J Epidemiol Community Health 66:ii9-ii15 doi:10.1136/jech-2011-200465
  • Research report

Navigating the swampy lowland: a framework for evaluating the effect of community mobilisation in female sex workers in Avahan, the India AIDS Initiative

Open Access
  1. Gina Dallabetta3
  1. 1CARE, Atlanta, Georgia, USA
  2. 2Futures Group, Washington, DC, USA
  3. 3Bill & Melinda Gates Foundation, Washington, DC, USA
  4. 4Manila Consulting Group, Inc., McLean, Virginia, USA
  5. 5Population Council, New Delhi, India
  6. 6Praxis Institute for Participatory Practices, India
  7. 7Bill & Melinda Gates Foundation, New Delhi, India
  1. Correspondence to Dr Christine Galavotti, CARE, 151 Ellis Street, Atlanta, GA 30303, USA; cgalavotti{at}
  1. Contributors CG, TW, ASK, UK and GD contributed to the articulation of the model of community mobilisation. TW, UK and GD were responsible for overseeing development and implementation of the community mobilisation intervention in India for the BMGF. CG, ASK, TW, NS and PN contributed to development of the measures of key constructs, and NS and PN oversaw data collection. CG and ASK wrote the paper with significant contributions from TW and GD. CG takes full responsibility for this manuscript.

  • Accepted 2 April 2012
  • Published Online First 3 July 2012


Background Few models of how community mobilisation works have been elaborated in the scientific literature, and evaluation of the impact of these programmes on HIV and other health outcomes is extremely limited. Avahan, the India AIDS Initiative, has been implementing community mobilisation as part of its prevention programming with groups of high-risk individuals across six states since 2005.

Purpose To articulate a programme theory and evaluation framework for evaluation of Avahan's approach to community mobilisation among female sex workers in four southern states in India.

Methods The authors use a goal-based evaluation approach to describe the programme goals and an underlying programme theory that specifies how the programme is expected to work. Using multilevel structural equation modelling with propensity score matching, the evaluation will compare what is observed in the data with the predicted relationships specified by the model.

Results The Avahan model of community mobilisation posits that meaningful participation in high-risk group intervention, structural intervention and organisational development activities leads to identification, collectivisation and ownership, which in turn leads to improved programme outcomes. Strong community groups and an enabling environment reinforce social norm and behaviour change outcomes and lead to sustained impact.

Discussion Specifying an explicit programme theory can aid in the evaluation of complex interventions, especially when the evaluation design is observational. In addition to articulating Avahan's community mobilisation approach in a model that can be tested, we recommend some specific measures and methods that could be used to improve evaluation efforts in the future.


  • Linked articles 200562, 200487, 200475, 200514, 200511, 200832, 201065, 200478, 201081, 200508, 200590.

  • Funding This study was funded by the Bill & Melinda Gates Foundation. ASK's time was supported by Manila Consulting Group under contract #200-2009-32280 with the US Centers for Disease Control and Prevention. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation or of the Centers for Disease Control and Prevention.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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