Re: Multiplicity of helplines and their effect on service delivery

[Guest guest]

Dear FORUM,

This is in reference to the posting from Mallika on multiplicity of helplines

and their effect on service delivery.

I am not sure that I have exactly understood your query about telephone

helplines. But I will try and frame my thoughts about the issue and hope that it

helps.

First, a bit about my background that might throw light on my answers. I was a

telephone counsellor in Mumbai city from 1994 to 2002 on two different

helplines. I was also responsible in part for helping Tata Institute of Social

Sciences to develop training programmes for telephone counselling for HIV/AIDS.

The result of those training programmes (held under the NACO Training Grant) was

a Source Book on Telephone counselling and later a Training Manual on the same.

Both are available at Tata Institute of Social Sciences. Please contact

carat@... for details.

Now for your question. I think you are asking about whether it makes sense for

different organisations to establish helplines in the same city at the same

time. Let's look at this from different angles.

a) From the monetary or resource angle:

If we had fewer helplines that combined their resources, we might save some

money that could be better utilised. Sure. That could be ideal. But who will

bell the cat? For organisations to pool their resources in such a manner there

has to be an atmosphere of trust and abandonment of territoriality. I see the

seeds of such collaboration in the AIDS Forum in Mumbai and the one that I have

heard operates in New Delhi. It is possible. But it takes a lot of work and

trust.

From the pragmatic angle:

Organisations have differing priorities and differing resources. So if

organisation A has funds at a particular point in time, Organisation B might not

be similarly blessed. Also, if we think of combining, it is possible that

agencies have different priorities for wanting to establish helplines. You

mentioned PSI and FPAI in your email. While I cannot claim to know the

ground-level reality in Kolkata, my experience of both organisations in Mumbai

informs me that they have very different mission statements. So, while they may

have similar interests in working on HIV/AIDS issues, they will come at it from

very different angles and probably desire to offer additional services in other

areas. These issues would also require discussion and some consensus before

approaching a collaboration.

c) From the quality of service angle:

Here, I would state quite emphatically, the more the merrier. In interacting

with different helpline personnel in Mumbai, I have observed different levels of

expertise in different areas. Some helplines are stronger in some areas while

others display strengths in other areas. Just as patients go doctor-shopping, it

has been my experience that callers also 'visit' many helplines.

It is not unheard of for a caller to tell a counsellor on the helpline, " I

called this helpline and they said this while you are telling me that. " Yes, in

a few instances, callers do report some gross misunderstandings. But for the

most part, the 'helpline-hopping' serves as a way to repeat the main message, to

play the same record. In some cases, callers are sophisticated enough to ask for

a more nuanced reply to some problem that is bothering them.

I also think that callers may have their own opinions of certain services. So

just as a patient in the Municipal Hospital will doubt that the lab report is

accurate, it is possible that callers may not trust every word on a helpline as

coming from a divine source. So different services help.

As part of the Tata Institute training programmes, I was fortunate to visit many

helplines in Mumbai. Through the good graces of NGOs in New Delhi, I also

visited some in that city. I have also visited some helplines in the US. Some

services were just a telephone and a desk in a room with other stuff happening

around.

The most sophisticated one that I have seen was the TARSHI helpline in New

Delhi. It is certainly worth a visit. But wherever I went, I learned about

different problems and the innovative ways that organisations have developed to

cope - some might work in Mumbai, some might not. But the message for me was

that we have to be open to establishing services that meet the needs of our

local communities and within our specific cultural context.

This does not mean that there are no established standards. Vineeta Chitale,

Rajiv Dua, Bindiya Nimla and myself tried to describe what we thought would be

feasible for India in our book on Telephone Counselling. It may be that what we

wrote in 2000-2001 differs from what we see in 2004. AIDS programming may have

improved and some of what we wrote is obsolete today. However, are the changes

for the better or for the worse?

The best yardstick is the number of calls and return calls that a helpline

receives. While this depends largely on the publicity of the helpline, you can

be sure that a poorly-run service will see a quick caller drop-off. Callers will

tell you quickly enough about the quality of your counselling.

Sincerely

Melita Vaz

University of Michigan, Ann Arbor.

E-mail: <melita@...>

[Guest guest]

Dear FORUM,

The concern raised by Mallika about multiple telephone help lines is

absolutely valid.

We do see a whole range of services being duplicated not only in

Kolkata but all over the country. This not only true for Telephone

help lines but for each and every aspect of HIV/AIDS programming.

Every organisation seems to reinvent the wheel each time a donor

comes in to pay for HIV/AIDS work. From communication materials,

manuals, publications everything is duplicated over and over again

with almost no value addition to the content.

The donors are equally to blame for this. Everybody is worried about

leaving their own marks on the field- visibility seems to be key

rather than effectively. Why cannot one helpline be strengthened or

expanded to provide more services. It cannot because more than the

cause the effect is important. Whose helpline will it be called-

seems to be primary.

UNAIDS has rightly called for the 3 ones policy- trying to bring some

uniformity to the chaotic scenario. But are donors listening- I do

not think so. Are the State AIDS Control Societies aware of all the

donors who are working in the state ? Are donors

proactive to put up a coordinated effort to the respond to the

epidemic?. We do hear of DAN meetings but what are the outcomes-

Hardly heard of any.

Good that somebody at least have realised the futility of duplicity

and am sure more will raise voices.

Shomik Ray

E-mail: <shomik@...>

[Guest guest]

Posted on behalf of Sanjay Chaganti, Program Director for Operation

Lighthouse, PSI's Integrated HIV prevention program.

Dear Forum:

PSI is a registered social marketing partner of the Ministry of Health and

Family Welfare and NACO. Since 1988, PSI has been involved in the social

marketing of various health products and services including oral

contraceptive pills, condoms, vitamins, safe water solutions, network of

private sector medical providers and HIV/AIDS prevention interventions.

The lack of an enabling mechanism owing to absence of adequate choice,

quality health care services, reliable information sources and counseling

facilities, has been the prime cause behind insignificant behavior change

practices in India. To achieve its behavior change goals, PSI introduced an

integrated source identity called Saadhan. Saadhan is an umbrella identity

for all RCH and STI/HIV/AIDS products, services and information (that of PSI

and beyond). For instance, PSI has developed a network of " Saadhan " private

providers in Rajasthan who focus primarily on family planning issues.

In the first quarter of 2004, PSI began the " Saadhan " help-line in Kolkata.

The helpline is part of PSI's overall objective of providing information,

counseling and referral services for a broad range of health issues and not

just HIV/AIDS. Currently, a communication campaign launched in Kolkata

focuses on increasing the saliency of the issue of HIVAIDS among the target

populations and directing them to call the Saadhan Helpline to clarify their

concerns. Subsequent communication campaigns will focus on other health

issues and refer interested individuals to call the helpline.

Therefore, it is imperative that the overall intervention is designed to

support various health issues and not just HIV/AIDS. Existing help-lines

that primarily focus on HIV/AIDS may not be able to adequately support other

health issues. The issues were discussed with the concerned WBSACS officials

prior to its start.

To summarize, the justification of opening our help-line in Kolkata are:

· The " Saadhan " helpline in Kolkata has been launched to provide a suitable

" call to action " for various health issues and not just HIV/AIDS.

· Counselors will need to be continuously trained to provide adequate

support on various health issues. PSI will do that.

Sincerely,

Sanjay

Sanjay Chaganti

Program Director

PSI India

www.psiopl.org

E-MAIL <justin@...>