10th October, 2008, Compiled by E. Mohamed Rafique, Resource Person and Rituu B. Nanda, Research Associate Issued:Discussions at the AIDS Competence Process (ACP) National Learning Event gave an opportunity for the participants to suggest some future steps. Accordingly, a skeletal National facilitation team (NFT) was set up to implement the next steps. Commenting on the report of this event, members of the AIDS community suggested ways to take ACP forward in India , detailing the role of NFT, as well as its basic requirements and concerns.
Respondents recognized that with ACP taking off in India , time was ripe to introspect and draw the road-map for communities that can become AIDS Competent in the coming years. To nurture this approach, and scale up ACP, a full-time and committed NFT is vital to establishing ACP in India , discussants felt. The ‘Facilitation team’ accompanies local programs and learns from them. Consequently, this team stimulates self-assessment, discerns the impact of the program, as well as shares and transfers lessons. India is ready for implementing a Facilitation team approach, subscribers assured.
Expansion of NFT must be democratic, based on self-selection of participants from different organizations and communities, who represent their own experience and that of their organization. Respondents realized that in constituting such a group, often there will be invitation for some at the beginning. Then as people get involved, usually through SALT visits, some will drop out and others will join in. However, discussants deduced that a permanent core group will remain, that develops the practice. With ACP spreading across Indian states, the core group will stimulate invitations from communities and respond with SALT visits, and follow-ups.
The NFT can depend for its communication primarily on a free e-discussion forum and web space with limited physical meetings, participants recommended. Some ACP members could support the NFT technically and financially, or act as the secretariat for the NFT. The secretariat could be strategically located probably in multiple places, to cater to different regions. Thus, subscribers advocated different organizations could act as regional offices for the NFT.
Support systems can be diverse and multiple, members noted. As local demonstration points begin to develop and become insightful in their practice, the NFT must look for opportunities to invite ‘newcomers’ into the situation for learning and transfer to other locations. Thus, even local communities are part of the support, as they are demonstrations of the way of working.
Support and learning visits
The NFT can support communities to develop their competence by organizing learning events, support visits and knowledge fairs. Visits need not be expensive or long distance, respondents commented. Moreover, neighbouring teams can visit the communities. The groups representing different responses can get together more locally, in states, and periodically at a national event, as supported by the ADB funded process.
Participants emphasized documenting and validating how Salvation Army built on culture, tradition and religion to put together the community’s response to HIV. Subsequently, this document could help NFT to clone the success of Salvation Army, which began the history of ACP in India . In addition, discussants were emphatic that NFT and those interested in propagating ACP must cater to the needs of the communities like:
· Transferring the success and lessons learnt in ACP between sites or states that are similar,
· Mentoring new organizations into the ACP fold,
· Taking the needs of the communities served by the new organizations into consideration for facilitating ACP
Health care settings
With doctors and nurses busy in Care and Support to spare time for long sessions, members suggested having a customized training wing of the NFT for those who would like to join the group of ACP practitioners. In addition, ACP in India must take up the issue of making the hospitals in the country friendly to People Living with HIV (PLHIV). Furthermore, respondents hoped that the NFT would provide for individual patient needs with a good Care and Support program. Members stipulated appropriate treatment and medication from within the community, rather than offering a referral. Therefore, they surmised that if NFT could integrate and emphasize treatment and support of PLHIV, in India ’s ACP program, it would see more buy-in from the PLHIV community.
Involve stakeholders in ACP
Members suggested inclusion of NACO, SACS, Healthcare workers, PLHIV, NGO, FBO, private sector, media, youth and academia in ACP. In addition, participants insisted on mobilizing resources to meet the needs for AIDS competence activities in India . Initial seed funding can come through UNAIDS, respondents proposed. Also, UNAIDS can mentor the process and provide technical support. Further, UNAIDS, NACO, and SACS can provide probable space for secretariat and regional office. Subscribers wanted to request funds through grant proposals like Global Fund, NACP-III, and other donors. Besides, industries can take up ACP as part of their corporate social responsibility for their communities. All agreed that we cannot wait for the ideal situation to garner funds. Instead stakeholders must build on whatever was done, with the existing good will, and the volunteers. Funding agencies must visit the communities, so that they know the practical problems organizations face while implementing ACP. To disseminate the ACP concept among other NGOs and especially among SACS, members suggested:
· Invite SACS officials to ACP events and SALT visits
· NGOs which are implementing ACP can invite SACS for staff meetings
· Send the reports of ACP events to SACS and NACO
ACP and skeptics
We persuade the skeptics by demonstration more than argument, respondents emphasized. Moreover, participants looked at the need to build solidarity among those whose experiences are evolving, and share this with others with the aim of “converting" them. Further, some raised the fears that as ACP experiences are not so deep-rooted, donors might write off ACP and it will be difficult to go back to them later. Nevertheless, as we do not have evidence, let them see and believe, participants decided. The SALT visits are one of the most effective tools for influencing people to reconsider.
ACP and NACP-III
NACP-III looks at active community participation and ownership for implementation of Targeted Interventions (TI) across the country. Therefore, this is an appropriate time for ACP to establish itself and take shape in the country, members observed. Presently, there are some examples of community led interventions in different part of the country, where Women in Sex Work and MSM have taken up issues of HIV. We can connect the knowledge resources they have with others who aspire to achieve ACP for themselves and for their community.
ACP and Mainstreaming
Mainstreaming is an effective strategy for a strong response to HIV in India as it addresses in the long-term, the multiple facets and underlying causes of HIV. Practitioners confirmed that ACP achieves mainstreaming of HIV in a more holistic way, at all levels of decentralization.
ACP and Targeted Interventions
As ACP moves forward, subscribers feared that there could be resistance from veteran practitioners, who perceive ACP as something new. Therefore, we need to propagate ACP in India as a compliment to the existing work and not in isolation as a new methodology. Moreover, the training modules in TI are according to NACO guidelines and manuals. What’s more, the local training needs assessment is rare in TI. In addition, since those outside the community provide technical support and facilitate the process in TI, there is hardly any input from the community. On the other hand, ACP is not about doing something new, members said, but an approach inclusive of the community’s core beliefs and strengths. It is here that ACP scores over the Targeted Interventions.
· Use ACP to stimulate political response to ensure “Universal Access to Treatment for all PLHIV
· ACP practitioners must have time for more direct discussion regarding the human rights of persons living with and affected by HIV
· Keep the commitment high of ACP practitioners and sustain the volunteers by a recognition system tied into the process
· A documentary film on the ACP field visit experience will augment the introductory presentations
· Strengthen the NGOs strategy and build the capacity of field staff
Concisely, ACP is not a new project, discussants realised, but it is about developing a different perspective towards the existing process. Essentially, this is what makes ACP also sustainable. There are several elements of ACP already in India , with a need to further deepen the vision and strengthen the practice. However, in tailoring the response to HIV, whether it is at the community level or at the National level, members cautioned, we often lose sight of the vision with which we started. ACP depends on what each one of us can contribute to the ACP process. The roles of all stakeholders and the National ACP team must be clear especially on what they must do and how to go about it. Herein, it will be good to learn from experiences of other countries who have initiated National Facilitation Teams.
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