PARTICIPATORY ETHNOGRAPHIC EVALUATION and RESEARCH : PEER Kirstan Hawkins Ben Rolfe peer@options.co.uk

1. PARTICIPATORY ETHNOGRAPHIC EVALUATION andRESEARCH:PEERKirstan HawkinsBen Rolfepeer@options.co.uk

2. SESSION 1INTRODUCTION TO THE PEER METHOD

3. PEER PRESENTATION • Rationale for PEER • Key principles of the method • How does PEER differ from other approaches? • Types of data produced • Reflections on PEER process

4. Participatory Ethnographic Evaluation and Research Rapid participatory method • Social analysis: in-depth ‘grounded’ qualitative data • Monitoring: changes from perspective of target community. • Advocacy and accountability: Mechanism through which to give voice to marginalised groups and engage in active dialogue • Communications: evidence based

5. Rationale • Developed as a method for researching behaviour and monitoring behaviour change • Field of SRH research dominated by positivist and empiricist research methods of demographic research, such as sample surveys and focus groups • First applied to researching sexual and reproductive behaviour in the context of HIV/AIDS prevention and reproductive health programmes

6. Rationale • Based on anthropological approach • Aims to gain an in-depth understanding of the social realities of people’s everyday lives through collecting narratives of social network • Standard methods tend to abstract people’s actions from socio-cultural and political context in which they takes place • Criticises notion dominant within demographic research that social behaviour is outcome of individual assessments /choices – ie place in context.

7. Where PEER has been used • Cambodia, Myanmar, Rwanda, Mozambique (PSI)- transactional sex -AIDS prevention • Nepal – Safe motherhood Project –Monitoring tool. Save, GTZ, Action Aid. • India (PSI) – Transport workers / CSW’s • Malawi – Young Women Access to VCT • Zambia – HCP + NUI • Ongoing: Haiti, Dominican Republic, Pakistan.

8. Research is undertaken by members of target community Carry out conversational interviews with others in their social network Principles of the method

9. Principles of the method • Prompts designed by peer researchers during a short participatory training • Questions (prompts) owned and relevant. • Research focus relevant and meaningful

10. Principles of the method Data analysed by peer researchers • Ownership • Voice • Clarify issues

11. Principles of the method Multiple outputs: • Formative Research • Monitoring • Advocacy, Empowerment & Voice

12. Principles of the method • Detailed social analysis carried out by social scientist • Produces quick actionable results in three months • Sustainable approach – build capacity

13. DevelopThemes Train Researchers FieldTest DefineObjectives Interviews Analysis 1 Day 3 Days 1 Day 5 Weeks 5 Days+

14. Outputs • Relevant evidence base • Communications strategy development • Creative brief • Entry points for behaviour change strategy • Foundations for community based monitoring

15. Use of PEER In-depth understanding of: • Social organisation and social networks • Decision making processes –beyond behaviour • Livelihood strategies, sexual networking, health seeking behaviour • Power dynamics and how power relations are experienced

16. Use of PEER Practically: • Understand processes of exclusion • which groups are excluded from accessing resources, and how • Understand barriers to access to services • and whether programmes are reaching poor and marginalized groups • Understand interactions between demand and supply sides

17. Dominican Republic: BCC design and monitoring Bateyes HIV prevention/social marketing: Objectives of PEER: • In-depth understanding of behaviour related to logframe indicators: partner reduction and increase condom use • Actionable qualitative data to complement baseline survey data

18. Survey Data: norms re partners N total = 1500 men and women resident in bateys Have had a regular sexual partner apart from spouse in the last twelve months (N=1360) 34.2% Have had occasional sexual partner in last twelve months (N=1360) 20.9% You think your spouse/partner has had other sexual relations in the last twelve months (N=957) 13.1%

19. Survey Data: partners and gender Of those who had a regular partner apart from spouse in last twelve months. Percentage male 71.4% Of those who had an occasional sexual partner in last twelve months. Percentage male. 87%

20. PEER DataSocial Norms: Men 2 competing norms “Ideal” type of respectable behaviour (in relation to other men): • Hombre-serio – has only a few partners (e.g two families) – supports partners financially. Male identity in relation to women: • Man must have many partners to be a man – important to compete with each other for machismo • Must be attractive to women – “vacano” – ie women must want him (eg papi-chulo) – women want him to look good and buy him things: chulo.

21. SOCIAL NORMS: Women Norm of fidelity • A respectable woman is a mujer de la casa – keeps the home and looks after children • A mujer de la casa is faithful to her husband • A woman with many partners is a mujer de la calle • Mujer de la calle are prostitutes – whether they have sex directly for money (cueros) or with many amantes • Women gossip about those who have lovers – call them “cuernos / cuernula.” • Women shun-reject other women who are known to have several lovers

22. Actual behaviour: men Men have multiple families and lovers – necessary to be a man Women not only accept but actively reinforce that men cannot be faithful to one woman • A man who is faithful to one woman is “palomo, pariguayo, maricon.” • From a woman’s perspective an hombre-serio does not exist – no real man can be an hombre-serio. • A woman would not consider looking at a man who does not have other women • A woman looks for a “tiguere” – a chulo/papi-champu

23. Actual behaviour: women • It is not economically viable for a woman to have only one partner. A woman cannot economically be supported by one man alone. • Most women have one or more amantes for financial support • A woman must not openly have lovers. • A woman who is “sabia” has lovers who support her financially and lovers for pleasure • Women may also have lovers for pleasure whom they support financially (chulos)

24. Survey Data: condom acceptability • In your community it is alright to use and be seen with condoms (N=1409) 86.4% • In your community people think that true/real men use condoms (N=1377) 83.5% • In your community it is acceptable for a woman to propose condom use (N=1421) 93.7%

25. Condom use • Men and women reinforce that men should use condoms with partners they do not trust (mujer de la calle) to prevent AIDS. • No woman identifies herself as mujer de la calle • Women propose that men use condoms with other women never with themselves • People fear gossip that they may have AIDS (and social exclusion) more than actual infection

26. For men condoms symbolise being responsible and protective of mujer de la casa from mujer de la calle • A responsible man is hombre serio – other men respect him. Responsible men use condoms • Men use condoms with mujer de la calle – responsible men do not go with mujer de la calle • Women like chulo – papi-chulo • Chulo want women to be attracted to them • Chulo don’t use condoms because women don’t like them and men don’t enjoy sex with condoms • Men tell their friends they use condoms because they want them to think they are responsible and not infected

27. For women condoms mean lack of trust and symbolise infection . • Man suggests condom • Man does not trust me – I don’t trust him • He is probably infected • He is a bad person and wants to infect me • He will put holes in the condom and try to infect me • I would rather he never suggested it • If he doesn’t suggest it he must be healthy • If he is healthy it doesn’t matter how many partners he has because he is not infected.

28. Recommendations • Do not link condom-use messages with number of partners • Condom promotion messages need to move away from messages of protection and towards messages that condom use signifies being healthy • Need multiple coordinated messages directed to each population segment that will, in the community itself, link up to change the current stigma against a condom user into a stigma against condom non-user.

29. Managed by Options. • DfID funded • £20 million over 5 years • Builds on Nepal Safer Motherhood Project (NSMP) 1997-2004

30. A programme approach working directly with government. • Capacity building MoH - gradual assumption of full responsibility for all activities related to improving MCH, including research, monitoring and evaluation.

31. PEER and KIM • A challenge to understand and monitor changes in the social context in which pregnancy and child-bearing take place. • Term key informant (KI) is used, as the concept of peers and peer networks limited meaning in small highly stratified communities of rural Nepal. • Key informants not selected from one homogenous group, but include women from different castes, ethnicity, social status, age and location.

32. KIM in 16 VDCs, every 12 months Community Village Level District level National level Peer Researchers VOICE VOICE VOICE R FORMATIVE RESEARCH FORMATIVE RESEARCH FORMATIVE RESEARCH R MONITORING MONITORING MONITORING R

33. Village Level Community Village Level • VDCs allocated money for emergency transport • VDCs initiated the use of curtains in the examination rooms • Some VDCs have decided to have at least 33% women in community groups, to have stronger voices of women in group decision-making. Peer Researchers VOICE R FORMATIVE RESEARCH R MONITORING R

34. District Level Community District Level • The process of the tool and the findings have been powerful. • Rigorous, credible and practical. • A number of NGOs have gone on to use the approach independently. Peer Researchers VOICE R FORMATIVE RESEARCH R MONITORING R

35. National Level Community National Level • Significant impact – refocused approach for SSMP • More emphasis on interaction, mothers-in-law, husbands & women • More demand side interventions, focus on equity. • # • Credibility - the KIs are from the community itself. • Powerful stories. Voice. Peer Researchers VOICE R FORMATIVE RESEARCH R MONITORING R

36. Strengths • Low cost method – upfront costs in capacity building • Carried out in private sphere • a depth of understanding about sensitive issues • beyond normative responses • Tool for advocacy • empowers marginalised groups to voice views • Can provide an entry point

37. Risks and Cautions • Does not produce quantifiable data. Does not replace quantitative methods • Initiates processes which can challenge existing power relations • Peer researchers may become biased in reporting over time if they identify strongly with the programme • Effectiveness depends on appropriate selection of peer researchers and clear objectives. • Turning insight into interventions requires capacity.