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Abstract
This paper discusses enabling and constraining factors related to the scaling-up of
the Scaling Up HIV/AIDS Interventions Through Expanded Partnerships (STEPs)
initiative, supported by Save the Children U.S.A. (SC), to combat HIV/AIDS in Malawi.
It also discusses potential threats to and contextual factors limiting scaling up of STEPs.
The report draws primarily upon the available literature and qualitative data collected
during a five-day visit to SC Malawi in December 2002.
STEPs started in 1995 as Community-Based Options for Protection and
Empowerment (COPE). COPE was a service-delivery program in Mangochi District to
assist children affected by HIV/AIDS. Through evaluations, SC realized that such an
approach was unsustainable, not cost-effective, and not scalable. Based on the
recommendations of the evaluations and on field experience, the program changed course
to mobilize collective action to combat the epidemic. Working in the Namwera
community in Mangochi under the National AIDS Commission (NAC), STEPs
revitalized the dormant decentralized AIDS committees and their technical
subcommittees at the district, community, and village levels.
Based on the positive experience in Namwera, the program changed its initial
strategy to that of an external change agent, assisting communities with community
mobilization and capacity building so that communities became empowered to act
collectively to address their problems. Village AIDS committees (VACs) first identify
the vulnerable. Then VACs plan responses on the basis of the nature and magnitude of
vulnerability within the villages, needs of the vulnerable, and capacity within villages to
respond. The committees also monitor activities and mobilize resources. As the needs of
the most affected communities are crosscutting, the program has become truly
multisectoral, with activities along the continuum of prevention, care, support, and
mitigation. STEPs has also been influencing national policies related to HIV/AIDS and
children.