Implementing Mechanism Narrative

The Connect project funded by USAID (October 2006 to September 2011), and implemented by Population Services International (PSI), aims to leverage and build public-private partnerships to increase the private sector response to HIV/AIDS and TB. The project is led by PSI and implemented in partnership with Y R Gaitonde Center for AIDS Research and Education (YRGCARE), University of Manitoba (UoM) and the Federation of Indian Chambers of Commerce and Industry (FICCI). The International Labor Organization (ILO) and the Revised National Tuberculosis Control Program (RNTCP) are technical support partners of the project.

Project Activities and Achievements:

The Connect Project aims to promote a vigorous commercial sector response to HIV/AIDS and TB by using the following innovative strategies of private sector engagement. The key achievements of the project are mentioned below.

1. Build public-private partnership models for motivating at-risk workers to adopt safer health practices in HIV/AIDS and TB

Connect in partnership with UoM, identified and prioritized the key economic sectors at risk for HIV in the state of Karnataka, to focus on behavior change among most at risk individuals. Over 239,000 individuals from the identified economic sectors have been reached with messages of abstinence and being faithful and over 470,000 with messages emphasizing risk reduction, especially condom use. More than 320 individuals were trained on these messages. Over 700 condom outlets, both traditional and non-traditional, have been established close to the at-risk communities leveraging the condom social marketing programs of PSI. Over 139,000 workers have been reached in the construction and garment sectors with TB (symptoms, diagnosis and treatment adherence) messages. 206 suspects got their sputum tested and all the 113 individuals who tested positive were put on directly observed treatment short-course (DOTS).

Eleven counseling and testing (CT) centers (five static and six mobile) have provided services to over 58,000 clients to date. Of the 11 centers, three in Mumbai and Vashi meet the Office of Global AIDS Coordinator (OGAC) criteria for public-private partnership. However, all the 11 centers qualify as a public-private partnership as per National AIDS Control Program (NACP III) guidelines and are involved in a collaboration with the local State AIDS Control Societies (SACS). Over 280 counselors and laboratory technicians have been trained in counseling and testing according to national and international standards.

2. Mobilize increased engagement of the insurance sector in HIV/AIDS mitigation in line with NACP III

Connect designed and developed India's first group health insurance scheme for people living with HIV/AIDS (PLHIV) through a public private partnership with Star Health & Allied Insurance. The pilot insurance scheme was launched in Karnataka in April 2008. The scale-up to enroll more members is currently underway in the four high prevalence southern states of Karnataka, Tamil Nadu, Andhra Pradesh and Maharashtra, and more than 1,200 people living with HIV have been enrolled so far. Capacities of state networks in Karnataka and Maharashtra have been built for awareness and mobilization. A Memorandum of Understanding (MOU) has been signed with the Indian Network for the People Living with HIV/AIDS (INP+) for advocacy with the insurance sector and the GOI (Government of India). Connect has initiated dialogue with other public and private insurance companies to look at community based insurance products as well as removal of HIV as an exclusion criteria in the existing insurance products.

3. Develop models for the prevention of mother to child transmission of HIV/AIDS (PMTCT) in the private medical sector

More than 8,900 pregnant women have been counseled and tested at three PMTCT centers at private sector hospitals in Bangalore, Visakhapatnam (Vizag) and Chennai. Of the total tested, around 360 HIV positive pregnant women are enrolled for the complete package of PMTCT services and more than 250 babies have been delivered till date. Of these, 171 babies have been tested using the DNA PCR tests, and 166 babies have tested negative (transmission rate of 2.9%). The Vizag PMTCT centre has been recognized by Andhra Pradesh State AIDS Control Society (APSACS) as collaboration with the private sector. APSACS has further invited Connect to provide technical assistance (TA) to set-up 10 additional PMTCT Centers in two districts of Coastal Andra Pradesh.

4. Build sustainable corporate partnerships and mobilize resources from industries for the cause of HIV/AIDS and TB

Connect has mobilized over USD 1.15 million in cash and kind from over thirty corporate in India for the cause of HIV/AIDS and TB. Some prominent contributors being Apollo Tyres, Tata Power, Suzlon, Johnson & Johnson, Big FM, Roche Laboratories, Aurobindo Pharma and Jindal Steel etc.

5. Strengthen the systems for scale up and transition of successful private sector approaches in HIV/AIDS and TB programming through effective linkages with the National AIDS Control Organization (NACO), SACS, USG partners, provider networks and professional and industry associations.

More than 280 companies in the public and private sector enrolled for HIV/AIDS and TB workplace intervention programs. Over 255,000 formal employees in these companies were reached. More than 450 companies successfully adopted the HIV/AIDS and TB workplace policy and many more signed the HIV/AIDS and TB pledge. Over 500 senior management members of the enrolled companies were trained on policy development and institutional capacity building. More than 400 master trainers and 1,200 peer educators were trained under the ILO's cascading model.

SACS was provided TA for targeted interventions (TI) with migrant workers and integration of workplace intervention in their annual action plan. Similarly, national, state and district-level Chambers of Commerce, industrial associations, Garment Workers Trade Union and Department of Labor were provided TA and capacities built for implementing the workplace programs and policies.

SUMMARY

Connect currently operates five static and six mobile HIV counseling & testing (CT) centers called Saadhan Clinics across project locations. The clinics are mainly targeted towards core groups such as female sex workers (FSWs), intravenous drug users (IDUs), men who have sex with men (MSM) and bridge population clients such as truckers, migrants and other at-risk groups, e.g., pregnant women, TB patients and spouses of clients having high risk behavior. The CT services are client-initiated and voluntary in nature. Up until July 2009, 'Saadhan' CT clinics have counseled and tested over 62,814 clients. The prevalence rate of those testing at Saadhan clinics is approximately 6% since their inception, which indicates that the services are successfully targeting populations at significantly greater risk than the overall population. Connect CT sites focuses on providing high quality counseling and testing as per the guidelines provided by Government of India (GOI) in the most anonymous and confidential manner. Connect emphasizes on ensuring the quality of services through regular monitoring and supervision and implementing strict quality control protocols. Connect stresses on linking the HIV positive clients to the care and treatment services and ensuring that the referred client actually avails the care and treatment services. Over 3,600 HIV positive clients have been referred to various care and support organizations. About 58% of these clients have actually utilized the care and support services.

Using FY10 funds, Connect will increase reach of its CT services to most at risk populations (MARPs) and vulnerable groups, advocate better testing methods with GOI, engaging corporate and industries to establish the public private partnership models, transition CT centers to public and private partners, document and disseminate the lessons learned from the public private partnership (PPP) models to various stakeholders.

Activity 1: Transition Connect operated CT centers to public and private partners in Most-At-Risk (MAR) sectors.

In FY08 and FY09, Connect focused on getting the Connect operated CT sites recognized by GOI as a part of National AIDS Control Program (NACP-III). All Connect operated sites are recognized by GOI. Connect leveraged support of test kits, quality assurance and training of counselors and medical technicians from GOI for its CT sites. Three Connect operated CT centers are supported by the private sector companies and corporate, under a public private partnership (PPP) as per the office of the Global AIDS Coordinator (OGAC) guidelines. One of the Connect operated CT sites in Mumbai was adopted by TATA Power, the largest corporate body in India. Additionally, this CT site is also linked with the local GOI bodies as a part of NACP-III. This public private partnership with the private sector and the local GOI body supports the staff salary, rent, demand creation activities and other running costs from the resources provided by the corporate entity and test kits, training, quality assurance of lab from the support provided by GOI. Thus, this CT site in Mumbai is sustainable and has the necessary government support to target the core and bridge population.

Using FY10 funds, Connect will mobilize resources from private sector industries and corporate to support the other Connect sites. Connect will approach the private industries and corporate in the most at risk (MAR) sector to mobilize them to adopt the CT services. Thus, during FY10, Connect will attempt to transition all CT sites to the local GOI bodies, industries and corporate. Connect will continue to provide technical support for effective operations and quality management of these sites beyond FY10, to ensure that these sites provide high quality services to the MARPs.

Activity 2: Advocating universal rapid HIV whole blood testing within CT clinics by building capacities of new service providers including community level workers.

Worldwide, rapid HIV test kits using whole blood are used for HIV testing at CT sites. The advantage of the whole blood rapid tests against the serum tests is that the test is easier to conduct (using one to two drops of blood drawn from a finger prick as against the blood drawn from the vein puncture as in case of serum testing), waiting time for results is less (10 minutes in case of whole blood test as against the minimum of ninety minutes to one day for serum testing) and it can be administered in field settings in mobile clinics or outreach CT clinics.

Universally, it is seen that there is client drop-out at government CT sites when serum testing is used and test results are not provided the same day or within the hour. There is currently no data available at the CT sites operated by GOI on the percentage of completed CT clients receiving test results and post-test counseling.

Connect will promote the use of whole blood HIV rapid testing within GOI and its partner NGOs by demonstrating its efficacy at the locations where Connect operated CT clinics are located. The advocacy efforts will involve reaching out to local District AIDS Prevention and Control Unit (DAPCU), State level SACS and NGOs to promote use of whole blood HIV rapid testing in static, mobile and in outreach CT sites.

Activity 3: Provide high quality CT services to core and vulnerable groups.

Connect CT services continue to reach the most at risk population such as female sex workers (FSWs), men having sex with men (MSM), injecting drug users (IDUs) and bridge population such as truckers, informal workers and migrant population. The goal is to reach out to male clients to affect behavior change by increasing safer sexual practices among those with multiple partners, particularly those who engage in high-risk behavior. Using FY10 funds, efforts will be intensified to further expand and reach out to the core population effectively.

Connect will also continue to reach out to at-risk women who are sex workers and wives of men partaking in high risk behavior like MSM, IDU and men having sex with commercial sex workers. Women now make up 35 percent of all new infections among adults in Asia, up from 17 percent in 1990, and are not addressed comprehensively by HIV programs. It is estimated that more than 90 percent of women living with HIV, acquire the virus from their husbands or from their boyfriends while in long-term relationships in Asia (UNAIDS). Since women are not empowered to seek health services, Connect CT sites will conduct 'outreach' CT camps with NGOs working with women, self help groups ( SHGs) and network actively with community based organizations (CBOs) exclusively working for marginalized women population.

Thus, in FY 10, Connect will actively work with NGO partners and collaborate with local GOI bodies to actively reach out to core and vulnerable, hard-to-reach populations and serve 15,000 CT clients.

Activity 4: Document and dissemination of "Best Practices in Saadhan CT Clinics" with government stakeholders and NGOs involved in CT programs.

Connect will conduct an evaluation of its various PPP CT models through external consultants/agencies. The evaluation will focus on assessing the quality of services and the impact created by Connect CT models. Connect will document and disseminate the lessons learned from PPP models of the CT services through regional level workshops to GOI, USG partners, NGOs implementing CT services. It is expected that over 50 organizations will benefit from these dissemination sessions. PSI will share tools on how "high quality" CT services and whole blood rapid tests with same-day results can be provided to most at-risk population.

Activity 5: Leveraging resources from the private sector.

Connect will focus on leveraging resources from the corporate sector to support the CT services with an objective to make the CT services sustainable beyond FY10. Connect will motivate private industries and corporations to support on the ground activities including mobile testing centers, testing kits, STI drugs, health worker salaries, collaterals and others in a designated area or across areas. The Connect project will mobilize resources by targeting large, established companies that have foundations or corporate social responsibility (CSR) initiatives which include HIV/AIDS programming. Connect will reach out to salaried individuals/high net worth individuals through payroll/online giving programs to support its CT initiative.

SUMMARY

With FY10 funds, the focus of Connect will be to document, disseminate and advocate the Connect models for strategic information that have been established and refined over the past four years. These models were established for identifying, prioritizing and selecting the economic sectors for intervention; demonstrating impact if any of health insurance on the lives of people living with HIVAIDS (PLHIV) through a quality of life assessment (QOL) and understanding the trends and patterns of corporate funding of HIV related activities as part of their corporate social responsibility (CSR). The process of refining these models was achieved through a process of peer review. Using FY10 funds, efforts will be channeled to build capacities of personnel and organizations such as USG partners, NGOs and key government institutions working in HIV and TB and broader health sector areas such as family planning (FP) and reproductive and child health (RCH) to implement interventions or formulate policies based on Connect learning. Specifically the capacities of these organizations will be built to collect and analyze strategic information relating to identifying and prioritizing work areas and decision making for initiating interventions.

Activity 1: Advocating the methodology for identifying and prioritizing most at risk economic sectors for HIV prevention programs.

Identifying and prioritizing economic sectors for HIV/AIDS programs was one of the key challenges that Connect confronted in Karnataka when the operations began in FY06. While there were many on-going efforts in implementing HIV/AIDS workplace programs, there was limited evidence and documentation available of the selection process of enterprises for implementing HIV workplace programs in India. In the absence of a robust methodology for prioritizing the economic sector, Connect developed a methodology to assess the risk levels of workforce to HIV infection in various economic sectors. In addition, an attempt was made to understand the structural characteristics of the sectors that decide the feasibility of a workplace program. The Karnataka most at risk (MAR) study conducted in FY07 was peer reviewed and published in an international journal. Based on the learning from Karnataka, Connect conducted a similar assessment in coastal Andhra Pradesh (AP) in FY08. Connect in FY09 will get the AP MAR study peer reviewed and published.

These methodologies evolved by Connect would be of immense help to similar organizations to replicate the same across other high prevalence regions in the country. In FY10, professionals from organizations such as USG partners, Government of India (GOI), nongovernmental organizations (NGOs) involved/interested in MAR will be trained to implement the methodology. Connect will also provide technical support to organizations in conducting MAR studies.

Activity 2: Dissemination of findings from the cohort assessment of quality of life (QOL)

Connect as part of demonstrating the impact of insurance coverage on PLHIV conducted the first wave of the QOL assessment for the cohort of PLHIV enrolled in 2008. The cohort was followed up in FY09 and will be done so in FY10 as well for the subsequent waves. Using FY10 funds, Connect will disseminate the findings from this assessment to GOI, PLHIV networks as well as insurance companies to provide strategic information on the impact and viability of insurance cover to PLHIV. Also, as the QOL study by Connect is one of the first community based QOL studies in India, it will also throw more light on the quality of life of PLHIV in the country. In FY10, Connect will facilitate documentation of the QOL assessment and facilitate the peer review for enhanced credibility. Technical support will be provided to organizations in conducting similar QOL assessments.

Activity 3: Dissemination of findings from the survey on corporate social responsibility (CSR) programs of high value companies in India.

From Connect's experience of mobilizing corporate resources in India, it was learnt that there is no readily available database on CSR programs of companies in the area of health. Segmentation of companies was difficult for marketing efforts due to paucity of data. In order to ensure focused efforts in mobilizing corporate resources in India, In FY09, Connect undertook a survey of top Indian corporations to understand the trends and patterns of social responsibility mandates and spending in India. In FY10, Connect will document and disseminate the findings from the survey, which will provide key insights of CSR programs in India with specific focus on HIV and TB interventions. This survey and its finding will also help GOI a better understanding on how to aligning its efforts in engaging the private sector as per the mandate in National AIDS Control Program III.

SUMMARY

In FY10 and beyond, Connect aims to become the active partner of Government of India (GOI) for mobilizing private sector insurance companies in defining their role and contribution to the national program as per National AIDS Control Program-III (NACP-III). Connect in the previous years also partnered with state nodal agencies implementing a social security scheme for low income populations for inclusion of people living with HIV/AIDS (PLHIV). In FY07, it partnered with Karnataka Network of People Living with HIV/AIDS (KNP+) and Star Health and Allied Insurance Company in India, in refining a group health insurance product for PLHIV. Star Health had earlier forayed into this untapped area by identifying it as a potential area of growth, given the lack of any other player in this field. Connects efforts in FY08 and FY09 were focused on sensitizing and mobilizing PLHIV networks/nongovernmental organizations (NGOs)/insurance companies and USG Partners for the provision of health insurance for PLHIV and demand creation for the products/schemes available. Efforts were also made to mobilize other private and public sector insurance companies to develop competitive products encompassing the needs of PLHIV. Using FY10 funds, Connect will focus on three major activities. First, Connect will transition the systems developed to mobilize and manage insured groups to PLHIV networks and other key stakeholders. Second, lessons learned from the experiences on mobilization and increased engagement of insurance sector to mitigate HIV/AIDS will be used to provide technical support to GOI and other relevant institutions to evolve viable health financing solutions for PLHIV in the country. Thirdly, Connect will use various regional, national and international platforms to disseminate the lessons learnt. Connect beyond FY10, will provide technical assistance (TA) to key stakeholders in enhancing their competencies in mobilization and managing health insurance for PLHIV as well as advocate for policy change and leverage private sector resources for marginalized PLHIV segments, such as widows and orphans.

Connect will also engage with key stakeholders in mainstreaming HIV/AIDS and TB in their existing programs for formal sector workforce. Connect will continue leveraging resources from individuals, private and public sector corporate to ensure long term sustainability of HIV/AIDS and TB programs.

Activity 1: Providing TA and building capacity of positive networks, NGOs, GOI programs as well as other organizations and to mobilize manage and scale up PLHIV insurance schemes

With the experience of facilitating a pilot insurance policy in India and the lessons learned in monitoring it over the past years, Connect using FY10 funds will continue to focus on building the capacities of the Indian Network for People Living with HIV/AIDS (INP+), regional networks and NGOs to independently mobilize, and manage insured groups. Capacities of the identified organizations will also be built in exploring health financing mechanisms for PLHIV insurance in partnership with micro-finance institutions and self-help groups. The key areas of focus for capacity building will be assessing the health needs of PLHIV, advocating with hospitals and insurance companies to provide quality services, sensitizing the insured on claim procedures and streamlining settlement processes. With the goal of supporting convergence of HIV care and support programs with existing government health and nutrition schemes, Connect will sensitize national and state government associations and NGOs working in reproductive and child health programs on the insurance model for PLHIV. It is expected that through such capacity building, the respective organizations are empowered to take direct interventions to mobilize and manage insured groups forward beyond FY10, with continued technical support from Connect.

In FY09, Connect identified and networked with GOI's social security scheme 'Rashtriya Swastha Beema Yojna' (RSBY) to extend insurance cover to low income PLHIV. Using FY10 funds, Connect will build the capacity of NGOs/CBOs in scaling up PLHIV enrollments and utilization of services under the scheme. This is an important step in building social inclusion of PLHIV, thereby reducing stigma and discrimination.

Activity 2: Transitioning of the sustainable models for financing PLHIV insurance schemes to PLHIV networks/NGOs/CBOs/other agencies

Affordability of the current insurance product has proved to be the biggest barrier to rapid scale up. The problem is further aggravated as the entire premium has to be paid as a single installment. In FY09, Connect worked on making the current insurance product/s, affordable to low income PLHIV segments by creating linkages with microfinance institutions to reduce the barrier regarding ability to pay. These learning's were documented and using FY10 funds will be disseminated to PLHIV networks/NGOs/CBOs who have been trained for mobilizing PLHIV for health insurance. This will greatly reduce the barriers on the ability to pay one time premiums for the current health products.

Activity 3: Advocate for removal of HIV/AIDS exclusion in general health policies with insurance companies and government agencies

HIV infection is an exclusion in most of the generic insurance products. With FY10 funds, Connect will continue to advocate with the insurance providers as well as policy makers for the removal of this exclusion. Connect with the evidence and experience gained through the pilot efforts in providing insurance for PLHIV will influence GOI to advocate for inclusion of PLHIV with community risk pooling and health insurance mechanisms, such as RSBY planned under the government health initiatives. Connect will also advocate along with GOI institutions in the regions/states to ensure that insurance agencies contracted to provide health insurance for poor by the respective regional institutions, do not exclude PLHIV.

Activity 4: Evaluation of the health insurance products and services/micro insurance schemes and systems established to mobilize and manage insured PLHIV groups

In FY09, Connect continued to promote the insurance products and micro insurance schemes available for PLHIV across the USG priority states in India. In FY09, Connect also developed and put in place systems to mobilize and manage insured groups of PLHIV. In FY10, various insurance products/systems for mobilizing and managing insured groups facilitated by Connect will be subjected to expert evaluations to understand how sensitive they are in catering to the needs of PLHIV in India and the viability of replication across the country.

Activity 5: Dissemination of models and lessons learned to Government agencies, other USG Partners, NGOs, Positive Networks and Insurance Providers

In FY10, Connect with technical experts will conduct evaluations, secondary analyses and documentation of health insurance and microfinance models for PLHIV. Connect learning on insurance efforts will be distilled to publications for the benefit of key stakeholders. This will act as a knowledge repository. Dissemination will also address the Ministries of Health & Family Welfare, Ministry of Labor, and Poverty Alleviation, IRDA and Women & Child Development and private sector players. Dissemination will be done through advocacy events, consultations, exposure visits, and conferences on Health Insurance for PLHIV (example FICCI/CII Conference).

Activity 6: Capacity building of government organizations, industry associations, sector specific stakeholders and NGOs for mainstreaming HIV and TB interventions within their sectors

Using FY10 funds, Connect will focus on providing TA to government departments such as the Department of Labor in mainstreaming HIV and TB interventions within their agenda. Connects support to relevant departments to integrate HIV and TB awareness education program in their existing programs will be transitioned to the mainstreaming component of State AIDS Control Societies in Andhra Pradesh and Karnataka.

FICCI and other employer's organizations in Karnataka and Andhra Pradesh will be encouraged to motivate its member companies to include HIV/AIDS and TB in their induction trainings and human resource policies.

In FY 09, different workplace models implemented under Connect will be evaluated internally as well as by external experts to find out the feasibility of replication. In FY 10, Connect will engage with GOI and other identified stakeholders to build their capacities on replicating the successful models. Connect will provide technical assistance to GOI, industry associations, sector specific stakeholders and NGOs in replicating the successful model with different groups at different locations.

Activity 7: Leveraging resources from the private sector

Using FY10 funds, Connect will partner with corporations towards establishing a corpus for a National Trust for HIV&AIDS in collaboration with the GOI. This trust will have a pool of funds available for the purpose of initially supporting the cost of insurance premiums for PLHIV such as orphans and widows, establishing, running and maintenance of all HIV and AIDS related programming efforts including PMTCT, counseling and testing, work place interventions and systems strengthening of organizations working on the issue of HIV and AIDS. Connect will also mobilize resources from high net worth individuals, private and public sector employees for HIV/AIDS and TB activities. Corporations will be motivated to support innovative programs which serve to address the brand building efforts of the corporate through CSR programs. Connect will work closely with its partners like FICCI, KCCI and other NGOs/CBO's to ensure capacity building on resource mobilization with a view to ensure sustainability of their programs through successful resource mobilization.

SUMMARY

Since FY06, Connect has reached over 250,000 workers across its project locations with messages of sexual abstinence, partner reduction and monogamy (A-B). Most of these contacts were achieved in the initial two years of the project when the PEPFAR focus was more on A-B. In FY07, following a shift in PEPFAR focus from A-B to other prevention, it was decided to scale down the number of individuals reached for A-B messages. Consequently, the number of individuals to be reached in FY08 and FY09 with A-B messages was scaled down to over 20,000. Using FY10 funds, Connect will continue to reach over 20,000 formal workers with the message of A-B through its workplace intervention programs.

Activity 1: Reaching formal sector workforce with A-B messages

In FY10, Connect will continue to reach out to the formal workers at their workplace through its workplace intervention program with messages on A-B. The workers will either be reached on one to one or in small group sessions. The messages of abstinence, being faithful, partner reduction and monogamy will be disseminated through the training sessions held for the workers. Workplace communication materials like posters, leaflets and pamphlets, based on triggers and barriers to adopting abstinence and being faithful will be developed for workers in the industrial sector who are vulnerable to high-risk behaviors. 'Master' trainers and peer educators will be trained to promote A - B messages and to foster social norms that promote risk reduction. Also, to increase senior management commitment for the cause, Connect will reach out to private sector companies to commemorate World AIDS Day.

Activity 2: Transitioning of Connect models to industrial organizations and NGOs

In FY09, Connect built the capacities of NGOs and industrial organizations in designing, implementing and monitoring of Connect models of reaching out to formal workers. Using FY10 funds, Connect will direct efforts to transition its models for reaching out to the formal workforce to these NGOs and industrial organizations. Efforts will be made to transition the overall management and knowledge of the program implementation, tools, materials and training modules for training the outreach workers for effective communication, monitoring and evaluation of the program.

Activity 3: Advocacy for scaling up program model for reaching Women in the Workforce Vulnerable to HIV/AIDS

In FY09, Connect implemented an intensive behavior change communications plan to reach out to women in the garment sector with messages promoting negotiation skills, improved health seeking behavior pertaining to reproductive health, HIV/AIDS and TB. Connect actively promoted increased use of preventive products and services; worked for increasing demand with voucher based schemes and on the ground communication activities. To improve access to services, the existing services in the public and private sector were mapped and linkages were established. Using FY10 funds, Connect will engage with local NGOs/garment workers union to implement the model established over the last year. This will involve identifying the right partner, mapping its competencies, capacity building for effective replication of the Connect model. To enable smooth transition, Connect will continue to provide technical support to the implementing organization on an ongoing basis. The learning of two years wherein Connect established a workable model of engaging with a most at risk economic sector and the transition to a local NGO/ workers union and successfully overseeing it will be documented and disseminated as a case study for advocating as workable model in other economic sectors where women comprise a majority of the workforce.

SUMMARY

Capitalizing on its experience of reaching the workers in the most at risk economic sectors, Connect will position itself as a key player in the area of interventions for most at risk workers. Since FY06, Connect has reached to more than 500,000 individuals with messages of other sexual prevention focusing on condom use. In FY07, Connect assessed the risk level of economic sectors for prioritizing the workplace intervention program in Karnataka. Construction, garment, fishing, mining and sugarcane were identified as most at risk economic sectors. Subsequently, Connect commenced behavior change communication activities in these sectors. In FY09, Connect transitioned its communication activities in the most at risk economic sectors of Karnataka to other organizations (nongovernmental organizations (NGOs) and sectoral trade unions) and measured the change in behavior. In the same year, based on the findings of the Andhra Pradesh most at risk assessment, Connect initiated behavior change communication activities in the identified economic sectors of coastal Andhra Pradesh. Using FY10 funds, Connect will focus on measuring the change in behavior amongst the most at risk workers in the economic sectors of Andhra Pradesh, transition its activities and assume a role of technical assistance (TA) provider. Connect will document and disseminate its learning and best practices based on its experiences in Karnataka and Andhra Pradesh.

Activity 1: Demonstrate impact of interventions in most at risk workers in Andhra Pradesh.

In FY09, Connect focused on demonstrating and documenting the outcomes from interventions through Behavior Change Impact Studies (BCIS) in the economic sectors of Karnataka. The BCIS measured changes brought about in behaviors among the target population due to project activities. In FY10, Connect will conduct similar BCIS in the economic sectors in Andhra Pradesh. Over 380,000 workers will be reached with 'condoms and other prevention' messages and over 20,000 workers will be reached through 'being faithful' messages.

Activity 2: Transitioning Connect models to government, NGOs and private sector organizations.

Under the mandate of the project, Connect in its final year will attempt to transition successful models of reaching out to most at risk populations. Using FY10 funds, Connect will focus on an external evaluation of the models created over the last two years. Basis the learning from the external evaluation, Connect will execute the transition of the successful model to community-based organizations (CBO) including sector specific associations/identified NGOs/government/private sector. Connect will build the capacities of identified organizations on effective management of programs across all levels including better targeting efficiency, social marketing of products and services, better monitoring and evaluation processes and tools for behavior change communication. The capacity- building plan will include training people on improving awareness on condom usage and tailoring messages related to condom use across various target populations in the most at risk economic sectors. Relying on Connect's lessons on building corporate partnerships, the identified organizations will be trained to raise resources for sustaining the programs.

Activity 3: TA to Government of India (GOI) and other private organizations.

Gaining from its experience in reaching out to the most at risk economic sectors, Connect will provide TA to GOI and other private organizations for implementation and scale up of the models. Connect will provide TA for identifying the most at risk economic sector, prioritizing the sectors for interventions and establishing the intervention models. Connect will also provide TA on development of communication tools and materials, training of the outreach workers for effective communication and monitoring and evaluation of the intervention.

Activity 4: Documentation and dissemination of best practices.

In FY10, the focus of Connect will be to document and disseminate the Connect models of reaching workers in the most at risk economic sectors. Based on an external evaluation of its intervention models the best practices will be identified. Connect will document the reasons for the success and failure of different models of reaching to MARPs with messages on other sexual prevention (consistent condom usage), lessons learned and challenges faced. The learning will be disseminated utilizing the available strategic platforms. Connect will organize national dissemination programs exclusively for this purpose. Working papers and articles based on Connect's experience will be presented at various international and national conferences to highlight models. Documents will be published in national and international journals and made available to stakeholders such as GOI, employer's organizations and other key stakeholders for wider dissemination. All publications will be made available in electronic versions as well as in hard copy.

SUMMARY

In FY08 and FY09, Connect established three PMTCT centers in the private medical sector, conducted an external assessment of its three centers and demonstrated impact. With FY10 funds, Connect will aim to become a technical assistance (TA) partner to the Government of India (GOI), United Nations Children Emergency Fund (UNICEF) and other PMTCT implementers in India. In FY10, Connect will focus on four major activities. First, Connect will transition the direct implementation of three PMTCT centers to the partner hospitals and will continue to provide TA. Second, Connect will provide TA to state AIDS Control Societies (SACS) and Federation of Obstetrics and Gynecologists Societies of India (FOGSI) for increasing private sector involvement in PMTCT. Connect will further engage the private sector hospitals through associations of private hospitals and nursing homes to motivate them to replicate the Connect PMTCT models. Third, Connect will try to influence other national PMTCT programs to replicate the best practices of Connect as identified through the external evaluation. Additionally, Connect will continue developing a knowledge bank on private sector PMTCT by documenting and disseminating lessons learned from implementing the Connect model.

ACTIVITY 1: Transition the Connect PMTCT "centers of learning" to partner hospitals.

In FY09, the Government of India (GOI) recognized the three Connect PMTCT centers under their public private partnership program. Under this program, Connect continued to leverage resources such as test kits, safe delivery kits, training and quality assurance for labs from the SACS. In FY10, Connect will focus on transitioning the service delivery components such as counseling, data maintenance and monitoring of PMTCT sites to the private partner hospitals. Connect will build capacities of the identified hospital staff in providing quality counseling and will link the PMTCT activities in overall hospital management systems.

Connect will build the capacities of local nongovernmental organizations (NGOs) and Community Based Organizations (CBOs) in demand creation of PMTCT centers and case management approach to follow-up the infected mothers and their infants. Connect team will build the capacities of the Community Advisory Board (CAB) to raise resources at the local level to support the PMTCT activities. Additionally, Connect will link the three centers of learning with other government programs such as National Rural and Urban Health Mission (NRHM and NUHM, particularly the Family Planning and Reproductive and Child Health programs), Revised National Tuberculosis Control Program (RNTCP), Orphan and Vulnerable Children (OVC) programs, Integrated Child Development Scheme (ICDS for leveraging nutritional supplements) for leveraging resources and better integration of PMTCT services with the health programs.

By the first quarter of FY10, Connect will transition its role from direct implementation and will continue to provide TA to the three sites to provide quality PMTCT services.

ACTIVITY 2: Influencing national PMTCT program to replicate the best practices implemented in private sector PMTCT.

In FY09, Connect collaborated with various key stakeholders to evaluate the private sector PMTCT programs in India and documented the best practices through a compendium. Connect conducted one national and two state level workshops to disseminate the outputs from the assessment. Using FY10 funds, Connect will make efforts to influence PMTCT implementers like GOI and UNICEF to adopt the best practices identified through the assessment in the national PMTCT program. Connect therefore, will work closely with the technical resource group (TRG) of national AIDS program for influencing national policy and guidelines on PMTCT. Connect in close conjunction with UNICEF and other key PMTCT players in the private medical sector will organize seminars and workshops highlighting the best practices in private sector that are cost effective and replicable in national program.

ACTIVITY 3: TA to GOI for expansion of public private partnership models for PMTCT integrated counseling and testing center (ICTC) services in private health sector.

In FY08, Connect initiated technical assistance (TA) to APSACS (Andhra Pradesh State AIDS Control Society) for expansion of PMTCT in private sector hospitals. As part of this collaboration, Connect partnered with APSACS to set up 10 additional PMTCT centers in the private sector in the districts of Vizag and Srikakulam of coastal Andra Pradesh (six, including existing Connect center in Vizag and four in Srikakulam district). Connect provided TA for identifying and mobilizing private hospitals for establishing the PMTCT services and monitoring the centers' activities. SACS provided test kits, safe delivery kits and training for PMTCT. The private hospital contributed the infrastructure and human resources for implementing the PMTCT services. In FY09 and FY10, Connect will provide TA to at least two other SACS (Karnataka and Maharashtra) in high prevalence states for setting up public private partnership models for PMTCT in the private sector along the lines of the centers in Andhra Pradesh.

ACTIVITY 4: Increasing private sector involvement in PMTCT through associations of private practitioners, nursing homes and corporate hospitals.

In FY09, Connect team initiated the process of engaging FOGSI for mobilizing private medical sector to establish PMTCT centers. In partnership with FOGSI, Connect conducted a mapping of the obstetricians and gynecologists in the program areas. Based on pre-determined selection criteria, Connect selected the private health facilities for establishing PMTCT centers in the private medical sector. Having selected the private medical facilities, Connect focused on providing intensive training to the designated staff of the hospitals on the various aspects (screening, counseling, safe delivery and case management) of PMTCT. Using FY10 funds, Connect will continue to provide TA and technical support visits to the private hospitals to monitor the various aspects, such as providing quality counseling, testing, and clinical care to HIV positive pregnant women and follow up of mother and baby pairs, on which training was provided to the health facilities.

Based on its experiences with FOGSI and the private healthcare providers, Connect in FY10, will identify and mobilize the private hospitals and medical institutions run by the corporate bodies and motivate them to establish and implement PMTCT services. Connect will evaluate and determine the cost effective business model of PMTCT services which would be attractive to the private hospitals. Connect will engage the private hospitals through meetings/conferences to disseminate the cost effective business model. Connect will provide TA for initiating the PMTCT services along the same lines as the other private health care providers. Using FY10 funds, Connect envisages mobilizing at least two corporate hospital bodies to establish PMTCT services.

ACTIVITY 5: Develop a knowledge bank for private sector PMTCT services.

Using FY10 funds, Connect will develop a knowledge bank for the private sector PMTCT. Connect team will come up with manuals and working papers on establishing, implementing and monitoring of PMTCT programs in the private medical sector. The key manuals are: a manual on a step by step approach for engaging private sector hospitals, establishing and implementing PMTCT services.

Connect will also develop and disseminate manuals for conducting stigma and discrimination workshops that can serve as tools for GOI and other implementing agencies to implement the stigma reduction programs in health care facilities. In addition, Connect will focus on publishing peer-reviewed articles on private sector PMTCT models in national and international journals to disseminate the lessons learned from Connect sites.