IHBP is a 3-year $32m integrated health project launched in October 2010 with PEPFAR and non-PEFAR funding, and implemented at national level and in Uttar Pradesh (UP). IHBP strengthens capacity of national GOI agencies and their state counterparts to design, deliver and evaluate behavior change communication (BCC) programs on a range of health issues. For HIV, IHBP works with NACO and the UP State AIDS Control Society (UPSACS) to strengthen institutional capacity to promote behavior changes to prevent HIV transmission and reduce stigma and discrimination through mid-media and interpersonal communication (IPC). IHBP aligns with PEPFAR/Indias Strategy goals 1 (improved access to quality services), 3 (building on country leadership and commitment), and 4 (health systems strengthening).

IHBP provides technical assistance (TA) to NACO and UPSACS via collaborative mentoring from project staff in planning, implementing and evaluating BCC campaigns, development of modules and materials, training of trainers, media planning and communications M&E. GOI will cover costs for all systems improvement actions, cascade training of health providers and field workers, mass production of communication materials, airing of media campaigns, and various campaign evaluations. Advocacy efforts will be undertaken to ensure that follow-up training and communication activities will be included in the governments annual Project Implementation Plans.

In FY12, IHBP will conduct baseline and endpoint Knowledge-Attitudes-Practices studies in districts where BCC campaigns for truckers and migrants are implemented; process evaluation to determine changes in quality of GOI BCC planning; monitoring and evaluation; quality monitoring of cascade training and follow-up after-training.

BCC activities are currently not monitored in existing M&E plans at the national and state level. In early 2012, IHBP will conduct a review of M&E related to BCC activities at the national level and in UP to assess adequacy of current M&E systems in measuring and monitoring coverage and quality of BCC activities, and to identify and prioritize gaps that can be addressed. In FY12 IHBP will support 3 additional activities to be developed based on the results of this review.

1.Support for strengthening M&E system on BCC in NACOIHBP will continue its support to NACO to strengthen its M&E system for BCC programs. While specific activities will be planned based on results of the BCC M&E review, they will include advocacy with NACO officials and program managers on incorporating BCC indicators in the existing M&E system, training of NACO M&E staff in collecting information from various levels, tracking and analyzing BCC indicators and incorporating them in M&E reports, and support implementation of the M&E system in pilot areas.

2.Support for strengthening M&E system on BCC in UPSACSIHBP will continue its support to strengthen the monitoring and evaluation system on BCC in UPSACS. While specific activities will be planned based on results of the BCC M&E review, they will include advocacy with UPSACS officials and program managers on incorporating BCC indicators in the M&E system, training of UPSACS M&E staff at the state and district levels in collecting information, tracking and analyzing BCC indicators, and support for implementation of the M&E system in pilot areas.

3.Support research to assess effectiveness of comprehensive BCC strategic plan of UPSACSIn 2012, UPSACS will initiate implementation of a comprehensive BCC strategic plan based on evidence generated from a 2011 Communication Needs Assessment. IHBP will support qualitative program evaluations, conducted in targeted areas, for early tracking of (1) acceptability of messages, materials and communication approaches among specific population segments and (2) implementation by health providers and community-based workers.

Various government and donor-sponsored reviews reveal weak capacity of GOI institutions for planning and implementing communication programs. Among the problems cited are: plans are not based on evidence and do not target behavior change of specific audiences; focus is usually on mass media and production of materials which raise awareness but are not effective in changing health behaviors; there is insufficient emphasis on mid-media and interpersonal communication activities; human resource capacity for communications is weak; and the M&E system is inadequate to track effectiveness of communication campaigns. In FY12, IHBP will support 3 activities to address these systems gaps.

1. Support capacity building on strategic communication planning, implementation and evaluation in NACO and UPSACS

IHBP will continue TA to strengthen institutional and human resource capacity in NACO and UPSACS for strategic BCC planning, implementation and evaluation. Based on an organizational assessment in 2011-2012, IHBP will continue regular technical assistance from project staff and long-term BCC consultants who will provide on-the-job mentoring and support to NACO and UPSACS IEC staff in managing various aspects of BCC work including strategic campaign planning, writing creative briefs, reviewing ad or media agency proposals, coordinating with local government on BCC, and developing mid-media and IPC campaigns. IHBP will hire creative agencies to enhance capacity of GOI IEC staff in developing creative communication materials, and media agencies to help NACO design and monitor effective media plans. IHBP will collaborate with NACO and UPSACS in developing communication-related research proposals and in overseeing research by contracted research agencies. IHBP will also support: training of trainers to enhance communication skills of health care and community-based workers; experience sharing through workshops and study visits; dissemination of best practices; and a system to recognize staff who demonstrate exemplary skills and commitment in performance of communication-related tasks.

2. Support institutional strengthening of NACO and UPSACS through capacity building of local nodal institutions

Since NACO and UPSACS will not be able to perform all aspects of communication work (e.g. production of materials, media planning, communication-related research), IHBP will strengthen local nodal institutions (academic institutions like the Indian Institute of Mass Communication, parastatal organizations like the State Institute of Health and Family Welfare, NGOs and commercial agencies) to assist these government agencies with communication at the national and UP state.

3. Provide TA for training of trainers of health care and community-based workers in UP

Stigma and discrimination continue to impede high-risk populations and PLWH from seeking diagnosis and care. Qualitative studies reveal that stigma and discrimination exist not only among the general population at the community level but also among health providers and community-based workers. IHBP will support development of innovative, participatory modules and training of trainers to reduce stigma and discrimination among health care and community-based workers in the government system and private health sector networks. It will strengthen the capacity of district level supervisors to provide supportive supervision for communication on stigma and discrimination reduction.

NACP-IV will consolidate the efforts of NACP-III to saturate coverage of MARPs and improve the quality of prevention services. In FY12 IHBP will support GOI at the national and state levels to update and improve prevention communication campaigns targeting migrants and long-distance truckers through 4 activities. The activities planned support targeted interventions carried out by NGOs and CBOs funded by UPSACS.1. TA at national level for BCC second phase campaign targeting migrants including development of communication materials and media plan.

A main goal of NACP IV is to accelerate the prevention response among MARPs. There is growing evidence that inter-state migration is fueling Indias HIV epidemic. To improve migrant access to services, in FY12 IHBP will build on the communication campaign already initiated in collaboration with NACO by strengthening campaign scale-up at transit points for migrants, and support intensive mid-media activities like song/magic shows, theater performances in trains and other education-entertainment activities. These will carry messages in line with the mass media component, including messages on stigma and discrimination.

2. TA to UPSACS to refine the communication plan to reach MARPs, update communication materials and retrain community health workers on campaign messages.

UPSACS has developed a BCC strategy targeting MARPs and vulnerable populations such as migrants and truckers in UP. IHBP will support UPSACS to refine its BCC strategy, update communication materials and messages as necessary, and provide retraining for community-based health staff on campaign messages. It will also provide technical support in monitoring and evaluating the MARPs communication plan.

3. Grants to NGOs in UP for innovative community mobilization, mid-media and IPC campaigns to reach truckers and migrants.

IHBP will award grants to local NGOs to implement innovative community mobilization, mid-media and IPC campaigns to reach long-distance truckers and migrants in UP in both source and destination areas. The BCC activities for truckers include film shows, individual or group sessions using entertainment education to desensitize and increase skills in condom use and reduce stigma and discrimination, and distribution of leaflets and flyers in transportation hubs where truckers congregate. Use of mobile phones to transmit compelling prevention and condom reminder messages will be piloted. Activities will be undertaken in migrant. Some activities (film shows, group communication sessions which will include competitions, entertainment, Question and Answer sessions) in migrant source areas will be implemented to reach migrants spouses and community influentials. These are aimed at creating an enabling social environment wherein HIV and safe sex will be openly discussed and stigma and discrimination will be reduced.

4. Quantitative research in UP to assess changes in knowledge, attitudes and prevention practices, including condom use, among truckers and migrants.

IHBP will develop a system to regularly monitor progress of NGO activities funded through the grants program. A research study will be conducted to evaluate results in terms of changes in correct knowledge, attitudes and prevention practices, including condom use among truckers and migrants. Capacity of the UPSACS network at district and block levels will be strengthened to coordinate and monitor NGO activities with support from IHBP.

NACO has dramatically scaled-up PMTCT services by establishing over 7,538 PMTCT centers throughout the country. Under NACP III, all stand-alone HTC and PMTCT Centers funded under GFATM Rounds 2, 3 and 6 were redesigned as integrated counseling and testing centers (ICTC). These centers provide HTC and PMTCT services, TB screening and linkages to ART service. NACO recognizes the need to ramp up demand generation activities to increase service uptake, and has been systematically carrying out campaigns based on the needs and gaps in the program. There is a continued need to scale-up demand generation activities as uptake of services remains below target, there is a high rate of loss to follow-up, and coverage is uneven. IHBP will support 3 independent but closely linked activities in FY12.

1. TA at national level for PMTCT campaign (based on new needs) including formative research, development of communication material prototypes and media plan.

IHBP will collaborate with NACO in designing, implementing and evaluating a demand generation campaign which will address barriers to uptake of services focusing on stigma and discrimination (thrust of NACP-IV IEC strategy). The campaign will have a unifying theme and strengthen national and state coordination regarding key messages and materials and train health providers on key messages and addressing stigma and discrimination issues. IHPB will hire creative agencies/consultants in designing the campaigns and proto-type materials. It will provide technical support for the roll-out and hire an agency to monitor and evaluate the campaigns. IHBP will also support NACO in strengthening the mid-media and IPC component of the campaign and in coordination with states.

2. Support capacity building for NGOs and civil society groups in UP to generate demand for PMTCT services.

Based on the National Family Health Survey -3, in UP womens knowledge of HIV is very low (40%), compared to that of men in UP (74%) and of women nationally (57%). Pregnant women are particularly vulnerable, especially spouses of truckers, migrants and high-risk groups. In coordination with UPSACS, IHBP will support NGOs and civil society groups to develop their capacity to promote messages regarding PMTCT at the community level. Small grants will be used for innovative community mobilization activities by these groups (e.g. use of entertainment education, local competitions, testimonials from women who accessed ICTC diagnostic services, film showings, community radio).

3. Support training of trainers of Accredited Social Health Activists (ASHAs) to communicate PMTCT messages.

IHBP will train trainers of GOI-supported community-based ASHAs, especially those operating in villages that are source areas for male migrants, to promote PMTCT messages among pregnant women and their spouses through group and individual communication sessions. ASHAs will incorporate PMTCT messages in their existing health communication functions, using existing community platforms. IHBP will support GOI to train ASHAs to organize one Village Health Nutrition Day (VHND) session on HIV and PMTCT for pregnant women, which will include reduction of stigma and discrimination. IHBP will develop a short film and prototype communication material (visual leaflet); GOI funds will be used to mass produce these materials.

Implementing Mechanism Indicator InformationRedacted