My Personal Development Journey: Nganjoni Village CED Project

NGANJONI VILLAGE PROJECT

GRAPHICAL PRESENTATION OF PARTICIPATORY ASSESSMENT REPORT.

List of Acronyms

AIDS- Acquired Immuno Deficiency Syndrome

CED – Community Economic Development

CEDO- Community Economic Development Organisation

CMAC- Council Multisectoral AIDS Committee

CSOs- Civil Society Organisations

FBO- Faith Based Organisation

HIV- Human immunodeficiency Virus

KIWAKKUKI – Kiswahili Acronym- Kikundi cha Wanawake Kilimanjaro Kupambana na UKIMWI

WEECE - Women Education and Economic Centre

SPSS- Statistical Package for Social Scientists.

FGD – Focus Group Discussion

Table of contents Page

1.0 Introduction to Participatory assessment 4

1.1 Objectives of the Participatory Assessment 5

1.2 Sampling for Quantitative data Collection 5

1.3 Research Tools and Justification 5

1.4 Data Collection and Analysis 6

2.0 Graphical presentation of Quantitative data Analysis 6

2.1 Community Assessment. 6

2.1.1 Frequency Distribution for age 6

2.1.2 Frequency Distribution for Education 7

2.1.3 Demographic data 10

2.2: Economic Assessment: Methodology 11

2.2.1 Comparing Independent Values with one way ANOVA 11

2.3 Environmental Assessment 13

2.3.1 Village’s Accessibility to Health Facilities 13

2.4 Health Assessment. 15

2.4.1 Monitoring and Evaluation data: Improved Children’s health 15

2.4.2 Testing research Hypothesis for 2 Independent Samples. 17

2.4.3 The consumption of healthcare 18

3.0 Conclusion 19

References 20

Annexes 21

1.0 Introduction to Participatory assessment

This is a graphical presentation of a participatory assessment report written as part of the CED project and also as partial fulfillment of the MSc in CED degree course. The concept of Participatory assessment is related to the approach of conducting research by collecting the views of the people living in the community on what activities they would like to carry out with the researcher’s support and those activities must be based on the communities’ real needs. This CED project is supposed to respond to this felt need. The assessment focused on the community, economic, environment and health in the target community with greater focus on healthcare related issues. The data collection tools were triangulated to be able to come up with the priority community need which led to the core problem to be addressed.

Part of this paper is from the participatory Assessment conducted between December 2007 and April 2008. More data was collected in August especially targeting the orphans’ caregivers. 2008. The quantitative surveys administered on the population have now been put on the SPSS data base and this has facilitated graphical presentation of the data. The qualitative section of the Participatory Assessment enabled the researcher to pick themes for Quantitative Analysis.

The quantitative data collection was conducted in a process that facilitated a triangulation with the qualitative tools used earlier. This section shares the methodology, research design, types and sources of data, sampling, the research tools and how they were triangulated. The research findings were based on Stresses, Sources of Stresses and Assets available in the community to be able to mitigate the Stresses identified by the community in each assessment area. This process enabled the researcher to work further with the community to identify a research problem.

The process involved the very first visit in October 2007 which was meant to build relationship with the host organization and community leaders. This was followed by the documentary review based on various village reports and after the participatory assessment; the literature review was based on the community best practices which could be used to inform the implementation of the research after identifying the problem. The research used both qualitative and quantitative methods to gather, organize and analyze data on the current conditions of the target community under the areas of community, economic, environment and health. Next was the identification of research design methods, sampling procedures for respondents, and appropriate tools for qualitative and quantitative data collection.

1.1 Objectives of the Participatory Assessment

a) To have first hand information of what is working, what is not going on well and what needs to be improved collected in a participatory manner.

b) To have leading community constraints, causes and assets identified and linked to researcher’s profession, skills and experience.

c) To have one problem prioritized by the community in a participatory manner.

d) To prepare the community for establishing a community which is engaged in a community economic development approach which provides the focus for evolving and managing the identified CED strategy.

1.2 Sampling for Quantitative data Collection: The total respondents for the April and August quantitative questionnaires were 84 out of a total sample size of 200 for both qualitative and quantitative representing 10% of the estimated village population of 2,000. Sampling was based on randomly picking names from a list of villagers from all the 6 sub villages. In each sub village there were at least 10 orphan’s caregivers. Both quantitative questionnaires were tested for validity 2 days before it was administered and amendments were made accordingly before being administered.

1.3 Research Tools and Justification: The only tool used this time was a Quantitative Survey Questionnaire. This was added to enable the researcher to have data which is quantitatively collected for the purpose of quantitative analysis. This was completed by conducting a description of frequencies and looking at relationships of two or more variables related to the research hypothesis and then presenting the results graphically. In particular it was used to help verify some of the theories or hypotheses that emerged during the qualitative methods. Quantitative surveys actually made statistics available for analyzing, making comparisons and interpretations of the data as measures to identify themes in qualitative data. The questionnaires were originally designed in Kiswahili and then were back translated into English. Triangulation was done by looking at the themes emerging from two qualitative tools and looking for measures to verify them using the quantitative tools as explained under each assessment. (See Annex 1-3)

1.4 Data Collection and Analysis: Data was collected on 2 occasions on April 18^th and August 9th with the Quantitative Survey Questionnaire administered on 84 respondents.. Some of the variables investigated included age, marital status, education, income, ways of earning a living, perceptions on HIV and AIDS, Orphan’s Support issues and accessibility to healthcare. The quantitative questionnaire that was administered on 9^th August primarily was targeting orphans caregivers. This also formed part of formative evaluation. The main techniques applied in data analysis were that the quantitative data was entered on a data base using the SPSS After this analysis, the data were cross tabulated to allow comparison across sources. Using such analysis, common patterns in the experiences reported by all qualitative and quantitative techniques were identified and examined.

2.0 Graphical presentation of Quantitative data Analysis

The graphs and tables below are mainly focused on statistical comparisons of the four assessments mentioned above in the community under study. The themes are picked from the qualitative data collected during the December to April Participatory Assessment. Interesting characteristics about the distribution of variables were picked. The focus was on the variables which complement the health assessment as the area of strategy for the study and my current professional area. The approaches at this stage include Frequency Distribution of the data, A Demographic table,

2.1 Community Assessment

2.1.1 Frequency Distribution for age

Figure 1: The Frequency Distribution of Age of caregiver

Key: Age categories of orphans caregivers

1.0 21-30

2.0 31-40

3.0 41-50

4.0 51-60

5.0 >60

2.1.2 Frequency Distribution for Education

Figure 2

Key: 2.0 primary school leaver 5.0 Other

3.0 Vocational training

Table 1 Age and Education of Caregiver


		Age of Caregiver	Respondent's education
N	Valid	6.51852E+91	6.22E+85
	Missing	4.02153E-87	3.19E-58
Mean		3.5268E-274	8.9E-304
Std. Deviation		-6.5073E+218	-4E+103
Skew ness		-1.00943E-22	2.2E-297
Std. Error of Skew ness		-1.947E+85	-1.3E+88
Kurtosis		-6.5528E+174	1.1E-256
Std. Error of Kurtosis		-2.1816E+161	-1E+164
Percentiles	3.85186E-34	0	0
	4.46015E+43	3.7858E-270	0
	4.07407E+90	1.2882E-231	0

Frequency Distribution and Descriptive Statistics

From Figure 1, the distribution of the age of the caregivers is represented by a normal curve whose skew ness is in the negative for the 76 respondents who filled in the questionnaire. The standard deviation is calculated at .92 which is a small deviation from the mean which is 2.9 while the skew ness is at -1.0. A small population is comprised of younger caregivers (21-30) and the elder caregivers (51- >60). Most of the caregivers are between 30 and 50 years. This distribution has impact on the caring role because the young group may comprise of elder children caring for siblings or very young parents who have not accumulated wealth while the elderly group might be in need of care themselves.

Figure 2 has a graph of the distribution of education among the population and it shows that the majority are primary school leavers. In this village the sample shows that no one has been to vocational school. The mean is 2.13 while the standard deviation is .34 and the skew ness is 2.2. The skew ness follows a positive direction and becomes negatively skewed for the primary school education. This frequency distribution compared to the age can explain why the population is in great need of community economic development intervention. This is because of the generally low education and the big caring role for the population aged 31 -50 years. A project supporting economic empowerment is inevitable.

2.1.3 Demographic data Table 2 Demographic data
	N=91
Age of caregiver	Sex
	Male(N=25)	Female(N=60)
21-30	1(14.3%)	6 (85.7%)
31-40	6(21.4%)	22 (78.6%)
41-50	9(29%)	22 (71%)
51-60	9(39.1%)	14 (60.9%)
>60	0	2 (100%)
Source of income
Business	0	1(100%)
Agriculture	25(27.8%)	65(72.2%)
Weekly expenditure
0-2999	6 (24%)	19(76%)
3,000-6999	11(24.4%)	34(75.6%)
10,000-19999	6(42.9%)	8(57.1%)
>20,000	2(28.6%)	5(71.4%)
Marital status
Married	11(40.7%)	16(59.3%)
Unmarried	1(33.3%)	2(66.7%)
Separated	1(12.5%)	7(87.5%)
Divorced	1(25%)	3(75%)
Widowed	8(18.6%)	35(81.4%)
Cohabiting	3(50%)	3(50%)

Demographic Characteristics: The analysis was done to get the major features of the population as related to the research objectives.

Agriculture as the leading source of income with 27.8% being male respondents and 72.2% being female respondents. Only 1 female respondent was engaged in business.

Generally low income reflected in the weekly expenditure whereby there were fewer male respondents (24% spending up to 2,999/= weekly compared to 76% for female. It is also interesting to note that more females (71.4%) are spending > 20,000/= per week. Also families with low weekly expenditure are likely to be experiencing high levels of poverty and therefore suffering from affordability. Also from the data, it is clear that poverty is associated with poorer physical access to health services and with poorer educational status. Moreover, children born and growing up in households where the respondent had primary education are more likely to be from families with low (primary) education.

As for Marital Status it is clear that most of the women in the sample 81.4% were widowed compared to only 18.4% of men. This shows that more women are surviving compared to men. This also implies the need to support women in this community.

2.2: Economic Assessment: Methodology:

2.2.1 Comparing Independent Values with one way ANOVA

Table 3

Respondents education compared to weekly expenditure
Education	Weekly expenditure
Variable	0-2999	3000-6999	10000-19999	>20000
Primary school leavers	25/91(30.5%)	41/91(50%)	11/91(13.4%)	5/91(6.1%)
Secondary school leavers	0	4/91(44.4%)	3/91(33.3%)	2/91(22.2%)

Figure 3 Comparing Independent Values with one way ANOVA

Key: 1= 0-2999 2= 3000-6999 3= 10000-19999

As hypothesized, the higher a person’s education level is, the more their weekly expenditure would be. Figure 3 and Table 3 above demonstrate that for the primary school leaver, the mean expenditure is between Tsh. 0-2999, where as the mean expenditure for secondary school leaver’s per week is higher in between Tsh. 3000-6999. In order to investigate the significance level of this difference, a one way ANOVA was conducted which was found to be highly significant with a non significant levene test. F(1,89)= 8.04, p<0.01.

2.3 Environmental Assessment

2.3.1 Non facilitative Environment: This community stress is due to remoteness leading to poor accessibility to Health Facilities. The problem of remoteness was reported during the semi structure interview. 75% of the care givers experience physical barriers as they try to utilize healthcare. They do walk to hospital of which the distance is already a barrier. Differences were found for each means of traveling for the three different types of facility but did not reach significance. This is also reflected for access to HIV testing. As for distance to health facility, the national averages are that most households live within 5 kilometres of a primary health care facility and that the majority do seek consultation when ill (Smithson). Of those who were ill did not seek treatment because of distance.

Figure 4 Respondents” means of Traveling compared to type of health facility

See graph in Annex 4

2.4 Health Assessment.

2.4.1 Monitoring and Evaluation data

Figure 5: Children’s health compared to 6 months ago

Key: 1: much better 3. Much worse

2: same /No changes 4. Don’t know

Table 4: Child's health status 6 months ago

		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	Much better	38	41.8	45.2	45.2
	Same/no changes	36	39.6	42.9	88.1
	Much worse	10	11.0	11.9	100.0
	Total	84	92.3	100.0
Missing	System	7	7.7
Total		91	100.0

The same was graphically presented on a pie chart as indicated in Figure 5

Figure 5: Child's health status 6 months ago

Improved Children’s health: The Repeated measure study design has been initiated to compare the before and after situation. The Research Question was: Does increase in household income or expenditure have an effect on the health status of the orphans? In this case does the household income have an effect on the health of the orphans? The participants received awareness raising on the importance of healthcare to the children and orphans in particular it will be interesting to see if they will behave differently and improve the health of the children. After the initial intervention in the community and by raising awareness on the importance of giving children good nutrition and taking them to hospital when sick, a quantitative survey was conducted on a small sample of 16 orphans’ caregivers. The results indicated that 39.6% health remained the same, 41.8 % got better while 11 % became worse. This can be attributed partly to the awareness raising and partly for other reasons such as inability to take the children to hospital when sick.

Therefore, the situation before is the household income as it was in April 2008 and the health status of the orphans. The situation after is the household income and health situation of the orphans after the training in business creation and management and participating in the Village Community banks (VICOBA). This will be done from 6 months onwards.

Figure 5 indicates that after intervention, in the last 6 months, majority of the children fall under the “much better category”. The mean is 1.67 while the Standard Deviation is 0.68 so there isn’t much deviation from the mean.

2.4.2 Testing research Hypothesis for 2 Independent Samples.

Figure 6: Number of Orphans compared to sex of respondents

Table 5: Number of orphans as related to Sex of respondent

Variable	Sex of respondent
Number of orphans	Male	Female
One to two	14/84(32.6%)	29/84(67.4%)
Three to four	4/84(13.3%)	26/84(86.7%
Five to six	3/84(33.3%)	6/84(66.7%)
> 6	0	2/84(100%)

Women are the leading orphans’ caregivers: The research hypothesis is that 2 populations are different. Comparing intervals or ratio data from 2 independent populations with an independent sample t test. In both the semi structured interview and focused group discussion where a mention was made of women being the leading caregivers. The research question was “Are the orphans cared mostly by male or female caregivers? This was also to answer the question on parental survival as well as access issues such as access to healthcare resources, likelihood of living with step parents in case of care by male parents, abuse of basic rights and other forms of protection. From Figure 6 and Table 5 Apparently out of 84 caregivers there were more females (63) than males caring for orphans within the ranges of one to two, three to four and five to six. This has an impact because in this culture women have little access to resources and may not be able to offer quality care.

2.4.3 The consumption of healthcare

Figure 8: Respondents’ Income compared to utilization of hospital

Table 6

Weekly expenditure & child taken to hospital whenever sick
Variable	Responses
Weekly expenditure	I accept completely	I accept	I don’t accept	I don’t accept completely
0-2999	1/34(12.5%)	5/34(62.5%)	2/34(25%)	0
3000-6999	4/34(30.8%)	6/34(46.2%)	3/34(23.1%)	0
10000-19999	1/34(11.1%)	5/34(55.6%)	2/34(22.2%)	1/34(11.1%)
>20000	2/34(50%)	2/34(50%)	0	0

Acceptance of Consumption of healthcare in the community: The consumption of healthcare is inversely related to need. Those who most need health are consuming it least. This matches with the “inverse care law” coined by Hart, J .T (1971) stating that those who need health care actually get the least. The “law” has since been found to apply in a wide variety of settings in developed and developing countries. (law quoted by Smithson, 2006).

Taking orphans health care as in this example, other substantial differences within population according to other socio economic variables such as education. From the previous data analysis, children born and growing up in households where the respondent had primary education are more likely to be from families with low income as well , not likely to be taken to hospital when sick or not to have good health. This has implications to policy since education determines health seeking behaviour. Looking at Figure 8 and table 7 the majority of the respondents either accepted completely or just accepted that children are taken to hospital whenever sick and an average of 23% said they didn’t accept.

4.0 Conclusion

In the light of all this, the problem I am addressing is that of,” Lack of sustainable health care support for orphans in Nganjoni village”. Orphan hood is one of the unfortunate consequences of HIV and AIDS and it is an entry point for other interventions. For example, the orphans could be living with sick parents who also need care and support. Emerging new questions are, “Can the support of coping mechanisms for families caring for Orphans’ in the Nganjoni village community lead to sustainable access to healthcare?” “Does utilization of resources available in the community help to improve the socio - economic health status of target families through the development of micro enterprises owned by those families?” These will be answered in December at the time of monitoring of the ongoing intervention in the community. Therefore, what will be monitored will include the impact of the intervention in terms of changes in caregivers’ income, orphans’ health status, economic practices at household level as well as general economic and health well being in the community

The people of Nganjoni are currently being supported to make shifts from Non – income poverty to wellbeing, from hopelessness to ability to take actions through informed decisions, from exclusion to physical access and participation. I am happy to be part of this process and be able to share my skills in a participatory manner. It is hoped that improvement positive health outcomes will eventually have impact on their community economic development.

References

Community Economic Development Program(2007-2009) Student Handbook, Southern New Hampshire University.
Rwegoshora, H.M.M (2006). A Guide to Social Science Research. Institute of Social Research. Mkuki na Nyota Publishers.
Centre for Community Enterprise.(2000) The Community Resilience Manual: A Resource for Rural Recovery and Renewal,www.cedworks.com.
Smithson, P (2006). Fair’s fair. Health Inequalities and Equity in Tanzania. Report prepared by Paul Smithson. On behalf of Ifakara Centre for Health Research and Development and Women’s Dignity Project.
Pavkov, T. W and Pierce, K. A (2003). Ready, Set, Go! A Students’ Guide to SPSS 11.0 for Windows. Purdue University Calumet McGraw – Hill Higher Education.

Annex 1 : Questionnaire for Quantitative Survey Administered in April 2008

QUANTITIATIVE QUESTIONNAIRE ON ASSESSING THE HIV/AIDS AND ORPHANS SITUATION IN NGANJONI VILLAGE COMMUNITY.

A. PERSONAL INFORMATION.

A1. Sex : Male………………Female………………….

A2. Date of Birth

Month……..Year……………..

(if you do not know date or month fill in 00 if respondent

mentions age only fill in A2a)

A2A. How old are you ?...................................

A3. Marital status:

1. Married/Monogamy

2. Cohabiting

3. Widowed

4. Divorced/Separated

5. Single

6. Polygamous marriage

A.4. Name of sub village.

1. Urenga – U

2. Kitumura – K

3. Nganjoni Juu – NJ

4. Nganjoni chini – NC

5. Sowoko – S

6. Muwe - M

A5. For how many years did you attend school? (Select highest level reached)

1. Never been to school 2. Class 1 -7 3. Form 1 – 4 4. Form V-VI 5. University

A6.What is your denomination?

1. Moslem 2. Hindu 3. Lutheran 4. Catholic 5. Other (mention)…………

A7. How many people live with you in your home ?.....................................................

A7a. How many are over 18 years ?.................................................................................

A8. How many children you live with have lost one or both parents ?...........................

A9. Do you have children ? Yes ……………No……………………..

(if the answer is yes proceed to A9a)

A9 a. How old is the youngest child (write to the nearest age)………….years (if < 1 write 1

A10. How much money do you spend for basic needs in a week ?

0 -2,999Tsh 3,000 – 9,999Tsh 10,000 – 19,999 Tsh 20,000 -34,999 Tsh >35,000Tsh

A.11. What is your main source of income ?

1. Business

2. Farming

3. Technical (Carpenter, Tailor, other…….)

4. Salaries work (nurse, teacher other………)

5. Non skilled work

6. Student

7. Not employed

8. Other (mention)

A12. For how long have you lived in this village ?

(If less than 1 year write number of months)

……………….. Years

………………...Months

B: HIV TESTING.

B1: Have you ever tested for HIV ? Yes………….No………………..

B2: If not yet. What are the reasons (select one)

1. I have never thought of it

2. Cant afford testing & travel is costly

3. Didn’t know I was at risk

4. Testing site is far from my home

5. Scared of getting results

6. Didn’t know where to go

7. Fear of how my partner will react

8. Can’t leave my work to go for testing

9. Was worried that my results won’t be confidential.

10. Not sure if I’ll get treatment if found positive.

11. Other (mention)…………………………………….

C: STIGMA, HIV AND AIDS.

C.1. How many people in your village do you think have AIDS ? Choose 1 of the answers.

1. 1 -9 2.10 – 19 3. 20-29 4. > 30 5. Not sure.

C.2. How many people in your village do you think would like to test for HIV ? (Choose 1 of the

answers) 1. 1 – 9 2. 10-19 3. 20-29 4. >30 5. Not sure.

C3: Do you know any person living with HIV and AIDS in this village ?

Yes …………………………No…………………………

C3a: If the answer is yes. Is any of those people related to you ?

Yes ………No…………

C.4: At the market, would you buy food from someone living with AIDS if he/she does not

look sick ? Yes……………..No…………………

C5: At the market, would you buy food from someone living with AIDS if he/she looks sick ?

Yes…………………..No………………….

C6:Do you fear being infected if you care for someone with AIDS ?

Yes……………….. No………………………..

C7: Do you know someone who has been affected by the following incidents because he/she has

HIV or AIDS.

(a) Abandoned by wife/husband/family

(b) Blamed

(d) Disregarded by family or community.

D: ISSUES BASED ON ORPHANS CARE . (Answer these questions to the best of your knowledge.

D.1. If you know an orphan who has experienced the following after losing one or both parents? Circle all right answers.

1. Stop going to school Yes No

2. Abandoned by 1 parent Yes No

3. Abandoned by relatives Yes No

4. Harmed Yes No

5. Sexually Molested/Raped Yes No

D.2.Orphans deserve children’s rights and additional protection.

1. Agree 2. Disagree 3. Don’t know.

D.3 Orphans could be a headache.

1. Agree 2. Disagree 3. Don’t know.

D.4. I will not be ready to live with an orphan

1. Agree 2. Disagree 3. Don’t know.

D.5. I will feel ashamed to live with an orphan who has HIV or AIDS 1. Agree 2. Disagree 3. Don’t know.

E: COMMUNITY SUPPORT SYSTEMS

(These question are about the way support is given to orphans in relationship to HIV and AIDS)

E.1. The community is responsible for caring for orphans?