Setting the Scene: Assessing and Planning with Harm Reduction Partners

This International HIV/AIDS Alliance (The Alliance) report summarises the results of site assessments on HIV and drug use in China, India, Indonesia, Kenya, and Malaysia. The assessments were conducted by the International HIV/AIDS Alliance and their teams of experts in four technical areas:

•  HIV prevention services for people who inject drugs;
•  HIV and drug-related policy and environment;
•  organisational development issues; and
•  monitoring and evaluation of interventions.

The assessments were conducted to guide planning for the Community Action on Harm Reduction (CAHR) project, funded by the Ministry of Foreign Affairs of the government of the Netherlands and implemented by the International HIV/AIDS Alliance. The assessments focused on the Alliance’s lead partners in implementation of the CAHR project and also focused on the sub-recipients (implementing partners) of five in-country organisations, along with an in-country situation assessment. [Footnotes are removed throughout by the editor.]

The CAHR project aims to expand coverage to more than 230,000 people who inject drugs, their partners, and children, with a range of services (HIV prevention, treatment and care, sexual and reproductive health, and other services) by 2014. In addition, CAHR aims to protect and promote the rights of these groups by fostering an enabling environment for HIV and harm reduction programming in the five countries.

The assessment and planning technique (APT) is a process which involves the application of a set of assessment and planning tools in order to develop a detailed plan for a new area of programming. It is designed to be applied in situations where:

• there is sufficient information collected through previous research and practice to inform the basic directions and scale of the future intervention.
• top-level parameters of the intervention have already been developed.
• funding for the intervention has already been secured.
• the lead implementation agency has already been identified.

The APT is based on existing rapid assessment techniques,  including: the World Health Organization (WHO)’s rapid assessment and response (RAR); The Global Fund to Fight AIDS, Tuberculosis and Malaria’s Principal Recipient (PR) assessment tools; and Developing HIV/AIDS Work with Drug Users: A Guide to Participatory Assessment and Response and other Participatory Techniques, which was developed by the International HIV/AIDS Alliance and its partners. APT shares the key features of the WHO’s RAR methodology, including speed, cost-effectiveness, use of existing data, multiple indicators and data sources, investigative orientation, induction, relevance to interventions and practical issues, community involvement, and adequacy rather than scientific perfection.

The process prioritises: participation, expediency, stakeholder and intervention alignment, and country ownership. The assessment and planning toolkit consists of the main guide and a set of auxiliary documents including budgeting and planning templates, aa well as a list of recommended services based on the Alliance’s good practice HIV programming standards and service analysis tool to: 1) identify gaps between the desired state and the current state of policy, organisations, and programming; and 2) plan what needs to be done, including identifying resources. The main areas explored in the process include: studying needs and vulnerabilities of people who inject drugs to define the programme's approach to service delivery; assessing services, providers, capacities, and potential, including linking through referral mechanisms; and analysing the social and political environment to identify the key barriers to launching some of the essential interventions for people who use drugs, including looking at procedures, policies, and laws that enable and promote access to services and at describing the role of the government and non-governmental organisations (NGOs) in implementation.

The document includes findings and recommendations by country through use of the APT (pages 10-44). It concludes with a process evaluation:

• Strengths include: APT can be a source of information that identifies interventions needing implementation or strengthening; it is a structure and scoring system to minimise bias; it fosters the inclusion of stakeholders, organisational capacities, processes related to human rights protections, and HIV policies; and it includes identification of structural issues.
• Limitations and areas of improvement include: APT lacks a rigorous literature review on the situation in the countries prior to the assessment visits; it needs to ensure that 'policy and environment' priorities respond to the needs of programmatic areas through making the sections of assessment crosscutting; it does not yet provide a clear picture on the funding available in the country and the key components supported by donors or the political situation and social structure; and it needs space for "unresolved issues/issues requiring follow-up" in each section of the assessment.