1. Background and Justification
With a recently estimated 5.1 million people infected by HIV (NACO, 2004), India accounts for 68% of the South Asian epidemic, 10% of the global epidemic, and ranks second only to South Africa in the total number of people living with HIV. The crisis has spawned initiatives from a variety of sector including federal government, state agencies, non-profit organizations, networks of HIV positive people and corporations. Nationwide survey conducted by SAATHII has shown that while over 1200 implementing agencies in the country are attempting to respond to the HIV/AIDS crisis, there exist major information gaps, inadequate capacity and limited resources that impede the ability of these agencies to deliver quality services. Based on results from national survey we have identified three barriers and consequent needs in the capacity-building arena:
1.1. Skill Building
Need - HIV/AIDS is escalating rapidly in India, and organizations need to quickly fill their knowledge and skill gaps to address the epidemic in a timely fashion. Offering courses online with online supplementary materials and regular exercises can therefore greatly accelerate the rate at which SAATHII can help build the capacity of HIV/AIDS organizations scattered across the country, especially in semi-urban and rural areas.
Barrier – A majority of the existing training programs are carried out face-to-face, and restricted in duration, frequency and locations. Accessibility of these courses is restricted to organizations in urban centers, and those with the financial ability to attend these courses.
Precedent – Information Communications Technology (ICT) is a cost-effective way to build knowledge and skills through education and training. Recent work in the field of HIV prevention in other areas of the developing world has confirmed the utility of using ICT to bridge distance and other logistical barriers (Kelly et al. 2004).
Related Experience– SAATHII has demonstrated success in offering such training programs offline. SAATHII has facilitated several workshops in India and internationally at the request of service organizations to train over a 1000 healthcare and NGO/CBO/Positive Network service providers on a variety of relevant issues. In one example, SAATHII has provided grant writing training to five large NGOs and thus helped them to obtain $1.2 million in funding for expanding prevention of mother to child transmission (PMTCT) services at 62 select private and public health facilities.
1.2. Collaboration and Information Exchange /Best Practice Sharing
- Need - There is a need for specialized forums whereby providers of a particular service (e.g. ARV-related counseling, behavior change communication, PMTCT) can network, exchange notes and share information on their respective experiences to enhance the collective knowledge base, and enable organizations and individuals to learn from each other and from best practices that have already been identified.
- Barrier - There is inadequate information exchange and sharing of best practices among service providing agencies and individuals. Most of the information available to date has been one-way and limited in reach. Additionally, there is a large duplication of efforts and insufficient linkages between related players.
- Precedent - The Nigerian-AIDS e-forum and HealthNet Kenya's AfriAfya projects are good examples of the effectiveness of such forums in an international context.
- Related Experience– SAATHII’s electronic listserv is recognized globally as a common channel of communication on HIV related issues in India, which facilitates information sharing among 1700 members. In addition SAATHII also facilitates collaboration and information sharing through its HIV/AIDS service directory of more than 1200 HIV/AIDS services and 200 funding agencies, and satellite conferences and networking events attended by key players from all sectors including government agencies, UN agencies, international agencies, NGOs and positive networks.
1.3. Technical Support and Access to Resources
Need - We have identified a strong need to enable NGOs access individualized technical support on an ongoing basis. This can be done by setting up an ongoing support and referral system that networks them to appropriate resource persons. There is tremendous potential to deploy ICT for this purpose.
Barrier - A common barrier faced by HIV/AIDS NGOs, especially those working in rural and semi-urban areas is inaccessibility of resource persons/agencies who can assist them with specific issues such as organizational development, program planning, grant writing etc. Such resource persons and agencies tend to be located in urban areas of India and very often it is the urban service-providing agencies that are most successful in accessing resources through them.
Precedent - Work in the field of HIV prevention in developing world has demonstrated the utility of ICT in linking service providers with training, technical assistance, and consultation in the use of new approaches developed from research (Kelly et al. 2004).
Related Experience: SAATHII has been assisting NGOs through customized support to bridge their resource needs and gaps in an offline context since 2001. SAATHII has recently developed a support center for voluntary agencies working with sexual minorities and is providing on an ongoing manner technical assistance to 30+ NGOs working with sexual minorities.
2. Project Objectives
2.1. General Objective
The general objective of this project is to strengthen the response to HIV/AIDS in India through the application of information communications technology. ICT will be used to build the capacity of service-providing organizations, particularly in rural and semi-urban areas, facilitate best-practice sharing and collaborations; and provide tailored support aimed at enabling access to specific technical resources.
2.2. Specific Objectives
- E-training: To increase reach and use of SAATHII and its collaborators' training activities using quality ICT-based instruction to reach a larger number of geographically-dispersed HIV/AIDS organizations in semi-urban and rural areas. A total of 15 modules will be developed: each to reach about 50 participants at a time. Three of these modules will be piloted during the project period. The research component of this objective would test the hypothesis that the online programs comparable to the currently offered offline programs in terms of progress made by trainees. In addition please refer to the evaluation section for further details.
- E-forums: To facilitate and enhance collaboration, information exchange and sharing of best practices and strengthen technical capacity among stakeholders in India through electronic bulletin-board forums in collaboration with global network of SAATHII volunteers and advisers. Upto 10 e-forums will be developed and maintained on specific topics. The research component of this objective will involve qualitative and quantitative assessment of information content in these forums.
- E-support: To provide focused support and referrals to organizations with specific resource needs assessed during the course of field visits and through e-trainings and e-forums. Twelve organizations will be selected to receive e-support during the project period. The research aspect of E-support will consist of examining its effectiveness in program enhancement of participating organizations that receive E-training and E-support versus those that only receives E-training.
3. Project Beneficiaries
The project will focus on four categories of stakeholders involved in the fight against HIV in India:
(i) Non-profit HIV service-provider organizations in rural and semi-urban areas who have access to the internet;
(ii) Individual physicians, counselors and social workers involved in offering prevention, treatment, care and support services;
(iii) Networks of HIV-positive people;
(iv) members of the public seeking up-to-date information on various HIV-related issues ranging from prevention to treatment to policy. Specific information on characteristics of the beneficiaries will be collected and compiled as part of the documentation of e-forums.
4. Project Sustainability
Building capacities of HIV/AIDS service providers is an ongoing process. Throughout the project period we will be continually developing content for e-training programs that we will continue to offer beyond the project period. Given the importance of the project and the overwhelmingly positive response to our current offline capacity-building work funded by Indian state governmental agencies in Tamil Nadu and West Bengal, international foundations and UNAIDS, we are confident that we will be able to secure additional funding for this project from these agencies. In the long term, we anticipate making the training programs financially sustainable by charging for the programs on a sliding scale basis, and also by seeking corporate sponsorship to defray part of the training costs. We also expect that the organizations for which we provide e-training and e-support will then be able to go out and help build capacity for other organizations in their area by raising resources locally.
5. Project Methodology
Activity common to all objectives
Infrastructure setup - acquiring dedicated hardware and software for setting up the online resource centre (first two months).
5.1. Methodology and Activities associated with E-training
- Select topics in which web-based training courses will be offered- We will analyze feedback received from previous non-web-based trainings, and needs indicated by other NGOs in an earlier SAATHII project - the Red Ribbon Directory of HIV/AIDS organizations. Based on these we will prioritize topics and technical areas for web-based instruction. Note that three courses will be offered during the project period but we plan to continue the activity beyond the project period.
- Adapt existing courses for web-based instruction - Currently SAATHII, as part of its technical capacity-building activities, offers a variety of training and skill-building courses on such subjects as biostatistics and research methods, documentation, advocacy and program evaluation, gender and sexuality, STD/HIV prevention and behaviour change communication development. These courses and trainings will be adapted for interactive web-based instruction, with add-ons such as interactive test taking and assignments downloaded and submitted electronically. The information specialist will assist in this process. This activity will take place concurrently with topic selection. We expect to develop at least 5 such course modules.
- Develop e-curricula for new courses - Between existing SAATHII staff and a volunteer network which includes academicians, public-health and medical professionals based in Asia, North America and Europe, SAATHII has the expertise to offer additional courses in management of anti-retroviral therapy, clinical management of HIV/AIDS, home and community based care for PLWHA, operations research, peer education, organizational management, strategy development, medico-legal and ethical issues around HIV/AIDS. Course content and testing instruments for these will be designed so as to enable web-based instruction in the future. This will be an ongoing process throughout the project period, which will result in the development of 10 course modules.
- Select suitable course management systems - We will select suitable CMS software from among the open-source and/or inexpensive solutions available based on our needs and customizability of the packages.
- Select participating organizations- The courses will be announced and students recruited via SAATHII's existing networks and mailing lists, which include people from about 1200 HIV/AIDS organizations. We will also pro-actively contact organizations that have indicated their capacity-building needs to SAATHII in the course of an earlier project, the Red Ribbon Pages directory of HIV/AIDS services in India. We will work with the substantial number of organizations in rural and semi-urban areas that are already connected to the Internet either at their home or cyber-cafes. Priority will be given to organizations that do not have other capacity-building resources in place. We will be working with a total of 150 organizations during the proposed period of this project, with the potential to scale-up based on results.
- Offer online courses - We will be offering three modules through the project period. Each will last for two months followed by evaluation and reporting, and be offered to an upper limit of 50 organizations each. We can thus offer e-training to up to 150 participating organizations through the project period, a tremendous scale up from what is possible to do through purely offline instruction. In addition, material will have been developed for a total of 15 courses including these three, reaching out to a potential total of 750 participants in all.
- Data analysis, evaluation and reporting - This will be carried out for each of the three courses offered during the project period as denoted in the timeline.
5.2. Methodology and Activities associated with E-forums.
- Identify subject areas - Through a series of feedback requests on SAATHII's current website and mailing list, we will identify gaps in the existing avenues for networking, and determine areas in which collaboration and information exchange is sought.
- Hire and train information specialist - Upon commencement of the project we will be hiring an information specialist and training her/him on issues of HIV/AIDS-specific information organizing and documentation.
- Research suitable technology- Concurrently with researching CMS software, we will be evaluating the different bulletin boards available for our use and picking the most suitable.
- Start community e-forums and recruit participants. Through the use of the bulletin board systems, SAATHII's Online Resource Centre will start offering opportunities for specialized and structured discussions, and opportunities for networking. For example, a particularly urgent need at the moment is to facilitate information exchange and sharing among physicians who are involved with India's HIV treatment and PMTCT programs. Recruited from our listserv and directory, individual physicians, counselors and social workers in India will be invited to share their knowledge, experiences and queries in the forums. We will also be drawing on our substantial volunteer base that includes public health, medical and social work professionals and graduate students in Asia, North America and Europe and inviting them as resource persons to participate in the forums. We anticipate developing 10 forums through the project period.
- Database development - The information specialist will work with the database development consultant to jointly determine how best to design databases, which will then be implemented by the database consultant. These will be in place by the end of the first five months.
- Documentation and evaluation - We expect that the e-forum discussions will generate substantial material (eg. best practices, FAQs) that will be documented, abstracted and uploaded for easy retrieval and search. Abstracts will be publicized widely to draw attention to the full text documents available on the databases. Evaluation details are given in the relevant section.
5.3 Methodology and Activities for E-support
Identify specific resource needs of organizations - From the organizations selected for e-training we will be identifying a subset with whom we will be carrying out exhaustive needs assessments and identifying priority areas for customized e-support. Due to the intensive nature of this activity we will work with a maximum of four organizations at a time, leading to a maximum of twelve through the project period.
E-support activities - Upon identifying the resource needs we will be working closely with each of the selected organizations by email and telephone to support them, provide specific resources via the online resource center and/or make appropriate referrals.
Evaluation and analysis - These will be carried out after each two-month period of e-support using methods described in the monitoring/evaluation section.
6. Project Timeline: Include a time-table/schedule of key activities.
6. Project Outputs
The project will produce an integrated Online Resource Centre for HIV in India, which will consist of:
- E-training modules - instructional modules delivered via dedicated web pages on the saathii.org website, with opportunities for interaction and discussion offered via chat room consultations and problem-solving exercises. Much of the non-interactive course content will be downloadable and can be printed out for later study.
- E-forum outputs: The E-forums will be available for general use beyond the project period. In addition, the body of knowledge generated by these e-forum discussions will be consolidated into FAQ and Best Practices documents for wider dissemination. They will be disseminated via the website on databases and will contain both constrained search and 'smart search' functionality. Abstracts of these documents will be circulated widely.
- Research papers and reports based on our analyses of the e-training, e-forum and e-support components, comparisons with the offline training and support programs, and quantitative and qualitative analyses of the capacity-enhancement obtained by the participants in these programs.
- A model of capacity building through ICT that can be then tested and adapted to other resource-limited settings.
7. Project Monitoring and Evaluation
In monitoring and evaluating the project we will address the following research questions tied to each of the proposed objectives:
How useful are the e-trainings and e-support activities in enabling participants build their organizational capacities?
Have they led to improvements in the quality of their programs or an increase in the number of programs?
Are the e-forums serving their purpose of increasing information and knowledge sharing? If yes, how effectively?
How successful is the documentation output of the e-forums in terms of accessibility, usability and information content?
Ongoing monitoring, quarterly reports and summative and formative evaluation methodologies will be worked out to determine of the online resource centre is conforming to expectations. Some of the indicators we hope to use are:
- For E-training: We will carry out pre and post course testing of all participants in the courses, which will then allow for statistical assessment of improvement in the knowledge base and skill set of participants (using matched-pair tests).
- For E-training versus Conventional training: We will further statistically compare the efficacy of web-based versus conventional (in-person) training. The variable for comparison will be the difference between post- and pre-course scores. The question we will be asking is: "Is the average improvement in scores after the course significantly different between e-training and offline training? This will allow us to improve quality of instruction via the online courses to match those of the offline courses, if needed.
- For E-forum activity: We will track membership and message posting rates on the bulletin boards we create. A significant increase in the total number of messages and in average number of messages per poster over the project period indicates successful use of the bulletin board. We will also be carrying out quantitative and qualitative analyses of content, where possible.
- For E-forum documentation usage and usability: We will be tracking website hits for the different sections of the documentation archives in the Online Resource Centre. Further, we will be gathering data on most-frequently used keywords so as to improve the databases on an ongoing basis. We will evaluate the documentation web pages using the Usability Testing Method described by Tullis (1998). This method allows one to separate out the three principal factors affecting usability, namely design of information architecture, textual content, and visual design.
- For capacity-enhancement through e-support and e-training: Through questionnaires and feedback solicited from organizations receiving the e-trainings and e-support, we will assess improvements they have made in terms of strengthening their existing programs and/or developing new ones, grants successfully obtained etc.
