TOOLKIT15 August 2000
Acknowledgements
Appendix 1: Participants at the HIV and Development Workshop, New Delhi, February 1998
United Nations Development Programme & The HIV Epidemic Since the late 1980’s, UNDP has made concerted efforts to raise awareness and understanding of the social and economic impact of the HIV epidemic on human development. This body of experience has led UNDP to believe that achieving high levels of development is the assured and sustainable response to the HIV epidemic. The Report of the Administrator to the Executive Board of the United Nations Development Programme and of the United Nations Population Fund’s Second regular session 13-17 June, 2000 argues that as the epidemic continues to spread and its consequences become more visible, sustained political and social mobilisation are essential if effective and intensified action on the ground is to be supported. UNDP’s proposed strategic plan for HIV/AIDS for 2001-2005 includes several elements, among them:
Approaches utilised in realising the above will include:
It is within this institutional and policy framework that the UNDP HIV and Development Programme is located and from which the Strengthening Community-Based Responses to HIV/AIDS in India project was initiated. The history of the project actually goes back to 1995 when UNDP provided support for a situational assessment and needs analysis of NGOs in India in relation to the HIV epidemic. This activity highlighted the need for increasing partnership between government and NGOs and for capacity development among NGOs. Follow-up visits were undertaken by a consultant over the course of the next two years and these drew attention to the need for enhanced understanding and skills in the use of participatory approaches consistent both with the community focus of these NGOs and appropriate to generating the kinds of solutions to the epidemic which would be locally relevant and sustainable. In many countries, initial responses to the HIV epidemic seem to have been based upon the assumption that fundamental problem to be addressed is one of lack of knowledge, and that, in itself, the provision of information will lead to changes in behaviour. Hence, drawing upon experiences of other health and development issues such as population and reproductive health, countries have invested in large-scale "IEC" campaigns, sometimes in combination with more focused programmes for specific groups. Thus, in India, mass awareness IEC campaigns have been initiated on HIV/AIDS using lectures, film shows, radio talk-shows, posters, flip charts, printed leaflets, transparencies, and messages inscribed on items of every day use such as combs, mirrors, and bindi packages. However, the large-scale nature of such activities has resulted in content, which tends to be general rather than specific, simple rather than complex, and externally determined rather than locally generated. Not surprisingly, impact evaluation consistently reveals significant potential in terms of creating changes in awareness but much less convincing evidence to demonstrate any significant impact upon behaviour. One broad conclusion from this experience is that awareness is a necessary, but rarely sufficient step in the process towards behaviour change. Another broad conclusion is that risk-associated behaviour such as unprotected sexual intercourse or sharing of equipment among injecting drug users, are essentially social behaviours involving more than one person and occurring within specific social, cultural and economic settings. Thus the focus of programmes needs to shift from the level of the ‘individual’ to that of the ‘community’. In many communities the most credible sources of support are the numerous NGOs which are involved in local health and development issues. Furthermore in many countries, particularly in India, there already exists a vast accumulation of expertise in relation to participatory development based upon principles of locally determined problem solving and respect for local knowledge and values. In support of NGO capacity-building, UNDP/HDP organised an Informal Consultation in February 1998 with a number of NGOs in order to share experience of using participatory approaches in relation to HIV/AIDS issues and to explore the development of collaborative, local strategies for expanding the use of such approaches. As part of this process, a number of participatory learning tools were developed by the consultant. The Informal Consultation led to UNDP supporting a training workshop (July 1998) on HIV and Development for NGO representatives. Subsequently UNDP funded similar workshops in seven states, with more experienced NGOs providing technical support to others as necessary. This process culminated in a training of trainers workshop in December 1998. Given its specific comparative advantages, UNDP, through the India country office and the HIV and Development Programme, has played multiple roles in this process: seed-funder, facilitator, ‘honest broker’, strategic partner, archivist and disseminator. While operating ‘locally’ in the Indian context, the project was always expected to generate lessons of far broader (geographical) relevance. The project has required a willingness among the collaborating partners to learn by doing; to experiment with new ways of working; to be willing to make mistakes, to reach out beyond traditional sectoral interests and boundaries, and to share the learning generated with others, within and beyond the immediate context in which the project took place. The project has succeeded in bringing together a strong group of NGOs, including those committed to participatory development and those involved in HIV/AIDS. This partnership, which extended over six states throughout the country, has transformed the initiative from a mere response to something more akin to a small movement. The spirit of this movement is manifested in the clear solidarity of the group when faced with common problems such as deteriorating relations with governmental agencies. Together group members analysed the problem, assessed their strengths and weaknesses and approached the challenge together. The group has sought to be inclusive: involving others who are committed to exploring the issues they have been exploring, such as: to what extent can targeted interventions be effective in India without an appropriately enabling environment? In elected democracies, how can governments be held accountable by civil society? Where should decision-making power rest for critically important programmes: with government or civil society? The commitment to ensuring that these same principles of participation and democracy are embedded in development practice has led to the development of a range of distinct participatory methodologies: for example, PRA, AIC, and PHAST. More recently (for example at the 1992 AIDS in Asia and the Pacific Regional Conference), NGO representatives expressed a need for participatory methods and tools relevant to HIV/AIDS to be developed and disseminated. Much of the material in this Toolkit is derived specifically from the SARAR methodology: a participatory, learner-centred approach which focuses on developing participants’ capacities to assess, choose, plan, create, organise and initiate. These are reflected in the acronym: Self-Esteem, Associative Strengths, Resourcefulness, Action Planning and Responsibility. SARAR emphasises the importance of realising the creative capacity of participants to explore, understand and address problems, and of encouraging them, from the outset, to assume ownership of the process of problem exploration, analysis and solution.
Despite some clear differences in methodology, most participatory approaches share some common core principles: Respect for the individual as an adult with experience, ideas and concerns of his/her own. Substantive content is not imposed on adults. Instead opportunities are provided to tap their own rich experience and to identify issues and situations requiring further analysis. Thus, participants are part of a process in which, in lieu of an instructor, there is a facilitator who encourages group participation and who is also learning from the process. The facilitator does not lecture but instead involves participants in inclusive and engaging tasks such as defining their own ‘ground rules’ on attendance and participation in the sessions. Ensuring an enabling environment in which the participants feel comfortable in expressing their ideas and in supporting or challenging each other if they so wish. This is particularly important in an area such as HIV/AIDS where sensitive issues are likely to emerge concerning sex and sexuality, stigma, gender and power relations, blame and hostility, family crisis and pain. To create and maintain this type of enabling environment, the facilitator tries to minimise hierarchical relationships, for example, by positioning tables and chairs within the working rooms in such a way as to ensure that participants can move around freely and form subgroups of different sizes. Use of non-conventional discussion media: pictures, cut out figures, "chits", props or other aids which the participants themselves can manipulate, sort out, prioritize, modify and interpret as they wish. This is another means of equalizing communication opportunities and helping to uncover talents within the group that might otherwise not be disclosed in a more formally stratified setting. Such tools potentially give all members of the group the opportunity to be involved in some way since it takes many different talents, for example, to create a mural, take part in a role play, or actively engage in group problem-solving. The aids also help to enliven the session, providing scope for creativity, analysis, planning and humour. This toolkit comprises eleven sample activities:
Sex and Sexuality
These tools have mostly been developed in India as part of an effort to build the capacity of NGO personnel to explore the nature of the epidemic and to consider relevant responses. The tools are readily adaptable by trainers for use in different social and cultural settings. For example, the Silhouettes activity, which was first developed for use in India, has been adapted effectively in South Africa. A longer and more intensive version of Wildfire has recently been used in the Caribbean while the Fleet of Hope (which originated in Tanzania) has been adapted successfully for use in Burkina Faso. In addition to different geographical and cultural applications, the tools offer potential for adaptation to meet needs within different sectors, among staff with different levels of responsibility and with different age groups. No tool is perfect, but most can be sharpened and refined with experience. Each experience brings new insights and offers more exciting possibilities. Questions will arise and provoke constructive inquiry; for example "Why use three discussion groups instead of two, or even one?" "How acceptable is it to use humour in exploring serious issues arising from the epidemic?" "Which types of tools are most conducive to encouraging freedom of expression on topics which are normally taboo in traditional societies?" The tools represent a range of participatory styles and cover a range of content areas: sexuality and related privacy or disclosure issues; the impact of conflicting and social values on sexual relations; socioeconomic repercussions of the epidemic on family life; causes and consequences of women’s increased vulnerability to HIV; ethical, moral, practical or other considerations in the choice of methods of prevention; the effects of HIV testing and disclosure on morale and human relations; the complex nature of the impact of HIV/AIDS on families, communities, businesses, enterprises, organizations and nations; and the hope attainable through a new vision and interagency commitment to working toward collaborative solutions. Despite differences in content, there are some important, common elements among the tools. First, each tool should be evocative in its fullest sense. Each activity is structured so as to enable participants to take a given problem apart, mull over it, interact, bring personal experience to bear on it and draw out conclusions which reflect their best thinking and innermost feelings on the subject. It is important to ensure that this process capitalises on the authentic lived experiences, values and affective responses of participants themselves. The role of the external agent is that of a "facilitator" of group process, that is, an enabler or synergist who encourages participants to think for themselves. The training of facilitators thus needs to sensitize them to ways in which specialist inputs can be brought into group discussion as a resource without dampening initiative and perpetuating dependence. A second principle common to these tools is their "user-friendly" design. To avoid intimidating the participants with considerable technical information, the content of each tool is often broken down into many components, small enough, and/or varied enough to invite confident handling by participants at all levels of learning. As part of this group leveling strategy, the tools may include pictorial illustrations, found objects and symbols which, besides livening up the text, serve to overcome barriers of literacy levels or of timidity and inexperience among group members. In addition, the design of the tool itself may help to prevent group members from lapsing into hierarchical relationships. As participants move out of their seats, reconstitute themselves into smaller clusters or teams, make choices and manipulate the tool’s components to reach their own conclusions, an atmosphere of excitement, inventiveness and confident self-expression is created. It is in this kind of atmosphere that positive commitments can be engendered and a strong foundation laid for continuing teamwork. A third principle applied to participatory tools is that they must be conceived as interlocking components of a longer-term capacity-building strategy. Although each tool has its own stated purpose, no tool can, in itself, provide all the conditions needed to achieve broad human development aims. This calls for perceptiveness, ingenuity, and skill on the part of the trainer in sequencing the use of different participatory tools and strategies so that a cumulative process of learning and growth is ensured. It also implies that trainers must be ready and able to draw upon other tools and techniques from their repertoire, if needed, at any given point. Two precautions need to be kept in mind to safeguard against undermining the benefits of the learner-centered participatory approach: Trainers must emphasize the seriousness of the purpose served by the activities and discourage participants from dismissing the tools as mere ‘entertainment’. It is important to avoid tampering with the format of the tool unless the possible effects of the change are clearly anticipated. An example is the coding of the human figures in the Demographic Silhouette activity (see pg. 14). If, in the interest of extending discussion to include other illnesses besides HIV/AIDS, the figures are coded with additional "dots", the result can be confusing and counterproductive. Nonetheless, trainers are encouraged to experiment with adaptations to existing tools, provided they try to anticipate positive and negative consequences which may result in terms of participants’ responses to the activity.
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