Attached in its entirety is the review of the 100% Targeted Condom Promotion programme in Myanmar. This was not an easy document for [him] to acquire. Strange to see a lack of circulation of a review for a programme considered to be a flagship of the NAP.
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Executive Summary
A review of the 100% Targeted Condom Promotion (TCP) programme in Myanmar was
conducted between 14-26 July 2005, under the initiative of the National AIDS
Programme (NAP), with support from the World Health Organization.
The review was intended to provide recommendations for improving programme
implementation, and specifically to propose adjustment in the coverage, quality and
approaches of the 100% TCP programme, in the light of changing developments and
needs in the Myanmar HIV/AIDS context.
The review included stakeholder consultations, in-depth discussions with NAP staff,
record reviews, and field visits to seven townships (Chan Mya Tha Zi, Chan Aye Tha
Zan, Pyin Oo Lwin, Hlaing Thar Yar, Insein, Pathein, Pyay). A debriefing session and
discussion of the key findings of the review team was held on 26 July with a wide range
of stakeholders, before finalization of the report.
The organization of sex work in Myanmar is complex and fluid. Identifying
establishments where commercial sex takes place and reaching sex workers, clients and
brokers is challenging. On the other hand, there are reports of recent changes in the
policy environment and in public opinion, which are conducive to a higher level of
openness about safer sex and condoms.
The review team had the impression that there was considerable variability in the
performance of the 100% TCP programme in the different townships visited.
Performance seems to vary with the maturity of the programme at township level (with
good results observed in townships which were included in the pilot phase), but even
more so, with the intensity of relevant programme inputs at the township level, and with
the degree of ownership and cooperation of local stakeholders, and most particularly,
senior law and order officials.
Thus, some townships show good results, while others still seem to be struggling with
initial implementation. Mostly health sector staff are enthusiastic and committed to
expand the programme, and many are supported at the local level by the township
authorities. However, all of the townships visited still need to move beyond the
implementation of condom promotion activities to realize the full range of activities
required to create an enabling environment for the "no condom, no sex" rule of the 100%
TCP programme. This requires the full cooperation of stakeholders that have not yet
been fully engaged in the process.
The programme faces a number of challenges in its efforts to increase coverage (both in
terms of increasing the number of townships involved, but also in terms of saturating the
sex worker population in a particular township), while maintaining quality. The
imminent rapid scale up of the 100% TCP programme, to achieve national coverage by
2010, requires urgent attention to a number of partnership, management and
programmatic issues, which are discussed in detail in the report.
The following is a summary of the key recommendations:
Build and nurture partnerships around the 100% TCP programme with other key
stakeholders in the government sector (especially the police and general
administrative departments) and the NGO sector (especially among INGOs that
are implementing programmes in sex work settings). Consider setting up a Task
Force to guide policy and programme development at national level.
Foster ownership of the programme at township level and set up mechanisms to
facilitate multisectoral collaboration at that level (through the setting up of a
township Task Force that would report to the CCG).
Intensify advocacy efforts at all levels that emphasize the critical importance of
reducing HIV transmission in sex work settings for the effective control of the
HIV/AIDS epidemic in Myanmar.
Purposively move beyond condom promotion activities to the next stage of
implementation of the 100% TCP programme. This implies a series of activities
to develop an enabling environment for the "no condom, no sex rule".
Owners/managers of entertainment establishments and guest houses need to be
more fully engaged in this effort, and an incentive and disincentive scheme for
performing/non performing establishments needs to be developed and applied.
Intensify efforts to reach out and support sex workers through peer outreach, to
empower them to negotiate with clients and brokers. Create a cadre of peer
educators and peer leaders, and involve them in policy development as well as in
programme planning and implementation.
In preparation for scale up, simplify and standardize monitoring and evaluation
procedures for the 100% TCP programme, focusing on supporting the regular
review of performance in order to inform decision-making at local level, and, at
national level, facilitate quality implementation and timely scale-up, guide
technical support, and track changes in key behaviours and HIV prevalence.
Resource and strengthen coordination activities and intensify capacity-building at
all levels (to develop tools and skills for important activities such as advocacy,
peer education, outreach, monitoring and evaluation)
Convene informal technical working groups to discuss improved programme
approaches and tools in key areas identified in this report, namely: advocacy,
partnerships, coordination and management, peer education, monitoring and
evaluation.
