The following measures could be taken to address the challenges related to the effective involvement of all relevant actors/sectors in the development of programmes at country level.

1. Basic factors on STIs & HIV/AIDS.
List the symptoms of STIs  in man & women
Describe why STIs increase the risk of HIV/AIDS list high risk situation for HIV/AIDS  describe the importance of complete treatment of STIs from a trained medical practioner of RME to address asymptomatic STIs  knowledge of rapport with referral HCPS.

2. AB and condom promotion
- Important of “Assistance” & ‘Be faithful’
- Demonstrate  the correct use of condom
- Describe all ways to promote condom usage among the risk group
-Demonstrate condom negotiation skills in a simulated exercise & knowledge about non-penetrative sexual pleasure
- Availability of free and different brands of condom
- use of condom and condom menu cards .
3. Interpersonal communication skills for STIs & HIV/AIDS prevention
- List criteria for effective communication for STIs/HIV/AIDS prevention
- Describe situations where counseling of people in high risk behaviour groups is desirable
-Difference between IPC and IEC
-Importance of IPC for referrals
-use of communication ands in IPC
-Describe the advantages of one to one and one to group
- Describe the use of BCC events.
4. Behaviour change communication
- Why and how behaviour change
-Style- Exhibition, Audio, Video, Street play
-method of conducting, preparation and  follow up
- role of BCC in prevention and care & support
5. Care & support
-role ICTC in early detection and advantages
-Role of  PPTIC  in prevention children from HIV
- Different aspects of preparing the community to accept PCHA, providing community care and home care
-Knowledge of referral centres for providing services to PCHA (infected and affected)
-knowledge about OI & ARV
-Net work of positive persons.

Miths and misconceptions related to condoms.
 
There are lot of myths and misconceptions prevailing in the community related to condom and these may be the reasons for people not using condoms. It is one responsibility to clarify these myths and effective promote condom usage.

Myths Facts
Using condom during sex Irritating  Not knowing  how  to use condom. Condoms are soft and lubricated. Proper use of condom will not cause irritation
Condom will tear during sexual acts If one uses old condom or does not expel our from the tip, this could happen
Condom is sticky an doily Sexual intercourse also is sticky due to the viginal and seminal fluids.
Condom reduces external sexual pleasure The obsession that condom is an external wear makes it to think so. Instead, it enhances the sexual pleasure by dampening the sensation of touch, thus prolonging sexual intercourse.
Women do not like it Women may not be aware of the benefits of condom usage. They will accept the condom usage once they are convinced about its benefits
The gained execution may fail during condom maneuver Educate by demonstrating practical tips.
     
ABC   The Basic
A: Abstinence
B: Be faithful (fidelity and reducing partner member)
C: Condom
ABC Approach
‘A’ &’B’ messages should be provided to all groups
‘C’ messages can be provided for selective groups but only if they are combined with ‘A’ &’B’ messages

Abstinence (A) Program
-Abstinence from sexual activity; only risk elimination method.
- Abstinence in elimination the risk of HIV transmission among unmarried individuals
-Delay of sex until marriage for unmarried individuals
-Promoting conducive social and community norms.

Be faithful (B) Program

Elimination of casual sexual relationships mutual faithfulness with an uninfected partner  among individuals in long form sexual partnership

Voluntary counseling and testing for partner  with unknown HIV status

Social and community norms supportive of partner education and marital fidelity.

Condom use (c) program
Understanding risk behaviors

Consistent risk – reduction strategy when risk  elimination is not practiced

Correct and consistent use of condom

Provision of medically accurate information about condoms including skills

Abstinence is the only risk elimination method.

The following key messages have to be explained on STI/HV/ AIDS Prevention

STI
Symptoms, Treatment, partner treatment, Health seeking behavior, serviced available for treatment, follow-up, efforts to be taken to avoid re-infection linkage between STI & HIV

HIV/ AIDS

How it will spread
How it will not spread
How to prevent
Demand generation KTC
Referral for counseling STI, Clinics, ICTCS
Private Health Care Providers, etc..,
Care & Support

PPTCT
Service available for PLHA
Home care
Eliminating Stigma & Discrimination
Motivating PLAA  family members for income generation ARV Drugs

Referral services available for medical ailments life sill education (Health & Nutrition, Yoga, Meditation, Physical exercise)

Condom:
Information on ABC approach
Need for wring condom
Varieties of condom
Availability of condom
Condom demo
Developing skill to use condom
Condom negotiation  skills.

Obstacles to effective communication

Differences in perception
Differences in languages
Differences in social customs
Difference in level of education
Unequal social  status or economic situation
Competing messages
Environmental hindrances.
Resistance to change, lack of willingness to make concessions
Lack of respect.

We invite you to post your contributions directly to the forums.

Dear members,

Here's a contribution by ASHISH SRIVASTAVA from India.

Thank you for your contribution!

Marcela

e-Forum Facilitator

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Received above issue.Addressing the challenges related to
effective involvement &implementation would depend on approaches
&accessment of health care services& system including public,
private & national program in various countries.
Due to differ socio-economic status of countries a static
or fixed health system & services are not adequate to address
the challenges.
Apart from above sectors& program scientist,business organisation,
social organisation,legal position ,educational institute,industry
should develop local,national,&international campaign& program
which have awareness & promote development objectives &participation.
A few funding measures can not effectively contribute
in development of program for country to country.Measures should be
based on country's needs,attitude,available resources,acceptability,
participation of community,society& various sectors.
Actors like MDG(U.N),WHO have formulated universal
comprehensive health care goals for developing & third world countries
Global-fund,world bank have approved various fund projects since
2000-2007.G.F process should also integrate state,national&inter-
national banking system &insurance mechanism.
Measures related to universal health insurance,
health services for minimum income level,infrastructure development
could address the real needs of program.External funding could
involve international& domestic air-line tax/cess,Clean Space
Mechanism (UNCCSM),clean development mechanism,social subscription,
international trade,industry social audit & contribution,nuclear
paying principles,testing missile paying principles with effective
involvement& implementation of funding process.

Thankyou
ASHISH SRIVASTAVA
ex-International marketing
C.C.M(SEAR-INDIA)81237

Thanks for the invitation to participate in the Discussion on the subject  Demand


- Effective involvement of all relevant  parties to include  Governmental , Non governmental  Public and  Private sectors, NGOs , Scientific  Researchers, Stakeholders  to form the basis of development , planning and implementation of programs with  Community Mobilization  to participate in these  efforts  and
  to set mechanisms that ensure these programs can reach remote areas to fight  HIV/AIDS , TB and MALARIA


-Global fund to organize training programs where relevant actors come together and share experiences to find common ground  and focus their efforts to fight these diseases  and their effects.

-Raise awareness and promote  education and  ensure access to information to all sectors through organizing  conferences , roundtables , internet websites, mass media ....etc.

-Balanced representation  in CCMs , transparency in its activities and accountability  with monitoring of programs and ensure political commitment to fight AIDS ,TB and Malaria .

May Farag
 

We invite you to post your contributions directly to the forums.

Dear members,

Here's a contribution by felixsammy from Kenya.

Thank you for your contribution!

Alastair
e-Forum Facilitator

 

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To address the challenges related to effective development programs at country level will vary from country to country. Though it will vary, there are common factors the great one being provision of adequate money to cater foe all the expenses undergone during implementations. To do this the actors must be fully committed because if the actors are determined they will not give up and abandon their missions incomplete. The actors need to be independent to avoid to be swallowed by government ministries. Their independency will provide unopposed agendas which will move freely to all their centre of interest and their budget development and easy to manage since it will be a package centric. Also limitations should be avoided thus the actors must not be purely religious noting that paganism still exists; there is need for the actors not to show discrimination and be for all. The same is also seen when the actors only prefer to support organization, groups e.tc. discriminating the support for individual interest who give support to orphans, who care for orphans in their families, who also are trained to advocate against H.I.V/AIDS you will find such people are burdened and need assistance and yet none is provided to them-this is a very great challenge which bridges the urban centered to the needy it should be taken seriously. Development of centre to the areas of interest so that the need are able to visit their officers at all times and also to make it cheaper for the officers to visit the people as far as possible at all times. Support the rural people by providing social amenities to them such as nets, medicines, food e.t.c. provide a monitoring team-this is because the monitors should not be the same officers who work as field officers thus they should be a team meant to provide proper monitoring for the effective development of programs undertaken. Ti cater for this, there must be adequate personnel to avoid reciprocating the same persons to monitor their work Introduction of practical work to replace the much theory told to the people will change the atmosphere of many people since they have heard of so many things and yet have seen none. Create unemployment to the jobless in the rural/remote areas because they are used to the environment and they can offer the best to the inhabitants. In conclusion, there is need to introduce H.I.V/AIDS lesions in primary and secondary schools by employing your own trained teachers-that can provide high sensitization to many youths countrywide.

Some of the challenges in involvment of relevant actors sectors in fighting TB are related to involvment of civil society: 1. civil society is not inough awarenes about the issue; 2. civil society is not puting pressure on government/MoH to make cost effective policy; 3. civil society is not asking the government to be not only responsible but also accountable on spending people's money puted in national programs. Aarrangements for the participation of different sectors – governmental and non-governmental, public and private – in defining demand and developing programs could be: 1. incourage proposals that are aiming at involving public private mix in analizying background and the needs of interventions; 2. incourage public-private mix proposals as criteria of GF financing; 3. incourage country proposals that involves representatives of civil society in monitoring and evaluating the programs financed by the GF. A measure to facilitate access of different actors to internal and external funding, particularly access to Global Fund processes in-country: ask for proposals that includes ACSM activities designated to educate public at large and representatives of civil society, aiming at making them much moore awarenes; it could be a criteria for financing programs that continues a former grant. Impact of this activity could be: a) they will put pressure on decizion makers to control the issue and to spent money on evidence based programs; b) they will organize themselves in a more effective way and will set up interested ONGs; much more much better.

Dear Participants, My GlobalFund. I am happy to participate on the discussion. A meaningful involvement to fight against HIV/AIDS, TB, Malaria and the role of the actors: 1. Community development and capacity building. 2. Development involvement of multi- stakeholders governmental/non-governmental. 3. Advocacy for Human Rights. 4. Awareness 5. Legislative protection and National Tolerance Policy against all vulnerability. 6. Resources and data bank 7. Fund Management and accountability. I hereby request to all individuals especially the young people, Policy makers, researchers, intellectuals, celebrities, social organization and the governments to involvement to form a forum under jurisprudence of The GlobalFund to participate in the fight against the diseases of HIV/AIDS, TB and Malaria. · Global Relationship. · Global Awareness Management. · National Legislation and the International Human Rights. · UN programme of Development and MDG issues · Fund Raising, Budgetary allocation. · Private/Public Sector stakeholders. · International Aids Request to the GlobalFund : · Provide Legal status to the forum · Country level funding for administration · Liaison · Resources and data banking · Internet communication · Provide access of fund Management · Other acceptable recommendations from the forum members. Thank you all. Asima Chakraborty General Secretary TOPER, Kolkata, India

The key is effective involvements of all key actors.How best do we have to involve all the key actors concerned? Would HIV/AIDS TB patience are going to be involved especially in the rural communities? If they are going to be involved,would they be given the opportunitieS to express their ideas and thoughts.The question now should be how best to involved to serve the purpose.The organization of the structure pose now a major problem.What would be the role of each key actor.Iam trying to see something,the global fund is pusing to do something better for the less previlledge in the society-so that everybody can benefit from the global health services they rendered.The essence of this forum should not only meant as a forum for people to express their ideas, but to work.If the global fund and forum members work in team, by next year round better changes will happen-more people will benefit from the global fund for hiv/aids malaria and TB.Funds will be well used.More organization will have access to the grants etc.Let me come back to the main topic in question.If the local NGOS, faith based organizations,comunity welfare groups would not form active part of the CCM changes will never happen.Please,other members should deliberate on this point.

Hello, All the activities related to the implementation fo the program should be targetted to the needy one. The program should be planned fom the base and should be targeted properly. Now, some care givers are giving the care, or some program coordinators working to achieve the results. I'm not blaming the coordinators. they have limitations to access the corns of the villages and rural areas. So the good way to achieve the best result is, correspondance through the local partners and through the new volunteer institutions and persons. Plan the target and implement the program with the help of local partners. In India, we require a thorough study regarding the vulnarability and a census of affected people. It should be the primary objective. Then its easy to fix the target group. Hope at least Global fund can implement some new projects through us and other young peole who are ready to serve the society without any monetory benefits. Thank you, Phenomon Joy feno@sify.com

Key challenges facing the involvement of relevant actors in the development of programmes at country level:

• Limited understanding of the roles of different structures and stakeholders in CCM and other structures
• Capacity to manage the participation forums and coordination structures
• Objectivity of some of key stakeholders- some stakeholders advocate for positions that cannot be supported by the evidence available
• Quality of representation and participation of the various stakeholders is usually poor

Measures

• Orientation/induction of CCM members and other stakeholders
• Developing/sharing guidelines for programme development
• Advocate for use of evidence in programme planning  

Regards

Tom Mogeni

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the involvement of relvenat actors and sectors should attracts the following, Especially in the developing countries , it is really diffcult to involve this relevants actors and sector due to the fact developing lack appropriate mechanism for accountability due to politic intrigues that is attachment to Government Agencies that this saddled with the responsibility of providing affordability and qualitative medical health care delivery system. The corruption practices and nor qualified personnel to head leadership position. For example, the CCM in Nigeria is not actually doing any possible mobilization to attracts relevants actor/sectors for scaling -up proactive response for government and other stakeholders but rather using This position for personal enrichments. how could you involve actors/sectors into any venture or stakeholders who has several years experincing challenges with -out any Governmentalincentives and expects them to commit themselves to this goal when themselves have actually view that those in the position of Authority are there for political infleunce or ther other. How can any NGOs that is community driven because such NGOs do not have an infleuntial person in this Agency you will not be able to access fund and other services that bring bebefits to the common. The avergae person or the common man is being left out of this the system thsat is being created for them selves for example how can you formulate a policy that the very people or region such policy is being formaulated or addressed are not part of the system. Solutions, we advocate that there shouldbe an open policy door that will creats an atmosphere for all starkeholders to participate and local NGOs who are passionately and community driven should be given equal access just as major NGOs are more favourable. The Country CCM MEMBER SELECTION SHOULD INVOLVE ALL STAKEHOLDERS. A SECT OF A PARTCICULAR FIELD MEMBERS SHOULD NOT BE ONLY IN THE BOARD OF AFFAIRS.

Following measures could be taken to address the challenges!  

1)       To raise awareness and knowledge levels in others, and ourselves especially in the grassroots level? 

- We can educate ourselves and our families and rural community about HIV transmission and how to prevent it, through using heir own country languages.

 - We can educate ourselves and others on what being, as well as what could be done locally, nationally, regionally and internationally, to prevent HIV transmission, and to care for support women, girls and young boys living with or affected by HIV/AIDS.

 - We can demand govt. include curriculums on HIV transmission and prevention in sexual education programs at school level.

 2)       To promote gender equality and women’s value? 

 - We can educate ourselves and our families and rural community on the human rights of women and girls, including sexual and reproductive rights and increasing the vulnerability of women and girls to HIV/AIDS.

 3)       To promote the human rights of women, young boys and girls? 

 - We can assert the human rights, including sexual and reproductive rights, of ourselves and others at home, work, place of worship, in the streets, wherever else conceivable.

 4) Women to be more independent economically?   

 - We can demand equal access for women to credit, capital and property and the ability to negotiate contacts in their own names and on their own behalf.

  - We can educate others and ourselves on the importance of women’s economic autonomy and the relationship between the lack of it and women’s increased vulnerability to HIV/AIDS.

  - We can demand the elimination of all discrimination against women in hiring, wages, benefits, training, job security, performance evaluation and other aspects of employment. 

 - We can demand women living with HIV/AIDS be paid for their work as AIDS educators and counselors. 

4)       To fight poverty? 

 - We can demand governments implement measures immediately to satisfy the Millennium Development Goals.

 - We can demand rich countries implements trade justice, eliminate the debt of poor countries, put an end to neo liberal conditions on aid and increase aid, in particular to meet the requirement to respond adequately to HIV/AIDS.

  - We can demand Govt. adopt legal frame work and strategies to secure access for all to basic social goods, such as safe water, food, moderate housing, education, comprehensive mental and physical health care, adequate social safety and employments.

5)       To obtain access to all to treatment for HIV/AIDS? 

 - We can demand to make use of TRIPS safe guards to make HIV/AIDS TREATMENT MORE ACCESSIBLE FOR EVERYONE.

 - We can demand to resist pressure from pharmaceutical companies and the govt. of countries with large pharmaceutical industries and put the survival and quality of life of people living with HIV/AIDS before profit.

 - We can demand to design and implement concrete action plans, involving people living with HIV/AIDS (including equal participation of women living with HIV/AIDS with targets, time lines, deadlines and milestones for HIV/AIDS treatment access for everyone, including specific measures to ensure HIV positive women have equal access to HIV/AIDS treatment.

6)       To obtain access for all to good HIV/AIDS services?

  - We can demand govt. adopt National AIDS policies that recognize the link between HIV/aids, gender inequity and poverty.

 -  We can demand to increase health budget with earmarked budget for women’s reproductive health and rights, including contraception and safe legal abortion, including voluntary testing and pre and post test counseling, prevention, care and treatment for all women and girls.  

7)       To raise women’s political voice? 

 - We can demand put in place measures to ensure women’s equal access to and full participation in power structures and decision-making.

 - We can demand to Govt. political parties, collective bargaining structure and other groups establish gender balance and eliminate structures and procedures that pose barriers to the equal participation of women and of women living with HIV/AIDS. 

8)       To eliminate HIV/AIDS related stigma and discrimination? 

 - We can demand to implement and enforce measures to protect the privacy of people living with HIV/AIDS and protect them from discrimination in the work place, at school, in the health care system and necessary others. 

 - We can demand health care systems implements clear guidelines of communication and conduct for HIV/testing, counseling and treatment protocols. 

 - We can demand health care providers treat HIV positive persons with dignity and respect and not allow prevention goals to outweigh human rights.  

 - We can record and denounce all instances of abuse or discrimination of people living with HIV/AIDS in all settings, including schools, religious places, the work place etc. 

9)       To promote CBO with directly funding?

  - We can demand to select CBO those are working in grassroots, promote them and provide direct funding and build its capacity to manage funding and preparation of worthy proposal. 

10)   To simplify global fund CCM and application process?

  - We demand to global fund to simplify their application process and CCM mechanism, CBO can participate easily.

Kind regards

Robert Paul

Community Life

Bangladesh.

face by these sectors are as follows

·        Misappropriation of funds

·        Inflated cost of program by some government officials

·        Pilferage of materials needed to promote the program

·        Sale of logistic materials to suite personal interest

·        Wrongful distribution of material to party members, relatives, friends etc

For effective involvement by the government and the private sector, policies must be divided into two segment. Policy to treat and Policy to control.

Policy to treat; This is a policy design to treat the affected people. I propose that such policy should be engineered by the government by granting tax relief, subsidies and free medical care. This will ensure proper allocation of resources because the benefit will go directly to the affected people if backed by law

Policy to control; This is where final solution is design to eradicate the problem. I propose that private sector should be encourage to promote this because it is the sector which can send policies quickly to all corners of the country . It has direct contact with people and know what is prevailing in the various communities. Their   involvement will help to reduce government expenditure. eg if government want to control malaria by means of mass environmental spraying to control mosquitoes, Churches, association and NGO can facilitate

it and the government by internal funding provide insecticide

Internal and External funding such as GF to the government and private sector should base on the following

criteria

·        External fund should go to most affected country

·        Fund should not be given to those who hold key position in the country but to those who can deliver

·        Beneficial NGO should be a registered one with a define office

·        Submission of strategic Plan and monthly report to appropriate office

Government therefore control the various organization by sending auditors periodically to audit them and also make provision of funds available to purchase automobile an other logistic input for the private sector to intensify their activities

From the above point of view, challenges for effective involvement of actors/sectors can be eradicated if above measures are put into consideration.