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Final Report for the
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Table of Contents II. Background and Country Context III. Country Program Description A. Introduction Country Program Description C. Accomplishments and Outcomes Goal: Policy Makers' Awareness of STIs/HIV/AIDS Issues in Nepal Increased
Purpose: Reduce high risk sexual behavior among core groups in the Terai
1. Sexually Transmitted Infection The primary objective of AIDSCAP's STI strategy was to ensure that populations in the Central/Terai region had access to effective STI services at their first point of encounter with service providers, including the formal and informal private sectors as well as at health posts. The strategy specifically integrated AIDSCAP's interventions with those planned by the European Economic Community (EEC) in support of HMG's STI strengthening and service delivery programs. The AIDSCAP STI component was designed to focus on the following key objectives:
AIDSCAP/Nepal's STI component underwent an evolutionary process from project startup The STI program was very much influenced by a number of critical factors, including: (a) the status of STI service delivery in the country from 1993-96, (b) HMG's high priority placed on the strengthening of national STI policy and service delivery; (c) the NCACP's service strengthening project underway with EEC assistance; (d) the high demand for STI services in the Central Region, and (e) the quality technical assistance provided by AIDSCAP's STI Technical Advisor. In the original implementation strategy, STI programming was planned around the development status of Nepal's national STI case management guidelines and the lack of STI services in the Central Region in 1994. As little STI research data was available in Nepal at that time the STI Technical Advisor and the Resident Advisor were joined by the NAPCP Director in January 1994 to tour the project area to conduct an informal survey of STI services and service demand at both the public and private/nonprofit sites along the highway and in major towns in the Central Region. This visit laid the foundation for Nepal's STI action plan from discussions, visits and informal interviews with physicians, paramedics, nurses, chemists and informal "quack" practitioners working in the target communities. The field visit also provided an opportunity to tour the construction site of HMG's new pilot STI clinic at Dhalkebar in Dhanusha district funded by the EEC. Following the January 1994 visit AIDSCAP's STI implementation plan was presented and approved by the NAPCP and the USAID Mission. First priority was to be given to assist the NAPCP (with the EEC) finalize the national case management guidelines and initiate the development of a core training curriculum for physicians based on the national guidelines in collaboration with Nepal Medical Association (NMA). Other complementary STI interventions would come later following the implementation of Nepal's upcoming baseline survey and situational needs. Other proposed implementing partners identified included Nepal Chemists and Druggists Association (NCDA), health NGOs such as the Family Planning Association of Nepal (FPAN) and private providers and provider networks. Nepal Medical Association In June of 1994 AIDSCAP signed its first project agreement with Nepal Medical Association to fund NMA to coordinate the development of a training curriculum and manage the delivery of training workshops to its membership -- private practitioners -- in the diagnosis and treatment of sexually transmitted infections using the simplified syndromic management approach. With direct technical assistance from Dr. Mugrditchian, the NMA and its curriculum development committee developed a two-day training curriculum for the general practitioner in Nepal's case management approach. The curriculum was pretested and finalized in a facilitators workshop with Nepal's senior venereologist prior to the startup of field trainings in late 1994. NMA managed the implementation of three two-day training sessions held in Bharatpur, Birgunj and Janakpur attended by physicians providing both private and public sector medical services in the region. Following the training the final project activity managed by NMA was the organization of a special STI session on the syndromic approach at NMA's 17th All Nepal Medical Conference convened at Butwal in February 1995 and attended by national physicians. The NMA initiative served a critical purpose for the design and implementation of AIDSCAP's other STI initiatives that followed over the life of the project. The NMA training curriculum was utilized as the core curriculum for training curricula for nurses/paramedics later developed by the EEC project in 1995; served as the basis for a simplified orientation curriculum on STIs developed by Dr. Mugrditchian on behalf of the National Health Training Center's Comprehensive Family Planning (COFP) curriculum in 1995; and served as the core for the NCDA chemist curriculum. Lessons-learned from the NMA training experience with Central Region physicians and later EEC trainings also created a large demand for the distribution and use of the curriculum beyond NMA. Utilizing remaining subproject resources and additional technical assistance inputs from Dr. Mugrditchian and a member of NMA's curriculum development team, Dr. RK Shrestha, the curriculum was adapted and finalized to reflect the NCASC's final, 1995 national STI guidelines in a full training package for general practitioners. The final package in English -- complete with overheads and color slides -- "The Case Management of Sexually Transmitted Diseases: A Training Package" was completed in 1996 and distributed by NMA/AIDSCAP to approximately 88 domestic projects, health agencies, NGOs and medical trainers. The manual was also distributed internationally through AIDSCAP in Asia, and to over thirty agencies at the Rockefeller Foundation. Nepal Chemists and Druggists Association The NMA project experience was critical to the startup and implementation of a pilot project for Nepal -- the STI/HIV/AIDS Prevention Education Strengthening Initiatives for Chemists and Alternative Health Care Providers project with Nepal Chemists and Druggists Association (NCDA) in January 1995. The need to strengthen chemist's STI drug dispensing and condom promotion practices was one well recognized and supported by the NCASC, the Department of Drug Administration and NMA. This need was also confirmed in the findings of New ERA's 1994 A Baseline Study of Commercial Sex Workers and Sex Clients on the Land From Naubise to Janakpur and Birgunj which showed commercial sex workers and their clients identifying private clinics and chemist shops as the preferred source of STI treatment. Another study investigating patient demand of STI services through chemists, New ERA's 1994 Qualitative Study of Chemist Shops on the Land Transportation Routes from Naubise to Janakpur and Birgunj reported that chemist shops located along the highway serve an average of 10 STI clients monthly, and that 68 percent of STI clients come for services without a doctor's prescription. The NCDA subproject was managed by a small project management team consisting of NCDA members, including the project manager, a project coordinator, an administrative assistant, a curriculum development committee and training consultants. At the advice of AIDSCAP's STI Advisor, a Technical Advisory Group (TAG) was appointed to guide the project's technical quality. The TAG membership included: the Director of the Department of Drug Administration, the President of Nepal Medical Association, Nepal's senior Dermatologist/Venereologist, the senior Professor of Pharmacology from the National University, other physicians, trainers, and representatives of NCDA. The TAG formed a Curriculum Development Committee among the members to develop a curriculum suitable for chemists. The draft curriculum was pretested outside the intervention area. The pretest provided great insight in the level of understanding of the technical material and the importance of simple, local language. Members of the TAG from the medical community felt that NCDA's proposed curriculum contents covering "The Three Major STI Syndromes and Medicine" presented the authority of prescription. A compromise was made by changing the name of this session to "Three Major STI Syndromes and Medicine Prescribed by Doctors". This was a compromise between the physicians' rule of prescription and the NCDA's motto of training.
To ensure the sustainability of this education program the NCDA felt it best to develop the capabilities of its own members to deliver training among peers at the district level. The NCDA conducted two-4-day Training of Trainers workshops to orient and train a total of 32 Novice Trainers in the NCDA curriculum. The TOT curriculum included: Training Methodology, Curriculum Content and Practice Sessions to develop Novice Trainers from among NCDA's strong and motivated local membership. Over the course of the 24-month project the NCDA trained a total of 579 chemist participants from nine districts in 22 two-day workshops. Of this total 69 percent of the participants work only as chemists and 31 percent provide dual roles as chemists and health providers. Of the total participants, 22 percent are government service health staff. Of the total participants trained by NCDA, 11 percent were female and 89 percent male. As the NCDA subproject was a pilot initiative to be tried for the first time in Nepal it was determined during subproject design that external research would be undertaken during project implementation to assess the training. Based on recommendations from the AIDSCAP Project Director and an internal USAID/AIDSCAP review team visiting Nepal in September 1995, the research component expanded to include a formal study protocol utilizing the simulated client or "Mystery Shopper" approach to assess changes in chemists' dispensing practices prior to and after participating in the NCDA training. The baseline mystery shopper survey, New ERA's A Baseline Study of Sexually Transmitted Disease (STD) Services Provided by Chemists in the Land Transportation Routes From Naubise to Janakpur to Birgunj, conducted in 1995, surveyed chemist's dispensing practices to male "mystery" patients complaining of symptoms of Urethral Discharge. At the completion of training in late 1996 New ERA conducted an impact study of 160 chemists who had participated in the NCDA training utilizing the same study protocol. The follow-up impact study, entitled Chemists Drug Dispensing Behavior and HIV Prevention Communication: An Impact Evaluation of Training Using Simulated STD Patients showed the following key results.
With the positive results of the NCDA pilot subproject and the demand for further training in the Central Region, AIDSCAP was able to fund a short follow-up intervention with the NCDA from February - April 1997. NCDA revised the original training curriculum based on the mystery shopper impact survey results, and conducted additional field and new refresher field trainings in the project intervention area. This small subproject utilized the same NCDA management approach with a full-time coordination team plus employing the former project coordinator in the role as a coordination/management advisor. This management approach allowed NCDA's new central committee staff to participate more fully in training management and development. As the NCDA is a retail membership association of member-volunteers -- the management of a development project creates its own set of unique implementation challenges. The NCDA 's 1997 intervention project trained a total of 52 chemists from the Central Region and 26 chemists from the Pokhara area in the two-day NCDA curriculum. The NCDA conducted one training in Pokhara (outside the project area) to retrain those who had participated in the curriculum pretest session in 1995. The most significant accomplishment of this short project was the NCDA's experience with a four-day residential Follow-Up Workshop for Novice Trainers convened in April 1997. This workshop brought together NCDA's 17 most motivated novice trainers from the districts to participate in a workshop to review the mystery shopper findings, to review participant evaluations, and through a team-building process provide feedback to the training coordinator/master trainers on ways to strengthen the core curriculum. The novice trainers final task was to assist in the development of a one-day refresher training curriculum for chemists who already participated in the two-day training. The NCDA's final accomplishment of the short project was to conduct a total of four refresher trainings for 105 chemist participants in the Central Region using the new one-day refresher curriculum. Follow-on activities undertaken by the NCDA consultant at the close of this subproject included the final adaptation, editing and printing of the NCDA two-day curriculum in Nepali and English, and the final adaptation of the one-day refresher training curriculum. Family Planning Association of Nepal AIDSCAP's partnership with the Family Planning Association of Nepal (FPAN) formally began with the participation of the FPAN/Chitwan Static Clinic doctor, Dr. BJ Neupane, in NMA's STI Case Management training in December 1994. Of all the district-based physicians participating in the NMA sessions, the only practitioner who exhibited any interest in the integration or application of the case management approach into local service delivery was Dr. Neupane with the full support of FPAN management. During the final stage of subproject design, Dr. Neupane was one of two Nepali physicians selected to participate in AIDSCAP/ARO's STI Managers course convened in Bangkok in 1995. The final project design for Chitwan was a simple plan to integrate STI services into FPAN/Chitwan's existing clinic and community-based outreach family planning and maternal-child health delivery services. The integration plan equipped and trained FPAN medical staff to provide STI diagnosis and treatment services based on the syndromic approach in accordance with Nepal's 1995 national STI case management guidelines. The FPAN subproject was designed as a pilot initiative. It was not certain how local women, particularly those at high risk (CSWs) would adapt to the FPAN service environment primarily serving married women and their families. What was certain from FPAN and AIDSCAP's experiences, was the importance of utilizing and training FPAN's most trusted and experienced health staff as key team members in the startup and development of the pilot. Dr. Neupane served as the project director and clinic medical director. Service delivery was managed on a daily basis by FPAN's long-experienced staff nurse with additional clinic support from other nursing and counseling staff. The FPAN subproject began as a seven-month pilot activity at one clinic location and over the life of AIDSCAP expanded to an 18-month project serving three clinical sites in the Central Region. startup activities included the renovation and equipping of the clinic for STI services with assistance from a local expatriate medical consultant, theoretical and clinical STI training for the nursing and medical support staff, and the startup of a health education room and services to support clinical activities with IEC/communications materials and special programs. While AIDSCAP support provided FPAN the opportunity to provide free consultations to both female and male STI clients -- project regulations prohibited the free provision of STI medications to FPAN clients. To overcome this programmatic constraint FPAN and AIDSCAP developed a Revolving Drug Fund which provided drug procurement capital and financing for the clinic's STI drug supply, and at the same time provided the patient with a lower cost source (approximately 15 percent below the chemists' market price) of STI medications. Critical to the startup and implementation of the Chitwan clinic was FPAN's coordination and outreach planning with the General Welfare Pratisthan's local outreach team working in the project/service area. To ensure that intraproject collaboration was formalized one subproject activity was a monthly coordination meeting of GWP and FPAN staff. While this project requirement formalized the relationship, the excellent inter-team relations between FPAN and GWP was forged early on and has become even stronger as the benefits of team partnership is realized in the provision of quality STI services to local women in need. The Chitwan clinic officially began operations in February of 1996 and was inaugurated by the Honorable Minister of Health the following June. The inauguration event highlighted the Ministry's recognition of the role of the NGO sector in STI case management, and the benefits of integrating STI services with family planning and other family health services. A clear benefit to the FPAN program was the ability to extend AIDSCAP support beyond the original August 1996 end of project deadline. The time and funding extension provided FPAN the chance to further test the Chitwan model and to replicate new models at the district level in two additional Central Region sites. The project extension in August 1996 allowed FPAN to hire an auxiliary nurse midwife to strengthen the office's outreach focus through their weekly clinic programs, to trial special women's health clinics in communities in need in neighboring districts and in remote areas in Chitwan district, and to provide additional, follow-up trainings to clinical and volunteer staff. Most importantly, the extension allowed FPAN the chance to build up its women's health programs in two additional districts with the opening of STI/FP/women's health clinics into the ongoing family planning programs in Hetauda (serving Makawanpur district) and in Janakpur (serving Dhanusha district). The opening of NGO women's health clinical facilities in these two districts has served to provide much needed health services to low-income women in these communities. The FPAN experience has been a most cost-effective investment for FPAN and the USAID health program in Nepal. With a minor investment and operational support, low-cost health services are both accessible and available to marginalized women, housewives, unmarried women and their partners. The FPAN experience speaks for itself. From February of 1996 through April 1997 the Chitwan clinic treated 1,039 patients for STIs, while Makawanpur and Dhanusha treated 131 and 105 patients respectively. For Chitwan, the provision of STI services has had a dramatic impact on the demand for all reproductive health services, including family planning methods. Chitwan's reputation as a quality and patient-friendly service site has spread throughout the district. In addition to its STI clients, FPAN experienced a growth rate of 65.7 percent in sterilization services from 1995 to 1996. FPAN's STI service integration pilot has demonstrated the fact that STI service integration is working in the Nepali health delivery context. Output 1: Access of Targeted Populations to Improved Sexually Transmitted Infection (STI) Prevention and Treatment Services Increased In terms of project outcomes the STI interventions have achieved much during the life of the Nepal project.
Note: For a discussion of NMA, NCDA and FPAN subproject process indicator and end of project accomplishments data please refer to The Subproject Highlights Section . Constraints to STI Service Strengthening in Nepal Constraints affecting implementation of the Nepal STI component include the following:
AIDSCAP/Nepal's STI Service Strengthening Lessons Learned and Recommendations for Future Programming
2. Condom Expansion and Promotion Accomplishments and Outcomes One objective of AIDSCAP's condom strategy was to increase the accessibility and demand for condoms in the project's Central/Terai region by strengthening the capacity of Nepal's condom social marketing program managed by Nepal Contraceptive Retail Sales (CRS) Company. While condoms in Nepal are distributed through three primary distribution systems -- the public sector, the private sector and through the USAID-sponsored social marketing program managed by Nepal CRS Company -- the AIDSCAP strategy was to affect increased overall demand for the "generic" condom for disease prevention as well as to strengthen consumer demand for the low-cost socially-marketed condoms. Working in collaboration with the USAID-sponsored SOMARC (Social Marketing for Change) project managed by The Futures Group International (TFGI), AIDSCAP focused on the following key objectives:
As USAID's technical assistance partner tasked to strengthen Nepal CRS Company's family planning social marketing programs was TFGI with the SOMARC project, the USAID Nepal Mission determined that AIDSCAP's condom activities would work under the SOMARC program umbrella, instead of working directly with Nepal CRS Company and other implementing agencies for condom programming. Initially all condom activities were managed by the TFGI manager for Nepal. AIDSCAP/Headquarters provided overall technical assistance to this component. The TFGI subagreement funded its implementing partners, Nepal CRS Company, Stimulus Advertizers, Ltd. and Himalayan International Marketing Associates Ltd. (HIMAL) to undertake an integrated condom strengthening program beginning in February 1994. Although TFGI subcontracts were not signed until late 1994, TFGI's local partners initiated development efforts by mid-1994 as the rest of the AIDSCAP interventions were in design and startup Due to TFGI's ongoing assistance to CRS, efforts to develop marketing analyses and distribution plans for expanding CRS' condom sales focus from chemist outlets to other outlets begin in earnest with experienced distribution technical assistance. CRS assigned a Central Region Task Force to coordinate its condom activities, and by mid-94 had completed a census of potential retail outlets in the target markets in the Central Region and had already opened more than 50 percent of its nontraditional outlet targets. While the nontraditional outlet expansion was ongoing, all other supportive activities including development of the condom campaign and startup of outreach were in the midst of program planning. While CRS was able to gain initial interest among retailers in selling condoms, in many cases it became a challenge to CRS to maintain long-term interest in condom sales by these "other" retailers because no other complementary prevention activities were yet in place. Over the next nine months, CRS did in fact experience a loss of interest by some retailers in selling the condom. A critical aspect of the CRS expansion plan was the objective to increase the frequency of visits by its sales staff to condom outlets. To enable CRS to achieve this, AIDSCAP supported the procurement of nine motorcycles and carriers for CRS sales staff. CRS felt that access to motorcycle transportation would expand the CRS sales fleet in a low-cost way. Due to difficulties in obtaining vehicle waivers through the AIDSCAP project contract, the local delivery of the motorcycles was not completed until 1995. CRS management then distributed the nine motorcycles to sales staff both in and outside the project area. A condom promotion and communications strategy was developed by the TFGI project manager and approved by TFGI management with concurrence from AIDSCAP in mid-1994. This strategy was key to the development of the condom communications activities and the component's integration with AIDSCAP's mutually-reinforcing program strategy.
Approval of the communications strategy next allowed for the startup of consumer research by HIMAL, a new Nepali research agency, and Stimulus' initial stages of campaign development. Over the next nine months HIMAL conducted qualitative and quantitative research among sexually-active men to determine perceptions of proposed communications messages and materials. Simultaneously Stimulus was engaged in developing its multimedia condom advertising and mass media approach for AIDSCAP consisting of three interrelated components, utilizing appropriate media for each level of intervention to motivate public interest in the condom for disease prevention:
Components one and two were directed primarily at men aged 15-29, and the third component directly targeted CSWs. Due to the complexity of issues and the wide range of audiences and media, it was felt that a special campaign logo or program identification was key to join together the various campaign (and project) components and partners. The logo was developed to serve as the HIV/AIDS awareness campaign identification and overtime has become the AIDSCAP/Nepal project "mascot" in the form of an animated condom character -- Dhaaley Dai. Development of the campaign logo and slogan involved months of research, pre-testing and design beginning in 1994, and was finalized in the spring of 1995. During the course of logo development Stimulus developed 80 logo designs. The four finalists were reviewed for final consumer testing by a "Delphi" group of project implementing agency partners, the NCASC, HIMAL and Stimulus. The winning logo, Dhaaley, is an friendly and active animated character using a shield (a "Dhaal" in Nepali language) to ward-off the attacking HIV virus. The logo's accompanying slogan "Condom Lagau AIDS Bhagau" rhyming in Nepali language proclaims, "Let's Wear Condoms to Drive Away AIDS". The "kicking" condom was chosen as the winner as it clearly conveyed messages of strength, protection, confidence and encouraged use of condoms and protection against AIDS. The second highlight of the condom campaign is the story Guruji Ra Antare. The story's central theme revolves around a truck driver (Guruji) giving key messages of HIV and STI prevention and protection to his assistant (Antare). The story serves to tie a number of media products to reinforce the campaign messages. In a collaborative effort managed by AIDSCAP's condom partners and the NCASC -- Nepal's first AIDS Awareness and Condom Promotion Campaign was officially launched in Kathmandu on July 24, 1995 in a public, media kickoff event. The campaign was presented to the public as the first multimedia campaign "to raise the public's awareness of the Human Immunodeficiency Virus (HIV/AIDS), to better inform men and women of the major modes of transmission of HIV, and to promote the condom as an effective measure to prevent the sexual transmission of HIV and other sexually transmitted infections (STIs)". The full campaign, when it was launched in the field in August 1995, utilized a variety of media materials to deliver key protection and prevention educational messages, including:
Throughout the life of the project the campaign was jointly managed with coordination of the street drama and media placement by Stimulus Advertizers, and the monthly videovan operations by the CRS videovan team. Reflection and assessment of the condom component was a major issue reviewed during the 1995 Program Review of AIDSCAP/Nepal. One of the review team's recommendations was to enact some structural changes in the management of the condom program. The team's recommendation was to modify the TFGI subagreement to continue support to Stimulus through the TFGI subagreement only through the completion of the subagreement in August 1996, and to immediately terminate support for CRS through the TFGI subagreement mechanism. Based on the ongoing implementation relationships and the need to strengthen CRS's direct involvement with AIDSCAP's other team partners, it was decided that CRS would be funded directly by AIDSCAP through a letter of agreement. At a later time the Stimulus activity would also be directly funded and managed with AIDSCAP. TFGI management of the CRS activities completed in late 1995, with the new direct CRS agreement underway in February 1996. CRS's new workplan was jointly developed by CRS and AIDSCAP program staff to reflect new program needs and to continue the momentum of activities initiated under TFGI The CRS agreement entitled "Nepal CRS Condom Promotion and Distribution Program" began initially as a short-term letter of agreement to be followed in mid-1996 with a larger subagreement subproject. But due to an internal management crisis within Nepal CRS Company beginning in the first quarter of 1996 which resulted in a complete change in senior management, and, in early 1997, a reorganization of the company -- the initial letter of agreement remained the only agreement mechanism with CRS through the life of project. In support of CRS' efforts to expand the accessibility and availability of retail condoms in addition to its ongoing videovan and communications activities, a major focus of CRS' new project initiatives was to strengthen retailers' understanding of condom social marketing, to test new initiatives to expand condom sales among nonprofit organizations working in HIV/AIDS, and to test other pilot condom sales strategies and promotions. Under the leadership of a dedicated AIDSCAP coordination team -- CRS managed the development of a new training program for nontraditional retailers and local community leaders focused on topics of social marketing, condom promotion in the community and a basic orientation on STI/HIV/AIDS. Stimulus Advertizers assisted with the design of the retailer training kit to complete the nontraditional retailer training package. Over the course of the subproject CRS conducted a total of 19 retailer trainings in local communities with a total of 555 participants of which 89 percent were male and 11 percent were female. A second major training initiative to expand condom marketing beyond the chemist community was a push by CRS to motivate interested NGOs working in HIV prevention, particularly outside the AIDSCAP project area and along Nepal's border with India, to promote indirectly or directly the socially marketed condoms. Work with the NGO community was something new for Nepal CRS Company. CRS had never worked directly with the nonprofit sector in this capacity. This was facilitated as a result of NCASC interaction with the AmFAR project and its grantees to seek alternative sources for condoms and a concerted effort to promote Nepal's only socially marketed condoms. With initial assistance from Save/US, CRS initiated its NGO relationship-building, and with later assistance from AIDSCAP's Nepal office -- completed the final development and testing of the condom social marketing curriculum. Over the course of the subproject, CRS conducted 3 training sessions with NGOs in the Nepalgunj (Midwest Region) area, Biratnagar (Eastern Region) area and in the Janakpur (Central Region periphery )area. A total of 42 NGOs (84 NGO staff) attended the CRS trainings, of which approximately 10 NGOs became active NGO partners with CRS in its NGO social marketing program. As the result of a CRS' internal management crisis, progress toward the achievement of planned activities was not realized during most of 1996. CRS was unable to manage the hiring of short-term subproject personnel and complete subproject administrative requirements and approvals to allow for the full implementation of the workplan. In addition, CRS was unable to meet basic narrative, process indicator and financial reporting requirements. The project coordinator and his team provided their best efforts to achieve the CRS workplan and implement core activities, including training and videovan operations, during a difficult period for the social marketing program. CRS's AIDSCAP team exemplified the fact that progress was possible despite the adversities of a lack of staff, vehicles and logistical support from senior management. In addition to CRS' special field initiatives to motivate interest in condoms and AIDS prevention through special essay contests, retailer display contests and pilot rack space buying, Nepal CRS' public image in the Central Region was significantly changed with its management of the videovan operations. Managed by a small videovan operations team, CRS held at least 126 videovan shows featuring the full videodrama Guruji Ra Antare in the Central Region from August 1995 through the end of project. CRS estimates that these performances were attended by approximately 50,875 men, women and children, and that during the performances, up to 837 comic books and 8,753 promotional condom wallets were distributed in the communities. The CRS videovan operations served to reinforce the similar mass media messages heard on national radio and television, by TARANGA's community street drama performances, and a part of ongoing community events managed by GWP's outreach staff in local communities. With the appointment of a new managing director in late 1996, CRS reevaluated its AIDSCAP subproject and developed a new workplan for its final months of implementation. While the ongoing activities continued, CRS planned two new activities, including a pilot Talk Radio Program "CRS Hotline " on the new Kantipur FM radio, and a sales force study tour to India. The one-hour weekly, primetime "CRS Hotline" radio call-in program, sponsored on eight Sunday nights was the first of its kind in Nepal. The radio program attracted a range of questions, comments and letters from men and women, particularly from adolescents and young adults. Each weekly program featured a health, AIDS or family planning expert or technical manager to field direct phone-in questions, responses to letter inquiries and intermixing the program with popular "pop" music played alongside CRS's condom and family planning radio advertising spots and the five AIDSCAP radio spots/jingle. The Hotline is a radio program in much demand by Kathmandu Valley adolescents. Listener comments suggest that the Hotline continue, as it fills a special radio programming niche for young adults. Comments heard by the public emphasize the need for CRS/The Hotline to be more organized and directed in reaching its intended radio programming objectives. In early May 1997 CRS finally managed its India study tour for field-based sales staff. Originally an international study visit/training activity had been planned by TFGI and CRS as an incentive to reward sales staff with strong condom sales records. Due to USAID's/project participant training regulations, it was felt that funding two CRS staff to a Thailand-based training program would only reward CRS staff with proficient English language skills and therefore be a disincentive to other field-based sales staff. The appropriate alternative was a study tour to India to observe other social marketing models and to gain insights into other condom interventions in the India context. The CRS team, accompanied by an AIDSCAP consultant with vast knowledge and experience in India's HIV/AIDS program, and a staff member of USAID/Nepal -- visited the cities of Delhi, Bombay and Madras, meeting condom social marketing programs, a condom manufacturer, and community-based NGOs. Overall, CRS considered the study tour to be a successful learning and sharing experience for its sales staff. In addition to learning about new strategies for condom marketing the team was able to share its Nepal experiences with its condom campaign and field sales activities with similar professionals working in India. The CRS staff is hoping to test some of these new approaches to condom sales in the future. CRS' expansion of condom outlets and condom sales have made tremendous accomplishments since the startup of its expanded "condom for disease prevention" strategy in 1994. It is particularly important to remember back to the initial days of the AIDSCAP project as CRS staff and management viewed its partnership with AIDSCAP from two very conflicting perspectives. One perspective viewed the AIDSCAP strategy as one that would destroy CRS' family planning condom consumer base. The other viewed the AIDSCAP strategy as one to better expand the Dhaal and Panther markets. Fortunately for Nepal -- CRS management promoted the new strategy and encouraged its staff to take advantage of the new partnership opportunities with organizations like GWP, Save/US, community-based NGOs, FPAN and NCDA. The expansion and impact of the condom initiatives was clearly demonstrated in Nepal CRS Company's performance data since 1993. CRS' condom sales in the 22-district Terai region expanded 189 percent from 1993 to 1996. In 1993 CRS sold 2,683,536 condom units. This increased to a high of 4,277,316 units in 1995 during CRS' strong product push, and decreased to 3,923,848 units in 1996. (CRS's performance decline in 1996 was not surprising given the company's management difficulties at that time.) Sales in the nine-district Central Region also showed significant increases over the project period -- from 689,328 units in 1993 to a high of 1,533,468 in 1995, to 1,303,576 in 1996. CRS' national sales figures (including areas outside the intervention areas) also showed significant increases, from 5,687,856 units in 1993 to 8,597,112 units in 1995, and 6,806,448 units in 1996. CRS's condom expansion was also demonstrated in its efforts to make condoms available in a variety of new retail establishments throughout the region. Prior to the AIDSCAP project CRS did not have a special focus to push outlet expansion. In fact, with only a few exceptions, they were only in chemists shops. As of April 1997 CRS opened 88 new nontraditional outlets to add to its 1994 census of 1,261 nontraditional outlets. In the 9-district region CRS markets condoms through approximately 2,149 nontraditional outlets. AIDSCAP's FY97 time and funding extension provided a much needed opportunity to support further continuation of the condom multimedia campaign started in July 1995. In September 1996 AIDSCAP began its direct funding of Stimulus Advertizers' activities following the completion of the TFGI subagreement. The new Stimulus subproject, the "AIDS Awareness and Condom Promotion Multimedia Project" supported continuation of the multimedia campaign, provided resources to develop new communications materials, and helped to expand Stimulus' capacity to develop and manage social media in Nepal. The opportunity to continue the HIV/AIDS Awareness and Condom Promotion Multimedia Campaign started in 1995 for a total of two years -- provided Nepal with a high degree of national television and radio media programming with clear and consistent messages on HIV/AIDS prevention and consistent condom use. From July 1995 through April 1997 Stimulus managed the placement of the following National Media:
From July 1995 through April 1997 Stimulus managed the placement of the following Regional Media:
To date no other HIV/AIDS program in Nepal has programmed mutually-reinforcing messages with a national and regional campaign focus as has been implemented by the AIDSCAP partners. While use of a program logo and its slogan have been the source of some discussion among individuals in the field, newspaper letters to the editors, and some Ministry of Health officials -- public complaints against the media have not stopped or altered the programming. Radio Nepal, FM Kathmandu and Nepal TV have remained and still today remain committed to the importance of providing directed mass media messages on HIV/AIDS to the public. At the community level the same situation continues. Local audiences and community leaders continue to make special requests to TARANGA and GWP to arrange for street drama shows in their home community. Likewise, cinema hall operators continue to express interest in screening the animated PSA, and in one case demanded a new copy of the PSA when the original film was damaged from overuse. AIDSCAP's FY97 extension also provided the project the opportunity to expand the original media strategy beyond issues of HIV prevention and condom promotion to test timely messages of People Living With AIDS in Nepal. While this is not a prevention objective -- the project partners, particularly influenced by a changing field situation described by GWP staff, managers and consultants in mid-1996 -- saw the timely significance of developing a sensitive media product dealing with the general public's fear of AIDS and persons affiliated with AIDS diseases. A joint intraproject decision, with the encouragement of the NCASC, was to develop video and radio media products highlighting three new key messages:
In view of the project's experience with the development of the condom campaign and the need to approach social advertising in a sensitive and collaborative manner in Nepal, the Stimulus subproject formed a small Media Advisory Team to participate as advisors for the development of new media efforts. The Media Advisory Team included at least one representative of the NCASC, Radio Nepal, Nepal TV, Ministry of Communications, GWP, Nepal CRS Company, AIDSCAP, Sights and Sounds and Stimulus. The team met at key points in the development process of the primary videodrama, videofillers and complementary radio spots to discuss and review concepts, scripts and products. The role of the team was most important to ensure message consistency, appropriateness and approval by the team members. While the utility of the Media Advisory Team was critical to the speedy censor approval of the final media by the Ministry of Communications and the acceptance of the media products by both the national radio and television -- experiences with this process have demonstrated the importance of official documentation of each approval step as well as the full and active participation of all team members in the process. The new media films and radio spots -- written, directed and produced by Deependra Gauchan and his team from Sights and Sounds -- include a 49-minute videodrama entitled "Asha" (meaning "Hope" in English) which is a story of a young, HIV-infected woman who shares with the viewer her personal story of unprotected sex, teenage innocence, and a look into how her family and friends support her in dealing with her personal illness. The new feature film is complemented with three, short videofillers, including "Raju", the look into a teenage boy's experience of unprotected sex; "Laxmi", a look into a wife's emotions and disappointments of how AIDS has influenced her family's future; and "Unite Against AIDS", a short film aimed at the general public depicting the many faces of AIDS and encouraging all to unite together against the dreaded disease. The two new radio spots, entitled "Raju" and "Luxmi" complement the videofilms in a radio format. The films and radio spots were officially launched on April 25, 1997 at Stimulus' final project activity -- a Lessons Learned Workshop for 82 media, advertising and HIV/AIDS communications professionals to share in Stimulus' experience in developing and managing an HIV/AIDS media campaign. Placement of the new radio spots began in April, and the films are expected to be launched on national television by July. Nepal CRS Company will begin showing the new films as part of its expanded videovan operations in August 1997, and distribution of the films to interested projects, NGOs and HMG district health offices is expected in July. Output 2: Extension of the Existing Condom Distribution System to Reach Target Populations In terms of project outcomes AIDSCAP/Nepal's Condom Interventions have made significant achievements during the life of the project:
Note: For a discussion of TFGI, CRS and Stimulus subproject process indicator and end of project accomplishments data please refer to The Subproject Highlights Section . Constraints to Condom Expansion and Promotion in Nepal A number of identified constraints affecting the Nepal project include the following:
AIDSCAP/Nepal's Condom Promotion and Expansion Lessons Learned and Recommendations for Future Programming
3. Behavior Change Communications Accomplishments and Outcomes AIDSCAP's behavior change communications (BCC) strategy was designed to influence social norms to support the adoption of low risk behaviors by CSWs and their clients. The core of the Nepal BCC strategy was the primary goal to reduce the rate of sexually transmitted STI/HIV infection among CSWs, their clients and other transient populations in the project area through the implementation of targeted communication interventions aimed to reduce high risk behavior. These objectives served as the basis for the field level interventions developed at the beginning of the project, and remained so through the end of the project. The strategy focused on changing sexual behavior by encouraging alternative safer sex practices. Specific objectives to attain this goal included:
Nepal's BCC subproject implementation strategy developed from lessons learned and the field experiences of other AIDSCAP projects in Africa and Thailand. While untested among this target group in Nepal -- AIDSCAP and PATH technical assistance guided the implementation strategy to utilize interpersonal communications and counseling on HIV, AIDS and STIs, and the transfer of risk assessment and risk reduction skills to target groups in local communities. The community-based outreach strategy was enhanced with the introduction of peer education techniques and strategies to create a network of peer educators from the target groups and to support all with extensive outreach, assistance and appropriately designed and tested information, education and communication (IEC) products. Early on it was decided that AIDSCAP would work with at least one nongovernmental organization to manage BCC activities in the field. While there was great interest elicited by many NGOs to work with AIDSCAP, there were very few NGOs that actually fit the necessary criteria. The Resident Advisor and the BCC Technical Advisor interviewed numerous NGOs in late 1993 to begin the preselection process. This process was easily narrowed to a few NGOs -- those with experience and interest in the target groups and those not overburdened with other donor or community commitments. General Welfare Pratisthan (GWP), a newer Kathmandu-based NGO working with transport workers, and Lifesaving and Lifegiving Society (LALS), the only Nepali NGO with outreach field and training experience were selected as the primary implementing agencies to manage AIDSCAP's BCC field interventions. Given the capabilities of the two NGOs at that time it was determined that GWP would coordinate and manage the community-based interventions and LALS would provide training and human resource development technical support to GWP. This BCC partnership design was launched with the startup of the GWP subproject in September 1994 and the LALS assistance subproject the following month. The two NGOs had been mutual partners in managing and expanding the BCC field programs through the life of the project. The BCC technical advisor worked directly with the staffs of both GWP and LALS and paid four TA visits to Nepal at critical stages in program and outreach startup, development of an IEC strategy, peer education programming and development of the final program extension. TA visits in Nepal helped both GWP and LALS managers and field staff -- separately and together -- with planning, programming, brainstorming, strategizing and developing curricula and IEC products. Utilizing its highway and factory-based HIV prevention experiences, GWP expanded from a small, self-financing NGO to a large, field-based INGO-supported organization during its AIDSCAP partnership. LALS on the other hand went from a donor-dependent community-based outreach implementing agency to a more diversified agency managing field implementation and technical assistance activities with a variety of international and national partners. GWP was provided financial and technical resources to recruit, build and strengthen a strong staff of outreach educators, supervisors and community health nurses to promote outreach and peer education interventions along the Central Region highway, in the adjacent communities and in the middle of the region's large urban centers. GWP's first challenge was to identify interested young men and women willing to educate those at risk about the dangers of HIV and STIs. Its second challenge was to motivate its outreach staff to learn about and understand its communities and then to initiate field based activities with sex workers and clients. The biggest hurdle at this time was to motivate the GWP team to focus on its primary target -- CSWs and mobile men who are clients of sex workers. It was much easier to target prevention messages to students, teachers, youth clubs and mothers than CSWs and clients. With encouragement from AIDSCAP senior management, technical assistance and team leaders GWP's outreach teams were motivated to focus on the more difficult and hard-to-reach individuals. The efforts were made a bit easier as the condom mass media campaign was launched, more IEC materials became available, and individual field workers developed more personal confidence and skills to work with marginalized women and their clients. Over time GWP staff made tremendous strides in communicating and reaching sex workers in cities, local brothels, rural communities and tea shops. Likewise they were able to better know the skills to successfully contact truck drivers, their assistants, migrant bridge builders, traditional musicians, rickshaw pullers, young students, local police and military recruits. Over the life of the subproject, GWP reports a total of 50,402 outreach contacts, including 2,641 CSW contacts, 36,558 male/client contacts and 11,203 other female contacts in the Central Region. As their confidence and skills strengthened GWP was able to make better use of the IEC materials, to distribute Nepal CRS' condom wallets and to provide the free government condoms to those in need. As GWP's skills improved with training and experience the team was better able to identify potential and interested individuals willing and able to be trained and serve as peer educators "sachayatak" among their peers. While the peer education phase has not been easy and not without frustrations, GWP has been able to successfully work with peer educators and over the past year has developed a wealth of experience on how this process must be adapted at the community-level if it is to work in the long-run in the Nepal context. Since 1996 GWP and LALS conducted 49 special training sessions for peer educators. A total of 545 peer educators were trained, and it is estimated that as of the end of project approximately 30 percent (165) of the trained peer educators work actively in this new role. While the impact of the GWP team may be depicted in its process indicator achievements (below), major accomplishments have been shown by the team in its development of personal and community relationships with local sex workers, India-returned sex workers, community leaders and local trade associations. GWP's staff relations at the community level provided access and demand for help from families and individuals in need of STI treatment or HIV care and emotional support. In many cases GWP has gone beyond its scope of work to help persons in need. This team attitude has resulted in acknowledgment and support by local politicians of the importance of behavior change communications interventions in their home villages, and has resulted in ongoing demand for attention and programming at the community level. In essence, the outreach approach is more than acceptable in the Nepal high-risk communities. To achieve further impact and reach larger numbers of people will require more strategic peer education interventions and focused activity planning with motivated community and business organizations. Nepal's BCC component was also complemented by a Nepal-specific Rapid Response Fund program which funded HIV/AIDS prevention activities conducted primarily in local communities. Early on in the project it was realized there was a strong need to react to local initiatives and to enable GWP/LALS to motivate community-based mobilization. The AIDSCAP RRF proposal format was redesigned for local needs and GWP/LALS staff were oriented to the RRF requirements in a one-day workshop organized by the CO in July 1995. GWP/LALS staff were critical in identifying potential RRF grantees, and assisted the grantees in planning and implementing their activities. At the local level AIDSCAP funded six community based NGOs in five districts. AIDSCAP also supported three other organizations -- Nepal Medical Association's Nepalgunj branch, Narayangarh Jaycees and the Kathmandu-based HIV/AIDS IEC NGO Coordination Committee to implement national activities. The RRF mechanism is one that needs technical direction and attention, but is a program that provides for valuable community participation and targeted programming in support of AIDSCAP's overall project objectives. RRF contacts and activities have had multiplied impacts in the local community and among national-level professionals. Output 3: Targeted Communication Interventions to Reduce High Risk Behavior Implemented in the Central/Terai Region In terms of project outcomes the Behavior Change Communications interventions have proved to be quite successful in the Nepal project:
Note: For a discussion of GWP and LALS subproject process indicator and end of project accomplishments data please refer to The Subproject Highlights Section . Constraints to Behavior Change Communications in Nepal Constraints affecting the Nepal project include the following:
AIDSCAP/Nepal's Behavior Change Communications Lessons Learned and Recommendations for Future Programming
4. Policy Accomplishments and Outcomes The objective of AIDSCAP/Nepal's policy strategy was to provide an environment within which the government and the private sector could mobilize the resources and interventions necessary to control STIs and HIV/AIDS, and thereby minimize the impact of the disease throughout the nation. It is a fair statement to say that the area of HIV/AIDS policies and policy awareness-building was not a top priority in the AIDSCAP/Nepal project strategy. During initial project design the AIDSCAP team identified several areas in which AIDSCAP might work in collaboration with the NAPCP to affect policy development and reform, but in fact, the major focus of the Nepal project was field-based intervention support through the private and nonprofit sectors. AIDSCAP's first activity in the policy area was support for three Nepalese, two from the Department of Health and one from the research community to participate in a "epidemiological Assessment of the HIV/AIDS Epidemics in Asia and Data Utilization in Policy Initiatives" workshop in Bangkok in December 1993. An output of this workshop was the Nepal delegation's development of a policy action plan to convene a policy workshop utilizing EPI-Model with the expectation to then formulate a Delphi group to influence existing AIDS-related policies. Nepal was one of the only Asia countries participating in the Bangkok workshop that actually followed-up the workshop in a concrete way. Nepal's first follow-up activity was support for an October 1994 visit by a World Bank epidemiologist to Nepal to provide direct technical assistance to the NCASC on HIV estimation and modeling, as well as a full orientation workshop on EPI-Model software. The workshop was most helpful to the NCASC staff and their understanding of modeling. Projections developed by NCASC staff were compared with previous projections developed during an earlier World Bank visit. This served to verify and create local ownership and understanding of the Nepal projections data. At the conclusion of the workshop the NCASC and AIDSCAP cosponsored a presentation on "The Epidemiological Situation and HIV/AIDS Projections for Nepal" attended by 75 government, NGO, donor and media guests. The presentation received large coverage in the local press with the key message encouraging Nepal not to wait until AIDS is a visible problem, but to focus efforts to increase awareness and education of HIV/AIDS and STIs among those at risk, and "to improve efforts to evaluate behavior change among these population groups. In 1994 AIDSCAP also supported four Nepali journalists to attend a specially-organized journalist workshop in Bangkok "HIV/AIDS Reporting in Asia, Facing the Facts." While the workshop itself proved to be technically useful for the Nepali participants -- AIDSCAP support provided an opening of relation-building with several motivated journalists -- including two representing a journalists' group -- Journalists Against AIDS in Nepal (JAAN) and also representing "Kantipur" and "The Independent" respectively. The third participant was a national leader in rural journalism and editor of "SATYA Weekly." The fourth participant, editor of Saptahik Bimarsa showed no further interest in AIDS media issues. In collaboration with the NCASC follow-on policy priorities planned included an Asia study tour for policymakers to be organized in 1995, and the management of HIV/AIDS orientation workshops for members of Parliament, as well as workshops for local journalists. These activities were given top priority by the NCASC until the Minister of Health instructed the NCASC chief to discontinue the planning of all policy activities with AIDSCAP and other INGOs. All planning was then put into a holding pattern which unfortunately continued for the entire life of project given the changing political environment with numerous changes in NCASC leadership, Ministry leadership, and national government priorities. This situation was further reinforced by the NCASC's unilateral development of a national AIDS policy framework (with WHO consultation) and the exclusion of all other donors, INGOs and the NGO community in the process. As discussed earlier in Section I. B. of this report, Nepal's HIV/AIDS national policy was approved and finalized in 1996. AIDSCAP took other opportunities to affect policy/awareness raising:
In coordination with the NCASC, AIDSCAP sponsored a follow-up visit by the World Bank epidemiologist to Nepal in early 1997 to assist HMG in updating its HIV estimates and to provide technical assistance to improve HMG's HIV sentinel surveillance system. A full discussion of these activities is discussed previously in Section I. A. With the closure of WHO and the absence of policy issue initiatives by other donors and support agencies in Nepal, AIDSCAP and USAID/Nepal recognize the important contribution that continuing support to the NCASC can have in the policy area. Output 4: Policy Makers' Awareness of STIs/HIV/AIDS Issues in Nepal Increased In terms of project outcomes the AIDSCAP's Policy Interventions have made some small, but important achievements during the life of the Nepal project:
Constraints to Policy Awareness Raising in Nepal Identified constraints affecting the Nepal project include the following:
AIDSCAP/Nepal's Policy Lessons Learned and Recommendations for Future Programming
5. Capacity-Building Accomplishments Globally the AIDS Control and Prevention Project was designed to support the capacity of developing countries to prevent and control HIV. This underlying development philosophy was built into the program design of every subproject activity supported by the Nepal country program. While Nepal's project goal was, "to reduce the rate of sexually-transmitted HIV infection in the Central/Terai region of Nepal," this was to be accomplished by means of local capacity-building -- through human resource development of staff, counterparts and beneficiaries and the institutional-strengthening of implementing organizations, partner and associated agencies, and recipient NGOs. Each and every subproject supported through the Nepal project contains at least one important institutional strengthening component. A few projects in the Nepal portfolio are in fact institutional-strengthening initiatives in entirety. In order to measure individual capacity-building at the subproject level it is suggested to review the individual subproject accomplishments presented in Section E of this report. The two AIDSCAP/Nepal subprojects regarded as full capacity-building initiatives include: (1) Lifesaving and Lifegiving Society's (LALS) "Human Resource Development Assistance and Training to General Welfare Pratisthan in Nepal" subproject implemented through three separate letter of agreement phases beginning in October 1994, and (2) Save the Children/US's "STI/HIV/AIDS Coordination and NGO Technical Support Project" which was implemented for a period of 13 months from February 1995 through March 1996. The LALS subproject was designed to provide orientation training, specialized trainings, staff skill-building and field oversight in HIV/AIDS and STI outreach and behavior change interventions. LALS' role changed overtime as the needs of the GWP changed in the field. LALS also provided specialized technical and orientation training to other AIDSCAP implementing agencies on an on-call basis. LALS provided training to FPAN clinic and volunteer staff, to Nepal CRS Company staff, as well as basic training and implementation support to small RRF grantees who were overwhelmed with their small subproject plans and requirements. The LALS team provided a very necessary and important service strengthening role in assisting AIDSCAP NGOs to better work at the community level. The second AIDSCAP subproject with a similar capacity-building focus was the Save the Children/US subproject, "STI/HIV/AIDS Coordination and NGO Technical Support Project." The purpose of this project was to enhance the capabilities of participating Nepali NGOs to effectively implement STI/HIV prevention education and condom social marketing programs and to promote efforts at program coordination. The SAVE project was a project activity not initially envisioned in the AIDSCAP strategy. But due to circumstances forcing an early termination of an HIV/AIDS technical assistance team overseeing the AmFAR program in 1994 -- USAID and AIDSCAP realized the strategic benefits to support SAVE's ongoing NGO capacity building activities with both the AmFAR and non-AmFAR NGO community. The SAVE/US project (1) provided direct technical assistance to participating NGOs to develop, pretest and finalize quality information, education and communication (IEC) materials; convened an IEC development workshop for NGOs; and directly facilitated the monthly meeting of the NGO IEC Committee; (2) developed and introduced a preventive counseling checklist and training curriculum, convened an HIV/STI preventive counseling workshop for NGOs, and initiated the startup Of a counseling working group; and (3) provided special assistance to Nepal CRS Company to encourage greater NGO participation in condom social marketing through the identification of potential NGO partnerships in the Eastern and Midwestern regions and in the development of a draft condom social marketing training curriculum. Following the completion of the SAVE/US subproject in 1996 SAVE/US secured donor support for a five-year program from the Government of Netherlands. SAVE/US and AIDSCAP then continued to provide shared-support to the HIV/AIDS NGO IEC Coordination Committee through 1997 (with AIDSCAP support programmed through an RRF grant). In the area of technical skill-building, AIDSCAP supported the development of implementing agency and NCASC staff through the provision of direct technical assistance in STI case management, behavior change communications, condom expansion and communications, evaluation research design, and HIV estimations and modeling primarily by external consultants from FHI/AIDSCAP Asia Regional Office, FHI/AIDSCAP Headquarters, PATH, The Futures Group International, and by local Nepali and expatriate consultants. A significant amount of technical skill building assistance was also provided directly by the AIDSCAP Nepal Resident Advisor and Senior Program Officer in particular skill areas such as technical writing/presentation skills, and HIV counseling and training skills, respectively. In the area of organizational and management skills development the majority of the assistance was provided directly by the AIDSCAP Nepal country office staff, including the Resident Advisor, Finance and Administration Officer, Senior Program Officer and other project staff in the following areas:
At the close of the project a local expatriate consultant helped the country office with agency final reporting. The process started with a one-day report writing and lessons-learned skills workshop held in March 1997 and attended by key implementing staff. This workshop helped to kickoff a challenging report preparation process which was completed in mid-July In the area of networking and global learning enhancement the AIDSCAP country office provided priority support to its implementing agencies and the NCASC, and secondary support to other NGOs and INGOs through the regular dissemination of recent HIV/AIDS and STI literature, periodicals, publications and FHI-produced newsletters and IEC materials. The regular update and mailings of special materials and periodical journal listings to Nepal by AIDSCAP/Headquarters and the Asia Regional Office for regional materials was much utilized and appreciated by the Country Office and by our local recipients. As the access to information on HIV/AIDS is so limited in a country like Nepal -- a small investment in a simple information exchange program has more than paid off for the country program. Other regular networking activities undertaken by the Country Office included support for the HIV/AIDS NGO IEC Committee, and attendance at all HMG-organized gatherings of sector donors/INGOs. Networking activities valued by the Country Office and implemented on time-permit basis included -- informal networking with NGOs and INGOs, participation at local HIV/AIDS seminars and workshops, and special presentations at NGO workshops. |
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