TI needs situation specific assesment ! Kerala, focus to be on Process !!

[Guest guest]

Dear Forum

Saw the report on the achievement of Kerala in Targeted

interventions.

I do share my happiness and sense of satisfaction to know that the joint efforts

from lot of key population members, NGO personnel, technical professionals and

the government officials in the past have yielded results.

Before concluding this as a clear indication that the achievements are

established and some other state's performance is poor we have to consider lot

of other facts and realities related to the implementation of Targeted

interventions in different Indian states.

Being a person associated with Targeted intervention in Kerala right from the

beginning I had the opportunity of being part of taking major decisions and

playing key roles in TI implementation in Kerala.

In this context, I think exploring the process through which TI process was

maturing in Kerala and making some of the innovations as replicable models, (of

course not all) could be the focus for the benefit of other Indian states.

An area of concern in this rating would be using a common tool in

ranking the performance efficiency of TIs of different states. As it

is known to all, prevailing socio political situation, baseline on

which the TI was initiated, available health and social development

infrastructure, profile of key population community members etc would

have lot of diversity, which would have direct and indirect influence

in the efficiency of TI implementation.

I am sure a common tool for assessment will not address these areas of diversity

and their influence in the TI implementation process.

If an indicator that could measure the impact of TIs in reversing / slowing down

the HIV epidemic would have been incorporated another dimension of the success

of TI could also been emerged where some state like Tamilnadu which has been

showing impressive trends in last few sentinel surveillance could have been

emerged better.

As per the HIV fact sheet published by NACO based on Sentinel surveillance from

200-2006, it is found that the HIV prevalence among FSWs in Tamilnadu have been

brought down from 8.8 % to 4.62%, among MSMs it slightly gone up to 5.60% from

4.20% and in IDUs 24.2% from 63.81%.

This achievement could be directly attributed to the TIs being implemented in

the state.

The respective figures for West Bengal rated as second best in

NACO assessment is 6.12% from 6.47 % in FSWs, 6.6% from 1.33 % among

MSMs and 4.64 % from 2.61 % in IDUs (with a relative high 7.41 % in

2005).Similarly the figures for Maharastra, the state rated as fast

improving continues to have 19.57% of prevalence among FSWs and 15.6

% among MSMs.

These figures indicate that the TIs in Tamilnadu has contributed significantly

to the HIV epidemic control.

There were good models those have emerged from Tamilnadu as well like, JAT

(joint appraisal team), demo centres, Regional training institutions run by

NGOs, Technical consultants from NGOs, Participatory Site visits etc. Many other

states have different such models worth studying and replicating.

The achievement of TIs in Kerala is the result of a consistent

partnership and the technical & operational innovations those were

added to the TIs continuously. The following milestones speak well

for itself regarding the TI emergence and shaping up process in Kerala

1. 1996-97 – The DFID (then ODA) initiated the process for TI

implementation when NGOs and professionals came up with strong debate

and suggestions for a Kerala specific strategic focus for TIs and put

forward norms those are NGO & community friendly. Most of these were

incorporated in the implementation state.

2 1996-97 The TI in Kerala was launched backed by the technical

support of " Management Agency " that was a new concept and it was

replicated later to Gujarat, AP etc and now existing in all states as

TSUs

3. The project Steering committee (Policy making level) and Core

group (monitoring level) those have been formulated as administrative

structures to the management agency have been functioning fairly well

and on structured agenda and follow up templates

4. The project contracts were continuous with timely re-

contracting (without loosing a single day) and each projects was

working in all phases on a well formulated technical contract, legal

contract and financial contract (this started by 1998)

5. Inclusion of partners representatives in the policy making

body (steering committee) from initial phase of TI implementation

gave more transparency in operations.

6. Very active and consistent involvement of KSACS officials

(including Project Directors) who are qualified and experienced both

technically and strategically to ensure that project implementation

was as per the contractual norms

7. Some of the innovations of KSACS like initiating a community

led project of PLHA groups when the group had only 7 persons in it

(in 2000) and later expanding it, creating the post of positive

speakers in TI during 2001, piloting Grama Panchayath led sexual

health intervention in 2001 which later helped develop a district

model in Malapuram, operational now have given better operational

models.

8. The partner mix in Kerala that included Medical College,

University departments, Quasi government bodies like NYK etc have

given opportunities for lots of cross learning,

9. Conceiving the concept of Transfer of ownership in realistic

terms by addressing " Exit Comfort " of implementing partners

and " Exist confidence " of the key population community to be taken in

the management unit agenda (2005 –2007)

10. Building a strong evidence base of all the relevant

dimensions through 7 research studies and integrating them into the

TI implementation frame work in 2 years (2005-2007)

11. Restructuring of the TI with clear technical and operational

clarity and cost effectiveness has given a new face to the Kerala

TIs. Time bound plan for community transfer of ownership, broadening

the field operations with lesser administrative structure and

ensuring rapid total coverage of key population have been the thrust

area.

12. Envisaging a concept of branding and standardization of TIs

that result in all TI displaying the progress of the project

activities on uniform display boards. (2006)

13. Centralized and transparent system for resource pool

development from which partners could select the TI implementation

staff (2006)

14. Sector specific capacity building through innovative

methodology to make the selected staff well verse with the program,

development of innovative communication strategy and communication

material with an interactive interlinked communication strategy for

the TIs specific for each of the thematic groups (as part of

restructuring)

Hence rather than ranking Kerala TIs are the best, it would be more

useful for the country if all the above mentioned innovations tried

in Kerala during different period are studied and their contributions

in making TIs more effective is explored. I would be happy to provide

the details of any of the above-mentioned innovations to anyone who

are interested

Regards

Dr. S.K. Harikumar

Senior Consultant in Behavior & Sexual health

Former NGO Advisor KSACS & Former Team Leader, Kerala PSU

sk.harikumar@...