Community, Infant Feeding, and AIDS: Empowerment Evaluation in Rural Eastern Cape

As a part of a three week learnership practicum, empowerment evaluation principles and practices were applied to antenatal and postnatal infant feeding counseling services offered by Iapile Gateway Clinic’s prevention of mother to child transmission (PMTCT) of HIV program. Empowerment evaluation engages stakeholders through the processes of planning, implementation, and evaluation, ultimately building these stakeholders’ capacities to sustain and improve services. Because of powerful sociocultural norms regarding infant feeding, empowerment evaluation was selected as a tool that would allow for sustainable and hermeneutic evaluation of the program, taking into account its dialectic relationship with local knowledge on infant feeding. Data on resources, strengths, achievements, challenges, and recommendations was collected through a series of formal and informal discussions with key personnel while assisting with daily duties. Additionally, baseline data was extrapolated from records routinely kept by the clinic. Generally, the antenatal and postnatal infant feeding counseling programs were highly efficient, testing and monitoring a large number of clients, given resource constraints. The programs were largely challenged by a shortage in highly trained personnel, a lack of social support for PMTCT clients, and incongruent record keeping for postnatal tracking. Recommendations thus included further skills development of staff, creation of a PMTCT-specific support group given the facilities and resources, and increased tracking of postnatal exposed infant health. With the last recommendation enacted, the program will have greater capacity for self-monitoring and will be able to better tailor the program to the needs of the clients. The evaluation was generally successful in its implementation of empowerment evaluation methodology, revealing the promise of improved community health promotion through the utilization of action research methods. Limitations of empowerment evaluation and action research are finally explored and recommendations for further study are offered