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Scaling up the FOCUS Programme of Family AIDS Caring Trust
   Last updated: 16.08.02
Implementers
Family AIDS Caring Trust (FACT) is a Zimbabwean NGO, established in 1988 with offices in Mutare and Chiredzi. FACT works with a variety of NGOs and CBOs to promote quality HIV/AIDS interventions.

The Family, Orphans and Children Under Stress (FOCUS) programme, established in 1993, works primarily with church-based CBOs to provide support to children affected by AIDS. They identify households where children's basic needs are unmet and help develop a sustainable plan to improve their quality of life.

Background
In 1991, FACT Director Dr. Geoff Foster was alarmed at the growing number of malnourished orphans he encountered during his work as a paediatrician at a government hospital. FACT then sponsored a research study to count the number of orphans, examine how communities and extended families were coping and determine how best to support their efforts.

The first FOCUS programme was established with a church group near Mutare in 1993. One year later, the group had succeeded in identifying a large population of orphans in the target area, prioritising the most needy households and mobilising the community to provide regular visits and support to these households.

The process of scaling up might actually be better described in this case as scaling out. As other churches heard about the success of the pilot project they asked FACT, the facilitating NGO to help them establish similar programmes. By 1998 FACT supervised 9 FOCUS sites with 178 volunteers providing regular visits to 2,764 orphan households.

Objectives and main activities
The objectives of the FOCUS programme are:
• To identify all orphaned children in each project's area and prioritise those households with the greatest needs.
• To visit these households at least twice a month.
• To provide these households with material support.
• To involve other community groups, leaders and organisations in all aspects of the operation.
• To enable these groups to work toward more autonomy and control over their own local programmes, eventually reducing their dependence on FACT.
• To identify early new problems affecting orphans.

As the FOCUS programmes expanded so quickly, FACT had to develop a new type of support model. It became necessary to re-evaluate decision-making systems and structures within the programme. There were attempts to enhance collective decision-making and encourage site supervisors to become more actively involved in planning activities and budgeting. An annual management meeting was introduced so supervisors of different sites could plan activities together with the FOCUS staff.

It became clear that:
• The capacity of the FOCUS staff to supervise new sites was limited.
• Identifying emerging problems was better achieved when attention could be focused more intensely on fewer sites, rather than more broadly on many.
• Community ownership made a project much more sustainable.
• FOCUS should begin to limit its activities to community mobilisation and technical support.

Resources and timeframe
The initial funding for baseline research was provided by Plan International (Mutare). A start-up grant for the FOCUS programme was provided in 1993 by Save the Children Fund (US). Since 1993, Plan International has provided most of the funds, with some additional support from UNICEF.

No specific budgets were set for the scaling up process in the beginning. FACT administrators believed that the expansion could be carried out using existing resources. When the new sites began to develop rapidly, additional money was requested and granted.

Because FOCUS relies so heavily on volunteers from within the community, the cost of establishing and maintaining a new site is a fraction of the total cost of running the programme. An assistant co-ordinator was hired at the beginning of the first scaling up in 1996, but no additional staff was added after that. Fixed programme costs such as Co-ordinator's salary, office rental and administration costs remained basically unchanged as the programme grew.

Additional costs of training, transport and support to communities represented less than 20% of total costs.

There were however, definite changes in the financial situation as the programme expanded:
• While the amount spent on material support increased with programme expansion, the actual number of households supported increased at a faster pace, resulting in reduction of support provided to each household.
• In 1997, due to limited capacity of FOCUS staff, a decision was made to reduce the frequency of site support visits in established programmes from monthly to bi-monthly. In alternate months, FOCUS site supervisors attended training and support meetings at FACT's offices. This increased supervisors' responsibility and provided peer support.
• The reduced availability of FOCUS staff for training of volunteers at sites was compensated for by establishing exchange visits for volunteers between sites. These visits proved to be popular and beneficial.
• The reduction in the amount of material support and supervision provided by FACT to FOCUS sites actually encouraged the CBOs to become more autonomous. Some developed additional resources within their own communities, or independently recruited from outside. One CBO obtained external donor funding and was able to employ its own staff, develop a Board of directors and become an NGO in its own right.

Outputs/outcomes
Although scaling up was assumed in the original project design, there were no specific targets set concerning coverage, impact or sustainability. Initially, there were no known models of community support to children affected by AIDS. Since the pilot programme, targets have been developed for new sites.

Few aspects of the original model were lost or diluted in the scaling up process. Though FACT was able to provide less material support to the newer FOCUS sites, this did not affect the functioning of the programmes and may actually have enhanced community ownership, decision-making and contributions. When community groups were challenged to make more decisions about their future development, they matured and became more empowered. The flow of monitoring data to FACT has become less efficient however, as a result of reduced supervisory visits to FOCUS sites.

Internal organisational implications
Overall, the process of scaling up was advantageous to the FACT organisation.
• The additional work for FACT staff in supervising several FOCUS sites was offset by an increase in mutual support from site supervisors and volunteers.
• The FACT organisation was able to gain a strategic understanding of the mechanisms involved in an effective scaling up process.
• Innovations introduced by community-based partner organisations will be helpful to FACT in developing future programmes.
• FACT decided in 1999 that they would not directly support any new FOCUS sites, but would supply technical support and training without formalised monthly visits, allowances or material support.

Evaluation
The pilot programme was evaluated in January 1995, one year after commencement. The findings have been published as a peer-reviewed article, Supporting children in need through a community-based orphan visiting programme, G. Foster et al, AIDS Care, 4:389-404, 1996. Among the findings:
• Community-based organisations were able to identify a high proportion of orphans living in their area, target those most in need, and provide regular visits and material support.
• These programmes can provide support to large numbers of affected families.
• The FOCUS model was targeted, effective and replicable.

Another major evaluation was carried out in 1999. These findings included:
• FOCUS programmes enjoyed high levels of volunteer retention and sense of community ownership.
• There was a need to diversify the FOCUS model so it could operate with lower levels of external support.

The most challenging aspect of evaluating the scaling up has been maintaining a balance between the requirements for FACT to supervise programme sites, obtain monitoring data and understand emerging problems, while also ensuring autonomy to the communities and fostering their sense of ownership.

Lessons learned
The success of the FOCUS programme is most clearly demonstrated by the mechanism by which it proliferated. Local leaders and pastors saw tangible benefits being provided to a community in need and sought, through their own initiative, to establish the programme in their own communities.

Despite the acknowledged success, the scaling up process could have been much more effective with more outside support. The FOCUS programme expansion received little support from outside agencies, government departments, international children's organisations or policy advisory groups.

There are a number of factors that appear to inhibit effective partnerships between large organisations and NGOs:
• Unrealistic reporting requirements.
• Lack of flexibility.
• Lack of trust.
• Partisan agendas.
• Inability or reluctance on the party of large organisations to embrace the idea of community ownership, empowerment and eventual autonomy of a project.

Source: A Question of Scale
This is an extract from A Question of Scale: The challenge of expanding the impact of non-governmental organisations’ HIV/AIDS efforts in developing countries,
by Jocelyn DeJong, published by the Horizons Project of the Population Council with the International HIV/AIDS Alliance in 2001. To view the whole report follow this link.

To download, complete with graphics, in pdf format (which requires Adobe Acrobat software to read it) follow this link (file size 1.43 Mbytes).