Cross Impact Analysis - Scenario Examples

The Community

In the community there have been many cases of AIDS. Generally the families known to have been infected were poor, but it is rumored that members of wealthy families have also been affected. In one case, two children, aged 5 and 7, are living with their grandparents since the deaths of their father (a trucker) and their mother. A local doctor is providing financial assistance. Their paternal uncle has occupied the house.

Some women have returned with their children after living in major cities. Rumors circulate about their return. They are depending on their families for support.

In the markets a stall-holder is experiencing a dramatic loss of business following rumors about the death of his new-born baby. Elsewhere in the market prices for goods and fuel transported from the city have been rising. Truckers say that city prices are rising steeply and that people should be grateful for regular supplies, as many truck drivers are too ill for consistent work. Business is thriving for bars, cafes and traditional healers.

Production has dropped at plantations because of frequent absence of female wage labourers. For management, this is compounded by difficulties in transporting products to markets.

At one tannery there is a strike with workers refusing to work with a cutter who has HIV. One of his fellow employees learnt this from a girlfriend who is a nurse at the hospital. The head office in the capital has stated there is no need to sack a good worker.

A few community organizations are becoming involved in HIV work. However, they are experiencing many difficulties.

The task is to develop a comprehensive and multisectoral programme using the cross matrix analysis.

Cross Impact Analysis - Situation Analysis

Critical data

1. Social (services) - Health / Education

Many AIDS cases

- Mainly among poor families
- But also in some wealthy families

Visible phase of the epidemic (AIDS)

- Substantial number of infections

Potential vectors

- Truck drivers
- Bars and cafes
- Women returning from cities to villages

2. Social (Institutions)

Solidarity and cohesion affected

- Increasing dependency ratio following return to community with their children, of women who lived in major cities
- Active community-based organisations but facing difficulties
- Orphans under care of strangers

3. Economy

Decreasing income

- Loss of transfers formerly remitted by women who return from major cities
- Difficulty in transporting goods from plantations

Decreasing production

- Plantations: frequent absences
- Manufacture: tannery, strikes

Inflation
- Increasing transport costs: truck drivers falling ill
- Rapid increase of prices in goods

Ethical issues and human rights
- Lack of confidentiality (hospital, nurses)

4. Analysis

AREAS	CONSEQUENCES OF THE EPIDEMIC ON THE AREA
1 ECONOMY 1.1 Agriculture 1.2 Manufacture 1.2 Commerce 1.4 Transportation 2.2 Energy
2. SOCIAL 2.1 Health/Education 2.2 Family/Community structures
3. POLITICAL 3.1 Human Rights 3.2 Government

The Strategic Planning Process

Purpose and Rationale

Reality dictates that maximum results have to be achieved through the judicious use of available resources. Strategic planning is essential and this exercise provides an opportunity for participants to reflect upon how this might be done.

Procedure

Participants work in small groups to develop strategic plans. It is suggested that they review the unfolding scenarios, demographic silhouettes and cross matrix exercises. Distribute to participants the hypothetical planning exercise

Materials: Attached exercise.
Time: 120 minutes

Planning Exercise

1. The National Setting

The country is economically successful and has significantly raised the standard of living of most of its population. However, significant pockets of poverty exist.

A strong tradition of community organizations and activism does not exist but religious institutions have a significant influence in daily life. Military presence is not visible and there appears to be no problem regarding human rights.

The objectives of the National AIDS Control and Prevention Programme are:

· to prevent further infection and reinfection of people;
· to assist those affected by the epidemic to continue to live as productive, active members of society;
· to minimize the adverse impact of the epidemic on social and economic systems.

The country has a recent, growing epidemic which is still largely invisible. Some cases of HIV-related illness and death have been reported in urban areas.

Surveillance in larger towns indicates the following levels of infection:

· urban female sex workers 10-20%
· STD clinic patients, 10-15%;
· pregnant women, 1-3%;

There are concerns about working in the hospitality industry, including for example sex workers. Donated blood comes mostly from volunteers. Where testing has been done (mainly in public hospitals in larger towns) infection rates in blood donors are 1%. Government is responsible for the formulation of laws and policies in all sectors.

This is a tropical country renowned for its natural beauty and wonderful beaches. The population of 300,000 is scattered around the island. Long traditions of social support and solidarity have created closely-linked families and communities. The island receives hundreds of thousands of visitors each year. These visitors remain mostly in hotels by the beaches and have very limited in-depth contact with the local inhabitants. Most of these relationships occur through services provided in the tourist and commercial areas. Most islanders have regular contact with outsiders. A thriving, but discreet, sex industry involving women and men exists and while disapproved, is never acknowledged by officials for fear of damaging the tourism industry.

Literacy levels are high but fewer boys than girls graduate from high school. The health system is highly functional and includes a series of health care clinics around the island.

Most people are Christian and there is strong tradition of other local spiritual beliefs. The island, because of its natural beauty attracts many thousands of tourists and provides circumstances in which considerable sexual activity does occur between local people and foreigners. Because of the islands urbanised nature, young women and men move freely between the villages and the main centres for economic reasons. In addition, the country hosts a Jazz Festival early in the year, which attracts a considerable influx of people from North America and Europe. A communal festival held mid-year enjoys generous participation by a number of locals and visitors from other Caribbean territories.

Those who have become infected are mostly men and women who work in and around the tourist areas. Close social relations within the island communities have allowed their status to become known and this has led to social ostracism.

There have been highly visible prevention activities, however these have mostly been driven by the health sector. The media have addressed HIV sensitively. Hotel owners refuse to discuss the issue. Safer sex is rarely discussed and condom distribution is very limited.

3. The task

The government has limited funding for HIV and AIDS programmes. Develop a strategy for limiting the spread of the virus in the area.

¬ How can those infected be assisted to live meaningful and active lives, to continue their economic and productive activities and to raise their children and plan for their futures?

¬ How can we design and develop a strategy to minimise sexual transmission of the virus in this community and keep infections as low as possible?

¬ How can a country ensure that those infected be a central part of the national response and why should it want to?

¬ How can those affected directly assist others to change attitudes and behaviours?

¬ How can those affected assist communities to reflect on norms and values which may contribute to the spread of the virus: machismo, gender stereotypes, alcohol and drug use, lack of respect for others, prejudice, etc.?

¬ How can policies and programmes be developed and implemented in respect of tourism?