UNICEF. Capacity assessment tools for organisations working with most at-risk adolescents

UNICEF Capacity assessment tools for organisations working with most at-risk adolescents October 2008

CONTENTS ACKNOWLEDGEMENTS... II CAPACITY BUILDING NEEDS IDENTIFICATION TOOLS... 1 BACKGROUND... 1 PURPOSE... 1 PART 1: BACKGROUND INFORMATION TO BE COMPLETED BY MANAGERS OF ORGANISATION. 3 PART 2A: TO BE COMPLETED BY MANAGERS OF ALL ORGANISATIONS... 5 STAFFING... 5 SERVICES PROVIDED BY ORGANISATION... 6 METHOD OF DELIVERING SERVICES PROVIDED BY ORGANISATION... 7 FOR ALL ORGANISATIONS...10 TYPE OF CLIENT USING SERVICES...10 RECORD KEEPING...11 STAFF TRAINING...12 REFERRAL...14 SUPPLIES...15 FINANCING AND BUDGET...16 PART 2B: FOR COMPLETION BY MANAGERS OF NGO/CBO SERVICES... 17 MANAGEMENT AND NORMATIVE ENVIRONMENT...17 VOLUNTEERS...19 RELATIONS WITH OTHER AGENCIES...20 FINANCE AND BUDGET...20 MONITORING AND EVALUATION (M&E)...21 STAFF TRAINING...23 PART 4A: FOCUS GROUP DISCUSSION QUESTIONS FOR STAFF AND MANAGERS ON CAPACITY FOR ALL ORGANISATIONS... 27 Age, gender and HIV...27 Human rights and ethical issues...28 Active engagement of target population...28 Scale up...29

Acknowledgements These Capacity Assessment Tools were developed by Hilary Homans on behalf of the UNICEF Regional Office for Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS). They draw upon examples of good practice such as, the International HIV/AIDS Alliance (2007) Community-based Organisations - Capacity analysis: A toolkit for assessing and building capacities for high quality responses to HIV. Funding for the development of the tools and the companion Facilitators Guide was provided by Irish Aid under the scope of the programme on HIV Prevention in Most at-risk adolescents in Ukraine and South Eastern Europe. The tools were developed to enable National AIDS Programmes and other responsible agencies assess the capacity of organisations to be able to provide HIV interventions for most at-risk adolescents. These tools were field tested in Albania and revised accordingly with the support of Alketa Zazo and members of the local capacity assessment team CANGO - Anduena Shkurti (Executive Director), Ridiona Stana (Project Assistant), Migena Mollanji (Programme Assistant), Migen Suloj (Consultant), and Erisa Vora (Volunteer). Thanks are also due to all the people who participated in the field testing, in particular Genci Mucollari and staff of Aksion Plus and Daniela Nika and the staff of the University Hospital Centre, Outpatient clinic. Finally, thanks are due to Arjan Harxhi (Director of Health Policy and Planning in Albania and Chair of the Steering Committee on Capacity Assessment, Klodian Rrjepaj (Director, Albanian National AIDS Programme) and Roland Bani (Monitoring and Evaluation Officer, Albanian National AIDS Programme). October 2008 ii

Capacity building needs identification tools Background The UNICEF/Irish Aid Multi-country programme on most at-risk adolescents (MARA) has collected data on HIV risk behaviour amongst adolescent boys and girls who inject drugs and/or are involved in sex work (or are sexually exploited), and adolescent boys who have sex with other males. However, services for these adolescents are as yet undeveloped in the region. There are good examples of programmes for adults engaging in HIV risk behaviours, but staff may not have been trained to work with adolescents. There are also a growing number of Adolescent or Youth Friendly Health Services (YFHS), but staff in these services may not be familiar with the specific needs of most at-risk adolescents. Finally, some of the needs of MARA fall outside the remit of health services and relate to protection, housing, social services and skills building. There is no information available on the capacity of each of these types of services to adequately meet the needs of MARA, whilst the need to scale up service provision is clear. Purpose This capacity building identification tool has been developed by UNICEF to assist governments and partners to work with governmental and civil society organisations (including the private sector and non-governmental organisations, NGOs) to identify their capacity needs in providing HIV prevention, treatment, care and support and related services for most at-risk adolescents (MARA). It can also be used to identify the capacity of services that do not yet provide services for MARA to be able to do so in the future after capacity has been built within the organisation. The capacity building needs identification tool identifies organisations with: o o o o good existing capacity of HIV prevention, treatment, care and support with MARA and potential to scale up for universal access limited existing capacity HIV prevention, treatment, care and support with MARA and potential to further strengthen capacity no experience to date of working with MARA, but with demonstrated capacity of working on HIV prevention, treatment, care and support with adults at-risk of HIV and future potential to work with MARA no experience to date of working with MARA, but with demonstrated capacity of providing services to adolescents (Youth Friendly Health Services, child protection or social services) and future potential to work with MARA October 2008 1

The tool aims to identify capacity building needs in the respective organisation. It is not an evaluation of the services and does not assess the quality of the services provided to most at-risk populations and MARA. Other assessment tools are available for such purposes 1. The end result should be a plan of any human and financial support required to build capacity of existing organisations to work with MARA and to scale up activities as well as indicators to monitor capacity building efforts and an evaluation plan to assess the impact of the support received. The technical questions relating to government services, staff training and range of services provided have been developed by UNICEF Regional Office based on experience of working with MARA in different settings. General questions on capacity of NGO/CBOs have been adapted from the toolkit developed by the International HIV/AIDS Alliance (2007) Community-based Organisations - Capacity analysis: A toolkit for assessing and building capacities for high quality responses to HIV. A further toolkit developed by the IHAA for capacity assessment of intermediary organisations may also be useful 2. This is a participatory exercise and completion of the capacity tool should be facilitated by a member(s) of the National Team in conjunction with key members of department or the organisation. The team will request copies of Annual Reports, Strategic Plans and financial data to review as part of the needs identification and organisations should be informed of this in advance so they can prepare the required materials. The tool is divided into four parts: Part 1: Background information for completion by all selected organisations. Organisations who do not wish to have their capacity built to provide HIV services for MARA will not proceed beyond this point. Part 2A: Interview guide for managers of all selected organisations (government, NGO, community based-organisations, CBOs) Part 2B: Interview guide for managers of NGO and community based-organisations, CBOs ONLY (not government) Part 3: Staff questionnaire Part 4A: Focus group discussion on capacity of organisation to provide services to MARA for all selected organisations (government, NGO, community basedorganisations, CBOs) Part 4B: Focus group discussion on capacity of organisation to provide services to MARA for all selected NGO, community based-organisations, CBOs) 1 COPE, IPPF and World Health Organisation tools for assessing adolescent/youth friendly health services. 2 International HIV and AIDS Alliance, IHAA (2008) Intermediary Organisations - Capacity Analysis: A toolkit for assessing and building capacities for high quality responses to HIV, IHAA, Brighton. October 2008 2

PART 1: Background information to be completed by managers of organisation 1.1 Name of organisation. 1.2 Type of organisation: Government 1 Non governmental organisation 3 2 Community-based organisation 3 Private practice 4 Other 8 If other, please specify 1.3 Address...... 1.4 Name of contact person...... 1.5 Email...... 1.6 Telephone.... 1.7 Fax...... 1.8 Does your organisation have access to the Internet? Yes 1 No 0 1.9 Does your organisation have a web page? Yes 1 No 0 If yes, please give webpage address 3 Registered with the government October 2008 3

1.10 Does your organisation provide any HIV services to the following groups? Adolescents 4 /young people Female sex workers Male sex workers Transgendered sex workers Injecting drug users Men who have sex with men Prisoners Displaced populations Migrants Children living/working on the street Children who have been sexually exploited If yes to any of the above, please complete following questions in Part 2 (all organisations) and part 2B for NGOs/CBOs. If no, thank you for your time Date of completion of questionnaire. Name of interviewer.. 4 Adolescents in this context are minors aged 10 to 17 and young people aged 10 to 24 years October 2008 4

PART 2A: To be completed by managers of all organisations Your organisation has expressed interest in providing HIV services for most at-risk adolescents so we would like to ask you some questions about the current organisation of your work and the services provided. Staffing 2.1 How many staff work for your organisation? Please do not include ancillary staff (drivers, cleaners, receptionists etc) Manager of service 5 Administrator Finance manager Full time paid Part time paid Volunteers Male Female Male Female Male Female Doctors TOTAL Gynaecologist Infectologist Internist or General practitioner Narcologist Paediatrician Psychiatrist Other (please specify) Nurses Lawyers Pedagogues Psychologists Social workers Outreach workers Peer educators Other, please specify 5 Do not count twice if the manager is also a doctor or other professional. October 2008 5

Services provided by organisation 2.2 How would you best describe the main work of your organisation? General health services HIV prevention services HIV testing (VCT) Harm reduction services HIV treatment services (ARV, OI) Palliative care Adolescent/youth friendly health services Child protection services Psychosocial support services Social services PLHIV support group IDU support group MSM Support group Sex worker support group Other, please specify Please tick if you provide this service How long have you been providing these services? Within last year 1 to 2 years 2 to 5 years Six to 10 years Over 10 years Other, please specify 2.3 What is the geographic coverage of your work? National 1 City/municipality 2 Names of cities........no. of cities District 3 Names of districts. No. of districts Local hot spots 4 Names of hot spots.......... No. of hotspots Other 8 Don t know 9 If other, please specify. October 2008 6

Method of delivering services provided by organisation 2.4 Which of the following methods does your organisation use to deliver services to clients? Clinic based health services 1 Hospital based health services 2 Mobile services 3 Drop-in services 4 Outreach services 5 Peer education 6 Shelter/safe house 7 Other 8 If other, please specify.. 2.5 Please tick if your organisation provides any of the following services now or would like to do so in the future? General counselling services Legal services Social services Child protection Sexual and genderbased violence Life skills training (assertiveness) Vocational/income generation skills Humanitarian (clothes/food) Other (please specify) Tick if currently provide this information Tick if would like to provide information on this topic in the future Don t know October 2008 7

2.6 Please indicate the range of HIV prevention and treatment information provided directly by your organisation and your willingness to provide information on these topics in the future: HIV prevention HIV treatment Human rights Sexuality Sexually transmitted infections Substance use Injecting drugs Reproductive health Other (please specify) Tick if currently provide this information Tick if would like to provide information on this topic in the future Don t know Other (please specify) 2.7 Please indicate the range of HIV prevention commodities provided directly by your organisation and your willingness to provide these commodities in the future: Male condoms Female condoms Lubricants Other (please specify) Tick if currently provide these commodities Tick if would like to provide these commodities in the future Don t know If not a health service provider, GO to Q 2.8 Only ask the following question for health service providers (for social and Child Protection services go to Question 2.9.) October 2008 8

2.8 Please indicate the range of HIV prevention and treatment services provided directly by your organisation and your willingness to provide these services in the future: HIV testing and counselling services Pre-test HIV counselling Post-test HIV counselling Rapid HIV tests Harm reduction services Needle and syringe exchange Needle and syringe distribution Methadone substitution therapy First aid Treatment of abscesses Overdose treatment Psychosocial support for IDUs Other (please specify) Tick if you currently provide this service Tick if you would like to provide this service in the future Don t know Prevention and treatment of sexually transmitted infections Syndromic treatment Clinical diagnosis Partner notification Other (please specify) Post-exposure prophylaxis Post-exposure prophylaxis Clinical management of rape HIV treatment Anti retroviral therapy Opportunistic infections Tuberculosis treatment Other (please specify) HIV care and support Psychosocial support services Home based care for PLHIV Palliative care for PLHIV Other (please specify) October 2008 9

For all organisations Type of client using services Now we would like to ask some questions about the type of clients who use your services 2.9 Age group of clients using services: 0 to 9 years Adolescents 10 to 18 Adults (over 18) Other Don t know Community based HIV prevention (including in schools) Outreach Clinic/facility based 2.10 Does your service ONLY work with adolescents/young people? Yes 1 No 0 If yes, what are the main characteristics of the adolescents who access your services? In school 1 Out of school 2 Living without parental care (with relatives) 3 Living or working on the street 4 Living in institutional care 5 National minorities (e.g. Roma) 6 Rural youth 7 Urban youth 10 Married 11 Single 12 Substance users 13 Injecting drug users 14 Boys who have sex with men 15 Adolescents who have been sexually exploited 16 Transgendered/transsexual 17 Living with HIV 18 Other 8 Don t know 9 2.11 If any adolescents use your service, do most of them: Come directly/self-refer without an appointment 1 Come directly with appointment 2 Referred by outreach workers 3 Referred by peer educators 4 Referred from school 5 Referred by youth projects/clubs 6 October 2008 10

Referred by health services 7 Referred by social services 10 Referred by child protection services 11 Other 8 Don t know 9 If other, please specify.. 2.12 If your service is not exclusively specifically designed for adolescents/young people, are there specific times when adolescents/young people can access your services? 2.13 Sex of clients using services by type of service: Male only Female only Predominantly male Predominantly female Roughly equal male/female Transgendered/sexual Don t know Community based HIV prevention (including in schools) Outreach Clinic/facility based Record keeping 2.14 Do you ask clients for their name when they register to use your service? If no, do you have an anonymous coding system (Unique Identifier Code) for clients? 2.15 Do you keep client records? If yes, how are records kept? Register 1 Computer records 2 Both 3 Other, please specify.. Please ask to look at the register and computer records. October 2008 11

2.16 Do you have a protocol on data protection? 2.17 Does your organisation collect written information on the following? Age of client Sex of client HIV risk behaviour of client Services provided to clients 2.18 Does your organisation produce annual statistics on number of: New clients using services Repeat clients using services If yes, please state: Number of new clients reached in 2007. Number of repeat clients reached in 2007 2.19 If exact numbers of clients are not known, please estimate how many were reached in 2007: Less than 20 20 to 49 50 to 99 100 to 199 200 plus New clients 1 2 3 4 5 Repeat clients 1 2 3 4 5 Number of new clients this year (2008)..... Number of repeat clients reached in this year (2008) If exact numbers of clients are not known, please estimate how many were reached in first 9 months of 2008: Less than 20 20 to 49 50 to 99 100 to 199 200 plus New clients 1 2 3 4 5 Repeat clients 1 2 3 4 5 Staff training 2.20 Does your organisation have a staff training plan? Yes 1 No 0 If yes, please ask to look at the training plan October 2008 12

2.21 Has your organisation ever conducted a training needs assessment? Yes 1 No 0 If so, when was the last training needs assessment conducted?.. 2.22 Please identify what training you have received by area (tick each area) and any areas you would like to receive future training in? HIV modes of transmission HIV treatment Voluntary counselling and testing for HIV Peer education Outreach Sexual and gender based violence Working with injecting drug users Working with pre-injectors 6 Working with sex workers Working with transgendered/transsexuals Working with men who have sex with men Working with national minorities Working with people living with HIV Human rights of most at-risk populations (IDUs, MSM, SW) Human rights of people living with HIV Behaviour change communication Gender programming Psychosocial issues Ethical and legal issues of working with minors Child protection issues Adolescent, health and development Communicating and counselling adolescents HIV among adolescents Sexually transmitted infections among adolescents Substance use among adolescents Injecting drug use among adolescents Clinical management of HIV among adolescents Organisational strategic planning Management Finance and budgeting Fund raising/resource mobilisation Advocacy and lobbying Other, please specify Received training by type Workshop On the job training Need training Yes 6 A pre-injector is usually a young person who has friends, parents or siblings who already inject drugs and therefore is vulnerable to start injecting themselves. October 2008 13

2.23 Do you encourage and enable staff to learn and develop their knowledge about HIV? If yes, how? Occasional informal discussions 1 Regular staff meetings on new HIV knowledge 2 Information distributed among staff on regular basis 3 Information distributed among staff on ad hoc 4 Other 8 Please specify..... Referral 2.24 In your job do you ever refer clients to other HIV information, commodities and services? If so, please tick which of the following your refer clients to and give their name: Information on HIV prevention Information on HIV treatment Information on human rights Information on sexuality Information on sexually transmitted infections Information on substance use Information on injecting drug use Information on reproductive health Condoms General counselling services HIV testing and counselling services Harm reduction services for injecting drug users Treatment of sexually transmitted infections Post exposure prophylaxis Mother to child transmission of HIV HIV treatment Anti retroviral therapy Opportunistic infections TB treatment Psychosocial support Home based care Palliative care Mental health services Networks of PLHIV Networks/NGOs for MSM Yes Name of referral service 1..... October 2008 14

Networks/NGOs for IDUs Networks/NGOs for sex workers Legal services Social services Child protection services Services for victims of trafficking Sexual and gender-based violence services Life skills training (e.g. assertiveness) Vocational/income generation skills Humanitarian (clothes/food) Other (name). 1.. Other (name). 1 Other (name). 1 To be completed by the interviewer (please add the number of organisations referred to in the question above) Number of organisations clients are referred to: None 0 One to two 1 Three to four 2 Five to nine 3 Ten plus 4 Other 8 Supplies 2.25 Does the organisation always have regular supplies of: HIV prevention information HIV treatment information Condoms Medicines HIV prevention supplies If no, No supplies provided by the organisation 0 Sporadic supplies of: Information 1 October 2008 15

Condoms 2 Medicines 3 HIV prevention supplies 4 (e.g. gloves, needles etc) Other shortages (please specify.. Regular supplies with occasional stock out of: information, condoms, medicines HIV prevention supplies 5 Financing and budget 2.26 Please state the funding source for the work of your organisation: Whole Partial None Government state 2 1 0 Government municipality 2 1 0 Global Fund to fight AIDS, TB and Malaria 2 1 0 UN agency 2 1 0 Bilateral agency 2 1 0 International NGO 2 1 0 Local NGO/charitable organisation 2 1 0 Private sector 2 1 0 Other 2 1 0 If other, please specify 2.27 Please state approximate annual budget for your organisation: No independent budget 0 Less than US$ 5,000 1 US$ 5,000 to 9,999 2 US$ 10,000 to 19,999 3 US$ 20,000 to 49,999 4 US$ 50,000 to 99,999 5 US$ 100,000 to 199,999 6 Over US$ 200,000 7 Don t know 9 This is the end of the questions for managers of government services. THANK YOU for participating in this interview October 2008 16

PART 2B: For completion by managers of NGO/CBO services Governance 2B1 Do you have internal rules for the organisation? If yes, do you have? Rules/principles written down 1 Rules exist, but not widely approved 2 Rules accepted and approved by all the members of the organisation 3 Other 8 Please specify...... 2B2 Do you have a committee/board that governs your work? Committee/Board established, but never meets 1 Committee/Board meets once a year 2 Committee/Board meets quarterly 3 Other 8 Please specify...... Management and normative environment 2B3 Does your organisation have a statute? If yes, please give a copy of the statue to the interviewer or the web link where the document can be accessed. 2B4 Does your organisation have norms and standards governing service delivery? If yes, please provide a copy to the interviewer or the web link where the document can be accessed. 2B5 Does your organisation have methodological guidelines for service delivery? October 2008 17

If yes, please provide a copy or to the interviewer or the web link where the document can be accessed. 2B6 Is there an Operation Plan for the work of your organisation? If yes, what time period does the Operation Plan cover? Between 2000 and 2002 1 Between 2003 and 2004 2 Between 2005 and 2006 3 Between 2007 and 2008 4 2009 and beyond 5 Other 8 Don t know 9 If other, please state time period covered If yes, please give a copy of the Operation Plan to the interviewer or the web link where the document can be accessed. 2B7 Is there an Annual Report for the work of your organisation in 2007? If yes, please give a copy of the Annual Report to the interviewer or the web link where the document can be accessed. If no, has your organisation ever produced an Annual Report? If yes, please state latest year a report was produced 2006 1 2005 2 2004 3 2003 4 2002 5 Earlier 6 2B 8 Does your organisation have its own office? Yes 1 No 0 If no, is the office shared with another organisation? Yes 1 No 0 2B 9 Does your organisation have its own meeting space? Yes 1 No 0 October 2008 18

If no, is the meeting room shared with another organisation? Yes 1 No 0 2B10 Does your organisation have its own equipment? Yes 1 No 0 If no, are office equipment (computer plus printer) shared with another organisation? Yes 1 No 0 Volunteers 2B11 Does your organisation involve volunteers who have different areas of responsibility? Yes 1 No 0 If yes, how many volunteers does your organisation work with? One 1 Two to four 2 Five to nine 3 Ten to fourteen 4 Fifteen to 19 5 Twenty plus 6 Don t know 8 2B12 Do you have meetings with volunteers? 2B13 Are volunteers involved in decision making within your organisation? Do you provide training for volunteers? If yes, is this? On the job/informal 1 External training 2 Other 8 Please specify October 2008 19

Relations with other agencies 2B14 Is your organisation part of a national network of AIDS service providers? If so, please state name of network(s).. Number of national networks 2B15 Is your organisation part of a regional or global network of AIDS service providers? If so, please state name of network(s).. Number of regional/global networks 2B16 How do the activities of the organisation fit into the National AIDS Programme? Please tick as appropriate. No specific relationship GFATM recipient Member of CCM Member of National AIDS Council Member of strategic planning committees Name them Other, please state Finance and budget 2B17 Does your organisation keep accounts of money that can be presented on demand? 2B18 Are accounts kept up to date and balances and statements are prepared at the end of the year? 2B19 Does your organisation have a bank account to hold its funds? 2B20 Does your organisation prepare, monitor and review the budget? October 2008 20

2B21 Do you maintain supporting receipts and invoices for all expenditure? If yes, which of the following apply? Receipts/invoices are sometimes needed to justify expenses 1 Receipts/invoices are always needed to justify expenses 2 2B22 Has your organisation ever written a project proposal for funding? If yes, how did you write it? Manager of service 1 Team effort 2 External consultant 3 Other 8 If other, please specify.... 2B23 How many successful proposals (resulted in funding) have you prepared? None 0 One 1 Two to four 2 Five or more 3 Please give the year of the last successful proposal you received funding for 2B24 Do you provide financial reports to donors? If yes, please tick if are they: Submitted on time 1 Ever returned for clarification 2 Monitoring and evaluation (M&E) 2B25 Does your organisation have indicators for the targets you want to achieve? If yes, which of the following apply to your organisation? Responds to immediate government requests for M&E data 1 Responds to immediate donor requests for M&E data 2 Have an M&E system and collect data on an on-going basis 3 THANK YOU for participating in this interview October 2008 21

PART 3: To be completed by staff and volunteers of organisation 3.1 Name of organisation... 3.2 Job title.. 3.3 Please tick if you are: Full time paid staff Part time paid staff Volunteer (unpaid staff) Other, please state 3.4 Please tick if you are: Male 1 Female 2 3.5 How long have your worked for this organisation? Less than one year 1 One to 2 years 2 2 to 4 years 3 5 to 9 years 4 10 or more years 5 3.6 Please state your professional background, please tick Administrator Finance budget staff Gynaecologist Infectologist Internist/General Practitioner Narcologist Paediatrician Psychiatrist Nurse Lawyer Pedagogue Psychologist Social worker Outreach worker Peer educator Other, please specify October 2008 22

Staff training 3.7 Please identify the training you have received in the following areas and any areas where you need further training to be better able to work with most at-risk adolescents/young people and adolescents/young people living with or affected by HIV. Please tick the responses that apply to you. HIV modes of transmission HIV treatment Voluntary counselling and testing for HIV Peer education Outreach Sexual and gender based violence Working with injecting drug users Working with pre-injectors 7 Working with sex workers Working with transgendered/transsexuals Working with men who have sex with men Working with national minorities Working with people living with HIV Human rights of most at-risk populations (IDUs, MSM, SW) Human rights of people living with HIV Behaviour change communication Gender programming Psychosocial issues Ethical and legal issues of working with minors Child protection issues Adolescent, health and development Communicating and counselling adolescents HIV among adolescents Sexually transmitted infections among adolescents Substance use among adolescents Injecting drug use among adolescents Clinical management of HIV among adolescents Organisational strategic planning Management Finance and budgeting Fund raising/resource mobilisation Advocacy and lobbying Other, please specify Received training by type Workshop On the job training Need training Yes 7 A pre-injector is usually a young person who has friends, parents or siblings who already inject drugs and therefore is vulnerable to start injecting themselves. October 2008 23

3.8 In your job do you ever refer clients to other HIV information, commodities and services? If so, please tick which of the following your refer clients to and give their name: Yes Name of referral service Information on HIV prevention 1..... Information on HIV treatment Information on human rights Information on sexuality Information on sexually transmitted infections Information on substance use Information on injecting drug use Information on reproductive health Condoms General counselling services HIV testing and counselling services Harm reduction services for injecting drug users Treatment of sexually transmitted infections Post exposure prophylaxis Mother to child transmission of HIV HIV treatment Anti retroviral therapy Opportunistic infections TB treatment Psychosocial support Home based care Palliative care Mental health services Networks of PLHIV Networks/NGOs for MSM Networks/NGOs for IDUs Networks/NGOs for sex workers Legal services Social services Child protection services Services for victims of trafficking Sexual and gender-based violence services Life skills training (e.g. assertiveness) Vocational/income generation skills Humanitarian (clothes/food) Other (name). 1.. Other (name). 1 Other (name). 1 October 2008 24

To be completed by the interviewer (please add the number of organisations referred to in the question above) Number of organisations clients are referred to: None 0 One to two 1 Three to four 2 Five to nine 3 Ten plus 4 Other 8 3.9 Have you ever in your work been: Subjected to violence by the police Subjected to violence by clients Not able to provide a service that was needed If yes, please specify.. 3.10 Does the organisation always have regular supplies of: HIV prevention information HIV treatment information Condoms Medicines HIV prevention supplies October 2008 25

If no, No supplies provided by the organisation 0 Sporadic supplies of: Information 1 condoms 2 medicines 3 HIV prevention supplies 4 Other shortages (please specify.. Regular supplies with occasional stock out of: information, condoms, medicines HIV prevention supplies 5 THANK YOU October 2008 26

PART 4A: Focus group discussion questions for staff and managers on capacity for all organisations Name of organisation.. 1= lack of capacity; 2= low capacity; 3 = medium capacity; 4 = good capacity Question Age, gender and HIV Do you think that adolescents require different types of HIV services? Why? Are you arranging the services according to the different needs of adolescents? How? No understanding Capacity score 1 2 3 4 Know that some young people engage in HIV risk behaviour and that some are vulnerable, but do not know what to do about it Have changed the way the organisation works to focus on young people and to ensure that they benefit from its activities Always analyse how young people are affected by HIV risk behaviour, HIV vulnerability, and access to services within the community, and respond with appropriate strategies Do you think that gender affects adolescent girls and boys HIV risk behaviour? Why is their behaviour different? Do you think that gender affects adolescent girls and boys use of HIV services? How does gender affect their use of services? Have you changed the way you organise your services to promote gender equity? Do you regularly analyse your data by gender? No understanding Know that women and men have different HIV risk behaviours and vulnerability, but do not know what to do about it Have changed the way the organisation works to promote gender equity, and that men and women benefit from its activities Always analyse how gender is affecting HIV risk behaviour, vulnerability to HIV, and access to services within the community, and respond with appropriate strategies October 2008 27

Question Human rights and ethical issues What do you know about the human rights of HIV at-risk populations (IDUs, MSM and sex workers) What do you know about the human rights of PLHIV? Where did you obtain this information? Do you have measures in place in your service to protect their rights? How have you changed your services? What do you know about ethical and legal issues of providing HIV services to minors? Do you know about the Convention on the Rights of the Child? Can you mention any national legal document which deals with HIV services to minors? Do you know at what age adolescents can access health services without parental consent? How did you find out about these things? How have you changed the way you work? Active engagement of target population Do people living with HIV participate fully in the activities, work, and major decisions of your organisation? How do you engage them? Do you involve them in decision-making? How have you changed your services to include their participation? UNICEF and Irish Aid No understanding No understanding No positive people involved, except to receive services Capacity score 1 2 3 4 Understand people living with HIV are often discriminated against and have rights that should be protected Know about the Convention on the Rights of the Child and national legislation on health services for minors, but do not know what to do Positive people act as volunteers but in no paid/decision-making roles Understand how human rights violations can make people more vulnerable to discrimination and risk of infection, but not sure how to use rights in their work or to help others Have changed the way the organisation works to focus on minors and to ensure that they can benefit from its activities Positive people fully represented in decision making/paid roles and are on the governing board/ committee Actively use explanations of the law and human rights to help inform, defend or protect vulnerable people, or to advocate to others e.g. law enforcement officers Always analyse how minors are affected by HIV risk behaviour, vulnerability to HIV, and access to services within the community, and respond with appropriate strategies to address their rights and the rights and responsibilities of parents and service providers Some training and policies exist to prevent discrimination, to provide support and benefits for PLHIV members FOR HEALTH SERVICE PROVIDERS GO TO FINAL QUESTION ON CAPACITY NEEDS October 2008 28

Question Capacity score 1 2 3 4 Part 4 B: This section for NGO/CBOs ONLY Do most at-risk populations and vulnerable groups that you work with fully participate in activities, work and major decisions of the organisation? How do you engage them? Do you involve them in decision-making? How have you changed your services to include their participation? Do not identify particular at-risk or vulnerable groups Work with at-risk populations as volunteers, but none are in paid decision making roles Members of at-risk populations are involved throughout the organisation as paid staff and on the governing board/committee Members of at-risk populations are involved throughout the organisation; they are involved in designing projects and are widely consulted on major decisions Does your organisation develop activities, involving all people concerned? How do you engage them? Do you involve them in decision-making? How have you changed your services to include their participation? Organisation mainly responds to immediate needs, with little planning Occasional short-term planning, e.g. major events or monthly activities All the organisation s ongoing activities are normally planned in advance with all staff and volunteers Annual plans are always developed and agreed with community members, volunteers, staff, and board (if one exists) Scale up Is the organisation interested in scaling up its services to meet the needs of MARA? Why? How do you propose to do it? Not interested Interested, but would need additional staff, resources and technical support Interested, but would need additional training for existing staff Interested and feel able to scale up with existing staff October 2008 29

FINAL SUMMARY OF ALL ORGANISATIONS CAPACITY NEEDS, PLANS FOR CHANGE AND SUPPORT NEEDS Capacity-building needs to provide services to MARA? Plans for action or change Suggestions for technical support (human and financial) Specify nature and duration of support needed THANK YOU FOR PARTICIPATING IN THIS FOCUS GROUP DISCUSSION October 2008 30