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

(EMPHASIS)

CARENew Delhi

01 Sep 2010

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

(EMPHASIS)

BACKGROUND

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 / Gaurifanta)– Destination area (Delhi - National Capital Region)(Mumbai)

Gaddachouki / Banbasa

Dhangadi / Gourifanta

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) (Mumbai)

Source point

Transit point

Destinationpoint

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

Sandhya Saxena (to join) 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 – NGO Partners Contracted

S# Name of the Organisation Address of the Organisation Area of work Contact Person Phone Number1 Anchal Charitable Trust, Delhi F-16, Naveen Shahdra, Delhi. Phone:

011-22323409, 22123950.Delhi & Noida Mr. Sanjeev Sheel 9811173780

Mr. K.K.Mishra 9911805361

2 Modicare Foundation

1 Taimoor Nagar, Opp D-996, Near Jal Board Office, New Friends Colony, New Delhi. Phone: 011-30842100 Delhi & Gurgaon Nivedita Das Gupta 9810040777

Sandhya Mishra 9350560005

3 Bhorukha Public Welfare Trust

63, Rafi Ahmed Kidwai Road, Kolkata. Phone: 033-22658092, 22174019, 22498341, 22261196

Petrapole area in West Bengal

Dr. Ishita Majumdar 9830119035Indrani Chakraborty 9830468651

4Human Development and Research Institute

45, Beniatola Lane, Kolkata-700 009. Phone: 033-22192092. Kolkata Dr. D.P.Mallick 9830510911

Piuya Chattopadhyay 9830007120Uday Sen 9831364680

5 Satyagrah Seva Samiti Ward No.2, Hata, Khushinagar, UP Gaurifanta transit, UP Er. Shri Prakash Verma 9935544534

6

Bhartiya Gramothan SevaVikas Sansthan (BGSVS)

929, Nazirpura, Near Tikonibagh Police Chowki, Bahraich, Uttar Pradesh Banbasa Transit point, UK Sanjay Awasthi 9839669663

Key Processes – Current activities of the NGO partners

• Mapping / Stakeholder analysis / Line Listing

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

• Status:– Mapping completed.– Stakeholder Analysis Completed– Line Listing Continuing

Mapping Data - Snapshots

Estimates of Mobile population (combined-both transit sites)

• Those from Accham, more people go to Mumbai than Delhi.• Those from Kanchanpur, more people go to Delhi than Mumbai• More number of people go to Delhi than to Mumbai from the two

source districts

 Total Mobile

Going Delhi

% to Delhi

Going Mumbai

% to Mumbai

Going Others

% to Others

Source - Accham 3253 407 13 1606 49 1240 38

Source - Kanchanpur 6543 2265 35 411 6 3867 59

Source - Others 15252 3919 26 3859 25 7474 49

Total 25048 6591 26.3 5876 23.5 12581 50.2

Projection Analysis at Transit Points - Nepal

• Approximately, 100,000 Nepali Mobile population cross over into India in a year through the two transit points[1]

• Out of that, approximately 11000 come to Delhi as destination and 8500 come to Mumbai.

Estimated Mobile population in Delhi

• Estimates from 20 locations around NCR

  Total (range)

Single With family

% age who are in India for less than 5 years

% age who are in locality for less than 5 years

People from Nepal

24000-26000

9000-10000

15000-16000

70 - 75 % 60 – 65 %

People from Accham/ Kanchanpur

6000-7000

2500 - 3000

3500-4000

70 – 75 % 60 – 65 %

Estimated Mobile population - Mumbai

• The Reaching Across Border Project carried out by FHI reached approximately 40,000 Nepali Population in Mumbai (3 years).

• The project worked with all Nepalis at certain specified areas (did not curtail impact population by source districts).

• The project worked at 4 districts of Nepal as source sites

Estimated Mobile population – West Bengal

• Approximately 7000 people cross over the border undocumented.

• Approximately 65000 people from Bangladesh are found in the locations mapped.

• Approximate number of people who have come from Jessore and Satkhira is 9750

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

Key Processes – Overcoming the communication divide across countries

• Communication Flow chart

E-forum discussion

Blogs

Chat, Tele, Video Conf

SMS

Discussion summary

Discussion Transcripts

Consolidated Replies

Final Blog

Group work Collaborative Document

Reports, Guidelines, budgetsUploading of

Transliteration Translated docs

Key Processes – Overcoming the communication divide across countries

• Communication Flow chart

Discussion summary

Discussion Transcripts

Consolidated Replies

Final Blog

Collaborative Document

Reports, Guidelines, budgets

Translated docs

Archives

Knowledge Assetsor Resourcesconsisting of RecommendedDocuments, Websites, Contacts, Organizations…

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

Snapshots of Activities in the Field

• EMPHASIS team at the Indo-Nepal Border at Gaddachouki

Snapshots of Activities in the Field

• Meeting with stakeholders at various locations

Snapshots of Visitors in the Field

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

Snapshots of Visitors in the Field

• Visitor to EMPHASIS – Jane Adisu & Nino Gurgulia

Who will EMPHASIS work with?

• Impact population (revised):– Mobile population from Nepal and Bangladesh to

India.– Mobile Population from Accham and Kanchanpur and

Jessore and Satkhira only– Both Men and Women (Single men and all women)– Come to India for at least three months at a time– Have been in India for less than 5 years– Spouses left behind at source sites

Budget Scenario if Mumbai included

  Overall  

  Original As per S1 Delta

P1 544,056 576,874 (32,818)

P2 32,475 93,410 (60,935)

P3 15,272 15,888 (616)

Mgt & Operation 669,161 687,738 (18,577)

  1,260,964 1,373,911 (112,947)

SPC 75,658 82,435 (6,777)

Total 1,336,622 1,456,346 (119,723)

THANKS

http://emphasis.ning.com