1. Enhancing Mobile Populations’ Access to HIV &
AIDS Services, Information, and Support
(EMPHASIS)
CARE
New Delhi
01 Sep 2010

2. 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.

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. Where will EMPHASIS work?
• Nepal-India route
– Source area (Accham and Kanchanpur)
– Transit area (Gaddachouki)
– Destination area (Delhi and National Capital Region)

11. Where will EMPHASIS work?
• Nepal-India route
– Source area (Accham and Kanchanpur)
– Transit area (Gaurifanta)
– Destination area (Delhi and National Capital Region)

12. Where will EMPHASIS work?
• Nepal-India route
– Source area (Accham and Kanchanpur)
– Transit area (Rupaidiya)
– Destination area (Delhi and National Capital Region)

13. 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
Destination
point

14. 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

15. 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

16. What has happened till now?

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Key Processes – NGO Partners
Contracted
S# Name of the Organisation Address of the Organisation Area of work Contact Person Phone Number
1 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 9830119035
Indrani Chakraborty 9830468651
4
Human Development and
Research Institute
45, Beniatola Lane, Kolkata-700 009.
Phone: 033-22192092. Kolkata Dr. D.P.Mallick 9830510911
Piuya Chattopadhyay 9830007120
Uday Sen 9831364680
5 Satyagrah Seva Samiti Ward No.2, Hata, Khushinagar, UP Gaurifanta transit, UP Er. Shri Prakash Verma 9935544534
6
Bhartiya Gramothan Seva
Vikas Sansthan (BGSVS)
929, Nazirpura, Near Tikonibagh
Police Chowki, Bahraich, Uttar
Pradesh Banbasa Transit point, UK Sanjay Awasthi 9839669663

25. Key Processes – Current activities
of the NGO partners
• Mapping
• 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.

26. 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

27. 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

28. 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 Assets
or Resources
consisting of
Recommended
Documents,
Websites,
Contacts,
Organizations…

29. Snapshots of Activities in the Field
• EMPHASIS team crosses
the heavily guarded Indo-
Bangladesh Border

30. Snapshots of Activities in the Field
• EMPHASIS team at
the Indo-Nepal Border
at Rupadiya

31. Snapshots of Activities in the Field
• EMPHASIS team at
the Indo-Nepal Border
at Gaurifanta

32. 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
– 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

33. Mapping Data - Snapshots

34. 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 -
Kanchanp
ur 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

35. Projection Analysis
• 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.

36. Estimated Mobile population in
Delhi
• Estimates from 20 locations around NCR
• Estimates of Impact Population: 3650
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 %

37. 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
• Based on the above figures, the approximate number of
impact population for EMPHASIS would be 3360.

38. 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

39. 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)

40. We enjoy our work too
• Some amazing sights
and tastes

41. Snapshots of Activities in the Field
• Visitor to EMPHASIS –
Richard Greenhalgh
(chair of CARE-UK
Board)

42. Snapshots of Activities in the Field
• Visitor to EMPHASIS – Jane Adisu &
Nino Gurgulia

43. THANKS
http://emphasis.ning.com