Table 2

Monitoring, evaluation and knowledge building efforts to document community mobilisation in Avahan

MeasuresIntended determination of measureComments
Routine programme monitoring (MIS)28: To measure peer effectiveness through their extent of contribution to core prevention services delivered by the non-governmental organisation (NGO). Data collected monthly since January 2005.
Ratio of high-risk population covered by programme to peersAdequate resources for peer engagement in outreach.Targets for ratio need to be set based on typology and density.
Proportion of outreach contacts (individuals met) made by peersExtent of peers leading outreach activities.Management use to shift outreach to being peer-led.
Proportion of peers (1) receiving sexually transmitted infection (STI) consultations during the month; (2) receiving STI consultations who underwent internal exams; (3) who receive STI consultations during the quarterExtent to which peers act as role models and early adopters of prevention behaviours.Need to ensure there is no programme incentive or penalty to distort assumed behaviour change.
Routine programme monitoring (MIS)28: To measure outputs of community mobilisation between 2007 and 2009 when monitoring effort was integrated into the behaviour tracking survey and Community Ownership and Preparedness Index (COPI).
Proportion of reported incidents of rights violation against high-risk populations addressed within 24 h.Measure of effort to address rights violations (including police violence and detainment) as a key inhibitor of behaviour change.Rights violations: captures incidents of violence and discrimination. Not effective. Dedicated monitoring later introduced.
Number of high-risk population members who have been assisted by the programme to get any government issued ID cardMeasure of programme's ability to improve social status of high-risk individuals.Two measures introduced to replace this. Number of cards applied for and number obtained. Frequency changed to annual.
Proportion of members of programme services and committees who are from the high-risk communityKey measure of the proportion of programme roles/positions held by members of high-risk community.Defining indicator too difficult. Measured in COPI instrument.
Proportion of members of programme committees who attended meetings in the monthKey measure of what proportion of high-risk community members of programme committees actively participate.Incentives for attendance problematic, and data too hard to collect from local level.
Proportion of high-risk individuals (excluding home-based sex workers) who are members of any community group or committeeKey measure of high-risk individuals' involvement/engagement in community group activities.Definition of groups difficult due to proliferation of informal non-programme and programme groups. Assessed through BTS.
Proportion of high-risk members of community committee attending committee meetings in monthKey measure of what proportion of high-risk community members of community committees actively participate.Incentives for attendance problematic and data too hard to collect from local level. Measured in COPI.
Proportion of community group members who are non-peersKey measure of the involvement of non-peers (high-risk individuals not paid by the project) in community group activities.
STI service quality monitoring41: to gauge relative community involvement in improving service quality. Applied quarterly to 10% sample of Avahan clinics between April 2005 and December 2008.
1. Community is involved in the clinic operations and management of the clinicEach of the standards at left has several indicators given equal weight and comprising a 5-point scale.Tool applied as part of improving quality standards for clinics. Results informed supportive visits.
2. Drop-in centre is fully utilised and managed by the community and community monitors the quality of STI services
3. High-risk individuals are satisfied with clinic staff, location, operation and services provided
4. Clinic and outreach staff coordination to increase involvement in the clinic
Avahan Quality Diagnostic Tool (diagnostic): applied in six state-level programmes June 2006 and June 2007 (two rounds)
Areas of constructs: (1) sense of mission, (2) programme design, (3) service delivery, (4) programme monitoring, (5) vulnerability reduction, (6) governanceDialogue-based participatory planning process facilitated by NGO. Method rooted in rapid rural appraisal and participation planning and action42Tool was not found to be robust enough to continue process after two annual rounds. Participatory planning remained in practice and measures revised and in COPI.
Integrated Biological and Behavioural Assessment (IBBA)43: Avahan intervention sites for all groups in six states for two rounds
Indicators assessed in round 1 (limited) included: (1) violence, (2) collective efficacy; in round 2 included (1) enabling environment/debt/violence, (2) claim identity, (3) collective agency, (4) collective actionSurvey designed for HIV impact assessment. Some questions related to community mobilisation included.Limited questions (four) on community mobilisation in baseline, and ten in round 2, makes analysis of community-level changes and association with outcomes challenging.
Intervention costing44: Avahan interventions for FSWs, HR-MSM and TGs in four states costed from 2004 through 2008
Detailed costs include aggregate cost for community mobilisation and enabling environment.Standard coding techniques. Financial and economic costs.Costs for community mobilisation and enabling environment are not detailed.
Behavioural tracking survey (BTS): Avahan intervention sites for all groups in six states for two rounds at 2-year intervals
Beyond standard demographic and HIV/AIDS behavioural questions indicator sets include: (1) enabling environment/debt/violence, (2) claim identity, (3) individual agency, (4) self-confidence, (6) self-efficacy condom use, (7) self-efficacy service utilisation, (8) mental health, (9) collective efficacy, (10) collective agency, (11) collective action, (12) social cohesion, (13) community ownership, (14) discrimination, (15) vulnerability reduction, (16) entitlementsCross-sectional survey conducted with a random sample of FSWs, HR-MSM, transgenders, and IDUs to monitor the effects of community mobilisation upon HIV prevention outcomes.Extensive sets of indicators required to measure complex interactions between community-level changes, outcomes and differences in contexts. The final tool included 91 questions.
Community Ownership and Preparedness Index method (COPI)45 46: implemented in Avahan programme sites on an annual basis (2009–2015)
Indicators assessed include: (1) leadership, (2) governance, (3) decision-making, (4) resource mobilisation; (5) community collective networks, (6) project and risk management, (7) engagement with the state, (8) engagement with larger society
  • Tool to measure community groups development against a vision for transformational community mobilisation.

  • Quantitative and qualitative methods are mixed, data triangulated from multiple sources and verification obtained for some response categories.

Survey and analysis design were developed by Praxis in consultation with high-risk communities and technical experts including Robert Chambers and John Gaventa from the Institute for Development Studies at the University of Sussex in the UK, based on best practices in participatory development.