Factors Influencing Successful Implementation

As discussed above, all five major components of the 100% Condom Programme have generally been implemented in most provinces.

That is, the overall level of programme inputs is uniformly high across the provinces, with only limited variation. This in itself is a rather remarkable achievement. Similarly, the level of success as measured by self-reported condom use by both sex workers and clients is also quite high.

The original intention of the IPSR study had been to examine in detail the impact of various programme inputs on effectiveness as measured by overall levels of condom use in commercial sex. However, the limited variations found in both the inputs and the outputs (i.e., levels of condom use) made this difficult. For this reason, the study was unable to determine the influence of components present in almost all provinces, such as campaigns to reach sex workers or extensive STD testing and treatment, that doubtless were among the most critical contributors to the success of the programme. It must also be remembered that national AIDS awareness and condom promotion activities were ongoing and certainly contributed as well.

In order to measure the influence of those factors that did vary somewhat from province to province, the analysis was redesigned to look at the sex workers’ use of condoms with their regular clients as the output variable. This form of condom use showed the greatest variation between provinces and different types of establishments. Thus, the impact of programme inputs on condom use with regular clients could be ascertained for those inputs that varied from province to province.

The two factors found to influence condom use with regular clients were:

· the extent of collaboration between the various actors within the province

· whether the province was home to one of the Regional Offices of Communicable Disease Control.

Increased collaboration with the governor, police, and establishment owners was found to increase the level of condom use with regular clients. Provinces that were home to the RCDCs were also found to have higher levels of condom use with regular clients. These findings can be tentatively interpreted to mean that the improved programme efforts that result from better collaboration within the province, and the expanded overall programme effort likely to occur in a province where both an RCDC and a PPHO are active, increase the programme’s ability to convince sex workers to use condoms with their regular clients, while RCDCs are effective in providing technical support and follow up.

IPSR made a further analysis of the effect of the different inputs on condom use with regular clients at different types of establishments.

This analysis found that different inputs were important at different types of establishments. In particular:

1. Accessibility and availability of condoms were more important in brothels than in massage parlours and hotels. This is probably because brothel workers depend largely on governmentsupplied condoms, while massage parlour and hotel workers also obtain condoms through private sources such as drug stores.

2. In restaurants, the quality of the management of the provincial programme and the provincial staffing levels were found to be more important to an effective programme than in the brothels.

This most likely is related to the greater difficulty of reaching the indirect establishments in the provinces. Only with good and effective management can the programme hope to reach these more challenging sites. Moreover, more staffing implies more capacity at the provincial level to reach the sites that were more difficult to access.

The most important lesson to be taken from these findings is that the specific needs of different types of sex establishments may vary and that programmes must adapt to these needs in order to maximize effectiveness.