|NGO Responses to HIV/AIDS In Asia (UNDP, 1992)|
|FACILITATORS' NOTE: FAMILY PLANNING AND AIDS PREVENTION - The Planned Parenthood Association of Thailand (PPAT)|
GENERAL POINTS ABOUT USING THE CASE
1. Participants should be encouraged to read the case and to prepare their own analysis before it is discussed with others in the classroom. The discussion questions should be handed out with the case to assist participants in their analysis.
2. Generally, discussion of this case has required 1 1/2 to 2 hours (assuming that participants have previously read the case and prepared their own analysis).
3. The discussion questions included with this case are intended to help participants to focus on what were considered to be particularly important issues illustrated in the case. However, the case may highlight many other interesting points for participants and they should be encouraged to examine, analyse and discuss these if raised.
4. The notes that follow are intended to assist the facilitator to prepare to teach the case. They provide a synopsis of the information given in the case, together with some ideas on strategies that CASP might adopt in the future. These notes should not replace the facilitator's own preparation and analysis. At all times, the facilitator should encourage the participants to reach their own conclusions, based upon a thorough analysis of the information given.
5. When introducing participants to the case, the facilitator should stress that the case is intended to facilitate discussion on important organisational and programmatic issues; it is not intended to demonstrate good or bad practices, nor to evaluate the work of PPAT. It should also be stressed that the case focuses on PPAT's HIV/AIDS activities; it does not attempt to represent the full range of PPAT's programmes.
(a) Facilitating Factors:
Despite the words of the Executive Director quoted in the case, PPAT's prime mission, as shown in Exhibit 2, is the delivery of family planning information and services. PPAT members and Staff were "committed to family planning" and, in addition, this was a time when there was still widespread fear of AIDS and discrimination against those infected with the HIV virus. PPAT's clients might themselves have been "scared away" from the family planning clinics if they felt that PPAT was dealing with those infected with AIDS. Similarly, PPAT staff might have been anxious about their own reputations and the potential risks involved in working with those who might be infected. Despite these potential problems, PPAT appears to have managed the transition with few problems. Some of the possible reasons, as indicated in the Case are as follows:
- IPPF, PPAT's most important funding agent and to which PPAT was affiliated, had established its own AIDS Prevention Unit;
- By 1989, the Thai Government was changing its HIV/AIDS prevention and education strategy. At that time," it was then seeking NGO-Government collaboration in the fight against AIDS and this would have helped to justify PPAT's action with its Council and Executive Committee members;
- International reports of HIV/AIDS prevention activities and programmes would have helped PPAT to convince both its members and staff of the need for it to get involved in HIV/AIDS;
- The increasing rates of HIV infection in Thailand would also have had an impact on how PPAT members and staff viewed the problem of AIDS;
- PPAT's managers were committed to "improving the quality of life for the Thai people". Given the regular meetings and the general open communication among the staff, it is likely that this commitment would have been shared by other staff and volunteers.
- PPAT staff educated themselves through reading and discussing information and reports about HIV transmission and prevention. In addition, several staff members attended training events and conferences on HIV/AIDS (such as the IPPF HIV/AIDS training programme for FPA staff). This would have helped staff to understand how HIV was transmitted and to reduce their own fears.
- PPAT encouraged staff members to discuss the situation and contribute to the decision about the course of action PPAT should take.
- PPAT made a gradual movement towards a decision (from 1982 to 1988).
(b) Factors that might influence HIV/AIDS and FP integration in other countries:
- Family planning might not be as well accepted as it clearly was in Thailand. Adding HIV/AIDS interventions to the family planning activities might be seen as threatening the effectiveness of the family planning efforts.
- Whilst family planning may be acceptable in some countries for married couples, the provision of sex education, counselling, and talking openly about STDs and safer-sex practices, might be very difficult. Public (and therefore, official) sentiment would therefore be opposed to any HIV/AIDS education and services being offered outside of the family planning clinic.
- Religious barriers might hinder the promotion of condoms for STD protection among unmarried couples, since this would be viewed as 'promoting promiscuous behaviour'.
- HIV infection levels might be perceived as less of a threat than in Thailand, so both family planning clients and staff might not accept the need to provide HIV prevention education or services.
- A government's position on HIV/AIDS (whether it recognises AIDS as a problem; whether it is willing to talk openly about the risks to everyone and how people can protect themselves; whether it has established any programmes either within the government agencies or through nongovernmental organisations) will also have a significant influence on how a family planning programme will respond.
- Donors often differentiate between condoms provided for family planning and those supplied to a country for HIV/AIDS services. A family planning programme might find itself in difficulties with its donors over the reasons for its promotion of condom use.
- The extent to which the family planning programme already offers other related services such as screening for cervical cancer, gynaecological examinations and treatment, STD services, etc. will probably have a significant influence on the ease with which HIV/AIDS interventions can be added to the portfolio of activities.
- PPAT was a well-established and well-respected Thai organisation, as evidenced by its 24-year history, the patronage of Her Royal Highness, the collaboration with Government agencies and the size of its volunteer network.
- PPAT had more than 7000 grass-roots and professional volunteers already active in promoting family planning information and services.
- PPAT already had extensive contacts with those communities which, for reasons of lifestyle, income levels, living and working conditions, might suffer disproportionately from HIV infection and yet might be the hardest for government services to reach and influence.
- As an integral part of its family planning education, counselling and services, PPAT staff already had experience of talking to clients about sexuality and sexual behaviour.
- Family planning clients represent those who are most in need of information about HIV protection.
- PPATs clinic services already included diagnosis and treatment of STDs, together with pre-marital counselling and check-ups. This gave them the opportunity to build HIV/AIDS information into their services.
(a) Steps taken by PPAT:
- PPAT kept in contact with the experiences of HIV/AIDS programmes in other countries, learning about effective (and ineffective approaches) to prevention.
- The meetings with HIV+ individuals to develop PPAT's own understanding of the issues involved and the concerns and needs of those infected.
- The extensive use of radio programmes and spots, together with the more restricted use of television programmes to disseminate HIV/AIDS information clearly matched the data on the availability of the radios and TVs in Thailand. (Exhibit 1) Similarly, high literacy rates enabled PPAT to make extensive use of written materials in its education programmes.
- The pre-testing of IEM materials and programmes.
- Interviews with viewers and listeners following airing of the TV and radio programmes.
- The letters from listeners/viewers asking for further information after the programmes.
- Development of targetted IBM materials for the different groups with whom PPAT was working (i.e. students, out-of-school youth, prisoners, fishermen and factory workers).
- The pre and post-meeting questionnaires administered to the participants at the HIV/AIDS education sessions among the slum communities.
- The follow-up of the peer-educators drawn from the slum communities and the provision of continued support and reinforcement for their work.
(b) Other Possible Indicators of Effectiveness:
- Requests from teaching staff at the schools and colleges to provide further information.
- Reports from the various peer educators about the frequency and the types of questions they are asked relating to HIV/AIDS.
- The numbers of condoms sold by the factory representatives prior to and following the inclusion of HIV/AIDS information in the workers' education programme.
- The conduct of KAP studies among the communities with which PPAT was working might have provided further indications of the impact of their education programmes.
- PPATs style of management, as indicated in the case, was both open and supportive. This would have encouraged staff and volunteers to voice and discuss their concerns and doubts and to work these through with their colleagues.
- The stability of PPAT's workforce indicated a general satisfaction with the organisation and its work. One could also assume that this stability indicates mutual trust between the managers and staff which would facilitate organisational change and development.
- Communication was clearly important to PPAT: the senior PPAT managers made frequent visits to the field to keep in contact both with the individuals and the programmes; informal discussions and sharing of information took place all the time. This would have helped to keep the managers in touch with the staff views and contributed to building a sense of teamwork.
- PPAT's approach to the allocation of work to staff members would have helped to ensure that many individuals would have the opportunity to work on the HIV/AIDS education programmes and thereby experience first hand both the communities' needs for information and their response to PPAT's programmes. This would help to develop understanding among the staff. The system would also have helped to maintain individual's interest in their jobs and to develop their skills.
- PPAT's HIV/AIDS interventions all grew out of their existing or previous programmes and PPAT built upon its contacts and its relationships with the communities. This should have made the clients more receptive to PPAT's HIV/AIDS education activities and helped PPAT in deciding on approaches that would be both acceptable and effective.
- PPAT had clearly managed to maintain a clear focus and mission. The annual meetings between the staff and volunteers, the fact that many staff have stayed with PPAT despite the availability of higher salaries within the private sector, and the fact that it had managed to integrate HIV/AIDS education activities into so many of its programmes and projects, were all evidence that PPAT had managed a significant programme change successfully and effectively.
(a) Strategies used for financing:
- In addition to IPPF, PPAT was receiving funds from five other external sources. This would have involved making contact with the funding organisations to establish their interest and the development of project proposals and budgets. It is also significant that each of these external donors had committed funds for at least two years (Exhibit 5 does not tell us when these projects funds were first made available).
- PPAT also received Government funding for the Hill Tribe Area Project, thus indicating that it is providing services to a community that the Government finds difficult to reach effectively.
- Other local sources of cash included sales of contraceptives and IEM materials, income derived from clinic service charges, membership fees and special fund raising events. Significant interest income was also derived from investment of funds.
- Contributions and donations in-kind are impressive (Exhibit 6), although participants might question how PPAT costed these. It also appears that PPAT might have negotiated some long-term agreements with the various contributors, or at least had sufficient confidence that the contributions would continue to be forthcoming over the following three years.
(b) Suggestions regarding future funding:
- All of the external sources of income (excluding IPPF) will be completed by 1995. Given the usual lead time for donors to commit new funds, PPAT needs to start an early search for new sources of programme support. The case indicates that external funding sources for Thailand, may be difficult to locate and this adds to the urgency. PPAT might be advised to search for donors interested in supporting HIV/AIDS projects as opposed to the traditional FP donors. Whatever the strategy chosen by PPAT to identify new external sources of funding, PPAT needs to 'parcel' its planned future activities, such that proposals can be developed for individual potential donors.
- PPAT might review its schedule of fees for clinic services, contraceptives, IEM materials and membership dues to establish whether these could reasonably be raised without affecting the volume of sales or client demands. Alternatively, PPAT might establish different schedules of fees for clinic services, depending on the location of the clinic and its clientele.
- Additional efforts on special fund-raising events might be considered, since income from this source appears minimal.
- PPAT might also consider the potential for charging small fees for the factory worker education programmes or starting new worker education programmes in larger companies in the Bangkok at other major urban areas.