Implementing Targeted Intervention

1. Implementing Targeted Intervention

2. What is implementation? Implementation is the process of translating the plan into real action. It includes all the activities that need to be carried out in order to meet the objectives.

3. How is this done? • Breaking the plan into activities (for e.g., under condom programming assess demand, plan for supply of condoms, storage, and set distribution channels) • Allocating resources for each of these tasks (how much money would be required for condoms? where will it be stored?) • Monitoring and driving the project (continuously monitor of condom distribution and usage) • Removing bottlenecks (address the barriers in condom usage)

4. Decisions during implementation • Project coordination (coordinating project activities like recruitment of ORW, PE, and distribution of condoms) • Deployment of personnel (deploying people for condom distribution, STI services) • Allocation of resources (allocating money for medicines, storage for condoms)

5. Steps in Starting and Scaling Up TIs

6. Work Plan • It is a planning and management instrument (tool) which provides a framework for planning the work and serves as a guide for carrying out that work during the period in question • The proposal submitted to SACS contains a detailed annual work plan which needs to be implemented

7. Developing Quarterly Work Plan (ex. Condom Programming Work Plan)

8. Implementation Plan Example– Condom Distribution Assess the Estimates (of condoms required for the state): At the National Level: • NACO estimates - on the basis of CMIS information, condom consumption by TIs for last 2 years • Assumptions for HRGs: • average no. of customers/partners that FSW/MSM/IDU encounter per day (2 per day) • average no. of active days in a month for FSW/MSM/IDU (20 days per month) • no. of target population being covered under the project • Condom estimations for HRGs: • Condoms for FSW population = 2 condoms X 20 active days X 12 months X no. of target population (FSWs) being covered • Condoms for MSM population = 2 condoms X 20 active days X 12 months X no. of target population (MSM) being covered • Condoms for IDU population = 1 condoms X 20 active days X 12 months X no. of target population (IDUs) being covered

9. Contd. • Condom estimations for the bridge population: • Condoms for Migrant population = 2 condoms X 30 active days X 12 months X no. of target population (migrants) being covered • Condoms for Trucker population = 1 condom X 30 active days X 12 months X no. of target population (truckers) being covered At the TI/NGO Level: • Further categorization of HRGs on the basis of the number of encounters/partners per day: • High Volume (4 or above clients per day) • Medium Volume (2-3 clients per day) • Low Volume (less than 2 clients per day) • Formats that can be used for categorization • HRG registration form (format no. 1 in the monitoring formats ready reference) • HRG master register (format no. 2 in the monitoring formats ready reference) • PE is trained to do an analysis of the client load for her site.

10. Contd. • Assess demands for different sub-categories D = (S X I X N) – C D = the condom requirement S = the number of FSWs (of that sub-category i.e. high, medium, low) operating in that area I = the number of sexual acts per day N= the number of days a sex worker is ‘active’ in a given month C = the number of condoms from other sources including clients • PM & ORW plan condom requirements under different supply channels through • outreach (peers, ORWs, volunteers) • outlets (depots, vending machines, condom boxes) • TI prepares quarterly indents for condoms - based on the actual requirement + 20% buffer stock for the next quarter • Further categorized as • free condoms – indents sent to SACS • socially marketed condoms – indents sent to SMOs through SACS or SACS consulted

11. Contd. Procure the Supplies: • Two processes: • budget to the TI/NGO based on the condom assessment for socially marketed condom, only during 1st year of the project - revolving fund • required supply of free condoms directly to the TI/NGO Distribute the Supplies: • Distributed through two major sources (Outreach and Outlets) • Peer Educators (at field level) • Outreach Workers (at field level) • Counselor/ANM (at clinic level) • Condom Outlets (public toilets, petty shops, tea shops, lodges) • Formats used: • ORW Field Diary (format no. 4 in the monitoring formats ready reference) • Free condom/lubricant stock register (format no. 7 in the monitoring formats ready reference) • CSM Stock register (format no. 8 in the monitoring formats ready reference) • CSM condom outlets register (format no. 9 in the monitoring formats ready reference) • DIC register (format no. 13 in the monitoring formats ready reference)

12. Contd. Monitor the Distribution/Analyze the Gaps: • Other formats used: • ORW summary sheet (format no. 6 in the monitoring formats ready reference) • Condom Gap Analysis done because: • Actual requirement - may differ widely • Condom distribution by staff not accounted for • Condom uptake from various sources needed • Acceptability of the condom strategy to be checked • Process for condom gap analysis: • Each PE captures information on demand at the site level • Data is compiled at TI/NGO level • Average condom demand along with the subsequent gap is calculated for every sub-group categorized under HRGs • Analysis then feed into the re-assessment of condom demand

13. Contd. Other Condom Programming Considerations: • Empower HRGs for condom use, skills to negotiate • Messages/IEC – to address local culture, tradition, practices, myths and misconceptions • Involvement of other key stakeholders in addressing stigma and discrimination • Handholding and analysis of STI, Outreach and ICTC information to support condom programme • Explore opportunities of ownership among the community for the socially marketed condoms, as this activity takes away almost 30% of the resources of the staff in TI

14. Conclusion • Developing work plan is easier but real challenge lies in implementation • Best plans can go wrong for e.g. delay in getting funds • Face any situation and focus on achieving objectives of the programme. • Money allocated for salaries is spent entirely while money meant for programme activities remains unspent. This needs to be avoided!