Enhancing Mobile Populations’ Access to HIV & AIDS Services, Information, and Support

(EMPHASIS)

CARENew Delhi

09 April 2010

What is EMPHASIS ?

• EMPHASIS is a 5-year initiative funded by the Big Lottery Fund, UK

• The programme aims to – reduce the vulnerability of key mobile populations to

HIV & AIDS along two mobility routes between Bangladesh/India and Nepal/India by delivering focused interventions at source, transit and destination points

– influence national and regional policies relating to safe mobility through evidence generated regionally.

Rationale for the Project – Mobility between the three countries

• High mobility exists between Bangladesh, Nepal and India – Poverty– high unemployment– political instability– differential economic opportunities

• Mobility has been necessary for the economic survival of families in both urban and rural communities of Nepal and Bangladesh

Rationale for the Project – Mobility and HIV

• Social, economic and political factors in origin and destination countries influence the risk of HIV infection– separation from spouses and families– unfamiliar social and cultural norms– language barriers– substandard living conditions– exploitative working conditions– sexual violence– isolation and stress

• These may lead mobile people to engage in behaviours, e.g. unsafe casual or commercial sex, which increase HIV risk.

Rationale for the Project – Mobility and HIV

• This risk is exacerbated by inadequate access to HIV services and fear of being stigmatised

• HIV prevalence is low in Bangladesh and Nepal

• Vulnerable mobile populations form a bridge with high prevalence areas of India

• 66% of those tested positive in a Bangladesh centre were returnees migrants

Rationale for the Project – Vulnerability of Women

• Women migrant workers – employed in unskilled jobs– domestic service or entertainment sectors– often without legal status– little access to health services– susceptible to exploitation and/or physical and sexual violence

• Women left behind at source sites– Face severe economic challenges– food insecurity– may be forced to exchange sex for food or money– At risk if their husbands return infected with HIV

Rationale for the Project – Existing responses of the Govts.

• Bangladesh recognises mobility as a major risk factor for the spread of HIV&AIDS. However, there is no programming for the mobile population in the government’s major national HIV Prevention Programmes

• In Nepal, although legislation is in place, there is a severe lack of cohesive response to address mobility and HIV systematically and comprehensively.

• In India, national programmes are constrained by the mandate to use national resources for the welfare of their own citizens, and do not address the vulnerabilities of citizens of other countries

What is EMPHASIS trying to achieve?

• Programme Goal: – To reduce the vulnerability to HIV&AIDS of populations mobile across

borders of Bangladesh, India and Nepal and to mitigate the impact on affected communities, with a specific focus on women.

• Programme Objectives – To demonstrate effective good practice models for HIV prevention, care

and support for mobile populations vulnerable to HIV&AIDS across India, Bangladesh and Nepal – for replication and scaling-up.

– To enhance capacity and contribute to government/civil society institutions and communities’ efforts to reduce the vulnerability of mobile populations and their families to HIV and to mitigate the impact of AIDS.

– To develop evidence-based advocacy and the creation of an enabling environment supportive of reducing vulnerabilities of mobile populations to HIV&AIDS

How will EMPHASIS do it?

• Programme Approach: – The programme approach will aim to answer the question: “What

approaches work with cross-border mobile populations and their families to reduce vulnerability to HIV infection?”

• The four areas of intervention will be:– Test a model of cross-border services. – Build knowledge about the mobile populations and their families

and their vulnerability to HIV infection – Build capacity of partners in the programme approach – Influence changes in relevant laws, policies, practices, beliefs,

attitudes, knowledge and behaviours

Where will EMPHASIS work?• Nepal-India route

– Source area (Accham and Kanchanpur)– Transit area (Gaddachouki)– Destination area (Delhi and National Capital Region)

Where will EMPHASIS work?• Nepal-India route

– Source area (Accham and Kanchanpur)– Transit area (Gaurifanta) – Destination area (Delhi and National Capital Region)

Where will EMPHASIS work?• Nepal-India route

– Source area (Accham and Kanchanpur)– Transit area (Rupaidiya)– Destination area (Delhi and National Capital Region)

Where will EMPHASIS work?• Bangladesh-India route

– Source area (Jessore and Satkhira)– Transit area (Petropole and adjoining areas) – Destination area (Kolkata, Howrah and adjoining areas)

Source point

Transit point

Destinationpoint

Who will EMPHASIS work with?

• Impact population:– Mobile population from Nepal and Bangladesh

to India.– Both Men and Women– Come to India for at least three months at a

time– Spouses left behind at source sites

First Year of the Programme

• Knowledge Building Phase

– Build knowledge, information, and analysis while supporting existing services for the target group.

– Using analysis, clarify assumptions about services for each of the two migration routes: Inputs → Outputs → Outcomes → Impact

What has happened till now?

Key Processes – Staff Recruitment

Staff Recruitment process started in September,2009 and all staff were recruited by January, 2010.

Staff Name Designation Place

Essa Mohammad Rafique Team Leader New Delhi

Nabesh Bohidar Manager (M-E-D) New Delhi

Anju Bala Admn Assistant New Delhi

Anupam Das Partnership Coordinator Kolkata

Surajit Chakraborty Partnership Coordinator Bahraich

Moushumi Kundu Partnership Coordinator New Delhi

Jatin Juneja Finance Officer (part time) New Delhi

Key Processes – Common Understanding

Induction Workshop (New Delhi-October 2009)

• Facilitators– Audrey Swift– Andy Melendez

• Key Outcomes:– Common understanding of the Programme Goals– Understanding of the key challenges in the

programme

Key Processes – Common Understanding

Inception Workshop (Kathmandu-Oct/Nov 2009)

• Facilitators– Audrey Swift– Andy Melendez– Ayesha Kariapper– Gulshan Rehman

• Participants: Country teams and NGO partners

• Key Outcomes:– Common understanding of the Programme

Goals and objectives– Understanding of the key challenges in the

programme– Routes– Draft Country work plans

Key Processes – Common Understanding

NGO pre-orientation workshop (New Delhi-Dec 2009)

• Participants: Potential NGO partners

• Key Outcomes:– Common understanding of the

Programme Goals and objectives– Understanding of the key

challenges in the programme– Routes– Process for NGO assessment

Key Processes – Common Understanding

CARE Staff Induction workshop (Lucknow-February 2010)• Facilitators (Md. Rafique & N Bohidar)• Key Outcomes

– Common understanding of the Programme Goals and objectives– Understanding of the key challenges in the programme– Routes– Work Plans

Key Processes – Common Understanding

• NGO Induction Workshop (New Delhi-Feb 2010) for NGO staff of Delhi/NCR

• NGO Induction Workshop (Kolkata-March 2010) for NGO staff of West Bengal

• NGO Induction Workshop – (Bahraich – March 2010) for staff of Uttar Pradesh

• Key Outcomes:– Common understanding of the

Programme Goals and objectives– Understanding Workplans and

Budgets– Mapping Exercises– Understanding on HIV and mobility

Key Processes – NGO Partners Contracted

• As the NGO partners were pre-selected, a process of NGO assessment was carried out with all the five NGOs. (Nov-Dec 2009)

• The NGO assessment was carried out by a team comprising of both programme staff and finance staff of CARE.

• Draft NGO contracts were sent to BIG through the Secretariat.

• Approval of the contracts were received in late February.

• NGO contracts were signed from the first of March

Key Processes – Current activities of the NGO partners

• Mapping + Needs Assessment + Stakeholder Analysis

• Why are these important?– Need to know who is coming, through which route and settling where.

What is the volume of mobility.– Pattern of mobility– Vulnerabilities– Need for mapping data to be rigorous.– Need for common methodology and outputs

• Developed a common methodology, tools and required outputs through a consultative process for destination and transit sites.

• Status:– Initial discussions and mapping exercises initiated in all the program

locations.

Key Processes – Overcoming the communication divide across countries

• Communication & KM - Ning

• One Stop Shop– Chat, Forum, Tele, Google-docs, Blog, Events,

Calendar, Map, Groups, Photos, videos, audios, Transliteration, Archives, Intra, Google-search, SMS-web, Wiki

• Status– Started in Dec 09, Analytics show high usage– Will require dedicated facilitator support

E-forum discussion

Blogs

Chat, Tele, Video Conf

SMS, Audio, Video

Discussion summary

Discussion Transcripts

Consolidated Replies

Final Blog

Group work Collaborative Document

Reports, Guidelines, budgetsFGD, Field or Immersion Visit

Transliteration Translated docs

EMPHASIS KM ProcessesKnowledge Assetsor Resourcesconsisting of RecommendedDocuments, Websites, Contacts, Organizations…

Archives

Financial Status• Total Budget for EMPHASIS: £ 4,999,969

Regional Budget : £ 2,143,821

Nepal Budget : £ 830,541

India Budget : £ 1,316,884

Bangladesh Budget : £ 708,723

• Project Start date is 3rd Aug’09 and ending on 2nd Aug’14.• Fund Code PN / FC : CSD010 / CS019• Expenditure till Dec’09 for Care India is £ 18,811.48.• Have signed the MOU with 5 Sub grantees in Year 1.• Constraints

– Waiting for the Foreign Contribution Regulation Act 1976 (FCRA) approval due to which we are not able to draw down the money from Care UK.

Snapshots of Activities in the Field

• EMPHASIS team crosses the heavily guarded Indo-Bangladesh Border

Snapshots of Activities in the Field

• EMPHASIS team at the Indo-Nepal Border at Rupadiya

Snapshots of Activities in the Field

• EMPHASIS team at the Indo-Nepal Border at Gaurifanta

We enjoy our work too

• Some amazing sights and tastes

Snapshots of Activities in the Field

• Visitor to EMPHASIS – Richard Greenhalgh (chair of CARE-UK Board)

Snapshots of Activities in the Field

• Visitor to EMPHASIS – Jane Adisu & Nino Gurgulia

Milestones in the First Year - India# Milestones for Year One - India Timeline Status 1 Recruitment of all staff at country and regional

level

End Qr 2 Completed

2 Training of partner NGOs on M&E

End of Qr 4 Will be done once M&E system is developed

3 Establishment of 1 Drop in Centre in Nepal, Bangladesh and India

End of Qr 3 On Schedule - Will be done by April

4 Mapping of existing service providers

End of Qr 3 On Schedule – Will be completed by April

5 First capacity building session with at least 5 NGOs/CBOs each in all countries

End of Qr 4 Will be done

6 First capacity building session with border security/ police in India and Nepal

End of Qr 4 Will be done

7 Publication of first set of leaflets and posters in India and Bangladesh

End of Qr 4 Will be done after BCC strategy is developed

THANKS

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