UNAIDS: When knowledge sharing saves lives

Applying knowledge-management techniques to help combat the spread of the HIV virus. By Geoff Parcell

I’ve just returned to BP after a fascinating and meaningful secondment to UNAIDS, the UN agency tasked with co-ordinating the response to HIV and AIDS. It’s the best thing I’ve ever applied my KM skills to. I knew I could save money for BP using KM techniques, but I didn’t realise they could also be used to save lives.

But what does an energy company like BP know about AIDS? The answer is, very little, though it is becoming more aware of it as a business issue among the workforce and the communities it works with. My knowledge of AIDS was limited to what I had picked up from the media, most memorably images of death and despair in Africa. In reality, the problem is worldwide. Some countries have managed to reduce the spread of HIV, while others face a catastrophe on the scale of that occurring in southern Africa. All projections predict the epidemic getting worse and current initiatives are insufficient. In those areas where the spread of the virus is being arrested, local response seems to have played a critical role.

So how did I get involved? Jean Louis Lamboray of UNAIDS had learnt, after living in a village in northern Thailand for several months, how people in the area had been successful in containing and reducing the spread of HIV/AIDS in their communities. He was looking for a way to share this knowledge, and someone recommended the book Learning to Fly to him. He read it in one sitting and then tracked down myself and Chris Collison, co-authors of the book, and asked us to visit him in Geneva. After our meeting, he enquired whether BP would be willing to lend me to the UNAIDS project for a year. BP felt it could not refuse such a request.

Before I realised what I had let myself in for, I was flying out to Chiang Mai in northern Thailand to learn first hand what the issues were from those infected and affected: from carers, health centres, school teachers and monks. After the first visit to a Thai village, I insisted we stop in a café to do an after-action review (AAR). The shared learning was powerful and we were able to re-use that learning on each occasion we made a visit or ran a workshop. Already we were learning from experience.

I presented work I had done with the operations community in BP – engineers and operators from refineries, factories and offshore production platforms who were striving for operational excellence. I learnt from the Salvation Army about local responses to the crisis and about the notion of ‘human-capacity development’. We saw some remarkable parallels and, over the next three months, worked with a group of people from a number of different organisations to develop an approach that relied on creating a facilitative environment, and included self-assessment, knowledge sharing and knowledge transfer.

In conjunction with UNITAR (the UN Institute of Training and Research) and the Salvation Army, we developed a project called AIDS Competence, which helped communities identify their existing strengths to respond to the issues of AIDS, as well as areas for improvement. Over the year, we visited a number of countries and communities – villages, retreats for people living with AIDS, cities, non-government organisations such as the AIDS Coalition and the Red Cross, and church-based organisations – and facilitated the sharing of experience. We visited three continents, but our approach extended far beyond.

The project culminated in a knowledge fair in Chiang Mai in July 2004, a festival where 140 people from more than 30 different nations came together and shared information on the basis of their strengths and what they needed to improve.

The approach to the crisis that we developed depends on a facilitative environment, one where interventions are less about providing material goods and more about encouraging societies to recognise their existing strengths and build on them. Ian Campbell of the Salvation Army, who has spent a lifetime working with communities around the world, says, “The capacity to respond is there locally. Human-capacity development is founded on the belief that local response is possible, that people can take charge and transfer what they learn to other communities.” From the assumption that communities are already doing something well, self-assessment helps them identify things to share and things to learn. This level of understanding is then reinforced with learnings from other communities, and lessons learnt can be captured and re-used by others facing similar issues.

The AIDS Competence approach acknowledges what is already happening to fight the spread of the disease, and encourages self-assessment as a tool that leads to the identification and exchange of strengths and practices to improve. It leads to knowledge sharing either in knowledge fairs or via electronic discussion forums, and to the capture of experience and principles for action in the form of knowledge assets. These elements, undertaken in a facilitative way, lead to an improved level of response. The collective capacity of the group to respond effectively to the HIV challenge is enhanced.

Knowledge-based benchmarking

One of the concepts I shared was that of self-assessment. Diverse operations across an energy company like BP have a lot more in common than people suppose, which means we have plenty to learn from each other. To help in the sharing process, it is possible to create a common set of measures that uses a common language. In BP, a diverse group of knowledgeable people from the operations community came together and defined 26 practices that were common to all operations, for instance safety operations and managing spare parts. For each practice, the group was able to outline five levels, level five relating to high performance and level one describing a more basic level of performance. Each operating site used this self-assessment framework to communicate with a cross section of the workforce to determine strengths and potential areas to improve operations. They each set themselves targets for a few practices they wanted to improve within a given timeframe.

After the meeting in Chiang Mai, those involved sketched out 16 practices that seemed to contribute to a community becoming AIDS Competent. They defined five levels, from basic to high. The resulting self-assessment framework was sent to the University of Chiang Mai, which tested it in a further seven communities. Within two weeks, encouraging results were returned and, over the next few weeks, the framework was developed further after it had been applied in Kenya, Uganda, Zambia and Rwanda. We froze the framework after three months, not because it was perfect but because it was good enough. It already allowed everyone to use a common language and set of assessment levels. By this time the number of practices had been simplified to ten, and the common language ensured everyone who had something to share was able to do so.

The self-assessment framework proved to be a valuable tool in encouraging communication between a diverse group of people. We used it inside the UN, at BP, in a rural community in Uganda, at a retreat for people living with AIDS and with cities such as Lyon. Whatever the group, people could recognise their strengths, share experiences and discuss their different perceptions. They could also identify and agree a number of target areas for improvement.

When a number of communities or groups had completed their self-assessment it was possible to benchmark their results against the range of responses from others to determine who there was for them to learn from and share with. We worked according to the principle that everyone has something to share and everyone has something to learn.

We used this approach at a retreat for about 50 people living with AIDS, each representing an individual district. They were enthusiastic about the approach and I recall two specific reflections: “I thought I was level five on this practice, but now I realise I have a lot to learn from others,” said one woman. Another said, “I thought we had to wait for an expert to tell us what to do next, but now I realise we can learn from others in this room.”

Knowledge sharing

In a similar vein, the knowledge-sharing events we developed were generally energetic, productive, positive occasions, as the following example illustrates.

UNITAR was running a project to help municipalities share their practices in HIV-focused services. We held a workshop in Lyon for cities around the world. Some cities had a high prevalence of HIV, others had a fewer instances of infection; some had high levels of resources to combat the virus, for instance Lyon, Barcelona and Gothenburg, while others such as Mumbai, Durban and Ouagadougou in Burkina Faso were resource poor. In advance of the workshop, all of the cities had assessed their capacity to respond to HIV and AIDS by using the self-assessment tool and involving a diverse set of stakeholders. Each city sent three representatives, one from the municipal authority – the mayor or head of the health department, for instance – one from an NGO or charity, and one person living with AIDS. For two days, people gathered together, shared with and learnt from each other. For each practice they shared, they learnt about ways in which their city could improve its response.

Indeed, it was far more than knowledge that participants left with. Lyon, as the host city, was committed to the process, but there were those who felt Lyon had more to offer poorer cities than it had to learn. But Lyon’s representatives were eager to learn about how to detect HIV infection as early as possible. The city had a growing influx of asylum seekers from eastern Europe, and too often infection was only diagnosed once a person was lying in a hospital bed with full-blown AIDS. During the sharing process, it was the president of the truck-drivers association of Ouagadougou who shared experience about testing for a highly mobile population of migrant workers. The solutions were fair, practical and cheap. The Lyon representatives scribbled furiously in their notebooks, but the greater benefit was the self-esteem the process gave the Ouagad-ougou representatives. Here was a city with a wealth of resources, listening to the experiences of a far poorer African municipality. There is no doubt that representatives from Ouagadougou went home with renewed confidence and commitment to fighting the spread of HIV.

A similar workshop had been held in Curitiba, in the south of Brazil, some months earlier, with the aim of allowing Brazilian cities to get together and share details about their response to HIV. Initially there was some doubt that a mega city such as Sao Paolo, with a population of about 12 million people, could learn from the likes of Manacapuru, a small city of 60,000 people on the banks of the Amazon. But at the end of the exchange, one of the representatives from Sao Paolo observed, “At the beginning we asked ourselves what we could learn from this woman from the jungle; ours was a much larger-scale problem. But when we talked, we realised we were both working in jungles: hers was made of trees and ours of concrete. We are very interested in some of her responses to the crisis and will adapt them to use in our own context.”

Building knowledge assets

One of the lessons we learnt in BP was the value of replicating ideas that had worked in one refinery in other locations around the world. In northern Thailand, HIV prevalence has fallen from over 18 per cent of a sample population to less than one per cent in a little over ten years.

What lessons can we share with Africa and other nations at risk so that they too can reduce the spread of the virus and improve the quality of life of those affected? At each knowledge-sharing event, we collected evidence of actions for communities to improve upon based on a range of experiences. This was added to in electronic discussions and has been collated and linked under the ten practices identified via self-assessment. For each practice, there are a set of principles for action and advice for the next group wanting to apply the practice. Each principle is illuminated by a number of real-life experiences. We are also working to identify the resources that will help in applying the principles: reports, web pages and subject-matter experts.

Experiences are also summarised to make them more accessible to those who join the discussion late. In a sense, these appear in a similar way to the FAQs one encounters every day on the internet. Many of these summaries look like common sense. There is, however, a huge difference between common sense and common practice. The latter relies on a good network of practitioners who realise they are facing the same issue and may have some insights that could help others.

When a new experience runs counter to established principles, it is debated by the community and the advice is amended if appropriate. In this sense, the work is never completed. A knowledge asset is not something to be published and then put on a shelf, but rather a living, organic process of sharing experience and drawing out common principles.

Evidence of success

We believe that what we are doing and sharing in this project is having a massive impact, but it is naturally very difficult to measure progress. It typically takes eight years from contracting the HIV virus before visible signs of the immune system breaking down emerge. During that time, a person appears and feels as healthy as someone without the virus. That’s a long time to wait to see if what we are doing is making a difference.

The clearest signal we have is that communities, municipalities and organisations are taking responsibility for their own response to HIV and AIDS. They are actively working together to improve the quality of life for those affected. There is an undeniable spirit of solidarity. For example, Mumbai is committed to sharing successful approaches between different neighbourhoods of this huge city. Durban has a vision of an AIDS-free generation by 2020.

In Brasil, organisations have already shared what they are achieving with cities in neighbouring countries. And in north-east Thailand, while limited funds have hindered regular knowledge-sharing workshops, authorities are committed to continue sharing with each other because they know it is making a difference in their communities.

I have had a fascinating opportunity to be involved in making a difference to people’s lives using knowledge-management techniques honed in a business setting. I am now back at BP, but cannot let go of what we have started at UNAIDS. The work continues, and our aim is to spread the self-assessment approach faster than the HIV virus travels.

Geoff Parcell is a senior adviser in knowledge management at BP. He can be contacted at geoff.parcell@practicalkm.com.