1. Enhancing Mobile Populations’ Access to HIV &
AIDS Services, Information, and Support
(EMPHASIS)
CARE
New Delhi
01 Sep 2010

2. Enhancing Mobile Populations’ Access to HIV &
AIDS Services, Information, and Support
(EMPHASIS)
BACKGROUND

3. 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.

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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

11. Where will EMPHASIS work?
• Nepal-India route
– Source area (Accham and Kanchanpur)
– Transit area (Gaddachouki / Gaurifanta)
– Destination area (Delhi - National Capital Region)(Mumbai)
Gaddachouki
/ Banbasa
Dhangadi /
Gourifanta

12. 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) (Mumbai)
Source
point
Transit
point
Destination
point

13. 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

14. What has happened till now?

15. Key Processes – Staff Recruitment
Staff 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

16. Key Processes – Common
Understanding
Induction 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

17. Key Processes – Common
Understanding
Inception 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

18. Key Processes – Common
Understanding
NGO 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

19. Key Processes – Common
Understanding
CARE 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

20. 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

21. 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

22. Key Processes – NGO Partners
Contracted
S# 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

23. Key Processes – Current activities
of the NGO partners
• Mapping / Stakeholder analysis / Line Listing
• Developed a common methodology, tools and required outputs
through a consultative process for destination and transit sites.
• Status:
– Mapping completed.
– Stakeholder Analysis Completed
– Line Listing Continuing

24. Mapping Data - Snapshots

25. Estimates of Mobile population
(combined-both transit sites)
Total Going % to Going % to Going % to
Mobile Delhi Delhi Mumbai Mumbai Others Others
Source -
Accham 3253 407 13 1606 49 1240 38
Source -
Kanchanp
ur 6543 2265 35 411 6 3867 59
Source -
Others 15252 3919 26 3859 25 7474 49
Total 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

26. Projection Analysis at Transit
Points - Nepal
• Approximately, 100,000 Nepali Mobile
population cross over into India in a year
through the two transit points[1]
• Out of that, approximately 11000 come to
Delhi as destination and 8500 come to
Mumbai.

27. 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 years
People from 24000-2 9000-1 15000-16 70 - 75 % 60 – 65 %
Nepal 6000 0000 000
People from 6000-70 2500 - 3500-400 70 – 75 % 60 – 65 %
Accham/ 00 3000 0
Kanchanpur
• Estimates from 20 locations around NCR

28. 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

29. 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

30. 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

31. Key Processes – Overcoming the
communication divide across countries
• Communication Flow chart
Chat, 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

32. 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

33. Snapshots of Activities in the Field
• EMPHASIS team crosses
the heavily guarded Indo-
Bangladesh Border

34. Snapshots of Activities in the Field
• EMPHASIS team at
the Indo-Nepal Border
at Rupadiya

35. Snapshots of Activities in the Field
• EMPHASIS team at
the Indo-Nepal Border
at Gaurifanta

36. Snapshots of Activities in the Field
• EMPHASIS team at
the Indo-Nepal Border
at Gaddachouki

37. Snapshots of Activities in the Field
• Meeting with
stakeholders at
various locations

38. Snapshots of Visitors in the Field
• Visitor to EMPHASIS –
Richard Greenhalgh
(chair of CARE-UK
Board)

39. Snapshots of Visitors in the Field
• Visitor to EMPHASIS – Jane Adisu &
Nino Gurgulia

40. 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 only
– 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

41. Budget Scenario if Mumbai
included
Overall
Original As per S1 Delta
P1 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)

42. THANKS
http://emphasis.ning.com