Case Study

Stories and Experiences of Key Populations

Forming Networks of CommunityBased Organizations

Early experiences from the Avahan India AIDS Initiative

Forming Networks of Community-Based Organizations: Early experiences from the Avahan India AIDS Initiative
BY BILL RAU

Acknowledgments
The author gratefully acknowledges the support and insights of CBOs and individuals representing communities served by the Avahan program, as well as the support and guidance of PraxisInstitute for Participatory Practices and Avahans state-level partners: International HIV/AIDS Alliance and Hindustan Latex Family Planning Promotion Trust (Andhra Pradesh), Karnataka Health Promotion Trust (Karnataka), FHI 360 (formerly Family Health International) and Pathfinder International (Maharashtra), Emmanuel Hospital Association (Manipur and Nagaland), and Tamil Nadu AIDS Initiative (Tamil Nadu). The author also thanks the following people for their valuable contributions to this publication: Tisha Wheeler of the Bill & Melinda Gates Foundation for her comprehensive technical review; James Baer for his careful editorial work; Pol Klein of Futures Group for the publications design; and Lori Merritt and Ginny Gordon of Futures Group for its final editing. This work was funded by the Bill & Melinda Gates Foundation. The views expressed herein are those of the author and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation.

Contents
ABBREVIATIONS 6 INTRODUCTION 7 GOALS OF CBO NETWORKS Addressing community members immediate concerns Providing a common voice in advocacy around policies and programs for social protection and development Providing CBOs with ongoing technical support and access to resources FORMING DISTRICT AND STATE NETWORKS OF CBOs The working group process Network structure Network functioning PROGRAM INPUTS Raising awareness Building capacity Developing secondary leadership Setting priorities Sharing lessons Financial support 16 18 20 21 23 24 26 26 29 31 31 31 16 12 14

Consultations 19

EARLY CHALLENGES AND STRATEGIES FOR GETTING STARTED Turning the network concept into reality Managing power relations Increasing problem-solving capacities Communication for problem solving and advocacy Keeping a focus on HIV prevention Keeping the networks interactive Managing expectations LESSONS FROM OTHER CBO NETWORKS Serving members Sharing experiences Linking with other organizations Expanding influence

32 34 35 37 38 38 39 41 42 43 43 44 45

CONCLUSION 48 REFERENCES 50

Abbreviations
AIDS CBO FSW HIV HR-MSM IDU NACO NACP NGO SACS TG acquired immune deficiency syndrome community-based organization female sex worker human immunodeficiency virus high-risk men who have sex with men injecting drug user National AIDS Control Organisation National AIDS Control Programme nongovernmental organization State AIDS Control Society transgender person

ABBREVIATIONS

Introduction
It has long been recognized that vulnerability to HIV infection is not simply an issue of individual behavior but involves complex webs of individuals, communities, and social structures. Can groups and networks also make people less vulnerable to this disease? This question is particularly pressing in a country such as India. Although the proportion of the population infected with HIV is just 0.3 percent, the absolute number is 2.4 million, making it the country with the third largest number of HIV-positive people.1 In India, those most at risk of HIV infection are among the most marginalized social groupsfemale sex workers (FSWs), high-risk men who have sex with men (HR-MSM), transgender people (TGs), and injecting drug users (IDUs)with little control over many of the factors that make them vulnerable to HIV. These include being denied proper access to education, employment opportunities, or healthcare because of their sex, caste, or sexual orientation. The discrimination such individuals face increases if they take up sex work or become addicted to drugs. Disapproval and ostracism from families and the general community are often compounded by harassment and violence from criminals as well as from the police. It is not surprising if those most vulnerable to HIV feel powerless in the face of multiple, diverse threats.

INTRODUCTION

Since 2003, communitiesi from six states in India have participated in an HIV prevention program called Avahan, funded by the Bill & Melinda Gates Foundation. Community mobilization has been central to Avahans strategy of encouraging up to 320,000 community members to work for HIV prevention and undertake other harm reduction activities on a sustained basis. From early on, the program encouraged and facilitated the development of informal groups of community members as part of its HIV prevention strategy. Groups often gathered at sites set up by Avahan program partners for the delivery of services. Over time, attendees at these service sites and peer educators began to organize more formally to address structural issues such as violence and access to government health services and other social services. As community mobilization gained momentum and leaders emerged, some informal groups matured into legally registered community-based organizations (CBOs). The CBOs engaged members in promoting HIV prevention and other issues of concern, including reducing social stigma and discrimination, and education for members children. Community mobilization and CBO formation have thus been important approaches for maintaining the quality and sustainability of services in the Avahan program, as well as ensuring service uptake by communities.

i Discussion among communities of female sex workers, men who have sex with men, transgender people, and injecting drug users in India has led many of them to reject the label high-risk. This publication therefore uses the term community instead of high-risk group, and community member instead of high-risk group member, to refer to those groups of people in India at highest risk of HIV infection who are the focus of the Avahan Initiative. However, for the sake of clarity and for consistency with generally understood terminology about men who have sex with men, those receiving services from Avahan are referred to here as HR-MSM to indicate that they are a subset of all MSM whose sexual behavior puts them at increased risk of HIV (because they have a large number of sex partners, sell sex, practice receptive anal sex, or a combination of these factors).

INTRODUCTION

I cannot take a [policy] issue directly to the state level, but with a state-level network, our rights and entitlements can be addressed.
PRESIDENT OF A CBO OF FSWs IN VIJAYAWADA, ANDHRA PRADESH

The Avahan program was designed to run for 10 years (20032013), and management and funding of the program have largely been transitioned to the Government of India, specifically the National AIDS Control Organisation (NACO) and State AIDS Control Societies (SACS). Since NACO and the SACS could not provide the same levels of financial and technical support for community mobilization and CBOs as Avahan was able to do, the Avahan program began to foster the creation of CBO networks to represent CBO interests at district and state levels, providing financial and programmatic input.

THE GOALS OF THE NETWORKS INCLUDE

Sustaining HIV prevention and community mobilization Addressing issues of common concern across CBOs and facilitating communication between them Providing a common voice in advocacy about policies and programs that affect the CBOs and their members Providing CBOs with ongoing technical support and access to resources The networking process has not yet matured, but the goal is that CBO networks will play a critical role in ensuring that communities remain active and viable partners in HIV prevention and continue to address the structural causes of their vulnerability.

INTRODUCTION

This case study is based on a qualitative review of the early stages of CBO network formation in the Avahan program to identify elements that strengthened the effectiveness of the networks. Interviews were conducted in early 2011 in two of the states where the Avahan program operates, Andhra Pradesh and Maharashtra, with several groups of subjects: staff of an Avahan-funded consortium that at that time was facilitating network activities;ii office bearers and members of CBOs; members of network working groups; and Avahan program staff. The interviews were complemented by observing the meetings of network working groups and by a review of program documentation and of studies of community mobilization in other contexts. This publication also reflects more recent perspectives offered by Avahan staff and consultants during its finalization. What follows is a description of the processes, program inputs, and capacity development that strengthened CBOs and began to create networks. It reflects the initial thinking and direction of those involved, and some of the early lessons learned and challenges arising are outlined. The experiences of community mobilization networks in other countries are also briefly considered. Although this case study does not cover the developments in Avahans CBOs and networks since the field work was conducted, it is hoped that what follows may be of interest to those implementing networking activities to strengthen community mobilization on a large scale.

ii  The process of network creation was initially facilitated by a consortium of organizations funded by the Bill & Melinda Gates Foundation to do this work. This arrangement was discontinued in 2012 and, from this point on, the process has been overseen by different configurations of statelevel implementing partners. In this publication, the consortium is referred to as networking facilitators.

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INTRODUCTION

How Avahan Is Organized

2, 3

Avahan was established in 2003 in India by the Bill & Melinda Gates Foundation. It is a focused HIV prevention program offering a standardized package of proven interventions to groups at highest risk of HIV infection and bridge populationsiii in six states: Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, and Tamil Nadu. These states, with a combined population of 300 million, accounted for 83 percent of the countrys HIV infections in 2002. The interventions provided by Avahan include behavior change facilitated by peer educators; management of sexually transmitted infections; condom promotion; provision of commodities (condoms, lubricants, needles and syringes); community mobilization; and advocacy for an enabling environment. At the state level, one or more organizations (known as lead implementing partners) oversees the HIV prevention interventions. At the local level, these interventions are implemented by smaller, grassroots nongovernmental organizations (referred to as local implementing NGOs).
iii B  ridge populations are persons who have sexual contact both with persons who are frequently infected with and transmit sexually transmitted infections and also with the general population.

INTRODUCTION

11

01

Goals of CBO Networks

12

Networks of communities affected by HIV and social discrimination have existed in India for at least a decade.
The Durbar Mahila Samanwaya Committee of West Bengal4 remains one of the most recognized movements of male, female, and transgender sex workers globally. The voices of human rights advocates working with sex workers in India have recently gained international recognition,5 and in 2009, after decades of work by MSM and legal and health advocacy organizations and individuals, homosexual sex was effectively decriminalized in India by a ruling of the Delhi High Court. Following advocacy in 2011 by a state-level network of CBOs of people who use drugs in the northeastern state of Manipur, a monitoring committee was set up by authorities in Churachandpur District to ensure adherence to minimum standards of care and treatment in the districts drug rehabilitation centers. In the southern state of Tamil Nadu, progress for TGs resulting from the work of NGOs, CBOs, and political leaders includes recognition of their distinct gender on voter identity cards and the provision of social welfare entitlements, including sex reassignment surgery. The efforts of human rights advocates, marginalized groups, and networks are a widely acknowledged strength of Indias HIV response, and their example helped inspire community members in the Avahan program to form CBOs. Today, many state- or district-wideiv networks of CBOs have formed and are working to improve conditions of daily life, address systemic violence, and advocate for social acceptance and respect.

iv  In India, a district is an administrative subdivision of a state. An average district has an area of 2,000 square miles and a population of 2 million.

GOALS OF CBO NET WORKS

13

We want to be accepted in society for who we are. The network will be a voice for our rights within the state and maybe beyond.
WORKING GROUP MEMBER, ANDHRA PRADESH

ADDRESSING COMMUNITY MEMBERS IMMEDIATE CONCERNS

One of the major catalysts for communities to form CBOs within the Avahan program was the need to express a collective identity, especially when addressing structural factors that placed them at risk of HIV infection.v These factors include harassment and violence by police, local gangs, and partners; denial of basic services by some providers; and public discrimination and stigma against community members. Many community members considered these issues to be of most immediate concern for their well-being and ability to sustain HIV risk reduction behaviors. A number of CBOs successfully took on these and other issues at the local level, for example with crisis response teams that quickly respond to incidents of violence against community members. However, they recognized that achieving broader and long-term solutions would also require interventions at district and state, if not national, levels. Individual CBOs often lacked the experience to formulate or initiate an approach to authorities at these levels. The creation of district- and state-level CBO networks was intended to provide a platform for this work so that efforts could be coordinated and communication enhanced.
vC  BOs of groups at highest risk of HIV also formed outside of the Avahan program context, in response to initiatives by other implementing organizations and local needs. The networks created through the Avahan program sought to incorporate these CBOs into their overall structures.

14

GOALS OF CBO NET WORKS

GOALS OF CBO NET WORKS

15

PROVIDING A COMMON VOICE IN ADVOCACY AROUND POLICIES AND PROGRAMS FOR SOCIAL PROTECTION AND DEVELOPMENT
As CBOs developed, one of the major issues they faced was gaining for their members the rights and access to social entitlements that are due to all citizens of India, including adequate healthcare, freedom from stigma and discrimination, various government schemes for social protection and development, and schooling (for the children of sex workers). Working for the rights of marginalized groups was seen as a central role of the networks at the time of their conception. Networks would not only address issues raised by one or several CBOs but could also monitor state and national policies and initiatives that affect large numbers of CBOs. In addition, the networks could give CBO leaders a platform to hone their skills and apply their experience to influence HIV policy and program planning and implementation at district, state, or national levels.

PROVIDING CBOs WITH ONGOING TECHNICAL SUPPORT AND ACCESS TO RESOURCES

At the time that network creation began, many CBOs within the Avahan program were well-organized, with effective leadership and a supportive and enthusiastic membership.vi Some had already registered successes in advocating for members needs, for example engaging local government officials on water supplies and access to ration cards. CBOs were also beginning to learn to sustain themselves
vi  The majority of CBO members pay a membership fee, which, while small, demonstrates their commitment to the organization.

16

GOALS OF CBO NET WORKS

institutionally: some had successfully applied for small grants from private enterprisesmostly for one-time activitiesand a few had received grants from government departments for advocacy and communications. The capacity support that led to this level of organizational development was a prerequisite for network creation. The CBO networks were conceived partly as a way of building on these early achievements to strengthen individual CBOs, deepen their leadership, and provide access to broader financial resources. Where appropriate, the networks would also offer capacity-building support to CBOs that had formed outside the Avahan program and that could be invited to join the networks.

GOALS OF CBO NET WORKS

17

02

Forming District and State Networks of CBOs

18

FOUNDATIONS FOR COMMUNIT Y MOBILIZ ATION

CONSULTATIONS
The process of forming networks began in 2006 with consultations that brought together a number of groups: The lead implementing partners, which, in addition to leading the Avahan program at the state level, assisted local implementing NGOs in fostering CBOs CBOs of FSWs and HR-MSM that had formed prior to the Avahan interventions Other CBOs, advocates, and networks of marginalized groups, including Durbar Mahila Samanwaya Committee, the SelfEmployed Womens Association, and the Lawyers Collective It was concluded that forming networks at that early stage of the program would not allow community groups to be mature enough to truly represent constituencies on the ground and that capacity-building support was needed first. By 2009, Avahan had CBOs established in most districts, and although they were still being strengthened, they had reached a level of maturity that allowed them to engage in efforts to form state networks. Avahan facilitated discussions at this point, including some of the earlier national advocates but focusing primarily at the state level and including local leaders from the communities served by the program, as well as SACS and implementing NGOs. The consultations were a two-way exercise: Avahans networking facilitators learned about existing or planned networks, plans for continuing HIV prevention and CBO support, and opportunities and constraints for the new networks. At the same time, they explained to the CBOs the rationale and initial plans for creating the new networks.

FORMING DISTRICT AND STATE NET WORKS OF CBOs

19

Further consultative meetings were held with leaders of CBOs at district and state levels to describe the intent and potential structure of the networks. Based on these consultations, the CBOs were invited to send a representative to join a temporary working group that would design the initial structure of the state-level CBO network. Because the concept of networks was new to most CBO members, the networking facilitators found that they needed to be fairly directive in forming the working groups and suggesting network structures. However, once the working group coalesced, the team could assume a facilitating rather than directive role.

THE WORKING GROUP PROCESS

In each state, the working group carried out several tasks: Conducted a survey to identify and count existing CBOs involved in HIV prevention across the state. Gathered ideas, concerns, and opinions from the CBOs, including non-HIV issues that preoccupied them. Built awareness among CBOs and their members about the emergence of a network and its potential to encourage CBO membership. Drafted bylaws for formal legal registration of the network, and set a process and standards for the election of office bearers. Working groups ranged in size from 15 to 40 members. A small stipend was provided for days worked, and modest travel and related expenses were reimbursed. Each group defined its own membership criteria.

20

FORMING DISTRICT AND STATE NET WORKS OF CBOs

Some examples include Willingness to give 1012 days per month for network activities, attend all working group meetings, and encourage community participation Ability to read and write Good communication and coordination skills

NETWORK STRUCTURE
Three-tiered network structures were originally envisaged, and such a structure was developed in Andhra Pradesh state, consisting of individual CBOs; a network at the district level (usually called a district federation), with elected office bearers who represented all CBOs in the district; and a state-level network representing the interests of all the districts, with representation drawn from the district federations (Figure 1). This structure in part reflected the practicalities of coordinating work among numerous districts in a state with a large population spread over a wide geographic area. (Other states ultimately adopted other approaches: in Tamil Nadu, for example, the working group decided to forgo district federations and have only a state-level network.) In many districts in Andhra Pradesh, there were community-based groups involved in HIV prevention that were not formally organized and registered with the government as CBOs. Early in the network formation process, some working groups decided that these groups should also be eligible to join the network because their goals were broadly aligned with those of the CBOs. This would help ensure that less formalized groups were also represented.

FORMING DISTRICT AND STATE NET WORKS OF CBOs

21

Figure 1: Network Structure in Andhra Pradesh

STATE

DISTRICT CBO FEDERATIONS

CBOs

22

FORMING DISTRICT AND STATE NET WORKS OF CBOs

A further issue was whether to form separate networks to represent FSWs and HR-MSM/TGs. While Tamil Nadu decided to have a single state-level network representing all communities, other states envisaged separate state-level networks to represent FSWs and HRMSM/TGs, because these communities tended to have distinct cultures and often differing concerns around issues of discrimination and access to health services.

NETWORK FUNCTIONING
The network structure was intended to promote dialogue between the various tiers to raise and solve problems that were common to many members: If individual members of a CBO bring forward a concern, the CBO will discuss it, see if it applies to other members, and look for ways that the CBO itself might address it. If the issue appears to be beyond the capacity of the CBO to resolve by itself, it can be forwarded to the district federation. The federation may advise on ways that the CBO can deal with the issue; or, if several CBOs have noted the same concern, it may decide to bring it to the attention of appropriate district authorities. (An example might be CBO members having difficulty getting identification cards because of a bureaucratic hold-up within a district government office.) If it is felt that the issue cannot be readily addressed at the district level, it will then be forwarded to the state network for consideration. The network can advise the district federation on appropriate actions that may not have been considered, or it may take up the issue itself with state-level stakeholders.

FORMING DISTRICT AND STATE NET WORKS OF CBOs

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03

Program Inputs

24

FORMING DISTRICT AND STATE NET WORKS OF CBOs

Many of the CBOs within the Avahan program were only two or three years old at the time that network formation began, and some were even younger. But it was apparent that
communities were highly empowered and capable of shaping effective network strategies. The energy and confidence of the CBOs came from having already achieved results, including organizing, which many members would not previously have considered possible. Before becoming involved in the CBOs, many of the leaders who became instrumental in forming the networks had been isolated individuals with little confidence, no support systems, and little hope for the future. Network formation built on their struggle to gain control of their life and was invigorated by their growing sense of support as they started relying on and taking action with others in their community. The Avahan program worked alongside the CBOs, providing specific program inputs to foster these dynamics and strengthen the CBOs capabilities.

PROGR AM INPUTS

25

RAISING AWARENESS
Thanks to Indias tradition of social movements among the marginalized, the idea of forming networks was not foreign to the CBOs, but it needed support. The process was facilitated by the CBO representatives who made up the working groups to form state networks. They recognized that the network concept must be agreed on by the membership of each CBO. One working group member noted, The idea of the network is very important and needs to be understood. Then we can act on the idea. To raise awareness of the potential and value of networks, regular consultations were held with stakeholders at all levels, including two or more meetings before a working group was formed. Each state established (or was making plans to do so) an advisory committee for setting up the networks, including government stakeholders, leaders of existing networks, academics, NGO leaders, and community representatives who were not necessarily already members of CBOs. Both the consultative processes and the approach to structuring networks were kept flexible. If an approach worked, it was suggested for use elsewhere; if not, changes were made or the approach was abandoned entirely. This flexibility paralleled the approach of the Avahan program more generally.

BUILDING CAPACITY
The formation of CBOs within the Avahan program followed several years of informal leadership development supported by the lead implementing partners. Members of communities had been recruited and trained as peer educators, with the added responsibilities of documenting their contacts with peers and solving problems within their communities. Others had joined rapid response teams to resolve issues of violence or harassment faced by community members.

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PROGR AM INPUTS

PROGR AM INPUTS

27

The network formation process took advantage of the existing leadership of the CBOs. Over time, some peer educators and other community members had taken a lead role in the formation of CBOs, serving as office bearers or on committees. Many members of the working groups were leaders within their respective CBOs and brought experience in organizing, managing, and motivating their peers. Some also had experience interacting with government authorities, law enforcement officers, and health providers, or already had contacts with members or leaders of other CBOs. Implementing partners and the networking facilitators provided several key inputs to district-level CBO federations: Building their capacity to manage issues brought up by CBO members Strengthening the lines of communication from grassroot groups to the network leaders Conducting technical assistance on internal management and ongoing delivery of HIV prevention services Organizing advocacy activities at the district level Building skills in public speaking and facilitation, media relations, and documentation of activities A corollary to skills building by outside facilitators was a system whereby CBO leaders who were members of the working group monitored one another to provide perspectives that were constructively critical and challenged other CBOs to move toward organizational development and networking goals. They could ask other members for help, encouragement, and ideas for moving forward. Working group members especially appreciated this form of peer support, contrasting it with the criticism that frequently occurs in

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PROGR AM INPUTS

hierarchical organizations. Since many steps in network formation and promotion were new for working group members, monitoring enabled them to learn from their mistakes as well as their achievements. The peer support mechanisms within the working groups increased the willingness of members to be proactive in working for network formation and to push themselves to take chances without fear of retribution. One technique for enhancing the problem-solving skills of network members was to incorporate into meetings activities that would require and develop specific analytical skills. The peer monitoring system supported this approach.

DEVELOPING SECONDARY LEADERSHIP

The continued strength and effectiveness of CBOs and networks will depend on having skilled and dedicated staff to carry out the essential functions that keep organizations viable. New leadership will be necessary if existing CBO leaders assume positions within a network and are unable to give so much time to their own CBO, or if they leave for other reasons. A third element of the skills-building process was therefore to build the capacity of second-line leadership, encouraging younger and sometimes reluctant or modest CBO members to assume leadership functions. Second-line leaders might receive training in financial and organizational management, issue analysis, private business sector outreach, or the drafting of funding proposals. These roles were considered essential to the effective operation of the district federations and state networks and, in many cases, for CBOs, too.

PROGR AM INPUTS

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30

PROGR AM INPUTS

SETTING PRIORITIES
Within a short time after formation, the district-level federations and state-level networks would be expected to make decisions affecting their CBO members. It was necessary to set priorities, since not all issues or aspirations could be addressed effectively at once. The networking facilitators role was to help the networks identify approaches, techniques, and tools that their members could use to analyze problems and identify likely solutions that would best serve their communities.

SHARING LESSONS
Even at an early stage, important lessons about network formation were being learned, which could be of benefit to other groups in India and beyond. The networking facilitators published a newsletter compiled from debriefing and trip reports, interviews with staff and network members, and even anecdotal reports from people across the networks. While informal and straightforward, the newsletter was a useful, simple tool to describe approaches to network formation that had been tried, the results, and any changes that were planned based on the experience.

FINANCIAL SUPPORT
In addition to capacity building, the lead implementing partners provided financial support to the district federationsmostly for group meetings and initiatives that gave the groups management experience. It was understood that with the transition of programs out of Avahan, support from the lead implementing partners would eventually end, and each district federation would be supported instead by the state network.

PROGR AM INPUTS

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04

Early Challenges and Strategies for Getting Started

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PROGR AM INPUTS

At the time of the field work for this publication, the concept of networks was well understood by most CBOs and working group members, but it had yet to be translated into functioning and active district federations and state networks. At this early stage of the process, the networks were still forming.
The steps still ahead, the strategies adopted to help networks get off the ground, and the challenges that were anticipated further illustrate the processes and program inputs required for building successful networks of CBOs and may be instructive for others in similar circumstances.

EARLY CHALLENGES AND STR ATEGIES FOR GET TING STARTED

33

TURNING THE NETWORK CONCEPT INTO REALITY

In India, formalizing the networks involved three steps: Holding elections for district- and state-level office bearers Having the networks registered as officially recognized bodies Prioritizing the issues that they would address during their initial operations (This was due to happen in 2011 and 2012) It was recognized that two ingredients might help catalyze network formation. These were expanding awareness of the networks and their functions among as many CBOs as possible and demonstrating quickly that state networks could produce results for CBOs and their members. Two instances of the latter show how CBOs engaged with influential organizations at the national level, partly on the strength of their incipient networks. In the first example, the networking facilitators joined with a NACO working group to advocate for the inclusion of community input in planning the next phase of Indias National AIDS Control Programme (NACP IV) and began a capacity-building process in this regard for CBOs across the six Avahan states. Through multiple consultations, representatives of hundreds of CBOs analyzed the targeted interventions of NACP III and offered recommendations for NACP IV. CBOs were also granted representation on the technical working groups involved in planning the new national program.6 Whatever the outcome of these attempts in shaping NACP IV, engagement with NACO around CBO input was important in demonstrating the power of networks and building CBO confidence. The second example concerns the Press Council of India, which in December 2010 invited 30 CBO representatives, along with representatives of NGOs and other experts from Tamil Nadu, Andhra

34

EARLY CHALLENGES AND STR ATEGIES FOR GET TING STARTED

Pradesh, Maharashtra, Karnataka, and Manipur to discuss revisions to media guidelines to make HIV reporting more sensitive and inclusive. In January 2011, the Press Council adopted many of the CBOs recommendations in a planning report. Both the invitation from the Press Council and the subsequent adoption of CBO recommendations on ways to improve reporting on HIV among socially marginalized groups are a significant achievement for the emerging networks.

MANAGING POWER RELATIONS

A further challenge was maintaining good working relationships with the numerous stakeholders and groups that had an interest in the CBO networks or might be affected by them. An example is Andhra Pradesh, where CBO networks for HR-MSM and FSWs already existed. Their members were ambivalent about the creation of new networks and worried that their own organizations would be marginalized although they expressed willingness to be contracted for specific tasks. The challenge for the networking facilitators was to acknowledge the experience of these networks and include the leadership in informing the new efforts, while moving quickly to establish complementary initiatives that would expand the scope of networks across states.

EARLY CHALLENGES AND STR ATEGIES FOR GET TING STARTED

35

Power relations among CBOs within the networks were also an issue. Those CBOs that lacked significant community mobilization experience might feel marginalized by ones that had it. They might be weaker organizationally and their institutional voices not as loud. Larger CBOs might feel entitled to more positions within networks than smaller ones. And networks and CBOs of men and transgender people might express traditional power relations vis--vis women in meetings and when setting agendas. In one states working group, internal difficulties about representation between long-established and newer CBOs resulted in half of the members dropping out. In another example, from Nagaland, before forming a working group, a listening consultation was held to more fully capture the concerns of the IDU community, and to outline how a state-level network could assist in addressing those concerns. Relations with SACS and with NACO had to take into account differing programmatic emphases: while NACO and the SACS were primarily concerned with sustaining HIV prevention and treatment services, the networks were also interested in promoting the quality of service delivery as well as structural issues that lay outside the purview of the SACS. These differences in perspectives on planning and implementation of policies and programs, and the degree to which NACO and the SACS on the one hand and the networks on the other were willing to listen and work with each other, would have an impact on the effectiveness of networks.

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EARLY CHALLENGES AND STR ATEGIES FOR GET TING STARTED

INCREASING PROBLEM-SOLVING CAPACITIES

Power relations can be handled, in part, by adopting analytical, problem-solving approaches. Expanding the problem-solving capacities of network representatives was therefore a further challenge to be addressed. Many working group members in both Andhra Pradesh and Maharashtra states were very ready to describe the problems faced by CBOs and group members at many levels. Less evident was an awareness of the multiple, underlying causes of the problems, prioritization of the problems, or an analysis of how they might be addressed. Building skills in analytical problem solving is a component of network development that could be added to ongoing trainings and interactions with working group members and later with network office bearers. As the problem-solving and lobbying skills of the networks are refined, some networks members will emerge as effective analysts and spokespersons on issues. There are numerous ways to provide training in aspects of analytical problem solving: Role plays and case studies that encourage participants to work on problems Interactive discussions and use of why and how questions Setting of a priority agenda from a long list of issues

EARLY CHALLENGES AND STR ATEGIES FOR GET TING STARTED

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COMMUNICATION FOR PROBLEM SOLVING AND ADVOCACY

Problem solving in the context of advocacy involves effective interactions with those who make or influence decisions. Many CBOs have access to decisionmakers, including representation on advisory and decision-making bodies at local and district levels, but representatives are not always effective at raising issues in a way that will be understood clearly. CBO members are often passionate about issues, but if they lack experience in advocating for them, they may provide only vague or anecdotal accounts that are not detailed enough to persuadeor conversely, they may over-talk them, providing more examples or details than are needed in an initial meeting or discussion, especially an advocacy or lobbying forum or meeting. The points that need to be addressed with CBOs include the following: Even taking into account cultural differences, short, concise, action-oriented messages are often the best way to gain the initial attention of busy decisionmakers with necessarily limited attention spans. If a person needs more information than is given in the basic message, they (or their staff) will usually ask for it. At that point, the overall message can be expanded.

KEEPING A FOCUS ON HIV PREVENTION

While CBOs will continue to play a role in HIV prevention with the transition of programming to the SACS and NACO, community mobilization and non-HIV prevention issues raised by CBOs will become linked to the district federations and networks. In essence, the federations and networks were conceived of as becoming the representatives of CBO interests.

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EARLY CHALLENGES AND STR ATEGIES FOR GET TING STARTED

Initial enthusiasm was strong among CBO members for the potential of the networks to address a variety of social, economic, and other issues. CBO members readily listed numerous issues they wished to see resolved to improve their lives and positions in society. The challenge for CBOs and the networks would therefore be to Sustain attention on HIV prevention to ensure that the quality and efficiency of services does not slip. Fulfill the expectations of CBO members to address other issues they might bring before the district federations and state networks. Maintaining good communication between CBOs, local health providers, and SACS will be important to continue prioritizing HIV prevention.

KEEPING THE NETWORKS INTERACTIVE

Two further challenges remain for networks to address at this early stage. The first is the tendency in bureaucratic societies to wait for direction or guidance before acting. One CBO office bearer replied to a question about how he foresaw relations with the networks by saying, Well wait until the network makes a decision and tells us what to do. However, one-way communication was not the vision for network effectiveness and sustainability. To combat this tendency CBO members will need encouragement and practice to be proactive in dealing with issues. Ongoing efforts will be required to increase and deepen awareness of the nature, expectations, and functioning of networks to make them dynamic and inclusive.

EARLY CHALLENGES AND STR ATEGIES FOR GET TING STARTED

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Networks and their members can be helped by building their capacity on how to communicate effectively; using some of the techniques mentioned in the earlier section on communication for problem solving and also including standards of reporting and documentation will be a necessary step.

MANAGING EXPECTATIONS
At the beginning of the network creation process, working group members were able to capitalize on their leadership profile in their communities. The process gave them new knowledge and skills. An example from Andhra Pradesh was learning the legal steps for creating a charter and registering the networks with government. Several working group members cited learning more about their individual and collective rights. Others noted that finding out how other CBOs dealt effectively with issues gave them a deeper appreciation for the value of sharing experiences. At the same time, the working groups had to put considerable effort into raising awareness among CBO members of the potential benefits of networks. By emphasizing process rather than making bold promises of results, they hoped to manage expectations and put the responsibility on the CBOs, their office bearers and members, and the facilitators of the network process to create systems and structures that might, over the long term, achieve results.

EARLY CHALLENGES AND STR ATEGIES FOR GET TING STARTED

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Lessons from Other CBO Networks

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Lessons from other CBO networks provide a context for comparison with Avahans experiences and point to ways in which networks may help to further HIV prevention.
SERVING MEMBERS
It may seem obvious that networks must, in the first instance, bring some benefit to their members,7 but this must be designed into routine management processes to ensure it remains the focus of the network. Members pay a membership fee from their own limited resources, and they understandably expect something in return. Benefits may be tangible, such as access to funding sources for specific activities, or they may take the form of technical assistance for strengthening aspects of a CBOs internal management. Another practical benefit may arise when the networks advocacy skills are used to address an issue of concern to one or more CBO members. Beyond this, in the same way that CBOs offer community members a sense of group inclusion and identity otherwise denied them by wider society, networks can expand this by helping members feel that they are part of a movement with district, state, or even national reach.

SHARING EXPERIENCES
Networks are an effective way for individual CBOs to share and learn from the experiences of peers. They help provide learning opportunities for CBOs regarding internal organization and change, leadership, and the attracting and keeping of new members. When used as learning organizations, networks become a means for CBOs to solve the kinds of problems that others have previously experienced.8

LESSONS FROM OTHER CBO NET WORKS

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Experiences can be shared through write-ups in network newsletters or reports, exchanges between CBOs, or informally during conversations at meetings. CBO networks can also recount their experiences and views to the government, business, and community groups they belong to. Decisionmakers and influencers are often unaware of CBO members concerns and needs, and simply exposing them to these issues can be an important step in gaining their support or involvement. Some CBOs in the Avahan program already share their perspectives outside their regular constituency. The CBO networks are likely to expand public engagement. It is important to note the risk that information may not be adequately or equitably shared among members due to the structure of networks. For example, small CBOs or CBOs in more isolated areas of a state may have fewer opportunities to gather with others or may receive information later than CBOs based in urban centers.9 In other cases, the interests of office bearers or staff of the networks may intentionally or unintentionally bias the types, amount, or timing of information that is shared.

LINKING WITH OTHER ORGANIZATIONS

Networks provide links to a wider and sometimes more experienced group of organizations that work on issues of marginalization and can strengthen the CBO network or individual CBO members. Any single CBO network has limits to what it can accomplish, and achieving structural changes usually requires alliances and links with other organizations. Such organizations may have relevant skills, specialties, or contacts. In India, an example is the Lawyers Collective, which provides legal expertise on human rights issues affecting FSWs, HR-MSM, and TGs.

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LESSONS FROM OTHER CBO NET WORKS

Several Indian and international NGOs (including some Avahan program partners) have expertise in social marketing, which may be of use to CBO networks that seek to build commercial businesses. Links with other organizations may be temporary and focused on a common objective. This could be a funding proposal that has several components that will benefit from inclusion of organizations with specialization around those components. Or it may be showing solidarity with other organizations seeking redress or improvements for their constituents. While forming alliances between networks is common, clarity about the purpose, organization, and processes is needed so that each partner understands its role and responsibilities.

EXPANDING INFLUENCE
A network grows and gains strength if it succeeds in attracting and including new members in a managed way.10 Such expansion depends on the networks internal organization. Guidelines for including new members are critical, along with guidelines on the networks internal working procedures. These will assure member organizations that the network is being run in their interest and as effectively as possible. A weak or poorly structured network will depend on personalities and is unlikely to fulfill its commitments to other organizations or its own members. Confusion about leadership and lines of responsibility will weaken a network. Development of second-line leadership is very important for internal structure and credibility.11

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If the network can achieve results and be seen as well organized, it will attract the attention of CBOs and other organizations, including government bodies, the media, and private companies. The networks presence at numerous meetings and events will increase its visibility and credibility. Being accessible to the media will eventually mean more publicity for the network and its issues. Influence through advocacy comes from being well organized and well prepared. A common weakness in networks is the absence of a solid analytical base to support the issues they address; another is not knowing how best to reach decisionmakers with key points and action items. Having evidence to support advocacy work demonstrates that the organization has done its homework and strengthens potential outcomes.12

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LESSONS FROM OTHER CBO NET WORKS

LESSONS FROM OTHER CBO NET WORKS

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Conclusion
The fostering of CBO networks was conceived as a logical step in the continued evolution of the Avahan program for HIV prevention in India. The mobilization of community members to practice safe sex and seek medical services led to the formation of CBOs whose mandate extends further to address inequity and make community engagement sustainable. Their work in promoting HIV prevention and addressing structural factors that contribute to HIV risk was an important achievement in itself. Given the interest of the CBOs in improving the lives of their members, district federations and state-level networks were seen as the logical means to expand opportunities for addressing CBOs concerns at structural levels (i.e., to work for institutional and policy change). The remit of CBO networks may also extend beyond HIV prevention: for example, in Andhra Pradesh, CBO members involved in structuring the new networks expressed a desire to become involved in the planning of non-health-related social and economic programs. A member of the working group in Maharashtra expressed a related sentiment: We are the network, we make it work, and it will assist us as we work on local issues.

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CONCLUSION

The initial experience of network formation within the Avahan program suggests that several foundational elements are required: Enthusiasm and commitment among CBO members in support of the networks Implementing partners with creative ideas, sound technical skills, and a willingness to broker important political relationships on behalf of communities, if necessary Innovation and flexibility that permit ideas to be tested and adapted to suit the circumstances of each state network Skills in analysis, communication, and problem solving, as well as capacity building in organizational management Agreement on the mission among the members of a network to ensure that differences do not divide constituencies within it Taken together, these strengths can provide a sound framework for the development of district federations and state networks. Networks of CBOs emerging within the Avahan program context may collaborate with other organizations and networks on specific issues or work to build a wider constituency for their own issues. In this way, they will take on roles similar to those of other civil society organizations. In the process, one of the major goals of many CBOsto be an active part of mainstream Indian societywill be realized. At the same time, the networks have the potential to be effective partners with NACO and the SACS in sustaining HIV prevention and also with various government departments in improving social protection across India in the years ahead.

CONCLUSION

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References

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REFERENCES

Global Report: UNAIDS Report on the Global AIDS Epidemic. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2010. AvahanThe India AIDS Initiative: The Business of HIV Prevention at Scale. New Delhi: Bill & Melinda Gates Foundation, 2008. Rau B. The Avahan India-AIDS Initiative. Arlington, USA: AIDSTAR-One, 2011. http://www. aidstar-one.com/sites/default/files/AIDSTAR-One_case_study_combination_prevention_ avahan.pdf. www.durbar.org

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Seshu MS. Tackling HIV for Indias sex workers. Lancet 2010; 376(9734):17. Community participation in the preparation of NACP IV. E-update #3, May 2011. www.365x6.net

Lodl K, et al. Coalition Sustainability: Long-term Successes & Lessons Learned. Journal of Extension, 2002; (40)1. www.joe.org/joe/2002february/a2.php. Accessed on March 9, 2011. Based on experience of the Community Based Health Initiatives (CBHI) Project in Tanzania. www.cbhi.or.tz/index.php?id=22. Accessed on March 8, 2011. Capacity Building in Network Organisations: Experiences from and Practical Guidelines for HIV and Other Networks. Utrecht, Netherlands: Voluntary Service Overseas Netherlands, 2009, p.34. Ogechi E. Blueprint for Building a Successful HIV Network in Kenya. No date. www.globalhealth.org/reports/report.php3?id=293. Accessed on March 12, 2011.

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11

Ibid, p.35. Ibid, p.43.

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REFERENCES

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Rau, Bill. 2013. Forming Networks of Community-Based Organizations: Early experiences from the Avahan India AIDS Initiative. Washington, DC: Futures Group. ISBN 978-1-59560-011-0

Futures Group One Thomas Circle, NW, Suite 200 Washington, DC 20005 U.S.A. tel: +1.202.775.9680 fax: +1.202.775.9698