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Conclusions and Recommendations
“At first, we wondered why we should do a needs assessment, but the more we learned, the more we realised it was crucial. The findings were astonishing. They revealed things which were completely new to us even though we’ve been working in our community for twenty years.”
Ahmed Ilias, Al-Falah, Bangladesh
The assessment process has strengthened NGOs’ relationships with both existing and new target communities, by requiring NGOs to listen to these communities, and question their own assumptions about them, before designing their projects. Reminding NGOs that their first step should be to ask questions to assess needs, resources and priorities rather than tell people about HIV/AIDS has been a useful corrective for many organisations familiar with a didactic and prescriptive style of health education. The experience from the Alliance’s partners in Bangladesh, Cambodia and Sri Lanka suggests that the participatory process of the assessments has engaged NGOs with their communities in ways that challenge traditional notions of expertise. Rather than extracting information for analysis, the participatory assessment process has sought to integrate local people’s expertise about their own experiences and expectations.
Recommendations
- NGOs developing assessments should be open to listening and learning about the reality of community needs and aspirations. Although this can provide a direct challenge to traditional NGO views and ways of working, this approach can result in a strengthened relationship between an NGO and a community. As well as being open to change, NGOs can also take practical steps to enhance this process – such as recruiting and training community members to serve as facilitators of the assessment with their peers.
Enhancing and expanding community participation in assessments prior to project design can contribute to community efforts by serving as a starting point for on-going community discussion of and action in response to the HIV epidemic. The importance of participation in this process is not to be underestimated in settings where people’s sense of agency and control over their lives is severely limited by history or contemporary political and socio-economic realities. As many of the NGOs reported, the assessment process provided a rare opportunity for members of the community they work with to discuss issues of gender, sexuality and sexual health. This kind of community dialogue helped in some cases to engender a community commitment to and ownership of the problems identified and responses planned. As the Community Development Centre, which worked with dock workers in Bagherhat, Bangladesh, reports: “A feedback meeting was organised at an elder’s house which was attended by labour leaders of the dock, interviewees, and general people. Most of them in discussions agreed to the findings, and wondered how they would resolve these problems.” Participatory processes of assessment can thus help to mobilise community concern about and action on HIV prevention.
Recommendations:
- The Alliance and its partners need to focus on ways to sustain the mobilisation of community concern and action initiated at the assessment phase. This could mean institutionalising community involvement in project design and subsequent projects (e.g. as staff or as an advisory body) and/or integrating the project into existing community structures (e.g. village development committees, parent-teacher associations) as well as in the evaluation of activities and outcomes.
The use of PRA tools in the assessment process has enabled greater community participation and demonstrated the potential of visualisation techniques to enrich discussion and understanding of vulnerability to HIV infection. But the real value of drawings and diagrams lies in the extent to which they are ‘interviewed’ and discussed by community members, assisted by NGO staff. Group facilitation and questioning skills and an adequate grasp of key concepts of vulnerability are critical to maximising the potential of these assessment tools, and some NGO staff lacked this requisite skills and understanding.
Recommendations:
- The technical assistance needs of NGOs should be identified prior to their assessments in order that appropriate TA can be provided to improve the capacity of the NGOs to conduct their assessments.
- Experience to date suggests that this TA will need to focus on key concepts of vulnerability (including HIV/AIDS, gender, sexuality and sexual health) and group facilitation and questioning skills.
The understandings of vulnerability generated by the assessment process were typically translated into strategic responses focusing on forms of sexual health information provision and service delivery (STD treatment and condom promotion.) This was determined less by the findings of the assessment itself than by the existing focus and capacity of the NGOs conducting the assessments. Some of the findings suggested a need for strategies such as counselling on sexuality and sexual trauma, advocacy on women’s rights and campaigns against male violence but these were rarely specified by NGOs in their ensuing project designs, perhaps because of an inadequate analysis of the strategic implications of the assessment and also because of NGOs’ inexperience with these types of work.
Recommendations:
- The Alliance must focus technical support on enabling NGOs and communities to develop strategies that respond to the broad range of factors of vulnerability identified during the assessment.
- The Alliance and its partners should support NGOs to work in collaboration with organisations which can provide the skills and expertise to complement their own.
Participatory community assessments can play a crucial role in developing more responsive and effective strategies and projects, their role in establishing baseline information, against which project progress may be measured, has not been fully explored. Few of the NGOs referred to in this report used the assessment process to collect data which could establish a baseline against which to monitor project implementation. Some might argue that baseline data collection can only be started once projects are designed and indicators determined. But a case can be made for incorporating a greater element of standardised, quantitative data collection on basic sexual health and service delivery indicators within the community assessment process, to the extent that the former did not compromise the latter.
Recommendations:
- The Alliance and its partners should consider how to strengthen the quantitative aspects of the participatory community assessment process, perhaps by producing guidelines for suggested basic indicators and means of verification.
Conclusions from stakeholders:
After a PRA workshop for sexual health needs assessment in Sri Lanka ....
“Before the [PRA] workshop, I worried that the Alliance might come and force-feed us another western “teaching”, but I am pleased that the Alliance helped us find first class local experts and pleased to have learned that PRA is being used and developed in Sri Lanka by our own people. I think we can all now see how appropriate this type of participation is for helping us work with the community.”
Mr Ekanayake, Alliance Lanka Provincial Field Officer
After participatory capacity building in Cambodia ....
“When we first started working on HIV/AIDS with the Alliance, many of us felt like head-less chickens, but now - after going through this long process together - we feel very confident and committed to working on AIDS”.
Kong Samnang, SEADO