Introduction The institutionalization of community mobilization is not well understood in literature. This paper aims to understand the role of the community-to-community learning strategy in the institutionalization of community mobilization among sex workers communities across eight districts of Andhra Pradesh, India. Materials and Methods Data collected during baseline (March, 2010) and endline (June, 2012) under an HIV prevention project (SAKSHAM project) was used to investigate the strength (as score) of community mobilization based on two learning strategies: non-government organization (NGO)-to-community-based organization (CBO) strategy, and community-to-CBO strategy. The strength of community mobilization was assessed based on different parameters. The change in scores were computed as a percentage of the improvement to the total potential improvement from baseline to endline on specific indicators and overall. Results Most of the CBOs considered in the pre-post assessment had been registered during 2004–2008. At baseline, the community ownership and preparedness index scores for the eight CBOs under the community-to-CBO strategy ranged between 21.5 and 27.7 while the scores for the three CBOs under the NGO-to-CBO strategy ranged between 16.3 and 21.5. By endline, the strength of community mobilization among CBOs under the community-to-CBO strategy increased 18 points (equivalent to 23% potential improvement) whereas the strength of community mobilization among CBOs under the NGO-to-CBO strategy increased only 10 points (equivalent to 13% potential improvement). The average percentage difference in improvement between the strategies was 10% (p = 0.102). Further analyses indicate that a greater improvement in community-to-CBO learning strategy was noted around managerial capacities and engagement with stakeholders than other parameters. Conclusion The community –to- CBO learning strategy presents promising results for HIV prevention with regard to institutionalization of community mobilization among sex workers communities. Findings support the scaling-up of community mobilization initiatives within HIV prevention interventions using well trained community members in India and elsewhere.
References
[1]
Chambers R (1997) Whose Reality Counts? Putting the First Last. London: Intermediate Technology Publications.
[2]
Tripathy P, Nair N, Mahapatra R, Rath S, Gope RK, et al.. (2011) Community mobilisation with women's groups facilitated by Accredited Social Health Activists (ASHAs) to improve maternal and newborn health in underserved areas of Jharkhand and Orissa: study protocol for a cluster-randomised controlled trial. Trials. 2011/07/27 ed. pp. 182.
[3]
Thomas T, Narayanan P, Wheeler T, Kiran U, Joseph MJ, et al. (2012) Design of a Community Ownership and Preparedness Index: using data to inform the capacity development of community-based groups. J Epidemiol Community Health 66 Suppl 2ii26–33. doi: 10.1136/jech-2011-200590
[4]
Michau (2007) Approaching Old Problems in New Ways. Gender and Development 15: 95–109. doi: 10.1080/13552070601179144
[5]
World Bank (2007) Community-Led Total Sanitation in Rural Areas: An Approach that Works. New Delhi: Water and Sanitation Program South Asia
[6]
Praxis (2009) Measuring Community Mobilization Processes – A Monitoring Framework for Community-Based Groups Under The HIVAIDS Programme in India. New Delhi: Praxis-Institute for Participatory Practices.
[7]
Jana S, Basu I, Rotheram-Borus MJ, Newman PA (2004) The Sonagachi Project: a sustainable community intervention program. AIDS Educ Prev 16: 405–414. doi: 10.1521/aeap.16.5.405.48734
[8]
Chattopadhyay A, McKaig RG (2004) Social development of commercial sex workers in India: an essential step in HIV/AIDS prevention. AIDS Patient Care STDS 18: 159–168. doi: 10.1089/108729104322994847
[9]
Sarkar S (2010) Community engagement in HIV prevention in Asia: going from ‘for the community’ to ‘by the community’—must we wait for more evidence? Sex Transm Infect 86 Suppl 1i2–3. doi: 10.1136/sti.2009.039289
[10]
Blankenship KM, West BS, Kershaw TS, Biradavolu MR (2008) Power, community mobilization, and condom use practices among female sex workers in Andhra Pradesh, India. AIDS 22 Suppl 5S109–116. doi: 10.1097/01.aids.0000343769.92949.dd
[11]
Cooke Kothari (2001) Participation: the New Tyranny? (Eds.). London: Zed Books.
[12]
World Bank (2012) India: Community Empowerment Key to Turning Tide on HIV. A Feature Story.
[13]
Pinto RM, McKay MM, Escobar C (2008) “You've gotta know the community”: minority women make recommendations about community-focused health research. Women Health 47: 83–104. doi: 10.1300/j013v47n01_05
[14]
Mintrom M (1997) Policy entrepreneurs and the diffusion of innovation. American Journal of Political Science 41: 738–770. doi: 10.2307/2111674
[15]
Bracht N, Finnegan JR Jr, Rissel C, Weisbrod R, Gleason J, et al. (1994) Community ownership and program continuation following a health demonstration project. Health Educ Res 9: 243–255. doi: 10.1093/her/9.2.243
[16]
Nyonator FK, Awoonor-Williams JK, Phillips JF, Jones TC, Miller RA (2005) The Ghana community-based health planning and services initiative for scaling up service delivery innovation. Health Policy Plan 20: 25–34. doi: 10.1093/heapol/czi003
[17]
CARE India (2010) Learning Sites Assessment of Targeted Interventions in Andhra Pradesh, A report. Hyderabad, India.
[18]
CARE India (2012) Community to Community Learning, A new direction for capacity building. Hyderabad, India.
[19]
UNFPA UNAIDS, APNSW (2012) The HIV and sex work collection: Innovation responses in Asia and the Pacific.
[20]
Narayanan P, Moulasha K, Wheeler T, Baer J, Bharadwaj S, et al. (2012) Monitoring community mobilisation and organisational capacity among high-risk groups in a large-scale HIV prevention programme in India: selected findings using a Community Ownership and Preparedness Index. J Epidemiol Community Health 66 Suppl 2ii34–41. doi: 10.1136/jech-2012-201065
[21]
Gaikwad SS, Bhende A, Nidhi G, Saggurti N, Ranebennur V (2012) How effective is community mobilisation in HIV prevention among highly diverse sex workers in urban settings? The Aastha intervention experience in Mumbai and Thane districts, India. J Epidemiol Community Health 66 Suppl 2ii69–77. doi: 10.1136/jech-2011-200514
[22]
Saggurti N, Mishra RM, Proddutoor L, Tucker S, Kovvali D, et al. (2013) Community collectivization and its association with consistent condom use and STI treatment-seeking behaviors among female sex workers and high-risk men who have sex with men/transgenders in Andhra Pradesh, India. AIDS Care 25 Suppl 1S55–66. doi: 10.1080/09540121.2012.749334
[23]
Galavotti C, Wheeler T, Kuhlmann AS, Saggurti N, Narayanan P, et al. (2012) Navigating the swampy lowland: a framework for evaluating the effect of community mobilisation in female sex workers in Avahan, the India AIDS Initiative. J Epidemiol Community Health 66 Suppl 2ii9–15. doi: 10.1136/jech-2011-200465