Exit Strategies in PSH Projects in Kerala

Exit Strategies - The concept

All strategies that go in to creating a social condition where sexual health services are ensured to the target population, where the CNGO (Core Non-Governmental Organisation ) would take up a ' facilitator ' role. It also offers a range of options to suit the local specific.

The central theme for exit strategies include,

• Creation of enabling environment.

• Behavioral empowerment of PSH towards safer sex.

In order to create a complementory relation between the primary stakeholders and the service providers the CNGO has to work towards a planned and progressive environmental manipulaion. Thus the essence of exit strategies can be identified as mainstreaming. It means a role shift of services from project mode to communitarian mode. It is not a one-time event or set of efforts ; rather a continuum of efforts influencing the service providing environment through ongoing facilitation.

Mainstreaming with Government systems

Apart from many other strategies, the workshop dealt in detail on the concept and methodology of mainstreaming as a goal and strategy for exit from the present project cycle.It tried to clarify the notion by giving another terminology to mainstreaming, i.e. Integration. Narrating the three ways to achieve this goal, the group tried to give a definition to the concept of integration.

• 1. Target groups to be accommodated by the larger community.

• 2. Stigma reduction to be achieved among themselves and that of others.

• 3. Incorporate all the key elements in to the existing system.

In the present PSH context, the responsibility to achieve this goal is primarily of the CNGO co-shared with the primary stakeholders and external stakeholders.

The process of mainstreaming is initiated by the CNGO, who acts as the enabler or facilitator. It consists of a series of facilitated actions within and outside the community.

• 1. Initially de-stigmatization process starts within the target group itself.

• 2. Continuous capacity building of target group is initiated and sustained.

• 3. Activities to strengthen the self-esteem.

• 4. Slow and deliberate diffusion with larger civil groups.

• 5. Advocacy with different agencies is initiated.

• 6. Heterogeneous groups will be formed wherever possible.

• 7. Thus a gradual acceptance of the target group by the mainstream community is enabled.

The process of mainstreaming definitely targets Government systems and institutions. Identifying these institutions and maintain linkage is a continuous and creative task. The following steps can be initiated to achieve this task.

• 1. Effective Behavioural Change Communication (BCC) should be disseminated to Professional counseling centers/ De-addiction centers/ Religious agencies/ Political parties/ Trade unions/ Mahila samajams/ CECs/ Recreation clubs etc.

• 2. To get clinical assistance, advocacy and linkage should be established with PHCs/ CHCs/ THQHs/ Private practitioners.

• 3. Condom promotion should be initiated through Anganawadis/ Traditional and non-traditional outlets/ Recreational youth centers/ Mahilasamajams/ CECs/ Distribution agencies/ PHC & sub centers/ Trade union offices.

Hurdles and Difficulties

A review of the current scenario of PSH projects in Kerala is contextual, the group thought, to initiate the process of mainstreaming. The hurdles and difficulties are listed in detail so as to find ways and means to overcome them effectively.

• 1. There is lack of group feeling among the stakeholders.

• 2. Existing mainstreaming initiatives need to be strengthened.

• 3. Most of the initiatives are centered on Community Based Organisation (CBO).

• 4. Marginalisation in the strict sense is widely faced by street sex workers.

• 5. The mainstream community does not accept stakeholders.

• 6. Stigma attached to sex work and sexuality is deep-rooted.

• 7. Stakeholders do not want to reveal their identity.

• 8. There is lack of infrastructure and other facilities.

• 9. Project does not address the felt needs of the stakeholders.

• 10. Primary stakeholders do not get opportunity to interface with institutions.

• 11. Primary stakeholders give least priority to mainstreaming.

Activities to overcome the hurdles

The group suggested the following activities to overcome these hurdles faced by the project workers in the field.

• 1. Initiatives should be facilitated to lobbying with secondary stakeholders/ opinion makers/ pressure groups/ local leaders etc.

• 2. Programmes to desensitize the Target groups/ Community groups/ Religious groups/Health care providers should be initiated.

• 3. Target group should be reoriented to identify the reasonable and correct priorities for the exit phase.

• 4. CNGOs should be able to generate the required degree of concern among the stakeholders for their own sexual health.

• 5. CNGOs should initiate discussions to develop a sexual health policy at the state level.

• 6. Project workers should be sensitive to address the felt needs of the target group.

Competencies and skills

A lot of competencies and skills are required, both for the STGs and CNGOs, to address these hurdles as well as to sustain the process of mainstreaming with Govt. systems.

• 1. Efficiency in lobbying with local power groups

• 2. Proven track record in handling developmental issues related to sexual health

• 3. Capacity to organize STGs

• 4. Sensitivity to issues related to sex workers/ sex and sexuality

• 5. Capacity to generate concern over these issues among external stakeholders

• 6. Skills to set up systems for continuous monitoring

7. Dynamic leadership skills with proper vision to lead the project

• 8. Management skills for primary stakeholders and staff to deal with any situation

External support

The group suggested that external support in various levels from Government and Non-Government institutions is essential to initiate and sustain the mainstreaming process.

• 1. To develop/formulate a sexual health policy at the state level

• 2. To lobbying with higher level political leadership

• 3. Technical and training support for capacity building

• 4. To sensitize the medical and paramedical staff

• 5. To organize seminars and debates at different levels

• 6. To explore financial support

Enabling political climate

A political climate should be conducive and essential to initiate and sustain the mainstreaming with Govt. systems and institutions. The group suggested several steps that would help the STGs and CNGOs in influencing the political climate of the state for better mainstreaming.

• 1. Individual one to one advocacy programmes

• 2. Advocacy programmes for different groups at different levels

• 3. Setting up of steering/advocacy committees comprising political and social leaders, MLAs, MPs etc.

• 4. Ensure the participation of local political and social leaders in the programmes of the CNGOs

• 5. Organise interface between primary stakeholders and political leaders

• 6. Include the political leaders in the review meetings of the project

• 7. Setting up of support groups of political leaders

• 8. Convene the steering committee meeting at the RDO/Municipal offices

• 9. Inspire the PRIs to provide space to start sub centers/supplementary projects etc.

Suggestions and recommendations

• 1. A draft committee should formulate a draft on sexual health policy.

• 2. A detailed report of the mainstreaming experiments initiated with Panchayat Raj institutions by several PSH projects.

• 3. Other best practices in this area need to be documented.

• 4. Lobbying the PRIs to allocate fund from their project allocation for activities under PSH components.