From interventionist to facilitative, strength-based approach

CARE EMPHASIS team works on issue of cross-border migration and HIV.  For last few years the team in  Mumbai has been working in destination for Nepali and Bangla speaking migrant community. The work includes providing information on HIV, outreach, infotainment etc. However engaging the community in HIV response was a challenge. 

Here is what happened…

Scenario in April 2013

CARE invited us (India competence) in April 2013 to introduce community life competence to the team for facilitating community response to HIV. The CARE team had deep concern for the community, “We want to prepare the community and not leave it in the lurch when the project ends in July 2014. What will happen to the community on issue of HIV as the community thinks HIV is CARE project? We would like to teach the community to fish rather than provide fish. We have tried so hard but not much progress has been made on community engagement in HIV”.  On the other hand community did not see value in overflow of HIV information and constant urging for HIV testing to meet CARE project targets.  One of the Nepali community members shared that ‘I pretend to sleep when the CARE team comes as they will begin the oft-repeated lecture on HIV”.  Bangla speaking migrant Mariam said, “I have told Rutuja (CARE team member) why she comes so far to our Kalva community in this torrent rain or scorching sun. I assured her many times that she may not come so often and I promised that I will tell her boss that she comes daily. By now we know four causes of HIV by heart. What is the point of repeating this information.

April-Nov 2013

We introduced the team to community life competence, which believes that community has the potential to respond to its issues of concern. However, sometimes the community is not aware of this potential. Therefore, by applying SALT can reveal strengths of the community and encourage it to take action.

So now the CARE team modified its way of thinking and working. Giving up the expert mode, they moved to a more facilitative mode. Rather than providing information and solutions, the NGO team started asking the community their hopes and concerns. What was the community proud of? What was their dream in terms of HIV? 

Nov 2013

I heard some stories of change post application of Community life competence process.

Bangla speaking community opens up and leads in transfer to other communities-Bangla speaking community was primarily Muslims and they did not open up on HIV.  Now the team working with this community like Sanskruti, Alamin Sheikh, Rutuja note a response from the community. Women have started openly talking about HIV and are sharing about HIV with loved ones even those living far off like on Ray Road. Community member, Ruksana candidly observed the change in CARE team - "Earlier the CARE team would deliver lectures on HIV. Don't mind but we were not interested in all that talk about HIV, we just nodded our heads. But now things have changed. CARE team meet us as friends, they talk about what we want and not about what they want for us. They have become a part of us. We are Muslims and we found very hard to be open about HIV but now we can share easily. We feel its our responsibility to share about HIV with our friends and relatives. We find ways to transfer to others when we meet them during festivals and weddings."

Transfer to six communities among Nepali Migrant community

Purna, Project coordinator, Nepali migrant community project-CARE team held a vocational training workshop where we also invited women from areas we don’t work in. Nabdurga community with whom we work and have applied SALT was also present. During this workshop, Nabdurga community through personal examples shared the importance of community to respond to HIV. The women from six communities were motivated and invited the CARE team to visit them. Nabdurga community also visited some of these areas and encouraged them to come together as a community. So, the vision and HIV response has been transferred to six communities- Bhagatsingh Nagar, Santosh Nagar, Shanti Nagar, Ambedgar Nagar, Kamia Estate (Goregaon). Lesson learned is says Purna, that when we outsiders urge the community they don’t pay much heed but peer-to-peer learning encourages horizontal local transfer. NGO can facilitate this process and thus increase the reach of the project manifold.

Increase in HIV awareness, testing, care and treatment- Yamuna, the M&E officers notes a spurt in testing cases since CLC and says that the CARE team was earlier struggling to meet targets of HIV testing among communities. Now the community members are coming forward for HIV testing and are also encouraging others to do testing. Communities are taking a lead in transferring information on HIV and STIs to new members in the community. They are also taking other community members to the hospital. “A community member called me up the other day to take a member to the hospital. But I was on other side of Mumbai. And the community member offered to take the patient himself.”

Community based organisations of Nepali communities taking ownership on issue of HIV- Sandeep Gaikwad and Purna, CARE team mentioned that there has been a change after they introduced SALT principles to the CBOs. Earlier the CBO saw EMPHASIS as Project of CARE team. CARE team members were being paid to provide information and services on HIV. But now after CLC CBOs have begun to realize that they, community members, are vulnerable to HIV and need to take action for their own health. Sanyukt Nepali Mahasangh (CBO) for instance now allocates some funds for HIV positive and cancer patients. When a PLHIV broke his leg, the CBO members for a month nursed him during the night by rotation. Now community members trust the CARE team and do not run away from us. – Yamuna laughs.

Community spirit growing stronger- Yashoda, CARE Team member who works with Nepali Migrant community- This story is from Nabdurga community- Now the community solidarity has grown. They have begun to help each other. Earlier one of the community members provided help to a woman whose little son had tetanus and she subsequently lost her son.  Recently when the same lady needed blood during her delivery, the community members came forward to offer blood.

Easier to set up a new group- Yashoda, CARE team- I know CLC has helped me tremendously in my work. I had been trying to set up a new group in Ramachandra line since one and a half year. It was not happening. The community made excuses that they work in day and night shifts and had no time to come together. But now lo behold after SALT visits, there is a sea change in them, she says smilingly. They have met many times and have begun to respond on HIV.

This experience shows that CARE top leadership have the belief that communities can do things for themselves and how community facilitation must go hand-in-hand with targeted intervention. Kudos to the CARE  EMPHASIS Mumbai team which was open to abandon the traditional way of working and adopt the bottoms up approach.  Sanskruti, project coordinator with Bangla speaking population says, “It is simple, it's about us the NGO staff, we have to change our attitude”.

I conclude with a quote from Annie Leonard-v“Real change starts with changing the game.

(I thank the migrant communities from whom we learned, got immense happiness and inspiration)

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Comment by Phil on November 25, 2013 at 11:02pm

Dear Rituu, 

It was a great pleasure to read this. The work by India Competence is a huge achievement and everybody involved in it (including you!) should take great pride in what you have done.

The text is full of phrases that show how the communities have taken ownership of their issues and started to deal with them. "We find ways to transfer during festivals and weddings." "Peer-to-peer encourages horizontal transfer." "They are taking other community members to the hospital (for testing)." "CBOs recognise that they, community members, are vulnerable to HIV. They allocated funds to..."

There are just so many beautiful touches in the text, so many phrases that gave me pleasure. It was an excellent way to start the week. 

Well done, India Competence. 

Best regards

Phil

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