Buddhist Leadership Initiative Evaluation 2008-2012, Cambodia (English)

7/28/2019 Buddhist Leadership Initiative Evaluation 2008-2012, Cambodia (English)

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BUDDHISTLEADERSHIPINITIATIVE

EVALUATION2008-2012

O C T O B E R 2 0 1 2C A M B O D I A


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ABOUT THIS EVALUATION

This evaluation of the Buddhist Leadership Initiative, Cambodia, took place through a desk

review of programme documents, a literature review, and quantitative and qualitative data

collection in ve provinces: Kampong Thom, Kampot, Siem Reap, Takeo and Prey Veng.

Interviews were conducted with key stakeholders and activity implementers includingrepresentatives of the Ministry of Cult & Religion, Provincial Departments of Cult & Religion,

UNICEF country ofce & sub-national staff, NGOs, monks & programme participants. A

quantitative survey was administered to programme participants in all ve provinces over

15 consecutive days in August 2012. Twenty focus group discussions were conducted with

programme participants (adults, children and monks) in the same time period.

The purpose of the evaluation was to provide relevant, comprehensive and timely data to

inform the future direction of the programme and to contribute to national learning.

ACkNOwLEDgEMENTS

The Evaluation Team extend their sincere thanks to H.E. Dork Narin, Mr Chhoeum Chhad

and Mr Ho Silin of the Ministry of Cult and Religion; the Provincial Departments of Cult

and Religion Directors and BLI Focal Points: Mr Korm Dampheng, Mr Chum Em, Mr Mom

Chandara, Mr Hoeun Yenthy, Mr Vann Bunna, Mr Tan Taychroan; Ven. Oeun Sam Art,

Ofce of the Great Supreme Patriarch of the Kingdom of Cambodia; Mr Hing Yan, Dean of

Preah Sihanouk Reach University; UNICEF country & regional ofce staff: Souad Al Hebshi,

Ulrike Gilbert-Nandra, Bunthy Chea, Gabrielle Robens, Usha Mishra and Ada Ocampo;

UNICEF zonal child protection staff: Soyorn Choun, Phalla Chem, and Chivith Rottanak;

Chanthy Prang, Save the Children Cambodia, Mr San Vandin and colleagues at Partners

in Compassion; and the many programme participants, adults, children, volunteers, and

the valuable input of the Buddhist monks within communities and at the highest levels in

Phnom Penh. The Lead Consultant would like to thank Ulrike Gilbert-Nandra, HIV Specialist

at UNICEF, specifically for providing substantial technical support throughout the

evaluation and through the process of developing this report. Special thanks also go toNikki Ward, Mr Savath, Mr Komsath and Mr Phim.

EVALUATION TEAM

JO kAyBRyN (Lead Consultant)

HOEUN SOPHEAk (Interpreter)

TONg SOPRACH (Interpreter)

MAk CHANTANARy(Researcher)

HANg PHALLy(Researcher)

PRUM VISETH (Researcher)


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CONTENTSACRONyMS ............................................................................................................................ 9

ExECUTIVE SUMMARy....................................................................................................... 11PURPOSE Of THE EVALUATION........................................................................................ 19

SCOPE AND METHODOLOgy............................................................................................. 21

scope ................................................................................................................................... 21

Methodology .................................................................................................................... 21

participants profile..................................................................................................... 23

liMitations ......................................................................................................................... 24

ethical considerations ................................................................................................ 25

INTRODUCTION TO THE BUDDHIST LEADERSHIP INITIATIVE ..................................... 27

iMpleMentation................................................................................................................ 30fINDINgS ............................................................................................................................. 33

survey coverage and focus group participants ............................................... 33

- PARTICIPATION IN ACTIVITIES................................................................................................ 36

relevance .......................................................................................................................... 38

- RELEVANCE TO NATIONAL POLICIES ..................................................................................... 38

- RELEVANCE TO UNICEF STRATEGIES .................................................................................... 41

- RELEVANCE TO THE MOST VULNERABLE PEOPLE ................................................................ 42

coverage and effectiveness ...................................................................................... 44

efficiency........................................................................................................................... 47

iMpact .................................................................................................................................. 49

- SPIRITUAL AND PRACTICAL SUPPORT FOR VULNERABLE CHILDREN ................................... 49

- SPIRITUAL AND PRACTICAL SUPPORT FOR VULNERABLE ADULTS ....................................... 53

- REALISED AND POTENTIAL OPPORTUNITIES ........................................................................ 54

- THE VULNERABILITY OF ADULTS........................................................................................... 55

- PROMOTING RIGHTS............................................................................................................. 56

- STIGMA & DISCRIMINATION.................................................................................................. 58

- THE ROLE OF MONKS ........................................................................................................... 62

sustainability................................................................................................................... 63

- MANAGEMENT AND OWNERSHIP OF THE INITIATIVE............................................................ 64

CHILD PROTECTION ISSUES ............................................................................................. 67

CONCLUSIONS..................................................................................................................... 69

RECOMMENDATIONS ......................................................................................................... 71

Ministry of cult and religion .................................................................................... 71

buddhist leadership and hierarchy ....................................................................... 72

unicef .................................................................................................................................. 74

BIBLIOgRAPHy ................................................................................................................... 75

SURVEy................................................................................................................................. 77


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LIST Of fIgURES

FIGURE 1: Survey participants by province and as a proportion ....................................... 23

of programme participants

FIGURE 2: Detailed information on all evaluation participants by province ..................... 24

FIGURE 3: Number of Districts, Communes and Pagodas participating ........................... 28

in the Buddhist Leadership by year

FIGURE 4: Numbers of adult and child participants by province (2011) ..........................28

FIGURE 5: Annual budgets by province and by year 2008-2012 ...................................... 29

FIGURE 6: Age distribution of survey respondents by sex .................................................. 33

FIGURE 7: Ages of focus group participants by province and by sex ................................. 34

FIGURE 8: Household size by province ................................................................................ 34

FIGURE 9: Household income per month by province ........................................................ 34

FIGURE 10: Income per capita per month by province in table format .............................35

FIGURE 11: Income per capita per month by province in graph format ............................35

FIGURE 12: Annual average income per capita by province .............................................. 36

FIGURE 13: Women self-help group members who meet regularly .................................. 36

at the pagoda for meditation sessions

FIGURE 14: Length of time as participants in the BLI by province .................................... 37

FIGURE 15: Participation in different types of BLI activities .............................................. 37

FIGURE 16: Based on monitoring data 2012 (11) .............................................................. 44

FIGURE 17: The most important activity for participants by province ...............................45

FIGURE 18: Children who meet regularly at a pagoda for support sessions .................... 49

FIGURE 19: Children who meet regularly at the pagoda for support sessions ................. 51

FIGURE 20: A self-help group member with her child ........................................................ 53

FIGURE 21: The activities considered most important by BLI participants ...................... 53

FIGURE 22: Expenditure of cash support by sex ................................................................ 58

FIGURE 23: Proportion of women and men excluded from social activities: .................... 58

BLI evaluation data 2012

FIGURE 24: Proportion of women and men excluded from social activities: .................... 59

Stigma Index data 2010

FIGURE 25: Proportion of women and men excluded from religious activities: ............... 59Stigma Index data 2010

FIGURE 26: Feelings of internal stigma by sex over the last 12 months: .........................60

BLI evaluation data 2012

FIGURE 27: Feelings of internal stigma by sex over the last 12 months: .......................... 61

Stigma Index data 2010


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BUDDHIST LEADERSHIP

INITIATIVE EVALUATION


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ExECUTIVE SUMMARy

introduction to the buddhist

leadership initiative

The Buddhist Leadership Initiative originated in Thailand in 1997 as part of UNICEFs

regional strategy for Buddhist engagement in the response to HIV and AIDS in the Mekong

Sub-region1. It was launched in Cambodia in 2000 by the Ministry of Cult and Religion,

with UNICEF support. An evaluation of Cambodias Buddhist Leadership Initiative was

commissioned by UNICEF, in 2007. The programme expanded from seven to 14 provinces

over its twelve years and currently 10 provinces participate reaching 2,300 adults living

with HIV and 1,500 vulnerable children in 239 communes. These men & women regularly

attend self-help group meetings at the pagoda which is preceded by a meditation session

led by a monk at the pagoda, usually twice per quarter. The Buddhist Leadership component

to reach vulnerable children takes the form of group sessions at the pagoda twice per

quarter and children get their transport reimbursed, a small amount of cash support, andmaterials especially for school.

An agreement through Annual Work Plans which have been in place since 2004 have been

signed between the Ministry of Cults and Religion, the Provincial Departments of Cult and

Religion and UNICEF to provide technical and nancial support and capacity building to

government staff and monks and the development of training materials. UNICEFs support

was targeted to reach adults and children over a longer period of time in order to increase

the effectiveness of the response to HIV and AIDS.

purpose

This evaluation aims to assess the organisational and programme performance between

2008 and 2012, including the Buddhist Leadership Initiatives efciency & effectiveness.It further sought to review the institutional capacity of the initiative; evaluate the outcome

of the programme with regard to the provision of support to individuals and families

affected by HIV at the household level; provide recommendations on how to include other

areas of child protection; and draw lessons & recommendations for programme adaptation

and revision. The evaluation was guided by the OECD DAC Principles for Evaluation of

Development Assistance as well as the UNICEF-adapted United Nations Evaluation Group

(UNEG) Evaluation Report Standards. It was implemented between July and September

2012 and collected quantitative & qualitative data in ve of the ten participating provinces.

Methodology

Field data collection took place over 15 consecutive days in August. The methodologyincluded a comprehensive literature review, key informant interviews with policy makers,

implementers and technical support staff, focus group discussions with women, men and

children affected by HIV, focus group discussions with monks, surveys of adults affected

by HIV, and observations of group interactions and individual behaviours during the data

collection. A total of 357 adults and children participated in the assessment: 214 adults in

the quantitative survey, 116 women, men, children and monks in focus group discussions,

and 27 government, NGO, Buddhist leadership and UNICEF representatives. Preliminary

evaluation ndings were discussed with representatives from MoCR & Buddhist leadership.

1 Initiated by UNICEF East Asia and the Pacic Regional Ofce (EAPRO) and Country Ofces, the Buddhist Leadership

Initiative was introduced in ve countries (Cambodia, China, Lao PDR, Myanmar and Viet Nam) of the Greater MekongSub-region between 1998 and 2004 (29).


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participants profile

The majority of the assessment participants were women aged between 30 and 49, which

reected the wider Buddhist Leadership Initiative demographic prole. In total 154 women

and 60 men participated in the quantitative survey, which mirrors that generally more

women participate in the initiative than men. Among the 20 focus groups there were 30women, 30 men and 30 children (18 girls and 12 boys). Among the 214 survey participants

there were noticeable demographic differences between provinces. A large proportion

(43%) of the surveyed participants had been involved in the programme for ve years or

longer. Approximately a quarter had been involved for 3-4 years, another quarter had been

involved for 1-2 years, and the remaining 9% had been involved for less than 12 months.

intended audience

Primary users of this evaluation will be Ministry of Cult and Religion, Buddhist leaders and

UNICEF. The ndings will be also shared with a broader group of relevant stakeholders,

including NGOs and development partners, working in the area of HIV and AIDS. The good

practices and lessons learned are intended to be used by MoCR, Buddhist leaders and

other relevant stakeholders to address the gaps and expand the services to other areasof child protection and inform MoCR on steps to institutionalise and sustain the initiative.

liMitations

Participants for focus group discussions were not selected randomly by the researchers,

who relied on Provincial Department of Cult and Religion representatives to select

participants. This was also true for the survey participants to some extent as the research-

ers relied on the Provincial Departments of Cult and Religion to select which pagoda they

would visit, but as visits were mostly arranged when regular meditation and self-help group

meetings were taking place all members of any self-help group had the opportunity to

participate in the survey. There were challenges with the quantitative survey, particularly in

relation to interpretation of questions into Khmer. In some cases this was due to emphasesaltering during the translation from English to Khmer, and in other cases there were

differences in understandings of terms or concepts. The majority of these were claried in

the early phase of data collection and in most cases earlier completed surveys could be

reviewed and corrected by corroborating responses within each participants responses.

ethical considerations

All programme participants (adults and children) were provided with written information

explaining the purpose of the research and with the researchers contact details. All partici-

pants were made aware that their participation was voluntary, that there responses were

given in condence, and all signed an informed consent form. Photographs were taken only

of those people who gave their consent, and with the understanding that the images would

be used in relation to these research ndings and not as part of any widespread publicitymaterial for HIV campaigns or public health messages in Cambodia.


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fINDINgS

relevance

The objectives of the Buddhist Leadership Initiative were found to be in line with and therefore

relevant to national and UNICEF strategies and policy frameworks. At national policy level,

the Buddhist Leadership Initiative directly responded to the governments Policy on

Religious Response to the HIV/AIDS Epidemic in Cambodia which was the rst of its kind

in May 2002. Alongside this, other HIV focused policies make specic references to the

role of faith leaders including the National Strategic Plan for the Comprehensive and

Multi-sectoral Response to HIV/AIDS III (2011-2015) which promotes the role of faith

leaders in reducing stigma and discrimination. The governments commitment to the

Convention on the Rights of the Child provided the backdrop for introducing the childrens

component. This looked at including children affected by AIDS and children vulnerable for

other reasons, championing an AIDS sensitive, but not AIDS exclusive approach.

Within UNICEF, the programme contributes to strategies and targets in UNICEFs CountryProgram Action Plan (2011-2015) such as developing national capacity for realisation of

child rights, results at greater scale for children, results-based programming, and the support

of key interventions for multi-sectoral response in HIV prevention, treatment and care.

For the most vulnerable people, the value of the initiative was found to be extremely high

and relevant, with almost all of the survey respondents reporting that the spiritual support

they had received through the BLI was very important.

Noting the rapid decline of HIV prevalence in Cambodia in recent years and the concentrated

epidemiological context among key affected populations, the research ndings question

whether the main objectives are still appropriate given the changing circumstances. Overall,

the support provided by the programme remains highly relevant to the most poor and

vulnerable community members, but the narrow focus on people affected by HIV meansthose who are highly vulnerable for reasons other than HIV do not qualify for support.

coverage and effectiveness

The Buddhist Leadership Initiative nancially supported 653 people living with HIV in

2011 to access their medication on a regular basis. Although the programme provides

some nancial support to child participants, if it also facilitates access to HIV services for

children who need them, this aspect was not emphasised in programme documentation

or by participants.

The cash support that the programme provides to children amounts to approximately $6

USD which is provided twice a quarter, part of which ($2 USD) is to reimburse their travel

costs for coming to the session, and the remainder is intended for education and other

household needs. Some children of adults in the self-help groups benet as well from the

cash that their parents receive from the Buddhist Leadership, for example, 6% of survey

respondents said they used the money to pay for their childrens education (fees and school

materials), and 5% of women who received cash said they used some of it for transport

costs for education.

Overall, according to programme monitoring data, largely output data, nearly all provinces

reached or exceeded their quantitative targets. One province reached 78% of its targets,

with the main barrier being that trained monks either left the monkhood or moved to

another pagoda and were not replaced.


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The initiative provided spiritual care to 2,355 adults living with HIV in 2011 through

its activities, and 64% of survey participants said meditation sessions were the most

important activity for them. In the same year the programme provided spiritual support

to 1,622 orphans and vulnerable children.

efficiencyEfforts to reduce the administrative costs were discussed at annual review meetings as

were comparisons between costs between different provinces implementing the same

activities. However, operational costs by the Provincial Departments of Cult and Religion

appeared quite high at the time of the evaluation, questioning whether activities were

delivered in the most cost efcient way.

Further, there were differing views about whether the Buddhist Leadership Initiative

activities were formally recognised as part of the Ministry of Cult and Religions workplan

which caused some implementers at provincial level to experience their engagement in

the programme as an imposition. Related to this, was an overall nding that government

civil servants requested nancial incentives (allowances in addition to travel costs) which

seemed contentious for several reasons and ultimately a disincentive to increase theefciency of the programme.

Cost efciency varied among the provinces. This was largely due to the way activities were

organised, with some provinces organising activities locally at district level requiring less

travel from provincial levels. Another reason was that in some provinces selected wats were

in faraway districts, necessitating long journeys to transport cash and in kind support to

programme participants.

iMpact

The Buddhist Leadership Initiative made a decision in 2010 to increase awareness among

children of their rights by developing a set of advocacy messages for monks to promoteduring the group sessions.

Monks often used the Five Buddhist Precepts or Virtues to encourage qualities such as

loving-kindness and compassion, while discouraging high-risk behaviours. The Dharma

(the teaching of the Buddha) was also mentioned as an important vehicle for transfer

of information from monks to community members, albeit by only 10% of focus group

participants. More members of the focus groups, approximately a quarter, mentioned

specic Buddhist teachings, such as aspiring to become self-reliant. On the whole, focus

group participants seemed to think that the messages that Buddhist monks give them

were appropriate, and a small proportion acknowledged that they would not expect monks

to use sexually explicit language to discuss HIV.

i m mm . Spiritual and practical support for adults is provided through the twice quarterly

meditation sessions and self-help groups. The practical application of meditating was

found effective and mentioned by nearly all of the focus group participants who described

how it helps calm them, helps them feel spiritually and emotionally strong, and it helps

relieve depression and anxiety. The self-help group activities, whether they focussed on

health and hygiene messages or had a more dynamic entrepreneurial emphasis were also

valued by the participants. The importance of the dual spiritual and secular approaches of

the initiative was mentioned specically by a small number of participants.

The self-help groups seemed to vary in their effectiveness to reduce peoples vulner-

abilities. Some had developed overlapping micronance mechanisms to facilitate loans


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for income generating activities and for emergencies, while others had never heard of a

savings and loan club and the nature and content of the quarterly sessions had essentially

remained unchanged for many years. There were noticeable differences within self-help

groups as well as between them, for example, one-off income generating activities had

been implemented prior to 2008 and the members of a self-help group who had been

programme participants at the time had benetted and continued to benet, while peoplewho had joined the programme later did not get access to the same opportunity.

Effects on rights awareness seemed to vary dramatically across the focus group

participants with some people citing legislation which should protect people living with

HIV from discrimination, despite which they felt that potential employers still managed to

sidestep the law.

The effects of cash support were considered very important by 83% of the survey

respondents and the most frequently cited expenditure was on food. A small number of

people used the cash for generating income. Many more said they would like to spend the

money on income generation but seemed more compelled to meet their immediate needs

of food with the cash rather than make investments which could earn them more income

in the future.

Almost all the survey participants said that levels of stigma and discrimination had reduced

as a result of the activities that involve monks. Meditation sessions and spiritual support

from monks seems to have impacted positively on peoples feelings of self-stigma, which

overall was reported at lower rates compared to respondents of the Stigma Index survey.

Although there were extremely positive effects for most focus group participants of being

visited at home by a monk, one participant pointed out that all of the activities inadvert-

ently advertise her HIV status without her consent, particularly the home visits. The visit by

the monks is not a quiet private event, it is quite the opposite when a contingent of people

descends on a persons home and the monk begins sharing messages about HIV.

Whether the Buddhist Leadership Initiative was able to reduce inequalities between theworst-off or most vulnerable and other people was more complex to ascertain. Data was

not systematically collected on whether participants nancial or social statuses had

increased, so any evidence of change was gathered qualitatively in the focus group

discussions. Within the same self-help group some individuals discussed increases in

economic stability while others had not achieved any improvements. Those that reported

improvements cited income generation activities and/or saving and loan schemes as the

key factor in changes to their economic situation.

At a strategic coordination and partnership level there were Provincial Departments of Cult

and Religion that regularly participated in Provincial Department of Health meetings in

order to coordinate responses, including with local NGOs, for example in Prey Veng and

Kampong Thom. However, close engagement with other government departments andNGO service providers was not consistent across all provinces. Similarly at local level, some

of pagodas linked in with existing governance and community structures such as Village

Health Support Groups (initiated by the Ministry of Health) while others did not.

sustainability

Most of the activities as they are currently implemented rely on external donor support.

Some one-off or time-limited activities have had profound results and do not need to be

repeated consistently, such as the rst home visit to a person living with HIV which can

signicantly reduce stigma and discrimination experienced by the person. The activities

seem more likely to be sustainable if they originate from each wat rather than organised

by the Ministry of Cult and Religion at provincial level. Monks can distribute donations

given to the pagoda to vulnerable people in the local community without incurring the


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administrative costs associated with the provincial level engagement, although the

amount of cash support that participants receive is likely to be less than current rates.

Sustainability of results could be increased if monks and other implementers more

systematically connected participants to other social protection schemes and other exist-

ing services.

At most levels of organisation of the programme, implementers and participants alike

did not seem to claim ownership over the activities, meaning they did not feel in charge.

It seemed to them all that someone else was responsible and they did not want to

suggest changes or take ownership for fear of stepping on toes. This is potentially most

problematic among monks who arguably should be more at the centre of the decision

making. A minority of self-help groups seemed to have increased their participation

spontaneously by meeting regularly within their communes once a week or more. Recently

(in 2011) UNICEF re-iterated that the initiative is only sustainable if integrated into

government plans and budgets, but to date most implementers and participants continue

to refer to the activities as a UNICEF initiative.

However, given the overwhelming value of participants of the spiritual support, the

initiative may well be sustained if planned locally, with monks at the centre and even in theabsence of external funding support. A challenge may be as to how overall achievements

and progress would be monitored and data shared.

child protection issues

Vulnerable children are supported by the Buddhist Leadership Initiative and opportunities

are taken to increase their awareness of their rights such as the right to have a name, to

be cared for, to be fed etc. The programmes approach to child protection issues could

go further than awareness raising, for example, informing children and parents that chil-

dren have the right to a name could more be more closely linked to birth registration by

monks and implementers providing specic support to register births such as instructions,

accompaniment or help completing forms. Currently, the programme promotes messages

for a limited number of child protection issues and there is scope for monks at both senior

level and at the pagodas to have greater understanding of serious abuse of childrens

rights.

conclusions

The Buddhist Leadership Initiative seems highly relevant to the national HIV policy

expectations of religious leaders to engage in the HIV and AIDS response. It has made

a signicant difference to most of its participants. With the HIV context in Cambodia

changing dramatically since its launch, with lower rates of HIV prevalence, increases in

access to treatment and an overall reduction in stigma & discrimination, the programme

has an opportunity to re-focus its efforts on reaching the most vulnerable and the worst

off, which is likely to include many people living with HIV but would also include peoplewho are vulnerable for reasons such as other illnesses and extreme poverty. Monks have

a positive inuence on both external & internal HIV related stigma experienced by people

living with HIV, while the cash support is very important to the poorest participants, at the

same time it causes some limitations to the programmes ability to include more people.

The more dynamic self-help groups have skills & experience of micronance mechanisms

to share with other groups which create opportunities for learning within the programme.

Overall the efciency of the programme does not compare well with other organisations

which are designed to implement similar activities, and its reliance on external donor

funding raises challenges to its sustainability. It seems likely that efficiency and

sustainability would be increased if ownership of the programme was with the monks

implementing the activity at pagoda level, and with senior monks in the Buddhist hierarchy

who have the authority and inuence to institute its aims and objectives into its networks

and education system.


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16. Design and promote cost-effective activities.

To increase effectiveness the following suggestions are made:

17. Promote the successful approach of providing spiritual support for vulnerable

community members.18. Facilitate monks increased capacity to identify people and organisations which can

support local communities to reduce their economic vulnerability.

19. Identify routes to agreeing and sharing the provision of spiritual support.

20. Increase awareness and training in child protection.

To increase sustainability the following suggestions are made:

21. Institute good practices around Buddhist responses to reducing vulnerabilities.

22. Use its leadership networks to explore expanding the role of monks in community

engagement.

unicef

To increase relevance the following suggestions are made:

Noting the rapid decline of HIV prevalence in Cambodia in recent years and the

concentrated epidemiological context among key affected populations, the research

ndings question whether the main objectives are still appropriate given the changing

circumstances. Overall, the support provided by the programme remains highly relevant

to the most poor and vulnerable community members, but the narrow focus on people

affected by HIV means those who are highly vulnerable for reasons other HIV do not qualify

for support. Therefore an overall relevance recommendation is for UNICEF to review the

objectives and the intent of the programme.

23. Support MoCR in the process of initiating and strengthening dialogue

24. Support MoCR to transition out of the current initiative

To increase effectiveness the following suggestions are made:

25. Provide technical support on income generation & reducing economic vulnerabilities

26. Promote the successful spiritual support approaches of the initiative

To increase efciency and sustainability the following suggestions are made:

27. Facilitate capacity building between current implementers.28. Help identify strategies to institute capacity building within the Buddhist hierarchy.

29. Support the MoCR and PDCRs to transition into a more strategic leadership and

coordination role.


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PURPOSEOf THE EVALUATION

The purpose of this end-of-programme evaluation, commissioned by UNICEF, was to

provide relevant, comprehensive and timely information to analyse the strengths & gaps in

the Buddhist Leadership Initiative in order to inform decisions about the future direction of

the programme. The evaluation report is available in Khmer & English and will contribute

to national learning and discourse on faith-based responses to HIV and development. The

ndings of the evaluation will be discussed with national partners to determine whether

the value and cost-effectiveness of the programme warrants its continuation, and in the

case of continuation whether changes are required to its strategies and implementation.

The evaluation will be used by UNICEF and Ministry of Cults and Religion to identify the

lessons learned and map the future programmatic directions with a concise national

adaptation by the Ministry and exit strategy for UNICEF.

Specically the evaluation aimed to:

Assess the organisational and programme performance for the time period 2008-

2012 (i.e. subsequent activities to the earlier evaluation in 2007 as part of a regional

process), including its efciency and effectiveness;

Review the institutional capacity and set-up of the initiative;

Evaluate the outcome of the programme with regard to the provision of support to

individuals and families affected by HIV at the household level;

Provide recommendations on how to include other areas of child protection; and

Draw lessons and recommendations for programme adaptation and revision;

The following criteria & evaluation questions were utilised to guide the evaluation following

the format of the OECD Development Assistance Committees Principles for Evaluation of

Development Assistance:

relevance

To what extent are the objectives and activities of the programme suited to contribute

to achieving the priorities and policies agreed at the national level as well as the

strategies of the Ministry of Cult and Religion (MoCR), Provincial Departments of Cult

and Religion (PDCR), Orphans and Vulnerable Children (OVC) Task Force and UNICEF

(e.g. National HIV Strategic Plan III, UNICEF Country Program Action Plan 2011-2015)

as well as human rights (Right to Health, Rights of the Child)?

What is the value of the initiative in relation to the needs of the worst-off groups/mostvulnerable people? What is the value of the initiative in reducing inequalities between

worst-off groups/ most vulnerable people and others?

effectiveness

To what extent were objectives achieved and what were the major inuencing factors?

To what extent did the initiative provide spiritual care for families and children infected

with and affected by HIV and AIDS (how appropriate are the messages)?

To what extent did the initiative contribute to support referral for most vulnerable

adults and children living with HIV to access medical care?

2 Organisation for Economic Co-operation and Development


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To what extent did the initiative contribute to cash support to vulnerable children and

what were the results?

To what extent did the initiative contribute to promote family based care for vulnerable

children as the best option for child care?

efficiency

Were the activities cost-efcient compared to other programs that aim to provide

support and to reduce stigma and discrimination against families and children

affected by HIV and AIDS?

Were the activities cost-effective with respect to operational costs?

How does the cost-efciency vary within the programme and why?

iMpact

What are the intended and unintended results of the Buddhist Leadership Initiative?

In particular in respect to:

The extent and the way the initiative contributed to increased self and community

acceptance and to reduced stigma and discrimination against families and chil-

dren affected by HIV and AIDS;

The extent to which the initiative was able to reach the most vulnerable people;

The extent to which the initiative contributed to decreasing inequalities between

the worst-off and best-off;

The contribution to strengthen the rights of people infected with and affected

by HIV;

The level of impact with respect to HIV knowledge and attitudes towards families

and children affected by HIV among communities, Ministry of Cult and Religion &

Provincial Departments of Cult and Religion staff, as well as monks;

Management and ownership of the initiative; and

Achieved coordination and partnerships.

sustainability

What are major factors that inuence the achievement or non-achievement of

sustainability of the programme (inter alia role, ownership and leadership of MoCR)?

Are the interventions and impacts on the worst-off/ most vulnerable people likely to

continue when external support is withdrawn?

What needs to be done to achieve sustainability?

How likely is it that the initiative will be replicated or scaled up?

In addition, the evaluation considered:

To what extent, and how, can the Buddhist Leadership Initiative structure be used to

address broader child protection issues?


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Key informant interviews with concerned NGOs (Save the Children Cambodia and

Partners in Compassion);

Focus group discussions and in-depth interviews with women, men & children affected

by HIV, and implementing monks;

Observations of participants.

The lead consultant led the qualitative data collection in English & Khmer which consisted of:

20 focus group discussions with 90 programme participants (30 men, 30 women and

30 children: 18 girls and 12 boys) and 26 junior and senior monks (total 116). Focus

group discussions lasted between 45 minutes and 1.5 hours. Groups were asked

a selection of similar and unique questions, and participants were encouraged to

discuss the issues that were most important to them;

Semi-structured interviews with 27 representatives of the Ministry of Cult and Religion

(1), Provincial Departments of Cult and Religion (17), UNICEF (5), members of the

Buddhist hierarchy (2) and NGO stakeholders (2). Questions were based on a prepared

interview framework and participants were encouraged to discuss the issues that

were most important to them.

A team of three researchers collected quantitative data from 214 programme participants

(154 women and 60 men) in the ve provinces. The survey was conducted in Khmer and

took between 20 and 40 minutes per respondent.

The evaluation team relied on requests to the Provincial Departments of Cult and Religion

to help identify programme participants to take part in the focus group discussions and

survey data collection. Nearly all data collection took place at a pagoda. In most instances

the participants were attending a regular support meeting for the meditation and self-help

group meetings. Provincial Departments of Cult and Religion selected the focus group

discussion participants in order to identify six male, six female and six child participants

per focus group, and all of the members of the self-help groups were invited to take partin the survey. The focus group discussions were conducted using an interview framework

to facilitate responses to similar questions across all groups as well as unique questions

depending on their specic contexts and situations. They were conducted in an informal

manner, often sitting in a circle on the oor of the wat or meeting space, or at a table with

seats in the grounds of the pagoda. Among the childrens focus groups the children were

encouraged to discuss what was important to them.

The mix of data sources was designed to obtain a diversity of perspectives. In order to

increase the level of data accuracy, the data collectors were trained in the data collection

tools, and daily debriengs during the eld work provided opportunities to clarify categories

of responses from programme participants. The quantitative data was input into Excel during

the eld work so that anomalies or patterns could be identied and followed up in focus

group discussions. Basic analysis was performed in Excel to identify proportional responsesto multiple choice questions and averages of data related to income levels. These

computed results focussed on identifying similarities and difference between responses

given by women and men and responses distributed by province.

A stakeholder consultation meeting was held at the completion of the of data collection to

share and discuss the preliminary ndings of the evaluation. Subsequently the survey data

was cleaned for errors, and analysed again in Excel with the results triangulated with the

qualitative data to both substantiate ndings and identify unique insights.


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Some questions in the survey instrument required some clarications or revisions as the

data collection progressed. For example, one of the response options to a question about

what activities people participated in was A monk gave me cash. There were differing

beliefs about whether monks can handle money so some respondents answered no but

indicated that someone else in the programme had given them cash. The question was

rephrased during the interviews so it emphasised the receiving of cash as part of theinitiative rather than whether a monk specically handed cash to the participant. An

ambiguity was revealed in the same question with the option A monk (or representative

from the District Ofce of Cult & Religion) referred me to a service because the initial

translation into Khmer placed an unintended emphasis on referring participants to this

service (i.e. the Buddhist Leadership Initiative activities) rather than another service as

the question was originally intended. The incorrect emphasis was not identied until the

latter part of the data collection. Responses to similar questions within each survey

response were corroborated and errors were corrected where possible. For example, some

participants indicated that they were referred to another service as above, but later when

asked which service they were referred to answered none. In these cases, the earlier

response was changed in the data cleaning process.

ETHICAL CONSIDERATIONS

Participation in the data collection was entirely voluntary and this was made clear to

potential participants. All participants (including children in focus groups) were provided

with written information in Khmer about the purpose of the data collection and the

contact details of the researchers and interviewers, and all signed a consent form. When

participants were asked to pose for photographs, the researchers emphasised their

prerogative to decline. Most agreed to appear in photographs on the understanding that

they will be used in relation to these research ndings and not as part of public media

campaign materials about HIV in Cambodia. A small number of individuals declined to

appear in photographs and they were reassured that their decision was respected by theresearchers. Photographs were taken only of those participants that consented.

The approach taken to interviewing children in the focus groups was to allow children

to lead in raising sensitive issues themselves rather than ask direct questions which

may have made them uncomfortable. For example, the researchers assumed that most

children were affected by HIV and some may have been living with HIV, and did not assume

that all the children in any group knew about each others situation or status. Therefore,

no questions were asked which would have caused a child to reveal their HIV status or

how they were affected by HIV. The researchers did not mention HIV unless the children

raised it as an issue rst. In some cases children mentioned they received HIV information

as part of the initiatives childrens sessions, in which case, the researcher asked them

how useful the information was and whether they talked to their friends and family

members about the HIV information they received. The researchers asked children about

their relationships with friends at school and whether any other children were unkind to

them. In one case, a child responded that other children bullied her by saying that she

would give the other children HIV. The researcher made no assumption that she was living

with HIV and asked her and all the children present about their own reactions to bullying

and what they do about it. At all times the researcher encouraged children to speak about

what was important to them.

The decision to focus on adults in the quantitative survey was motivated by the fact that

the majority of programme participants are adults. Children had the opportunity to share

their views as part of the focus group discussions.


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A signicant proportion (164 or 77%) of people was visited at home by a monk and other

implementer although the frequency and number of visits were not recorded for these

respondents. The 2007 evaluation noted that monks in focus groups mentioned that home

visits were infrequent at that time and constrained by: a lack of material support; a lack

of support from senior monks; and a lack of motivation for monks to spend their time

on home visits (12). Since then the BLI has instituted regular home visits as part of itsactivities. In general, according to programme documentation, home visits are made twice

per quarter to persons living with HIV and who are too ill or frail to come to the pagoda.

Across Cambodia the number of people who are inrm because of HIV has reduced

dramatically as a result of increased access to treatment. In most provinces the number of

people visited per quarter is less than 30.

There was ambiguity about the fourth option on the list A monk (or representative from the

District Ofce of Cult & Religion) referred me to a service because the initial translation

into Khmer placed an unintended emphasis on referring participants to this service (i.e.

the Buddhist Leadership Initiative activities) rather than another service as the question

was originally intended. The incorrect emphasis was not identied until the latter part of

the data collection. Initially 173 participants checked this option, but 148 conrmed that

they were referred to another service in a later question. The results in the chart have beenupdated to reect the lower number.

RELEVANCE

relevance to national policies

The objectives of the Buddhist Leadership Initiative were found to be in line with and

therefore relevant to national and UNICEF strategies and policy frameworks. At national

policy level, the Buddhist Leadership Initiatives aims and impacts contribute to achievinga range of the HIV related priorities and policies. The programmes key priorities, agreed

on in late 2011, are (13):

To improve care and support for people living with HIV

To promote compassion for and support to families affected by HIV, & other vulnerable

children

To provide care and support to vulnerable children, including children affected by HIV

The Buddhist Leadership Initiative component that includes vulnerable children was

introduced as part of the governments commitment to the Convention on the Rights of the

Child which Cambodia ratied in 1992. Recognising that the state has the responsibility

to act in the best interest of the child, the government has introduced a wide range of

policies related to the care of orphans and other vulnerable children. Over one third of allHIV affected households are caring for a child orphaned by HIV, and there are more than

85,000 children in Cambodia who have been orphaned or made vulnerable by HIV (1).

As such the BLI started to promote family based care for vulnerable children as the best

option for child care in 2010 and this was piloted in the four provinces of Prey Veng, Svay

Rieng, Kampong Speu and Kampong Thom (14). This was undertaken to explore if and how

local religious clergy can play a role in promoting family based care among households who

have high child dependency ratio and who are economically impoverished or vulnerable for

other reasons. As a result of this pilot, the important role of religious leaders was formally

recognized in the new government guideline on alternative care.


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commune councils & religious leaders should be supported to maintain a prominent role &

ensure that monks play a key role in mobilising the community and reducing stigma (22).

In the above context of national priorities & policies which emphasise the role that Buddhist

monks can and should have in the response to HIV, the Buddhist Leadership Initiative

upholds its relevance because participating monks are perceived by the target group toplay a hugely signicant role in reaching out to people living with HIV by visiting them at

home and inviting them to the pagoda, and by applying Buddhist messages to the context

of HIV.

relevance to unicef strategies

The Buddhist Leadership Initiative commenced in the previous UNICEF Country Programme

of Collaboration (2005-2010), and has been modied and adapted over the years. It

remains relevant to a number of UNICEF strategies and targets as articulated in the

Country Program Action Plan (CPAP) (2011-2015), namely:

Developing national capacity for realisation of child rights: The programme has contributed

to this strategy by promoting child rights across the participating provinces through the

Provincial Departments of Cult and Religion & monks engaged in the Buddhist Leadership

Initiative. The emphasis on child rights was introduced in 2010, and as a result has raised

awareness of child rights among all the implementers and the participating children and

their families. The CPAP additionally identies the strategy of simultaneously developing

the capacity of local groups at village level to effectively interact with village leaders,

demand quality service provision, and identify local solutions to issues. In this regard, the

Buddhist Leadership Initiative has signicant potential to contribute to this secondary

strategy because of its implementation location at pagodas. However, to date, manage-

ment and coordination has remained at provincial level with limited engagement of local

communities in implementation.

Results at scale for children: UNICEFs engagement in Cambodia, prior to the current CPAPtimeframe, was concentrated in six of the 24 provinces. The Buddhist Leadership Initiative

has contributed to the strategy of more comprehensive coverage by UNICEF by expanding

its reach. It currently operates in ten provinces, and over its twelve years has been opera-

tional in fourteen.

Results-based programming: Systematic data collection has become instituted in the

Buddhist Leadership Initiative activities and all provinces provide detailed records of the

numbers of adults & children participating in the range of activities every quarter. Learning

and knowledge sharing takes place at annual meetings of all provincial level implementers.

The quantitative data collection allows the programme to monitor its progress and

achievement of targets easily. This is signicant in the context of the limited capacity

in monitoring evaluation of the Provincial Departments of Cult and Religion, however, it

should be noted that currently the targets are all output-based rather than outcome-basedThis means that the programme records the numbers of pagodas, villages, districts and

provinces involved, and the numbers of children and adults in receipt of activities.

Support key interventions for multi-sectoral response in HIV prevention, treatment and

care: The Buddhist Leadership Initiative has engaged the Ministry of Cult and Religion at

national & provincial level in the response to HIV, including through cross-ministry working

groups and the development of the rst national policy on faith-based responses to HIV.

The Buddhist Leadership Initiative is relevant to the following Programme Components and

corresponding Key Progress Indicators


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Two focus group participants mentioned that the rst precept conicts with income

generating activities that involve livestock. They explained that the monks promote the

message that they should not take life, not even from the smallest bird, while at the same

time the participants are or have been encouraged by Buddhist Leadership Initiative

representatives or NGOs to breed chickens and other animals. Given that vegetarianism

is not a deliberate practice by Buddhists (some participants said they could afford toeat meat only rarely) or Buddhist monks to any signicant degree in Cambodia, these

participants did not seem highly conicted by the opposing messages but they acknowl-

edged the dissonance.

The Five Buddhist Precepts or Virtues to encourage qualities such as loving-kindness and

compassion, while discouraging high-risk behaviours that were mentioned by both monks

and participants in focus groups were:

1. Abstain from taking life.

2. Abstain from taking what is not given.

3. Abstain from sexual misconduct.

4. Abstain from false speech.

5. Abstain from fermented drink that causes heedlessness.

the extent to which the initiative

supported referrals

In the fourth quarter of 2011, the BLI provided nancial support to 653 people living with HIV

to access treatment. Among the 214 survey participants, 133 said they were referred to

HIV services and 60 said they were referred to health services for non-HIV related matters.

The programme provides some nancial support to child participants ($6 USD which is for

their transport to the sessions and to spend on education or other household needs) but it

does not explicitly provide nancial support for children living with HIV to access treatment.

One monk and a handful of participants mentioned that monks discuss PMTCT servicesbut no data was collected which could indicate whether messages around PMTCT create

referrals in practice.

In the context of the Buddhist Leadership Initiative referral support means helping a

person living with HIV with nancial resources to collect their antiretroviral therapy from a

hospital or clinic on an on-going basis. This is a different denition from the more widely

used understanding in that a referral is the process of directing someone to medical care,

and once that person has been connected to the medical service that they require the

referral is complete.

the extent to which the initiative contributed

to cash support to vulnerable children

As mentioned the children participating in the BLI activities received a small cash benet of

$6 USD for their transport costs to attend the sessions at the pagoda, and the remainder

is intended for education and other household needs. Children did not participate in the

quantitative survey so detailed information is not available on the expenditure and results

of the cash support. However, anecdotally, in the focus groups with children, most said they

give the money to their parents who do the household purchasing and manage household

budgets. One boy who lives with his grandmother spends the money himself by buying food

and he explained that he likes to be able to use the money this way and feels proud to be

able to bring food to his career.


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Some of the children of adults participating in the self-help groups also benet directly

from the cash that the adults receive. Five per cent of women who received cash said they

used some of it for transport costs for education; 13 people (6%) said they used the money

to pay for their childrens education (fees and school materials); and two people said they

bought medicine for their children.

the extent to which the initiative proMoted

faMily based care for vulnerable children

Monks in focus groups reported promoting messages about good parenting skills among

adults with children, particularly by giving encouragement to children. In this way the

initiative promoted more caring family environments. This must be understood against the

background of a pilot where in 2010, UNICEF supported PDCRs in ve provinces to pilot

in selected communes the support to testing a new government guideline (Prakas) on

implementing the Alternative Care Policy. This test saw monks assisting families in crisis

situations and thereby linking the BLI to the evolving child welfare system under the Prakas.

This process included the training of all ve PDCR, MoCR focal points and monks from the

10 communes on the Prakas new procedures. During this time, monks conducted homevisits to 340 families which were believed to be at risk of separating from their children

and provided moral, spiritual and small cash allowances (one to three times per family per

quarter). Monks worked closely with commune council focal points for women and children

and district social workers. Small, regular cash transfers of $10 USD per family were used

to support vulnerable childrens basic needs and education.

A review of programme documents found that eld visits demonstrated that the support

from monks was well appreciated by government, commune workers and, importantly,

vulnerable families, many of whom were affected by HIV. The decentralized approach

greatly assisted in the forging of a high degree of involvement and ownership by PDCRs.

Moreover, visits by UNICEF staff to Tep Vong, the Great Supreme Patriarch of Cambodia,

also supported this collaboration and revitalized high-level support within the Buddhist

fraternity for this initiative. As a result of this pilot, the important role religious leaders playin protecting children at the community level was formally recognized in the Prakas

EffICIENCy

Support to orphans and vulnerable children was noted to have signicant variances in

spending between provinces in 2010. Participants were asked to review the operational

costs and reduce them where possible and a target limit was set of 25% for operational

costs in 2009 (24) and reiterated in 2011 (14).

There are potential inaccuracies in the monitoring of participants and therefore thecalculations of the costs of activity per person. An effort was agreed in 2009 that Provincial

Departments of Cult and Religion would reduce the likelihood of double counting of

orphans and vulnerable children by preparing a master plan which would include all

children who are enrolled for support (25).

Other issues of efciency were not claried in the evaluation, for example, there are costs

associated with providing cash for transport (referral support) to people living with HIV to

access treatment. The costs are for travel and allowances for a Provincial Department of

Cult and Religion representative to make a visit to each of eight districts once per quarter

to distribute the cash to 80 participants receiving this support. It is not clear why there are

separate costs for a person to deliver this support when presumably the cash could be

given to participants at the meditation sessions/self-help group meetings or during home

visits.


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The cash payments to programme participants are potentially divisive between those who

get a cash benet and those who do not, and are one of the reasons why the monks and

Provincial Departments of Cult and Religion nd it difcult to include more people in the

activities that take place at the pagoda. They nd it awkward to try and explain why most of

the participants receive cash for coming to the activity and some do not.

Another challenge related to the cash benet is that it is given to all self-help group

members and vulnerable children participants regardless of whether income is one of their

priority vulnerability factors. In identifying children to participate in the programme, income

is among the selection criteria, however, among both adults and children it is hard for the

Provincial Departments of Cult and Religion to differentiate which participants are poorer

than others. From the focus group discussions and the survey data it seems that some

of the participants are living in severe poverty and that the cash helps them signicantly.

However without facilitating any routes to increase their income on their own, the practice

of giving cash seems likely to be needed indenitely for some of the participants.

Although in earlier joint reviews of the programme, Ministry of Cult and Religion & UNICEF

agreed that the Buddhist Leadership Initiative would be integrated into the ministrys

workplans, there seemed to be mixed views within Provincial Departments of Cult andReligion as to whether this had happened. One Provincial Department of Cult & Religion

director was condent that the programme had been integrated into its work plan, while

others were adamant that it had not. Regardless of whether the activities are integrated

into workplans, a senior representative from the Ministry of Cult & Religion highlighted

the fact that the ministrys structures are not designed to implement a programme of

this nature. This accounts in large part for why the activities are implemented with higher

costs compared to other initiatives of a similar nature: the Buddhist Leadership Initiative

activities are not part of the ministrys core business, and every activity that a provincial

or district representative participates in incurs allowance and travel costs for each person

per activity. A comprehensive cost comparison with a range of other implementing organi -

sations was not possible within the time constraints of this evaluation; however the costs

of the home visits within the BLI were compared to home visits of an NGO. Essentially the

NGO could make 10 times the number of home visits per quarter as one of the Provincial

Departments of Cult and Religion.

In 2009 the costs of home visits in the programme were reviewed and found that on

average, home visits cost $35 USD to deliver $20 USD (24). A maximum target of 25% for

administrative costs was set for home visits in 2009 (24). Some cost-comparison tables/

charts were included in an annual meeting report which highlighted the variances in

expenditure between provinces for the second quarter of 2011 (26). Some of the differences

seem to be caused by the differences in distance that monks had to travel to visit people,

and the suggestion was made that more pagodas should be involved, particularly those

more local to where people live. Overall it seemed that there was some tension between

UNICEFs expectations about how the provinces spend and monitor their budgets (14) (26)

and the provinces capacity to increase their efciency.

The 2010 annual review meeting discussed the difference between the costs to provide

meditation sessions between two provinces when they reached the same number of people.

The suggestion was made that provinces that spent more should review the situation with

the staff that manage the activities to nd ways to achieve the same results with less money

(14). The efciency of the programme is hampered by the distribution of incentives

both to the implementers and the programme participants. Incentives are requested by

the government to perform tasks and providing them is common practice in Cambodia,

similar to sitting fees or meeting fees given to government ofcials who participate

in external meetings in other countries. Therefore, implementers (i.e. representatives

of Provincial Departments of Cult and Religion and District Ofces of Cult and Religion,

volunteers and monks) receive an incentive and their travel costs for each activity, as do

the programme participants. The payment per person for carrying out activities creates adisincentive among implementers to increase the efciency of the programme and reduce

implementing costs.


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Group sessions for orphans and vulnerable children are usually held at pagodas twice a

quarter for up to 30 children at each pagoda. The format consists of a monk leading the

children in meditation for ve to ten minutes and then providing advice on appropriate

behaviours, such as paying attention in school and to teachers, and respecting older

people. A representative from the Provincial Department of Cult and Religion or District

Ofce of Cult and Religion gives the children advice about hygiene, health and nutrition.

A decision was made in 2010 to increase childrens awareness of their rights as part of

the programme. Advocacy messages for monks to share during the support sessions with

vulnerable children, including children affected by HIV, were agreed at the 2010 annual

review meeting (27). In one pagoda, children were informed of their rights through a written

letter which was sent to their home so they could discuss it with their parents or guardians.

ADVOCACY MESSAGES FOR MONKS TO SHARE DURING SUPPORT SESSIONS FOR

VULNERABLE CHILDREN

1. Children and adults who have HIV or another chronic illness have the same rights

than all other people and deserve respect and compassion.

2. All children have four fundamental rights:

You should not suffer discrimination.

Your best interests should be at the top of the agenda when decisions affecting

you are being made.

You have the right to survive and develop. This includes the right to mental and

physical well-being.

You should be free to express your views. And these views should be taken into

account in all matters that affect you.

3. You have the right to have a name. The birth of any child should be registered with

the commune council within 30 days after the child is born.

4. You have the right to be protected from physical and mental injury and abuse, and

from neglect, whether youre living with your parents or other approved caregiv-

ers; no one should hurt you.

5. HIV is not transmitted by everyday contact. HIV is not transmitted by: hugging,

shaking hands, everyday contact, sharing bed or food, mosquito and other insect

bites.

6. Education gives you choices & the condence to take advantage of those choices.

7. Education is not just good for you as an individual. If you are educated, you can

share what you have learned with your family and friends.

8. Washing hands with water alone is not enough! Proper hand washing requires

soap and only a small amount of water. Hand washing with soap can preventdiseases. You have to wash your hands at two critical moments: before touching

food and after using the toilet, and always with soap! You should wash your hand

while signing Sa-at cheanich.


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negotiated with the head teacher for her granddaughter to register at the school at no

cost. But having successfully achieved this, she did not dare to try and negotiate any other

discounts (i.e. for fees for the private afternoon schooling). The girl has one notebook for

her school work which she writes in for all her subjects. She grows some vegetables and

can sometimes sell them for 500-1000 riel ($0.12-0.25 USD).

In contrast another girl in the same group lives with her mother who owns a food stall

selling noodles and earning approximately $5 USD a day. Her mother has successfully

negotiated all of her daughters afternoon private schooling for free with the teachers. The

girl also earns money herself with her friends when she is not at school by carrying bricks

from the factory to the truck; they earn $2.50 USD per day which they share between them.

The isolation of the girl living with her elderly grandmother with zero income except the

occasional sale of some vegetables and living off the goodwill of her neighbour made

her seem exceptionally vulnerable in comparison to her peers in the same group. But the

activities at the pagoda did not seem to meet her specic needs. She seemed to be in a

precarious position and in need of food and safe adult supervision. The sessions at the

pagoda provide her with peer support, friendships and good advice, and she receives $6

USD (twice per quarter) and some in kind support such as school materials. However, thissupport does not address the underlying causes of her vulnerability.

All of the facilitators and monks who supported the childrens sessions seemed committed

and enthusiastic about the activity. But there were instances which raised questions

about the level of training in and understanding of inclusive practices among some of the

group facilitators. During a session for children in which a monk provided advice, there

were children loitering at the doorway and some sitting inside the wat that were ushered

outside by a facilitator because they were not OVC before the monks blessing took place.

It is understandable that children that are not ofcially part of the programme would not

receive the resource-constrained aspects such as the money for transport but it seemed

unnecessary to reject them from the activity. In another instance, a number of children

among a large group were instructed to stand up and the facilitator explained that these

were taking daily medication, presumably identifying them as living with HIV. None of the

children standing or remaining sitting had any noticeable reaction to this announcement,

but nevertheless it seemed to be a breach of the privacy of the children if they were living

with HIV. Even if everyone in the group already knew that they were living with HIV, identify-

ing them to a group of visiting strangers (i.e. the researchers) showed a lack of judgment

and understanding regarding the childrens right to condentiality.

Overall, the outcomes of the childrens sessions were dependent on the skills and abilities

of the facilitating monk and Provincial Department of Cult and Religion or District Ofce of

Cult and Religion representative. Where a monk engaged with the children outside of the

six-weekly activities of the Buddhist Leadership Initiative, children were lively and talkative

about their participation and experiences. Where childrens participation was limited to

the six-weekly sessions there were varying responses. One group of children was visiblysupportive of each other, as they chatted and planned who would ride on which bicycle on

their journey home after the focus group discussion. In other cases, children respectfully

expressed their appreciation for the sessions but their near-identical responses could be

interpreted to reect socially desirable bias (the tendency of respondents to answer

questions in a manner that they think will be viewed favourably by others). Stigma and

discrimination remains an issue for some children, whether they experience victimisation

at school or whether they prefer to keep their visits to the pagoda a secret.


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There was a difference noted between the current activities of the Buddhist Leadership

Initiative and the practices reported by people living with HIV in the 2007 evaluation. Most

of the people living with HIV in the focus groups in the earlier evaluation said they belonged

to a self-help group that met regularly at a pagoda. The focus seemed similar to the current

programmes self-help group content: advice and discussions about health care, hygiene

and taking antiretroviral therapy. The people living with HIV surveyed in 2007 said theywere encouraged by monks to contribute money to the group to help individual members

in the case of emergency. Among the monks surveyed at the same time, 49% said they

met with the groups once a month, and 19% reported weekly meetings (12). The 2007

evaluation reported that the rationale for introducing the self-help groups was linked to the

economic impact that people living with HIV experienced as result of their status. When

asked, in 2007, who assisted them most with their economic problems, 32% of people

living with HIV said family members, 28% said NGOs, and 10% said wats and monks,

although 59% of self-help group members also said that monks provided income generat-

ing support for their group.

At one end of the spectrum, the self-help groups showed a high level of autonomy and

organisation by sub-dividing into smaller groups according to the members village/com-

mune, and with elected leaders. These smaller local groups met regularly outside of theprogrammes activities, and the members demonstrated high levels of nancial literacy

with multiple types of savings and loan schemes. In response to questioning about the

high levels of activity in the active self-help groups with savings and loan facilities, the

facilitating monk said that the people in the area were particularly entrepreneurial and

self-organised. They lived close to a major tourist destination which offered opportunities

for employment and income earning.

At the other end of the scale, the activities did not seem to reect any denition of self-

help group: they were one-way information streams from facilitator to participant, and the

information given did not change over time. Male participants of one focus group described

coming to the pagoda twice per quarter for eight years and receiving the exact same

messages on health, hygiene and reminders to collect their medication. These and other

participants said they were too shy to make suggestions in the group, and in most cases

there was no opportunity for discussions or to make suggestions. They said they were

too afraid to go off-topic and talk about anything other than their health. Among the

male focus group participants mentioned, none had ever heard of a savings club. When

asked about what they might do if they could have some help increasing their income, two

responded they had no idea; that they had never thought about; and that no-one had

ever asked them before. The self-help groups should provide a support network for the

members and facilitators to help each other solve their challenges, whatever they might be.

the vulnerability of adults

The question of whether the initiative has reduced inequalities between the worst-off or

most vulnerable people and others has a more varied response. Although the activitiesincreased peoples feelings of inner strength as reported by approximately half of focus

group participants, it seemed to reduce inequalities for some but not all of the worst-off

and most vulnerable people. An obvious measure of inequality is income disparity, which,

as already mentioned, had become a key factor for many people living with HIV. At one

pagoda, four out of six participants in the focus group reported increases in their nancial

situations as a result of self-help group activities, while the other two members had

not achieved the same improvements. The range of activities that take place within the

self-help group meetings, which happen immediately after the meditation sessions, was

highly variable. Where self-help groups facilitated savings & loan facilities, or participants

beneted from income generating grants in an earlier iteration of the programme (pre-

2008) there were examples of women and men who had turned around their situations of

nancial instability and poverty. However, this success was achieved inconsistently both

between provinces and also within individual self-help groups. So while for some of theparticipants the initiative has reduced inequalities it does not seem to have a deliberate or

comprehensive strategy for doing so.


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BUDDHIST LEADERSHIP


Similarly to the disparity in circumstances among members of the childrens groups, there

were notable differences in the economic and health stability of adults within some of the

self-help groups. Statistically signicant data was not collected in regard to improvements

Buddhist Leadership Initiative Evaluation 2008-2012, Cambodia (English)

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