Enhancing Mobile Populations’ Access to HIV & AIDS Services, Information, and Support (EMPHASIS) CARE New Delhi 01 Sep 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 Destination point
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
Key Processes – Staff RecruitmentStaff 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 UnderstandingInduction 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 UnderstandingInception 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 UnderstandingNGO 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 UnderstandingCARE 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 ContractedS# 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: Delhi & Noida Mr. Sanjeev Sheel 9811173780 011-22323409, 22123950. Mr. K.K.Mishra 9911805361 1 Taimoor Nagar, Opp D-996, Near Jal Board Office, New Friends Colony, New Delhi. Phone: 011- 2 Modicare Foundation 30842100 Delhi & Gurgaon Nivedita Das Gupta 9810040777 Sandhya Mishra 9350560005 63, Rafi Ahmed Kidwai Road, Petrapole area in West Kolkata. Phone: 033-22658092, Bengal 3 Bhorukha Public Welfare Trust 22174019, 22498341, 22261196 Dr. Ishita Majumdar 9830119035 Indrani Chakraborty 9830468651 Human Development and 45, Beniatola Lane, Kolkata-700 009. 4 Research Institute 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 929, Nazirpura, Near Tikonibagh Bhartiya Gramothan Seva Police Chowki, Bahraich, Uttar 6 Vikas Sansthan (BGSVS) Pradesh Banbasa Transit point, UK Sanjay Awasthi 9839669663
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.
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 chartChat, Tele, Video Conf Discussion Transcripts forum discussion E- Discussion summary Blogs Consolidated Replies SMS Final Blog Group work Collaborative Document Uploading of Reports, Guidelines, budgets Transliteration Translated docs
Key Processes – Overcoming the communication divide across countries• Communication Flow chart Discussion Transcripts Knowledge Assets or Resources Discussion summary consisting of Recommended Documents, Consolidated Replies Websites, Contacts, Final Blog Organizations… Collaborative Document Reports, Guidelines, budgets Archives Translated docs
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
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
Estimates of Mobile population (combined-both transit sites) Total Going % to Going % to Going % to Mobile Delhi Delhi Mumbai Mumbai Others OthersSource -Accham 3253 407 13 1606 49 1240 38Source -Kanchanpur 6543 2265 35 411 6 3867 59Source -Others 15252 3919 26 3859 25 7474 49Total 25048 6591 26.3 5876 23.5 12581 50.2• 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
Projection Analysis• Approximately, 100,000 Nepali Mobile population cross over into India in a year through the two transit points• Out of that, approximately 11000 come to Delhi as destination and 8500 come to Mumbai.
Estimated Mobile population in Delhi Total Single With % age who % age who are (range) family are in India in locality for for less than 5 less than 5 years yearsPeople from 24000-2 9000-1 15000-16 70 - 75 % 60 – 65 %Nepal 6000 0000 000People from 6000-70 2500 - 3500-400 70 – 75 % 60 – 65 %Accham/ 00 3000 0Kanchanpur• Estimates from 20 locations around NCR• Estimates of Impact Population: 3650
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.
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
Budget Scenario if Mumbai included Overall Original As per S1 DeltaP1 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)
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