DFLO Pastoral Community-Based

HIV/AIDS Prevention, Care and Support

Program

BASELINE SURVEY REPORT

MAY 2018

www.vcidafrica.org
Acknowledgement
This report was written by the technical team of the Vocational Centre for International Development
(Mr. Miki Gilbert Ngwaneh – Founder and Director and Ms. Nkwah Azinwi Ngum – Program
Development Officer). Our appreciation to the highly experienced team of development professionals
at VCID who participated in the data collection, entry and cleaning processes.

We are grateful to the donors: Diocese of Limburg, Kindermissionswerk , Missio-Aachen and the
Diocese of Kumbo for the great care and support they have for our beneficiaries. Our desire is to
make them proud by aiming for results and sustainable impact in our communities of intervention
within the Diocese of Kumbo.

In addition, we would like to give special thanks to the VCID/DFLO team of data collectors for their
hard work in collecting all of this information and conducting the preliminary cleaning of the data.
Furthermore, we want to thank the local Civil Society Organizations and community leaders in each
of the selected communities for their assistance in facilitating the collection of the data for this
baseline study. We also want to acknowledge that we could not have collected this information
without the collaboration of the parish priests, deanery and divisional supervisors as well as leader
couples who gave up their time to respond to the survey and participate in key informant interviews.
Executive Summary
Acronyms
List of figures
List of tables
Table of contents
 1. Project Background
Globally, the number of children below 18 years who have lost one or both parents to AIDS
stands at 14.3 million and above. The vast majority of these children live in sub-Saharan Africa,
in which Cameroon is a part. Despite the recognition of the magnitude and negative
consequences of this problem, not much is done to improve the well-being of children affected
by HIV/AIDS as well as People Living with HIV/AIDS (PLWHA) themselves. The condition of
these victims of HIV/AIDS is further compounded by prevailing food insecurity. The North West
Region of Cameroon has one of the highest regional HIV prevalence rates in Cameroon; with a
standing record of 6.3%, significantly greater than national estimates at 4.5% (source:
Demographic Health Survey, Kumbo; n.d), with women and young people being the most
affected. In Cameroon, the rate of people who go for voluntary counselling and testing stands at
20.7%, with minimal proportion from the rural areas.

In the North West Region in general and Bui Division in particular, visible among PLWHA, are
symptoms of malnutrition. HIV/AIDS and malnutrition exacerbate one another in a mutually
reinforcing cycle, and cause damage to the immune system independently. PLWHA often report
a higher prevalence of malnutrition than other adults. Often, the whole household suffers as
HIV/AIDS and malnutrition combine to render adult PLWHA less able to engage in income-
generating activities and childcare. Despite the precarious situation of PLWHA and orphans and
vulnerable children (OVCs), interventions designed for their wellbeing remain a challenge in
terms of sustainability. In an attempt to meet the socio-economic and psychological needs of
PLWHA and OVCs in the Diocese of Kumbo, the Diocesan Family Life Office proposed to embark
on a holistic approach of Prevention, Care and Support to orphans and vulnerable children as
well as PLWHA.

1.1. Project rationale

The rationale for the HIV/AIDS Pastoral Program through a community-based approach is
designed to implement sustainable measures that have multiplier effects on the target
beneficiaries. The Program aims at continuously raising awareness on HIV/AIDS pandemic
through holistic pastoral ministry to Persons Living with HIV/AIDS and the affected population.
 1.2. Project goal and objectives
The goal of the program is to contribute to reducing stigma and discrimination and HIV/AIDS
prevalence rate by 10% by 2021. This will be done by strengthening the ability of communities
to care and support for OVC and persons living with HIV and AIDS (PLWHA). To accomplish
program goal, DFLO seeks to:
• Provide pastoral support to target beneficiaries (Income Generating Activities for CBOs,
BTAs, caregivers, single parents and YFL as well as sponsorship of OVCs at primary and
secondary school levels);
• Prevent spread of HIV/AIDS among youth and care/support OVCs and PLWHA through
BEPHA program
• Support OVCs in vocational training programs/schemes;
• Effectively manage the DFLO HIV/AIDS program

1.3. Project beneficiaries

The program is designed to meet the needs of a cross section of beneficiaries within the Diocese
of Kumbo. The direct beneficiaries of the project include:
1. Orphans and vulnerable children
2. People Living with HIV/AIDS (Otherwise referred to as Break Through Association)
3. Single Parents
4. Caregivers
5. Community-Based Organization and
6. Youth-For-Life
 2. Study Methodology
2.1. Study sites
Baseline data were collected from across three Sub Divisions in Bui Division and two Sub
Divisions in Donga-Mantung Division. In all, 18 communities were considered for the study
below
Table 1: Target baseline communities in the Diocese of Kumbo
Division Sub Division Baseline Communities
Bui Jakiri Jakiri, Vekovi, Mesai and Nkar
Nkum Ngondzen, Kuvlu and Tatum
Kumbo Meluf and Mbah
Donga-Mantung Nkambe Tabenken, Moh, Binsua, Nkambe
Town, Nwangri and Bakichini
Misaje Misaje, Kibo and Nkanchi

Logistical and financial feasibility required limiting baseline data collection to five out of the
Eleven Sub Divisions. Of the 18 communities, 05 were purposively selected from semi-urban
areas, with the rest rural communities. All the study communities had to have parishes, with
access to parish priest, divisional, Deanery supervisors and leader couples that could be used
for key informant interviews. Figure 1 also shows the data collection locations in the two
Divisions of the Diocese of Kumbo

2.2. Study objectives

The overall purpose of the study was to gain a greater understanding of the situation that a
cross section of DFLO target beneficiaries go through with regards to household food insecurity
issues as well as the various coping strategies used by the different beneficiaries across the
Diocese of Kumbo. Addendum to the issues surrounding food insecurity and coping strategies,
the study was also designed to assess and obtain a broad view of the educational, nutritional,
general health and economic concerns. Specifically this study was designed to:
- Assess community-level perceptions and experiences on household food concerns for
PLHIV, OVC, single parents and caregivers and their households;
- Determine the varying coping strategies across the board and
 - Assess community-level potentials and opportunities to better meet the socio-economic
needs of households hosted or hosting the target beneficiaries.

A structured questionnaire was administered to selected target beneficiaries in each study

community to obtain information on access to food and coping mechanisms during instances of
food insecurity. The questionnaire (annex 2) was administered to all the target beneficiary
groups and each target study community was randomly selected. At the level of the community,
each target group was mobilized at the parish level to ease the data collection process. That was
also to ease identification of the various target beneficiaries through their respective groups.
Each enumerator began with the household food insecurity scale tool before correspondingly
proceeding to the coping strategy index tool.

2.3. Sample and sampling techniques

The sample size of 150 interviews per Division was calculated to detect a 15% change over time
assuming a 50% baseline level for any indicator, using a one-tailed test with 80% power, 95%
confidence, and a design effect of a 10% non-response rate. This target was surpassed with a
total of 325 respondents (176 and 145 from Bui and Donga-Mantung respectively).

Study participants were drawn from the beneficiaries of the project in the sampled
communities. Targeted population groups included OVC, BTAs, Caregivers, Single Parents and
CBO members. Program staff (Divisional and Deanery supervisors), leader couples and parish
priests were interviewed as key informants.

A multi-stage cluster sampling approach was applied1 to sample Sub Divisions, Communities,
and beneficiary groups. The sampling frame assumed an equal distribution of the sampled
population by sex. Table 2 shows the required and actual sample sizes for the different
respondent categories of the baseline study.

1
Turner, A.G., Magnani, R.J. and Shuaib, M. (1996). “A Not Quite as Quick but Much Cleaner Alternative to the Expanded Programme on
Immunization (EPI) Cluster Survey Design.” International Journal of Epidemiology, 25(1), pp. 198-203.
Table 2: Number of target beneficiary groups involved in the baseline study
Type of # sampled in Margin of Confidence Sample Actual
respondents communities error (%) level (%) required sample
Youth-For-Life 55 3 95 60 55
Single Parents 76 5 95 60 76
BTAs 65 5 95 60 65
Caregivers 55 3 95 60 55
CBOs 73 5 95 60 73
Total 324 300 324
Key informants 08 16
Key informants were carefully selected. VCID staff reached out to key informants highlighted in
the protocol and established availability interviews. If these individuals were unavailable for
interview, they were replaced with someone in a similar position. To heighten the chances of
gaining and in-depth view of field realities, lead interviewers were encouraged to increase the
number of key informants as much as possible.

2.4. Selection of respondents

The selection of respondents for the baseline survey was highly supported by the DFLO staff.
The first step was giving consideration to all the target groups involved in the project (Youth-
For-Life, Break-Through Association, Caregivers, Community-Based Organizations and Single
Parents). To ease the data collection process, only communities with a cross section of these
target groups were prioritized and the team setup was designed to function as such. In each
community, the field enumerators were tasked to administer the tool to at least 10 members of
the group and a total of 30 groups were selected for the data collection process. While at the
level of the community, DFLO staff, divisional and deanery supervisors as well as parish priests
facilitated the mobilization of respondents.

Since the respondents assembled in one spot for the exercise, the enumerators were requested
to divide the total number group member by the minimum target (10). If the BTAs in Ngondzen
were 30, a systematic random sample of every 3rd BTA member was selected for the study. In
order not to allow the rest of the members of the group not to feel uninvolved, a small but
meaningful focused group discussion was initiated to gain further insight into the same issues
under investigation. Every 3rd farm with occupants was considered as was the case with those
who assembled at one spot.

2.5. Data collection

2.5.1. Survey instruments
In order to reflect the intended target recipients of the DFLO program, three data collection
instruments were developed for and administered to the different groups:
1. Household Food Insecurity Access Scale
2. Coping Strategy Index
3. Key Informant Interview Guide for Parish priests, Divisional and Deanery Supervisors as
well as Leader couples

The first two tools had instructions to be followed by the enumerators. For the first tool on food
insecurity access scale, two types of related questions were asked: the occurrence questions
and the frequency-of-occurrence questions. The recall period was also stressed which was if a
particular food insecurity condition ever occurred during the previous four weeks or one
month or 30 days. These different options of ensuring the recall process was emphasized for
accuracy and robustness of findings

With the second tool which was administered alongside the household food insecurity access
scale, emphasis was on how households cope with the increasing food insecurity scenarios as
home. Instead of taking it as far back as 30 days, the tool required them to indicate the number
of times in a week they have has to engage in a particular behavioral coping strategy.

These standard tools were chosen for the following reasons:

1. They agree with most indicators designed to ameliorate the living conditions of
vulnerable and poverty stricken households;
2. They can easily be used to track the impact of any intervention;
3. They are easy to use after a meaningful trial especially during the dry run process

The last tool which is the key informant interview checklist plunged into aspects of the target
communities to involve:
 - An understanding of the project by the key informants;
- Diagnosis of the community potentials – vocational training centres,
agriculture/gardens,
- Analysis of the state of education of OVCs
- Knowledge of HIV/AIDS and other related diseases.

These instruments were adapted and pilot tested among enumerators to ascertain the user
friendliness. While the questionnaire tools captured issues of food insecurity and coping
strategies, the key informant interview guide focused on program implementation successes
and challenges, capacity, and transition and program sustainability.

2.5.2. Data collection protocol / quality control measures

The study team was divided into two, each comprised of 6 members - a team leader or
supervisor and five (05) others assigned to BTA, CGA, SPG, CBO and YFL groups respectively.
Each team spent 03 days in the field, with research assistants conducting an average of ten
interviews with beneficiary groups per day. Key informant interviews were conducted by the
team leaders with the support of the DFLO field level supervisors, leader couples and parish
priests.

For the most part, interviews took place at the parish level within the Diocese of Kumbo. Since
the data collection process coincided with the farming season, some beneficiary group members
were interviewed at their farms.

Informed Consent
All selected beneficiaries were informed, prior to consenting, that their participation is
voluntary and does not affect their eligibility to receive services from the programs now or in
the future. At the start of all interviews, participants were informed orally of the purpose and
nature of the study and its expected risks and benefits. Because of low literacy levels, the
interviewer requested verbal consent of the participant to conduct the interview. If verbal
consent was given, the interviewer signed the consent form for the participant. Adults provided
consent for themselves to participate in the survey. As part of the consent procedures,
beneficiaries were informed that the data collected would be held in strict confidence at the
level of DFLO. To ensure that the beneficiary was aware that the survey includes questions on
highly personal and sensitive topics, the interviewer forewarned the beneficiary that some of
the topics are difficult to talk about.

The beneficiary was made aware that he or she would be free to terminate the interview at any
point and able to skip any questions to which he or she did not wish to respond.

Compensation
The project team was committed to assuring that study participation was voluntary; therefore,
no compensation for participation was given. Respondents were made aware that the
interviewer was present only to ask questions and not to provide any gifts or assistance.

Quality control measures

To ensure a high quality of data, interviewers were carefully trained, and completed
questionnaires were reviewed as part of quality check procedures. Data collectors were trained
on data collection methods and provided with some hands-on practice sessions on the
questionnaires. Guidelines on good data collection practice were provided.

Each completed questionnaire was reviewed first by enumerator who administered it, then by
the supervisor or team leader, before submitting it to the VCID office for final scrutiny and
storage. Questionnaires with inconsistencies were returned to the various team leads the
following day for clarification and/or correction. Each day concluded with a review of the day’s
work and collective and individual feedback to the enumerators by the supervisor.

2.5.3. Data processing and cleaning

After the data were collected from all the communities, data processing was carried out in
Kumbo, at the VCID office. Nine data entry clerks were recruited to enter qualitative and
quantitative data. 04 entry clerks were involved for quantitative data using excel. To validate
data entry of the quantitative data for the two tools (Household Food Insecurity Access Scale
and Coping Strategy Index), two teams of data entry clerks entered the respective data sets.
Duplicate files were then compared using a double-entry validation process. Inconsistencies
were corrected by referring to the questionnaires until a zero-percent error level was reached
for the two datasets.

For qualitative data, key informant interview recordings were transcribed. Transcribed texts
were read for emerging themes and to generate codes for data categorization. The data were
then sorted thematically using the codes developed from the interview guide and the data.

2.6. Data analysis

As above, the data were first entered into excel spreadsheets. The data were then exported to
SPSS 20 for analyses. Others were simply analyzed using excel. Frequency distributions of all
study variables by sex and age group were calculated, including chi-square tests of statistical
association.

Transcripts were analyzed using qualitative content analysis, which is a process of identifying,
coding, and categorizing patterns in data. All transcripts were re-read and recoded several
times to improve inter-rater reliability. Codes were then developed based on identification of
key words and sentences. Relationships between coded data were then explored, and clusters of
related codes were categorized into sub-categories of data. Sub-categories of data were then
compared, re-grouped, and merged under various themes. Codes, sub-categories, and themes
were mutually exclusive. Themes were modeled as a web of interconnected issues to
conceptualize an overall picture of the findings.
 BASELINE SURVEY RESULTS
In a world where over 800 million people go to bed hungry with close to 50% of the number
from Sub Saharan Africa, there is need to continuously support households to better their food
security situation. Though Cameroon on a global scale is moderately food secured, national data
suggest that some regions are severely food insecure than others. The North West Region of
Cameroon is one of the highest hit by food insecurity mostly because of the current socio-
political crisis that has plagued the region for close to two years. Often neglected, food security
and nutrition are critical for individuals, households and communities affected by HIV/AIDS.
Addressing food security and nutrition in all settings is vital to achieving access to HIV/AIDS
prevention, treatment, care and support by 2020, according to the DFLO program.

In the following sections, we will discuss the results of a baseline study carried out in Bui and
Donga Mantung Divisions of the North West Region. The results aim to show the food security
needs of potential beneficiaries of the DFLO program and the relationship this has on HIV/AIDS
and livelihoods in the communities.

I. KEY FINDINGS IN BUI DIVISION

1.1 Perspectives on food security across beneficiaries in Bui
The food security situation in Bui Division is relatively moderate. The division is comparatively
urban and therefore, households can readily access social services and information relating to
food security and nutrition. Based on the proximity to information, the populace of Bui Division
has developed coping strategies that has helped them mitigate the impact of food insecurity in
the community. Despite the contributions of households to mitigate the effects of food
insecurity, food insecurity still persist owing to several factors such as the current socio-
political crisis, price hikes, climate change and other related factors. The following subsections
present the results of the baseline studies carried out in Bui Division.

1.1.1 Demographic data on respondents

Data for this analysis were collected from 176 respondents in the study area. Of this number,
116 were female and 60 male (figure 1), indicating that the ratio of female to male in the
community is approximately 2:1; therefore the community is female dominated. Generally,
women are biologically, socially and economically more vulnerable than men to HIV. For a
community that is female led, the risks of this situation occurring is high.
 Sex structure of respondents in Bui

60

116

Male

Female

Figure 1: Sex structure of respondents in Bui.

The study also categorized the respondents according to the age brackets. As indicated in figure
2 below, close to 59% of the population fall between the age of 43 and 65 years while 41% fall
between 20 and 42 years old. This is an indication of an ageing population and could be
explained by the fact that, most young people are moving out of the study area with push factor
being the current socio-economic situation or poverty. This could further be attributed to the
lack of non-farm activities in the community that young people can engage in as well as the fact
that there is increasing HIV/AIDS related deaths among young people in the community.

Age structure of respondents in Bui

≥ 65 ≤ 20
54 - 64 7% 10%
16% 21 - 31
18%

32 - 42
43 - 53 13%
36%

Figure 2: Age structure of respondents in Bui

In terms of the economic/occupational status of the respondents, figure 3 shows that the
community is mainly agrarian with only 11% of the population being students, 9% teachers and
3% involved in vocational trades. This result has a negative relationship with the level of
education within the community; households earn very little from their agricultural activities
and therefore cannot support education (see figure 4). Lack of food security could also constrain
people’s choices about work and education; child feeding and bearing, and can lead to increase
mobility for work. Mobility and limited options for earning an income in turn can lead to high-
risk behaviours such as engaging in sex for food or money.

Occupational status of respondents in Bui

140
120
100
Axis Title

80
60
40
20
0
Farmer Nurse Hairdresser Tailor/Semstr Retailer Student Teacher
ess
Series1 121 4 3 2 10 20 16

Fig 3: Occupational Status of respondents

The educational level of the target community members was also recorded using the sampled
population. Figure 4 demonstrations that 52% of the respondents have had only primary
education and 44% have had at some secondary level education. The level of tertiary education
in the community is low (2%). There exist an inverse relationship between education and
reduction in HIV risks and food security. Better educated children are more likely to absorb
prevention information and adopt safer behaviours. The completion of secondary school,
especially among young women, may lower the risk of HIV infection. Households that are food
insecure are more likely to take children out of school in order to work to supplement the
income lost as a result of their parents’ illness and/or death. This data show that a majority of
the population can at least read and write but also explains why the level of farming in the
community is high (see figure 3 above).
University No
Level, 3 Education, 3

Secondary Primary
Level, 79 Level, 94

Figure 3: Educational status of respondents in Bui

In the study area, 71 of the beneficiaries indicated that their household2 size is between 4 to 6
people while 49 noted they had between 7 to 9 household members (figure 5). There is a direct
relationship between household size and food security. The tendency is that households with
increasing numbers are likely to be food insecured than households with fewer members. This
relatively large household sizes could indicate that birth rate in the community is high; hence
there is a need for sex and reproductive health education within the communities.

Average household size of respondents

80
70
60
Axis Title

50
40
30
20
10
0
Zero 1-3 4-6 7-9 10 - 13 ≥ 14
People People People People
Series1 14 32 71 49 6 4

2
Household here refers to a family unit that lives together, sharing the same source of food
Figure 4: Average household size of respondents in Bui

The religious background of the responded was also documented and results revealed that 168
were Catholics and 7 were from other denominations. This result indicates that there is need to
broaden the scope of the beneficiaries.
Religious background of respondents

Muslims
Other denominations
Catholic
0
100
200
Other
Catholic Muslims
denominations
Series1 168 7 1

Figure 5: Religious background of respondents

1.1.2 Food anxiety among beneficiaries

As indicated on figure 7, 81% of the respondents acknowledged that they were worried on what
to provide as food for their household in the month before the survey. This result could be
linked to low farm yields and declining revenue to purchase food in times of scarcity.

Food Anxiety among beneficiaries Frequency of food anxiety

19% Often (>10 times in
19% the Past 4 weeks)
Yes 18%
No Sometimes (3 - 4
times in the past 4
81% 17% weeks)
46% Rarely ( once or
twice in the past 4
weeks)
Figure 6: Food Anxiety among beneficiaries in Bui Fig 7.1: Frequency of food anxiety

Based on frequency of food anxiety (figure 7.1), 18% of the respondents said in the month
before the survey, they were worried about food issues at home for >10 times for the past 30
days. Further findings revealed that 46% had food anxiety at least 3 to 4 times while 17% said it
was rare for them to face anxiety levels with regards to food. This frequent anxiety levels could
be accounted for by the fact that a majority of the household sizes are large hence increasing the
burden of feeding the entire household.

In a community where HIV/AIDS is prevalent, this high rate of food anxiety not only has an
effect on the affected but also the infected as it further places psychological stress on the
caregivers and the patients; hence weakening their already fragile immune system.

1.1.3 Incidences of beneficiaries not eating preferred food

As represented on figure 8, 89% of the total respondents said they were not able to eat the food
they preferred. The few who could afford the preferred food must have been the small
proportion involved in non-farming activities as recorded in the occupational structure of the
sampled population.

Inability to eat preferred food among Frequency of inability to eat preferred

No
beneficiaries Response
food
11% Often (>10
11% times in the
Rarely ( once Past 4 weeks)
or twice in 19%
the past 4
Yes weeks)
20%
89% No Sometimes
(3 - 4 times
in the past
4 weeks)
50%

Fig 8: Incidence of households not eating preferred food Fig 8.1: Frequency of households not eating preferred food

According to respondents eating preferred food would mean eating “fufu-corn and vegetable”,
which is mostly regarded across the community as a standard food by culture. Field analysis
further captured respondents’ views that when they start eating other dishes like rice, it is an
indication that they are not eating their preferred food. This shows that this community has
some cultural inclination to their stable dishes.

Based on frequency, figure 8.1 indicates that the month before the survey, 50% of the
respondents were unable to eat their preferred food at least 3 - 4 times while just 20%
indicated they were able to eat their preferred food. This relatively high frequency of
occurrence contributes to psychological stress to both the infected and the affected persons in
the communities as earlier mentioned.
1.1.4 Incidences of beneficiaries accessing limited food variety
As presented on figure 9, on a total of 176 respondents, 149 (84.6%) ate limited food variety in
the month before the survey. This high level of limited access to food variety has an inverse
relationship with HIV/AIDS treatment. Access to food is one of the main pillars of the food
security and is emerging as an important barrier to adherence to care and treatment
recommendations for people living with HIV and AIDS.

Access to limited food variety among Frequency of access to limited variety of

beneficiaries food
No Response
15%
No Often (>10
times in the
Yes Past 4 weeks)
22%
0 100 200
Rarely ( once Sometimes (3
or twice in - 4 times in
Yes No the past 4 the past 4
Series1 149 27 weeks) weeks)
16% 47%

Fig 9: Access to limited food variety Fig 9.1: Frequency of access to limited variety

Further analysis as in fig 9.1 above reveals that 22% of the respondents during this survey said
they had access to limited variety of food >10 times and 47% noted they had access to limited
variety of food at least 3 - 4 times in the month before this survey. This could be linked to
increasing food prices depriving the most vulnerable fabric of the community members from
access to food varieties. This high rate of limited access (69%) to food has a direct relationship
with adherence to care and treatment of persons living with HIV/AIDS, education of the young
people and work mobility among members of the household, posing as high risk factors to
HIV/AIDS.

1.1.5 Incidences of beneficiaries eating socially undesirable food

Eating socially undesirable food here refers to food that otherwise would not be eaten under
normal conditions where households have access to best optional food items. This could be
ingredient deficient foods like “painted rice”3, food left in the market squares or food abandoned
because of one defect or the other or a combination of all. Based on fig 10, 119 respondents
indicated that they have had to rely on undesirable food because of lack of resources. This result

3
Rice prepared by households without ingredients except salt and oil
defeats three major components of the food security pillar that is access, availability and
utilization and is largely related to poverty.

Incidence of eating socially undesirable Frequency of eating socially undesirable

food among beneficiaries food

67 57
119 42
10
57
Often (>10 Sometimes Rarely ( once No Response
times in the (3 - 4 times or twice in
Past 4 in the past 4 the past 4
Yes No weeks) weeks) weeks)

Fig 10: Perspectives on eating socially undesirable food Fig 10.1: Frequency of eating socially undesirable food

Figure 10.1 highlights the frequency of occurrence for respondents eating socially undesirable
food. As shown, of the 119 eating socially undesirable food, 10 of them said they had to do this
>10 times while 67 of them noted this happened to them at least 3 - 4 times in the month before
the survey. Figure 10 and 10.1 indicates a high prevalence of people eating socially undesirable
food in the community. Eating socially undesirable food means eating food of poor nutritional
value and may lead to food poisoning and other related illnesses. For people living with
HIV/AIDS, poor nutritional intake not only weakens the effectiveness of the ARDs taken but
could weaken the entire immune system hence patient is prone to secondary infections or
opportunistic diseases.

1.1.6 Incidences of households eating smaller sizes of meals

Accessing food by households in a community is one step and doing so in the right quantity is
another. Figure 11 illustrates the quantity of food intake by households and indicated, 81% of
respondents said they had smaller meals than they felt they needed because there was not
enough food. Having smaller meals imply households have developed a rationing mechanism to
ensure that every member of the household can at least have food to eat. Thus, the findings
show that rationing food across the different communities in Bui Division is normal, not because
the household members desire it but they are actually compelled to do so due to limited food in
terms of quantities.
 Frequency of households eating
Beneficiary households eat
smaller meal sizes
smaller meal sizes Often (>10 times
in the Past 4
weeks)
No
19%

10 Sometimes (3 - 4
No Response 34 times in the past 4
93 weeks)
Yes
81% 39

Rarely ( once or
twice in the past 4
weeks)
Fig 11: Beneficiary households eat smaller meal sizes Fig 11.1: Frequency of households eating smaller meal sizes

As shown on fig 11.1, 93 of the respondents noted they had smaller meals in the month before
the survey at least 3 - 4 times. This relatively high rate of smaller meal intake among
respondents could be linked to poverty/low incomes especially as greater percentage of the
population is agrarian. Low farm yields resulting from climate change or poor farming
techniques or lack/limited food storage facilities could also be a contributing factor. Also for a
community that is agriculture based, there is need for the household members to eat in large
quantities (high calorie intake) to be able to work longer hours in the farm. Having smaller sizes
of food would mean household members work less hours in the farm, justifying low farm
outputs and yields.

1.1.7 Incidences of beneficiaries eating fewer meals

The baseline survey also complemented the above findings by taking interest in the number of
times households consume food within the day for the past four weeks prior to the study. Figure
12 indicates that about 76% (135 respondents) of respondents said ‘YES’ to the option that they
had to eat fewer meals than they felt they needed because there was not enough food to eat.
Eating fewer meals which is sometimes not nutritive or does not meet the required dietary
requirements has negative implications in the cognitive development of young children as well
as PLWHA and hence increases the burden on the community and the society at large. These
findings could be attributed to the fact that respondents have limited knowledge on
home/kitchen gardens to supplement their food for home consumption or as a result of rising
food prices in the local markets.
 Beneficiary households eat fewer Frequency of households eating fewer
number of meals number of meals

100%

80%
14 80 41 41
Axis Title

60%

40%

20% Often (>10 Sometimes Rarely ( No

times in the (3 - 4 times once or Response
0% Past 4 in the past twice in the
Yes No weeks) 4 weeks) past 4
Series1 135 41 weeks)

Fig 12: Households eat fewer numbers of meals Fig 12.1: Frequency of households eating fewer meals

With regards to the frequency of eating fewer meals, figure 12.1 indicates that 14 of the
households have had to eat fewer meals >10 times and 80 households said they ate fewer meals
at least 3 - 4 times in the month before the survey. This high frequency could be as a result of
increasing food prices making it more difficult for households to purchase food given their low
income earnings. For PLWHA, the effect is worse because once people are infected with
HIV/AIDS they have to eat more often to meet the required extra energy and nutrient needs;
hence eating fewer meals threatens acceptable health standards.

1.1.8 Incidences of households not having food to eat

Visible in the communities as indicated by the baseline findings was that fact some households
do not have access to food of any kind. As illustrated in fig 13, 50% of the respondents indicated
that there were times when they had no food of any kind to eat within the household because of
lack of resources to get the food. This result put into perspective the tenet that the level of
hunger in the community is relatively high owing to factors related to increasing food prices,
falling farming yields as well as changing climate. One could further juxtapose this occurrence
based on the rural nature of the communities. In Cameroon for instance, it is easier for
households in urban and semi urban areas to access food of any kind from the markets than
their rural counterparts. This explains the reason we have incidences of some households not
having food to eat of any kind. These findings can be explored with the aid of figures 13 and 13.1
below.
 Incidence of beneficiary households
Frequency of households not having food
having no food of any kind to eat of any kind to eat
Yes No
4% Often (>10 times
in the Past 4
22% weeks)
50% Sometimes (3 - 4
50% 50%
24% times in the past
4 weeks)
Rarely ( once or
twice in the past
4 weeks)

Fig 13: Incidence of household having no food to eat Fig 13.1: Frequency of not having food of any kind to eat

As shown on figure 13.1, of the 50% of the households who indicated that they had no food to
eat (the “yes” option of fig 13), 4% of them noted that this happened >10 times and 22% said it
happened at least 3 - 4 times in the month prior to the survey. This indicates that of the 50%
who said “yes” to not having food of any kind to eat, 26% of them had severe impact of food
insecurity. This again could be linked to the factors mentioned above as well as the current
socio-political crisis plaguing the region forcing households to flee to food deficient areas.

1.1.9 Incidences of households sleeping hungry

Another scenario across communities in the Diocese of Kumbo is that of communities going to
bed hungry. Figure 14 shows the incidence of households sleeping hungry because there was
not enough food. As indicated, just 39% of the respondents noted they slept without food. This
relatively low result could be an indication that households have developed some coping
strategies to meet household food needs.

Incidence of households going Frequency of households going to

to sleep without food sleep without food

No Response 108
Yes 40
Rarely ( once or twice in the past 4…
39%
No Sometimes (3 - 4 times in the past 4… 25
61% 3
Often (>10 times in the Past 4 weeks)

Fig 14: Incidence of sleeping without food Fig 14.1: Frequency of going to sleep without food
Figure 14.1 shows the frequency with which respondents went to bed hungry. As shown, 25
respondents noted this happened to them at least 3 - 4 times. The result for frequency of
occurrence and incidence is an indication that food insecurity in the community is moderate but
the effects on the vulnerable population like women and girls, young people and people living
with HIV/AIDS has ripple effects on the community as a whole.

1.1.10 Incidences of beneficiaries unable to have food for the whole day
As indicated on figure 15, when respondents were asked if there was ever a time for the past
four weeks that they or any member of their household was unable to have food for the whole
day and night, 91% said this did not happen to them. This implies that respondents when in
difficult situations with regards to food insecurity, develop coping strategies to enable them
have at least a meal a day. This result further justifies the low frequency of households going to
bed hungry as presented on figure 15.1.

Incidence of households going for a Frequency of households going for a day and night
day and night without food without food

Yes No
100%
Axis Title

80%
9% 60%
40%
20%
0%
91% Often Sometim Rarely ( No
(>10 es (3 - 4 once or Response
times in times in twice in
the Past the past the past
4 weeks) 4 weeks) 4 weeks)
Series1 1 8 7 160

Fig 15: Incidence of going for a day & night without food Fig 15.1: Frequency of going for a day & night without food

Figure 15.1 represents the frequency with which respondents or any member of their
household went for a day and night without food. As indicated, the frequency of any member of
the household going for a day and night without food is relatively low. This is an indication that
households have knowledge on food security and nutrition and are able to develop mitigating
strategies.
1.2 Critical areas of observations
Based on the results presented above, the following observations can be made;

i. Demographically, the population is an ageing one and is female headed with relatively
large household sizes. The level of educational attainment in the community is low and
majority of the households depend on agriculture for livelihoods;
ii. The low level of educational attainment in the community could be related to the fact
that young people are pulled out of school to provide extra labour in the farms to meet
the growing need for food;
iii. Another pertinent observation is that, the level of food insecurity in the community is
relatively moderate. This could be justified by the nearness of the community to social
services and information relating to food security and nutrition;
iv. It apparent that households have developed different coping strategies hence the rate at
which a member of any household would go to bed hungry or would stay for the whole
day and night without food is relatively low;
v. The current socio-political crisis that has affected the region for close to two years could
be a major contributing factor to the rising food prices and hence food stress in the
communities;
vi. There are cultural believes surrounding eating certain kinds of food, hence could limit
efforts to promote food diversity in the communities;
vii. Respondents were predominantly Catholics which is a reflection to the final structure of
the DFLO beneficiary groupings since this study embarked on data collection through the
previous beneficiary groups.

1.2 Key Recommendations

Considering the above analysis and the critical domains of observation, the following key
recommendations can be outlined:

 There is need to intensify initiatives that help keep the younger folks in the communities.
This can help scale down on the level of HIV/AIDS as most cases are as a result of out-
migration to neighboring towns/cities in search of greener pastures;
 The economic activities of the communities should be diversified as up to 68.75% of the
population are involved in agriculture;
 The level of scholarization in the communities need to be improved as there is a direct
relationship between the level of education and the probability to contract HIV/AIDS;
 Uncontrolled birth rate seems to be on the increase in the communities as depicted by
the increasing nature of household sizes. Thus, DFLO as part of their intervention should
help prevent the rampant spread of HIV; prioritize sex and reproductive health
education among community members;
 The scope of beneficiary households should be increased to ensure a fair balance across
denomination. Currently, above 80% of the beneficiaries are catholic Christians. This
could look simple but meaningful for future funding opportunities as the principles of
inclusion and diversity could be a marginal criteria for future funding;
 Also DFLO should have as criteria the household size. Household with higher no of
people should be highly considered as household size increases or decreases the degree
of vulnerability;
 Food anxiety scenarios especially among BTAs should be greatly minimize. The trauma
of being infected is enough and any further addition of psychological stress related to
food will only heighten the chances of experiencing lower life expectancy amongst these
target beneficiaries;
 All beneficiaries should increase their access to multiple food varieties. This should be
stressed during the training on vegetable gardening. This should also mean DFLO
engages in intensive sensitization and awareness raising on the need for households to
access nutritionally rich food items. This could help limit the case of PLWHA having
attacks from opportunistic diseases;
 Food rationing in the communities could be improved by sensitizing the communities on
post-harvest management as well as the need to diversify sources of food items round
the year;
 Incidence of household members especially among BTAs not having food to eat of any
kind should be eradicated. This is not permissible as it does not support the effectiveness
and efficiency of ARDs;
 Build and improve the capacity of households on resilience mechanisms or coping
strategies to improve livelihoods and food security. Home gardens could be used as a
resilience tool, “one house one garden”. This will promote food diversity among
 households and enable them earn extra revenue from the sale of the extra garden
produce;
 Non-farm activities should be encouraged and promoted. Vocational training like hair
dressing, carpentry, and fashion design among others could be encouraged such that
households can earn extra revenue to cater for other needs of the family;
 Encourage and promote nutrition education especially among women and caregivers.
This could be done in churches, schools, market squares and other social gathering.
Community knowledge on food security and nutrition will improve health and wellbeing
especially among the vulnerable population.
 II. KEY FINDINGS IN DONGA MANTUNG
2.1 Perspectives on food security across beneficiaries in Donga Mantung
Though the communities in this segment of the Diocese of Kumbo are primarily agrarian, the
level of food insecurity is higher when compared to Bui division. This could be related to rising
food prices, falling agricultural yields, changing patterns of climate among other factors. Higher
food insecurity in this community could also be related to the fact that the community is
relatively remote compared to Bui division making it difficult for households to access
information on food security and nutrition as well as alternative sources of livelihoods. The
results presented below give an impression of the realities in the communities in Donga
Mantung division.

2.1.2 Demographic data on respondents

In Donga Mantung, 148 respondents were surveyed. Similarly to the results from Bui division,
Donga Mantung is also a female dominated community as indicated in the figure 16 with 102 of
the interviewed respondents being female.

Gender structure of respondents

120
100
80
60
40
20
0
Male Female
Series1 46 102

Fig 7: Gender structure of respondents in Donga Mantung

With regards to the age structure of the population (figure 17), contrary to the results from Bui
with just 13% of the population in the age bracket of 32 and 42 years old, in this study area,
25% of the respondents are relatively vibrant and youthful. This could imply that the
communities in Donga Mantung Division are experiencing out-migration as is the case with Bui
Division but on a comparatively lower scale.
 Age structure of respondents

5%
10% 7% ≤ 20
20% 21 - 31
25%
32 - 42
43 - 53
33%
54 - 64
≥ 65

Fig 17: Age structure of respondents in Donga Mantung

The educational status of the respondents was also considered. As indicated on figure 18, of the
respondents who took part in this survey, 87 of them indicated they had just primary education,
with 25 showing evidence of some secondary level of education and 35 of them having no
formal education. This data could indicate that though a youthful population, the level of
educational attainment in the community is relatively low compared to Bui. This could be due
the fact that a majority of the community households depend on rudimentary agriculture for
livelihood and hence earn less income to support education of the children. It could also be
linked to the fact that there are inadequate educational infrastructures to accommodate young
people of school going age or the probability that the households have less value for education
or are unaware of the importance of education. As indicated above, there is a higher tendency
for educated households to be food secure and also to adopt preventive methods to HIV/AIDS.

Educational Level of respondents

87

25 35
1
Primary Secondary University No
Level Level Level Education

Fig 18: Educational Level of respondents in Donga Mantung

The educational status of the communities in Donga Mantung is also sharply demonstrated by
the prevailing occupational structure. In terms of occupation, figure 19 indicates that a majority
of the respondents depend on agriculture for livelihood with just 7 respondents indicating some
form of vocational skill. The main issue as revealed by field findings are not only that they
household engage in agricultural activities but the problem of practicing poor and unproductive
farming methods. Since the main economic activity in the community is agriculture and mostly
carried out by women because the community is female dominated, there is huge need to build
on existing agricultural efforts; going beyond production for home consumption to commercial
purposes. Just like in Bui, there is need to diversify economic activities in the community, such
that more revenue can be earned to meet growing household needs with access to food in the
required quality and quantity inclusive.

Occupational status of respondents

140
120
100
80
60
40
20
0
Farmer Tailor/Se Retailer Student Teacher
mstress
Series1 124 6 1 10 7

Fig 8: Occupational status of respondents in Donga Mantung

The study also considered the aspect of household sizes in the community as food security and
household size is undeniably related. In Donga Mantung, as indicated on figure 20, the average
household size is between four (4) to six (6) people. Compared to Bui division, Donga Mantung
has smaller household sizes; however this together with low incomes from agricultural
practices has a negative relationship with the educational attainment of the community as well
as the overall standard of living in the community. These results will also mean that the burden
of taking care of this relatively large household size rest on the woman who lead households.
More so, dealing with a very vulnerable population in terms of HIV/AIDs, these relatively
household sizes in already affected communities is a cause for concern.
 Household sizes Religious background of respondents

1-3 150
14% 22% People 100
26% 4-6 50
People
38% 0
7-9 Catholic Other Muslims
People denomi
nations
Series1 122 19 7

Fig 20: Household sizes in Donga Mantung Fig 21: Religious background of respondents in Donga

As presented on figure 21, a majority of the respondents in the study area were Catholics (122)
with a limited number of beneficiaries from other denominations, with limited cases of other
denominations included.

2.1.3 Food anxiety among beneficiaries

Food anxiety is usually central to any study that has to do with the livelihood situation of
household members. For the case of the DFLO program in the Diocese of Kumbo, the baseline
survey conducted within the framework of the DFLO funded program for the prevention, care
and support of PLWHA and the affected populations documented the household perspectives on
food anxiety and the frequency of occurrence in Donga Mantung as on the figures below.

Food anxiety among Frequency of food anxiety

beneficiaries
60
50
No 40
26% 30
20
Yes 10
0
74% Often Sometim Rarely ( No
(>10 es (3 - 4 once or Response
times in times in twice in
the Past 4 the past 4 the past 4
weeks) weeks) weeks)
Series1 31 51 28 38

Fig 22: Incidence of food anxiety Fig 22.1: Frequency of food anxiety among beneficiaries
In the study area, participants were asked about their food anxiety levels in the month before
the survey. As shown on figure 22, 74% of the respondents indicated that they were worried
that their household would not have enough food to eat. Though still high, this result is 7 points
lower than the occurrence in Bui division. This high level of food anxiety has a direct
relationship with the mental/psychological state of beneficiaries especially PLWHA, hence
further deteriorating their health. Increased food anxiety could be related to the fact that
beneficiaries lack other sources of food except food gotten from their farms or lack resources to
purchase food. Taking stock of the frequency of the incidence of food anxiety in Donga Mantung
Division, 74% of the beneficiaries who indicated food anxiety, fifty one (51) of them noted that
this happened at least 3 - 4 times and 31 indicated that it happened >10 times in the month
before the survey. This high frequency could be related to the fact that it was the planting
season and hence household preferred to plant their last seeds instead of consuming.

2.1.4 Incidences of beneficiaries not eating preferred food

The lack of resource is a major contributor to beneficiaries or any member of their households’
inability to eat their preferred food. Figure 23 has a negative relationship with the occupational
level of the community. Generally, smallholder farmers bring very little revenue from their
farms and therefore, are limited with regards to eating preferred food. Also, the relatively large
family sizes make it difficult to adequately feed the households with their preferred food. This
would mean that households are more concerned about what they can have as food regardless
of quality or preference.

Inability to eat preferred food among Frequency of inability to eat preferred food
beneficiaries Often (>10 times
in the Past 4
13% weeks)
13% 24%
Yes 15% Sometimes (3 - 4
times in the past 4
87% No weeks)
48%
Rarely ( once or
twice in the past 4
weeks)

Fig 23: Inability to eat preferred food Fig 23.1: Frequency of inability to eat preferred food

Of this 87% who noted their inability to eat their preferred food due to lack of resources, 24% of
them indicated that this happened more than ten times and 48% of them indicated that it
happened at least 3 to 4 times in the month before the survey, (see fig 23.1). This result indicates
that beneficiaries eat food not because of preference but because they have no choice or are
limited by resources. This implies, if beneficiary’s resources increase, there is a probability they
would eat their preferred food.

2.1.5 Incidences of beneficiaries accessing limited food variety

Having access to food is just one part of the food security story and accessing a variety of food
stocks is another. We expect households to be able to diversify their food items but this has not
been the case as in fig 24 below.

Access to limited food variety among Frequency of access to limited food variety
beneficiaries

150
71
100 40
22 17

50 Often (>10 Sometimes Rarely ( No

times in the (3 - 4 times once or Response
0 Past 4 in the past twice in the
Yes No weeks) 4 weeks) past 4
Series1 131 17 weeks)

Fig 24: Access to limited food variety Fig 24.1: Frequency of access to limited food variety

If beneficiaries do not have preference over the food they eat, it implies they are limited in
variety. Figure 24 shows that, 89% of beneficiaries had limited access to food variety in the
period prior to the survey. For PLWHA and children, eating a variety of food can strengthen
their immune system and therefore improve on the overall wellbeing. Beneficiaries not able or
limited in variety of food are more susceptible to deficiencies in micro and macro nutrients.
Also, for a female dominated community, with majority of the women in child bearing age, the
variety of food they eat translates to the health of the baby they will bear. Of these 131
respondents who indicated limited access to variety of food, figure 24.1 indicates that 40 of the
respondents have not accessed a variety of food items for above 10 times within the past 30
days while 71 highlighted their inability to access food variety between 3 – 4 times for the past
thirty days prior to the baseline survey.
2.1.6 Incidences of beneficiaries eating socially undesirable food
Among community members, there are certain categories of food items that are regarded as
socially undesirable. By socially undesirable food, we imply food abandoned in market squares
or food items that would not normally be consumed in the community except in worst
situations. As indicated on figure 25, 123 of the respondents accepted that they have had to eat
food they consider socially or personally undesirable. The number of people who eat socially
undesirable food in this study area is 4 points higher than in Bui. This result indicates that
households in Donga Mantung experience more food related diseases than their counterparts in
Bui Division.

Eating socially undesirable food Frequency of eating socially undesirable

food
Often (>10 times in
the Past 4 weeks)

Sometimes (3 - 4
25 17% 22%
No times in the past 4
22% weeks)
39% Rarely ( once or
twice in the past 4
weeks)
Ye 123 No Response
s

Fig 25: Eating socially undesirable food Fig 25.1: Frequency of eating socially undesirable food

As shown in figure 25.1, the frequency at which beneficiaries ate socially undesirable food in the
month before the survey was high. Of the 123 beneficiaries who indicated that they ate socially
undesirable food, 39% of them noted that this happened at least 3 to 4 times while 22%
indicated that it happened at least ten times. For people living with HIV/AIDS, poor nutritional
intake not only weakens the effectiveness of the anti-retroviral drugs (ARDs) taken but could
weaken the entire immune system hence patient is prone to secondary infections and or
opportunistic diseases.

2.1.7 Incidences of households eating smaller sizes of meals

Eating smaller meal size is a common practice across communities and their households as a
way to cope with rising food insecurity in the North West Region, especially in the rural
communities. As indicated on figure 26, 88% of the respondents revealed that they or one
member of their households have had to eat smaller sizes of meals because there was not
enough food. This indicates that households in time of scarcity have to ration their feeding to
make sure that at least every member of the household has food to eat. Compared to results
from Bui, Donga Mantung is 7 points higher with regards to the number of households who eat
smaller sizes of meals.

Households eat smaller Frequency of households eating smaller

sizes of meals meal sizes

12%
58
44
Yes
28 18
88% No Often (>10 Sometimes Rarely ( No
times in the (3 - 4 times once or Response
Past 4 in the past twice in the
weeks) 4 weeks) past 4
weeks)

Fig 26: Households eat smaller meal sizes Fig 26.1: Frequency of households eating smaller meal sizes

With regards to frequency of occurrence, 58 of the respondents indicated that this happened to
them at least 3 to 4 times in the month before the survey and 44 of the respondents said that
this incidence happened to them more than ten times (See fig 26.1). This result indicates that
the level of hunger among households is relatively high when compared to Bui Division.

2.1.8 Incidences of beneficiaries eating fewer meals

By fewer meals we are referring to a member of the household eating less than the standard
three square meals because there was not enough food. Figure 27 indicates that 134 of the
respondents said at least one member of their household had fewer meals in the month before
the survey. This result could be attributed to the fact that respondents do not have
home/kitchen gardens to supplement their food or as a result of rising food prices in the local
markets. Gripped with all of these food challenges, households resort to reducing the number of
times they eat in the day as a coping mechanism.
 Incidences of households eating Frequency of households eating fewer number
fewer number of meals of meals

Often (>10 times

in the Past 4
weeks)
9% 25%
20% Sometimes (3 - 4
times in the past 4
134 weeks)
46%
Rarely ( once or
twice in the past 4
14 weeks)
No Response
Yes No

Fig 27: Incidence of households eating fewer meals Fig 27.1: Frequency of households eating fewer meals

As an indication of frequency of this occurring, figure 27.1 shows that of the 134 respondents
who agreed to the fact they have had fewer meals, 25% of them noted that this happened >10
times while 46% of them noted it happened to them or to at least one member of their
household at least 3 - 4 times. This relatively high frequency of occurrence again implies that
households within the community do a lot of food rationing to meet up with the food needs.
Given that the population is youthful, this result could imply that elderly people have to sacrifice
their food for the younger folks.

2.1.9 Incidences of households not having food of any kind to eat

This indicator is very critical to the overall food and nutrition intake in the community.
Compared to 50% in Bui division, 91% of respondents in this study area indicated they or other
members of their household had no food of any kind within certain periods of the month prior
to the survey (fig 28). This result is an indication of alarming rates of hunger within the
community under study. The findings also reveal therefore the limited or no knowledge on
coping strategies to mitigate the impact of food insecurity. Figure 9 thus brings to the fore the
frequency of households having no food to eat in Donga Mantung for the past 30 days of the
month prior to the baseline survey.
 Incidences of households having no food to eat Frequency of households having no
food to eat
No
9%

67
38 29
Yes 14
91% Often (>10 Sometimes Rarely ( No
times in the (3 - 4 times once or Response
Past 4 in the past 4 twice in the
weeks) weeks) past 4
weeks)

Fig 28: Households have no food of any kind to eat Fig 28.1: Frequency of households having no food of any kind to eat

As indicated on figure 28.1, of the 91% of respondents who indicated not having food of any
kind to eat, 38 of them said this happened more than 10 times while 67 of them indicated it
happened at least 3 - 4 times within the same time frame. This high prevalence of having no
food to eat could be linked to the fact that Donga Mantung is a remote area and access to
resources to purchase food is limited. It could also be due that fact that it has been the most hit
by the current socio-political crisis in the region forcing households to flee to nearby
communities.

2.1.10 Incidences of households sleeping hungry

Across the North West Region of Cameroon, especially in the rural areas, sleeping hungry is not
so much of a crime but a critical indicator of food insufficiency. This scenario, though common,
turn to vary from one community to another. Figure 29 indicates the number of households
who sleep hungry because there was not enough food to eat. As indicated, 82 respondents noted
that they have had to sleep hungry because there was not enough food. This situation is worse
when compared to the same scenario in the Bui division with only about 39% of the
respondents experiencing this adverse situation of food insecurity. This could be explained by
the fact respondents in this study area lack coping strategies to enable them meet up with the
growing demand for food.

Based on the findings, the incidence of households sleeping hungry is evident in the
communities. This will also mean a net reduction in the number of meals a household member
is required to access as well as the possibility of regular rationing of meals by reducing the sizes
of the meals.
 Incidence of households sleeping Frequency of households sleeping
hungry hungry
Often (>10
11% times in the
Past 4 weeks)
45% Sometimes (3 -
82 23%
66 4 times in the
21% past 4 weeks)
Rarely ( once or
Yes No twice in the
past 4 weeks)

Fig 29: Incidence of households sleeping hungry Fig 29.1: Frequency of households sleeping hungry

To enable us measure the frequency of households sleeping without food, figure 29.1 gives a
clear representation of the results. Of the 82 respondents who showed positive to sleeping
hungry, 23% of them noted it happened at least 3 - 4 times with the past four weeks prior to the
survey while 11% indicated that it happened >10 times.

2.1.11 Incidences of beneficiaries unable to have food for the whole day
Compared to the results in Bui Division showing only 9% of the total respondents unable to
have food for the whole day and night, results from Donga Mantung indicate that 31% (fig 30) of
the respondents went for the whole day without food. This data shows that the level of hunger
and food insecurity in Donga Mantung is alarming. This could be as a result of poor knowledge
on different coping mechanisms during periods of food stress. It could also be as a result of poor
farm yields and rising food prices which prevent households from purchasing food.

Incidences of households without food for Frequency of households without food for the whole
day
the whole day

Often (>10 times

7%
10% in the Past 4
31%
weeks)
14% Sometimes (3 - 4
Yes
69% 69% times in the past
No 4 weeks)
Rarely ( once or
twice in the past
4 weeks)

Fig 30: Households without food for the whole day Fig 30.1: Frequency of households without food for the whole day
With regards to the frequency of this incidence occurring (fig 30.1), of the 31% who indicated
that they had no food of any kind for the whole day, 7% of them said it happened >10 times in
the month before the survey; 10% said it happened at least 3 - 4 times while 14% said it
happened once or twice. Generally, educated populations are more likely to adopt coping
strategies, however in Donga Mantung, the level of literacy/educational attainment is low
compared to Bui Division. This low literacy rate could be linked to this high rates of food
insecurity in the Division.

2.2 Critical areas of observations

Based on the results presented for Donga Mantung Division, the following observations can be
outlined:

- The demographics from the study area show a relatively youthful population compared
to Bui division, though with lower educational attainment especially among the female
folks;
- Donga Mantung is predominantly agrarian with relatively smaller household sizes when
compared to Bui division. Non-farm activities are almost absent in the study area;
- The area is also noted for the small nature of family sizes as compared to Bui Division;
- Due to the remoteness of the division, the population is limited with regards to access to
social services and information related to food security, the community is almost
completely ignorant on coping strategies. This has greatly worsened household food
security concerns.
- Based on severity, food insecurity in Donga Mantung is more severe than in Bui division.
The number and frequency of households who go for a day without food, eating socially
undesirable food and fewer meals per day is far greater in this region than in Bui.
- Cultural believes surrounding eating certain kind of food is also a limiting factor to food
security in the community;

2.3 Key recommendations

The analyses of the results from Bui and Donga Mantung division are similar but for the fact the
impact of food security in Donga Mantung is severe compared to Bui. Based on the severity of
the impact, the following recommendations can be made:
- The level of scholarization in the communities need to be improved as there is a direct
relationship between the level of education and the probability to contract HIV/AIDS;
- The economic activities of the communities should be diversified as more of the
population is involved in agriculture;
- DFLO could prioritize activities that can help keep the mobility of youth stable or
reduced. This is because the smaller family sizes is not as a result of low birth rate but
due to rampant out migration to neighboring cities and towns. This can also help scale
down on the level of HIV/AIDS as most cases are as a result of out-migration to
neighboring towns/cities in search of greener pastures;
- The scope of beneficiary households should ensure a fair balance across denomination.
Currently, above 80% of the beneficiaries are catholic Christians. This could look simple
but meaningful for future funding opportunities as the principles of inclusion and
diversity could be a marginal criteria for future funding;
- Also DFLO should have as criteria the household size. Household with higher no of
people should be highly considered as household size increases or decreases the degree
of vulnerability;
- Food anxiety scenarios especially among BTAs should be greatly minimize. The trauma
of being infected is enough and any further addition of psychological stress related to
food will only heighten the chances of experiencing lower life expectancy amongst these
target beneficiaries;
- All beneficiaries should increase their access to multiple food varieties. This should be
stressed during the training on vegetable gardening. This should also mean DFLO
engages in intensive sensitization and awareness raising on the need for households to
access nutritionally rich food items. This could help limit the case of PLWHA having
attacks from opportunistic diseases;
- Incidence of household members especially among BTAs not having food to eat of any
kind should be eradicated. This is not permissible as it does not support the effectiveness
and efficiency of ARDs;
- Build and improve the capacity of households on resilience mechanisms or coping
strategies to improve livelihoods and food security. Home gardens could be used as a
resilience tool, “one house one garden”. This will promote food diversity among
 households and enable them earn extra revenue from the sale of the extra garden
produce;
 Non-farm activities should be encouraged and promoted. Vocational training like hair
dressing, carpentry, and fashion design among others could be encouraged such that
households can earn extra revenue to cater for other needs of the family;
 Encourage and promote nutrition education especially among women and caregivers.
This could be done in churches, schools, market squares and other social gathering.
Community knowledge on food security and nutrition will improve health and wellbeing
especially among the vulnerable population.
 3. Coping strategies among beneficiaries
In the face of food insecurity across the different communities involved in the baseline survey,
the study took interest to document the various coping strategies used by households to secure
food. The table below shows the coping strategies used by households in the Diocese of Kumbo:
Table 3: Overview of coping strategies used by all DFLO beneficiaries to access food
Response option Never Seldom (1-2 Sometimes (2-3 Often (4-6 Daily
days a week) days a week) days a week)
Rely on casual labor for food 0% 5% 14% 80% 1%
Send children out to work 2% 20% 60% 18% 0%
Buy/borrow food on credit 0% 0% 15% 80% 5%
Rely on less expensive/less 0% 0% 2% 80% 18%
preferred food
Send children to eat elsewhere 53% 25% 15% 5% 2%
Go a whole day without food 82% 11% 6% 2% 0%
Reduce portion sizes of food 0% 0% 0% 0% 100%
Reduce frequency of meals per 0% 0% 0% 0% 100%
day
Borrow food from relative or 0% 40% 55% 5% 0%
friend
Send household members to eat 80% 10% 8% 1% 1%
elsewhere
Harvest immature crops (e.g. 1% 30% 60% 8% 1%
green not-fully mature maize)?
Consume seed stock held for next 5% 40% 49% 4% 1%
season
Sell livestock to get money 0% 10% 65% 20% 5%
Steal crops from another 80% 18% 2% 0% 0%
person’s farm
Collect leftovers from markets 10% 55% 25% 10% 0%
and farms
Go to eat in festive places 0% 80% 14% 6% 0%

3.1. Break-Through Association

Based on the occurrence and frequency of occurrence questions on household food insecurity
access scale, the baseline study further recorded the different coping strategies that are unique
to people living with HIV/AIDS, otherwise referred to as Break-Through Association. The
findings revealed the following coping strategies:
Table 4: Coping strategies among BTAs
- Rely on less expensive/less preferred
food;
- Reduce frequency of meals per day;
- Rely on casual labor for food;
- Buy/borrow food on credit;
- Reduce portion sizes of food;
- Steal crops from another person’s farm;
- Send children out to work;
- Borrow food from relatives/friends;
- Harvest immature crops;
- Send household members to beg;
- Consume seed stock held for next
season;
- Sell live stock to get money;
- Go a whole day without and
- Send children to eat elsewhere.

An in-depth study further categorized these coping strategies based on the degree of utility as
on the table below:
Table 4.1: Categorized coping strategy among BTAs
Highly used Moderately used Minimally used
- Reduced portion sizes - Send children out - Sell livestock to get money
of food to work; - Go a whole day without
- Reduced frequency of - Buy/borrow food food
meals per day on credit - Send children off to eat
- Rely on less elsewhere
expensive/less - Harvest immature crops
preferred food - Borrow food from relatives
- Rely on casual labor for and friends
food - Consume seed stocks held
for next season

With reference to the table above, it can be deduced that the coping strategies highly used by
BTA members is not medically recommendable as one would expect them to have enough food,
more often and of high quality in order to compliment the use of anti-retroviral drugs. Also,
their physiognomy and or health status do not warrant them to be engaging in any form of hard
labor as a means of accessing food. Their moderate use of other strategies like sending children
out to work and buying food on credit is evident of their low income level and also heightened
vulnerability to poverty related challenges. The minimally used strategies are explained by the
fact that some of them carry in themselves a high degree of stigma like sending children to eat
elsewhere. In all, the socio-economic needs of these categories of beneficiaries require close
attention within the framework of the DFLO program.
 3.2. Caregivers
Based on the occurrence and frequency of occurrence questions during the baseline study, the
findings revealed very unique responses with reagrds coping strategies among caregivers
within the DFLO target beneficiary communities. Some of these coping strategies include:
Table 5: Coping strategies among Caregivers
 Rely on less expensive/less preferred  Buy/borrow food on credit
food  Reduce portion sizes of food
 Reduce frequency of meals per day  Send children out to work
 Rely on casual labour for food  Harvest immature crop

The findings were further categorized to showcase which of the coping strategies are highly
used or moderately used or minimally used as on table 5 below.
Table 5.1: Categorized coping strategy among CGAs
Highly used strategy Moderately used strategy Minimally used strategy
 Rely on less  Buy/borrow food on  Send children out to
expensive/less credit work
preferred food  Harvest immature
 Rely on casual labour crops
for food
 Reduce frequency of
meals per day
 Reduce portion sizes
of food

Further analysis of the findings indicates that the highly used strategies by caregivers are those
that can result in acute malnutrition (eating less preferred food) and expense of calories (casual
labor for food). It is evident that all the strategies used by this category of beneficiaries are
sustainable solutions to household food insecurity.

3.3. Youth-For-Life
The situation of youth in the target communities is not different in terms of coping strategies to
food insecurity. On the incidence and frequency of occurrence of food insecurity among Youths
for Life, the baseline studies revealed that they adopted different copying strategies like:
Table 6: Coping strategies among YFL members
- Rely on less expensive/less preferred
food;
- Reduce frequency of meals per day;
- Rely on casual labor for food;
- Buy/borrow food on credit;
- Reduce portion sixes of food;
- Steal crops from another person’s farm;
- Borrow food from relative/friend;
- Harvest immature crops;
- Send household member to beg;
- Consume seed stock held for next
season;
- Sell livestock for money;
- Go a whole day without food;
- Go eat in festive places and
- Collect leftovers from markets or farms.

A further classification revealed that some strategies were used more than others. Table 6.1
summaries the degree of use of the different coping strategies.
Table 6.1: Categorized coping strategy among YFL
Highly used Moderately used Minimally used
- Reduced frequency of - Buy/borrow food - Go eat in festive places
meals per day on credit - Go a whole day without
- Sell livestock to get - Harvest immature food
money crops - Send household members
- Rely on less - Consume seed to beg
expensive/less stock held for next - Steal crops from another
preferred food season person’s farm
- Reduced portion sizes - Collect leftovers from
of food markets or farms

Apart from routinely reducing the portion sizes of food and the frequency of meals per day as is
the case with other target beneficiaries, the YFL members also highlighted that they sell
livestock to get money for food and engage in socially unaccepted practices like going to eat in
festive places, stealing crops from another person’s farm as well as collecting leftovers from the
markets and or farms as a coping strategy.

Though the coping strategy of selling livestock to get money for food is rather practice by the
YFL members, according to the DFLO program, this strategy is highly plausible to the other
target beneficiaries with regards to the pass-on-the-gift component of the program. This
indicates that when the gifts are handed, it will serve as a source of income for them. It also
means that YFLs have an understanding of how to run a business. Also, reducing the frequency
of meals as coping strategy for YFL would indicate that their calorie/energy intake is low. This
low energy level has an effect on their productivity in the farms as well as their business as they
will turn to work lesser hours in the farm thus reducing yields.

3.4. Community-Based Organizations

Community Based Organizations (CBOs) exhibited a wide variety of coping strategies that span
across those already highlighted by other target beneficiaries. Reflecting on the occurrence and
frequency of occurrence questions on food insecurity, the following coping strategies were
recorded among CBO members in all the study areas:
Table 7: Coping Strategies among CBOs
 Rely on less expensive/less preferred  Borrow food from relative/friend
food  Harvest immature crops
 Reduce frequency of meals per day  Send household members to beg
 Rely on casual labour for food  Consume seed stock held for next
 Buy/borrow food on credit season
 Reduce portion sizes of food  Sell livestock to get money
 Steal crops from another person’s  Go a whole day without food
farm
 Send children out to work

A closer observation of the responses further provided the team the opportunity to categorize
the results as per the frequency of use for a particular strategy as on table 7 below.
Table 7.1: Categorized coping strategy among CBOs
Highly used strategy Moderately used strategy Minimally used strategy
 Reduce frequency  Buy/borrow food on  Go a whole day
of meals per day credit without food
 Rely on casual  Borrow food from
labour for food relative/friend
 Reduce portion  Send household
sizes of food members to beg
 Consume seed stock
held for next season
 Sell livestock to get
money
 Send children out to
work
Though the table above is indifferent from others in terms of the categorized coping strategies,
it is hoped that the DFLO intervention package for CBOs will cause a reversal consistent practice
of reducing the frequency of meals per day, relying on casual labor for food and reducing
portion sizes of food.

3.5. Single Parents

Single parents are very central to the existence of the DFLO program. The baseline study also
involved this category of beneficiaries and documented the occurrence and frequency of
occurrence of food insecurity. The following coping strategies were identified among the single
parents:

Table 8: Coping strategies among Single Parents

- Rely of less expensive/ less preferred
food;
- Reduce frequency of meals per day;
- Rely on casual labor for food;
- Buy/borrow food on credit;
- Reduce portion sizes of food;
- Steal crops from another person’s
farm;
- Send children out to work;
- Borrow food from relative/friend;
- Harvest immature crops;
- Send household members to beg;
- Consume seed stock held for next
season;
- Sell livestock to get money;
- Go a whole day without food;
- Send children to eat elsewhere;
- Go eat at festive places and
- Collect leftovers from market or
farms.

An in-depth analysis further discloses that some coping strategies where used more than others.
The table below gives a breakdown of the degree of usage of the different coping strategies
among single parents.

Table 8.1: Categorized coping strategy among SPGs

Highly used Moderately used Minimally used
- Reduced frequency of - Borrow food from - Go a whole day
meals per day relative/friend without food
- Rely on less - Consume seed stock - Send children to eat
expensive/less held for next season elsewhere
preferred food - Sell livestock to get - Collect leftovers from
- Reduced portion money markets or farms
sizes of food - Send children out to
- Rely on less casual work
labor - Harvest immature
crops
Also visible among the single parents are strategies that are highly used to cope with the
increasing scenarios of food insecurities. Reducing meal sizes, reducing the frequency of meals
per day, relying on less preferred food and casual labor are among the most common coping
strategies used by single parents. At a minimal scale, very few of the single parents agreed that
they can either send children to go eat elsewhere, engage in involuntary fasting or visit markets
or farms to collect leftovers in order to sustain the family.

The adoption of the highly used coping strategies among SPGs has a negative effect on their
health, their children as well as on the cognitive development of these children. For children
below the age of 5 years, eating a variety of meals regularly helps the child’s brain to develop. In
the absence of this, there is high tendency for some aspects of development to be impaired. Also
children who feed well are more likely to stay in school than children who do not feed well,
reducing portions of food or reducing the frequency of meals as coping strategy indicates that
children from single parents are prone to staying away from school because of hunger. Though
a moderately used coping strategy, sending children off to work implies they will have to miss
out on school. For the DFLO program which aims to support vulnerable children in primary
schools and colleges, these could be detrimental for the success of the program.

Critical areas of observation

The above analysis of coping strategies among the different categories of DFLO beneficiaries has
the following critical observations:
1. The beneficiaries often rely on casual labor for food, borrow/buy food on credit and rely
on less expensive/less preferred food;
2. All the beneficiaries agree to have consistently reduced meal sizes and the frequency of
food as a means to cope with food insecurity;
3. The beneficiaries sometimes send children to work, borrow food from relatives,/friends,
harvest immature crops, consume seed stock and sell livestock to get food money;
4. Beneficiaries rarely collect leftovers from markets/farms as well as go to eat in festive
places as a coping strategy;
5. Most beneficiaries see sending children/household members to eat elsewhere, going the
whole day without food and stealing crops from another person’s farm as the least
strategy to cope with food insecurity. This is culturally and socially unacceptable but as
respondents put it, these strategies are used as the last option.
Key recommendations
Based on the above critical domains of observations, the following recommendations can be
advanced:
1. Improve on the level of food access by beneficiaries through the establishment and
expansion of gardens;
2. Fully equip beneficiary groups with the help of pass-on-the-gift initiative to allow
beneficiary households to increase income levels;
3. Sensitize beneficiaries on the need to rather increase the frequency of food per day but in
a diversified manner with the help of garden crops;
4. All beneficiary groups for the DFLO pass-on-the-gift should be made to understand the
chain effect of the initiative and the DFLO team should ensure that by the end of the
program, the impact on first and second level beneficiaries should be visible;
5. To ensure effectiveness in the pass-on-the-gift initiative, all beneficiaries should show
proof of readiness through the construction of fences for piglets and commitment to
ensure the security and wellbeing of goats.
 4. Community potentials
The survey team navigated along with the key informants to gain an insight into some of the
outstanding potentials in the respective communities that could be leveraged to scale up the
success level of the DFLO program. Key interest was on the necessary infrastructures and
facilities within the target communities.

4.1. Vocational training centres

Technical Vocational Education and Training (TVET) is central to the sustainability of the DFLO
with regards to the orphans and vulnerable children. This component is critical as
considerations are to be given to programs that are market responsive and also based on
available training centre in and around the target communities where these OVCs are found.
After a critical diagnosis conducted by the study team, findings revealed different categories of
technical and vocational training centres as follows:
- Technical workshops promoted individuals in various communities;
- Authorized Technical Vocational Education and Training Centres. These categories are
promoted by the government, private bodies and the mission.

The analysis of these TVET facilities shows that a majority of the training centres are in the form
of small scale workshops, promoted by individuals. The study further documented the
characteristics of the privately owned technical workshops as follows:
- Training units are not authorized;
- In most instances, the units have only 01 trainer;
- The training content is not diversified to touch other areas of capacity development like
leadership, management and entrepreneurship;
- The training programs lack theoretical backing;
- Trainees most often remain localized both in skills acquired and in productivity;
- The maximum number of trainees in these centres is five (05);
- There are no formal entry requirements for the programs.

Some of these training centres are extremely important as they are located in areas where the
big and much enriched training centres promoted by the government, private and mission
bodies cannot operate. Thus, despite their limitations, they fill gaps in very remote localities
that no one else can despise. The figures below show some of the workshop facilities in the
remote areas of the Diocese of Kumbo.

Shoe mending workshop in Tabenkan Carpentry workshop in Misaje

Painting workshop in Nkar

Despite the under developed nature of these vocational training centres, there also exist some
standard and well equipped vocational training centres within the Diocese of Kumbo. Notably
among them are: St. Francis Home for Skill Training and the Vocational Centre for International
Development.
a. St Francis Home for Skill Training
This training centre is authorized by the Ministry of Employment and Vocational Training,
reference number 185/MINFOP/SG/DFOP/SDGSF/CSACD of 9th April 2014. This centre offers
the following programs:
- Carpentry
- Sewing
 - Motor cycle repairs
- Shoe manufacturing and mending
- Knitting
- Arc welding
The figures below show the sectional views of the training centre

Sectional View of the administrative Block

Carpentry workshop Knitting room

Sewing room New facilities under construction

In addition to these programs offered at this centre, the trainees also undergo coaching in the
following areas:
- General English, French, Mathematics and Citizenship;
- Agriculture and animal husbandry
- Basic Computer skills training;
- Religion and moral instruction and
- Physical education
The centre has 07 technical trainers and 05 administrative staff. In terms of facilities, they have
following equipment:
- 06 functional computers;
- 04 functional knitting machines;
- 14 sewing machines
- 02 designing machines
Worth noting is that the equipment are rapidly depreciating especially for the sewing section
and requires frequent maintenance.

b. The Vocational Centre for International Development

This is a training centre with programs designed to meet international standards. The training
centre is authorized by the Ministry of Employment and Vocational Training (Authorization No.
382/MINEFOP/SG/DFOP/SDGSF/SACD/2017) and is a member of the International Vocational
Education and Training Association (IVETA). The centre provides professional training in the
following Technical Vocational Education and Training areas:
- Fashion Design and Clothing Industry;
- Hair dressing, barbing and make up studies
- Project management
- Computer studies
All trainees in the above programs undergo the centre’s entrepreneurship and business
development program, to allow them graduate as job creators and not employees. The
programs in the centre range from:
- One year diploma program with 3 months placement;
- Two years advanced diploma with 6 months placement (Only for fashion design)
- 03 months specialized training certificate in fashion design and clothing industry
The Vocational Centre for International Development has a capacity of 25 modern sewing
machines, 04 new designing machines, 25 computers, 03 hair driers and many hairdressing
accessories. This can be seen with the help of the following pictures.

Computer Lab Partial View of Saloon

Fashion Design Section of the Centre

Cross section of participants at a project management course

Key recommendations
Based on the findings, the following recommendations can be advanced to help achieve the
objectives of the project with regards to care and support to orphans and vulnerable children:
- The centre to be prioritized for vocational skills training should be St Francis Home for
Skills training (Carpentry, welding, knitting and shoe manufacturing) and The Vocational
Centre for International Development (Fashion Design and Clothing Industry,
Hairdressing, barbing and makeup studies as well as Computer studies);
- Beneficiary OVCs located in areas far off from where these standard training centres a
situated should be advised to relocate if they do have relatives leaving in and around
Kumbo. This is to ensure that they have quality training. Otherwise, workshops in
remote areas should be properly screened and considered on the condition that trainees
from such centre will have to undergo intensive placement at either St Francis Home for
Skills Training or at the Vocational Centre for International Development;
- Orientation should be provided to beneficiary orphans and vulnerable children to focus
on market responsive programs and those that are easy to start up and operate.
 4.2. Agriculture/Gardens
The agricultural component is central to the success of the project. During the baseline study,
the key informants alongside some field observations revealed the following agriculturally-
related information:
- Across communities, common food crops like maize, beans, potatoes and plantains were
identified as being cultivated by households. Worth noting was the sporadic practice of
gardening with carrots, tomatoes, cabbages and celeries also cultivated;
- Though not grown at large scale, onions and gallics are also cultivated in the
communities;
- There exist family farm schools across the communities, providing technical support to
households but at a more reduced scope;
- Livestock farming is also common is also common in the communities by not for
commercial purposes;

Recommendations
Based on the agricultural component of the project and informed by the baseline findings, it will
be valuable to engage in a partnership with Family Farms School, a structure of the Diocese of
Kumbo to champion the capacity development program on gardening among DFLO beneficiary
groups. This will be more sustainable and will also keep the donors well informed on how the
Diocese of Kumbo understands and implements efforts to strengthen partnerships.

4.3. Knowledge of HIV/AIDS and other related diseases

Basic knowledge
A majority of respondents reported having heard of HIV and AIDS (83.8%, N=324), with no
differences between the females and males. Semi urban were more likely than their rural
counterparts to report having heard of HIV and AIDS. Among those who had heard of HIV and
AIDS, 97% agreed that HIV can be transmitted by shared needles. Four-fifths of those who had
heard of HIV and AIDS agreed that a mother can transmit to their child in pregnancy. Over 90%
agreed that abstinence reduces HIV risk (91.3%, N=324). Nearly the same proportion agreed
that condom use can reduce HIV risk (87.5%, N=324).
Rejection of major misconceptions
A majority of those who had heard of HIV and AIDS agreed that HIV cannot be transmitted by
sharing a meal with PLHIV (85.5%, N=324). Half of the respondents who had heard of HIV and
AIDS agreed that HIV cannot be transmitted by kissing (53.9%, N=324). A majority of
respondents agreed that HIV cannot be cured by herbs (85.5%, N=324). Nearly four-fifths
agreed a healthy-looking person can be HIV-positive (78.3%, N=324).

Attitudes
Respondents reported relatively accepting attitudes toward people living with HIV and AIDS.
Approximately 80% reported a belief that if a person has HIV and is not sick, they should be
allowed to freely interact with people in community (78.4%, N=324). Just over one-quarter of
respondents believe that families with HIV-positive individuals are treated unkindly by other
people (25.9%, N=324), and that people who receive free services are treated unkindly by
community (27.7%, N=324). Approximately 15% of respondents believe families with HIV-
infected individuals are treated unkindly by community members (15.4%, N=324).

Critical domains of observation

- There seems to be a huge disparity between knowledge and practice as far as preventing
the spread of HIV/AIDS is concerned. Households show a great knowledge on the causes
of HIV/AIDS but yet the rate of HIV/AIDS is still on the increase;
- The level of stigma in the communities with regards to PLWHA is higher among younger
persons than older persons. This is partly because the degree of interaction drops as one
gets older in the communities. Also, stigma is higher among woman than men infected
with HIV/AIDS;
- Though BTAs report having built their self-esteem, societal perceptions still over shadow
their abilities to freely interact in the communities. So the level of acceptance in the
communities is still very limited.

Key recommendations
- DFLO must implement strategies that will aim at changing behavior especially as it is
necessary to report a decrease in the number of PLWHA and also the number of OVCs as
 well as caregivers. This will be one of the parameters that will be used to measure
success;
- The communities and their households should be well sensitized on the importance of
co-existence amidst HIV/AIDS;
- DFLO program should ensure the proper resilience building of PLWHA. This should be
done by the DFLO staff, after being coached by an experienced development related
agency or consultant.

5. Understanding roles within the project framework

To be able to understand whether or not key stakeholders in the project understood their role
or understood the project, they were interviewed accordingly. The results of which are
presented below;

5.1 . DFLO staff

Of the five DFLO staff directly involved in project implementation, when interviewed on their
understanding of the project and their role in the project, four of them indicated that they partly
understood the project and their roles in the project. Challenges highlighted were related to the
new components that have been included in this new phase of the project.

A capacity needs assessment was also conducted to identify the skill gap of the staff. Staff
indicated their capacity development needs which were taken into consideration in designing
staff capacity development training.

5.2 . Diocesan Technical support

There was also a need to verify whether or not the technical support team of the project also
understood the project and their roles. These category of staff indicated that they fully
understood their role but need from time to time to revisit the project document to stay abreast
with the project implementation. They indicated their commitment in ensuring the success of
this project.
5.3 . Divisional and Deanery Supervisors
These supervisors were interviewed on their knowledge of the project and their role at the
community level in ensuring the success of the project. All of the eight (8) supervisors
interviewed in Donga Mantung and six (6) in Bui Division indicated knowledge of the project
and their roles in the project. Some of the roles highlighted were;-

- Community mobilisation and ensuring leader couples are doing their job effectively
- Providing psycho-social counselling to households
- Follow up to ensure that beneficiaries adhere to trainings and counselling
- Educate households on Natural Family Planning methods

During this interview, these supervisors highlighted some of the challenges faced in the field.
Some of the challenges mentioned include but not limited to the following;

- Poor collaboration among the community field staff

- Remoteness of some communities making movement and communication challenging
- Resistance to change or adherence to counselling
- Increasing prevalence of HIV/AIDS in the communities
- Limited counsellors making the work difficult

5.4 . Leader Couples

Eight leader couples were interviewed across the two divisions under survey. These
respondents indicated some knowledge of the project as well as their role in the
implementation of the project. Some of the roles highlighted include but not limited to;

- Follow-up with beneficiary members trained on the various components of the project to
ensure they are implementing the knowledge gained from the training
- Attend training of trainer’s capacity build workshops and in turn train the different
beneficiary group members
- Work in collaboration with the Divisional and Deanery supervisors to ensure the success
of the project
5.5 . Critical areas of observations
- Most of the Family Life staff interviewed portrayed limited knowledge of the project and
from critical stand point, can affect the effective and efficient implementation of the
project;
- The staff also showed a lack of a clear cut knowledge on their roles and expected output
and deliverables within the project;
- There appear to be limited coordination among the various stakeholders involved in the
project implementation.

5.6 . Key Commendations

- DFLO staff needs to be firmly coached on their roles and responsibilities especially as
most parts of the project are very technical and requires sound knowledge and skills to
ensure proper supervision;
- The staff of the DFLO program should also be periodically appraised to determine the
level of satisfaction as per their roles and responsibilities towards the implementation of
the project;
- As earlier indicated in their training report, there is need to change roles of staff and
proper accountability mechanisms instituted to ensure adequate tracking of project
activities and outputs of the project
- Program coordination meetings should be regularly organized where DFLO, supervisors
and Diocesan Technical team are converged to determine the level of progress of the
project, the associated challenges and the road map for the achievement of results. this
will also improve on collaboration and communication among all the key stakeholders;
- Increase the number of volunteer counsellors in the communities so that more people
can be reached with IEC programs
- Encourage exchange programs among different beneficiary groups and communities
such that best practice can be shared and improved on
Annexes
Annex 1: Location of communities in the two Divisions of the Diocese of Kumbo
Annex 2: Data collection tools

Informed Consent
I am (name) from the Vocational Centre for International Development, a training and
consultancy institution based in Kumbo. We are working in partnership with the Diocesan
Family Life Office, Diocese of Kumbo to implement a project in your community. We aim to
help reduce household hunger and improve on the health outcomes of people living with
HIV/AIDS and their households in your communities.

In order to accomplish this, it is important we determine your household level of access to food
(food security status). We will therefore need to ask you some questions which will help
us collect this information. We request you kindly think carefully before you answer these
questions. We ensure completely confidentiality of your responses.

The entire interview will take about 20 minutes

Please, you are not obliged to answer any question you do not want to, and you may stop the
interview at any time. However, we would happily encourage your active participation to
enable us achieve our goal of reducing household hunger and improving health outcomes.

Do you agree to participate in this

interview? Yes No
 Interviewer Instructions
There are two types of related questions. The first type is the occurrence question and is
followed by a related frequency-of-occurrence question. The occurrence questions ask if a
particular food insecurity condition ever occurred during the previous four weeks (30days).

The frequency-of-occurrence question, asks how often the reported condition occurred during
the previous four weeks.
 Whenever the response to the occurrence question is NO, you should skip the
related frequency-of-occurrence question. If the response is YES, then ask the related
frequency-of- occurrence question.
 The respondent answers on behalf of the household and all its members
 Please provide explanations whenever necessary so that the respondent clearly
understands.
 After completing the questionnaire, check to make sure all the questions have been
duly asked and the appropriate responses provided legibly.
 Ensure the appropriate codes have been duly filled in

Household in this context refers to people belonging to the same house (sleeping in or not)
and take meals at least 4 days a week from the main kitchen
HOUSEHOLD FOOD INSECURITY ACCESS SCALE (HFIAS) TOOL
SN QUESTION RESPONSE OPTIONS CODE
1. In the past 4 weeks, did you
worry that your household would 0 = No (skip to Q2)
not have enough food? 1=Yes
(Anxiety about acquiring food)
1.a 1 = Rarely (once or twice in the past
How often did this happen? 4
weeks)
2 = Sometimes 3-10 times in the past
4 weeks)
3 = Often ( >10 times in the past 4
2. In the past 4 weeks, were you or any weeks)
household member not able to eat 0 = No (skip to Q3)
the kinds of foods you preferred 1=Yes
because of a lack of resources?

2.a 1 = Rarely (once or twice in

How often did this happen? the past 4 weeks
2 = Sometimes (3-10 times in the past
4 weeks
3 = Often (> 10 times in the past 4
3. In the past 4 weeks, did you or any weeks)
household member have to eat a 0 = No (skip to Q4)
limited variety of foods due to a lack 1 = Yes
of resources?
(undesired diet
3.a repetitions) 1 = Rarely (once or twice in the past
How often did this happen? 4 weeks)
2 = Sometimes (3-10 times in the past
4 weeks)
3 = Often (> 10 times in the past 4
4. In the past 4 weeks, did you or any weeks)
household member have to eat some 0 = No (skip to Q5)
foods you found socially and 1 = Yes
personally undesirable to because of
lack of resources obtain other
types of foods?
(Eat undesirable
4a. food) 1 = Rarely (once or twice in the past
How often did this happen? 4 weeks)
2 = Sometimes (3 – 10 times in the
past 4 weeks)
3 = Often (> 10 times in the past 4
weeks)
5. In the past 4 weeks, did you or any
household member have to eat a 0 = No (skip to Q6)
smaller meal than you felt you 1 = Yes
needed because there was not
enough food?
.5a 1 = Rarely (once or twice in the
How often did this happen? past
4weeks)
2 = Sometimes (3 - 10 times in the
past 4 weeks)
6 In the past 4 weeks, did you or any 3 = Often (> 10 times in the past 4
other household member have to eat 0weeks)
= No (skip to Q7)
fewer meals in a day because 1 = Yes
there was not enough food?
6a. 1 = Rarely (once or twice in the past
How often did this happen? 4 weeks)
2 = Sometimes (3 - 10 times in the
past 4 weeks)
3 = Often (> 10 times in the past 4
7 In the past 4 weeks, was there ever weeks)
no food to eat of any kind in your 0 = No (skip to Q8)
household because of lack of 1 = Yes
resources to get food?
7a. 1 = Rarely (once or twice in the past
How often did this happen? 4 weeks)
2 = Sometimes (3 - 10 times in the
past 4 weeks)
3 = Often (> 10 times in the past 4
8. In the past 4 weeks, did you or weeks)
any household member go to sleep at 0 = No (skip to Q9)
night hungry because there was 1 = Yes
not enough food?
8a. 1 = Rarely (once or twice in the past
How often did this happen? 4
weeks)
2 = Sometimes (3 - 10 times in the
past 4 weeks)
9. In the past 4 weeks, did you or any 3 = Often (> 10 times in the past 4
household member go a whole day 0 = No (questionnaire is finished)
weeks)
and night without eating anything 1 = Yes
because there was not enough food?
9a. 1 = Rarely (once or twice in the past
How often did this happen? 4 weeks)
2 = Sometimes (3 - 10 times in the
past 4 weeks)
3 = Often (> 10 times in the past 4
weeks)

3
Biographical data

Gender 1 = Male 2 = Female

Age

A = ≤20 B = 21 – 31 C = 32 – 42 D = 43 – 53 E = 54 – 64 F = ≥65

Educational Level (encircle the correct option)

Some Primary Completed Primary Some Secondary Completed

Secondary

Some High School Completed High School Some University Completed University

Occupation

1 = Farmer 2 = Teacher 3 = Nurse 4 = Hair dresser 5 = Tailor/seamstress

6 = Retailer/Business 7 = Student 8 = Others (specify)

Marital status

1 = Married 2 = Single 3 = Divorced 4 = Widow(er) 5 = Others (Specify)

Religious background

1 = Catholic 2 = Protestant 3 = Muslim 4 = Hindu 5 = Others

(Specify) Household size

A = Zero B=1–3 C=4–6 D=7–9 E = 10 – 13 F = ≥ 14

Sub Division/community (e.g. Bum – Buabua)

THE COPING STRATEGY INDEX TOOL
 With this tool, repeat the main question for each behavior
 Try to provide explanations to help clarify the respondent as to what is being asked.
 Probe and make some notes to explain responses if it becomes necessary.
 After completing the questionnaire, check to make sure all the questions have been
duly asked and the appropriate responses provided legibly.

CSI TOOL
In the past 7 days, if there have been times when Raw Severity Weighted
you did not have enough food or money to buy Score ( F) weight score =
food, how often has your household had to: (W) (F x W)

Simply add each behavior to the question above

1. Rely on casual labour for food (Parents) 1
2. Send children out to work 3
3. Buy/borrow food on credit 2
4. Rely on less expensive/less preferred foods 1

5. Send children to eat elsewhere 4

6. Go a whole day without food 4

7. Reduce portion sizes 1

8. Reduce frequency of meals per day 1
9. Borrow food from relative/friend 2
10. Send household members to beg 4
11. Harvest immature crops 3
12. Consume seed stock held for next season 3
13. Sell livestock to get money 2
14. Steal crops from another person’s farm 4

15. Collect leftovers from markets or farms 4

(scavenge)
16. Go to eat in festive places 2
17. Delayed seeing a doctor or bought drugs for
You/household member?

TOTAL HOUSEHOLD SCORE Sum total for all the

individual strategies

DFLO Baseline Survey, May 2018 … powered by vcidafrica.org