmont University non-profit organization with a membership of more than 40
Bluefield College accredited American private universities and colleges located on
Brewton-Parker College campuses in 19 USA states. Each member is committed to a high
California Baptist University value of quality academic learning and supports the
Campbell University internationalization of higher education through student and faculty
Campbellsville University participation.
Carson-Newman College
Charleston Southern University CGE member institutions represent approximately 72,050
Cumberlands, University of the undergraduate students and more than 7306 full-time faculty.
Dallas Baptist University Beginning in 2009, CGE established an affiliate membership and will
East Texas Baptist University enlist from the current 241 partner universities representative of the
Baptist College of Florida 81 nations currently cooperating with CGE.
Georgetown College
Grand Canyon University
• Over the past 22 years, CGE faculty and students have built an
Hannibal-Lagrange College
international reputation for quality academic programs with a
Hardin-Simmons University
component of service to nation and community. CGE has become a
Baptist College of Health Sciences
valued partner in professional training and has established special
Houston Baptist University
institutes for professional training and educational development in
Howard-Payne University
China, Thailand, Bhutan, and Jordan.
Judson College
Louisiana College
Mary-Hardin Baylor, University
• CGE has an ongoing professional training program in China that
Mercer University upgrades the educational skills for teachers and school personnel.
Meredith College During the winter term, CGE conducts workshops in China designed
Mid-Continent University for enriching skill development and classroom effectiveness. In the
Mississippi College summer, CGE sends CGE faculty to different locations to specifically
Missouri Baptist University train teachers per their local needs.
North Greenville University
Oklahoma Baptist University • CGE has additionally conducted workshops for professional training
Ouachita Baptist University for English teachers and International Business skills in Vietnam,
Samford University Indonesia, Tunisia, Lebanon, Mongolia, and Italy.
Shorter College
Southwest Baptist University • The CGE Executive Board recently expressed an interest in directing
Truett-McConnell College CGE’s expertise and university involvement to opportunities with
Union University ministries of education, universities, and schools in Africa and
Wayland Baptist University South America.
William Carey University
Williams Baptist College
• Botswana has been approved as a potential location for appropriate
CGE educational and training programs that are mutually beneficial
to the professional partners and national schools. This program
could be similar to the established model program in China.
REDLEAF LEARNING
• Dan Rice and David Hood have a combined 30 years experience in the CBT and e-
Learning space. Together they have delivered over 1 million learning module
training sessions to companies like AT&T, Bank of America, CSX, Seagate, Hertz,
and Coca Cola. They have also served the needs of many community colleges
including Central Piedmont Community College, Oklahoma City Community
College, Gateway Community College, and Cuyahoga Community College to name
a few.
• In order to meet the needs of Botswana, Dan Rice and David Hood
have tailored the RedLeaf Learning System. RedLeaf is a 100% online
training system designed to handle multi level organizations like school
systems. Nested learning portals allow organizational student data to
flow up to parent portals while securing data from sister portals.
• The modular construction of the system allows for future upgrades and
enhancements without system downtime.