Outreach Planning

1. Outreach Planning

2. Objectives of outreach planning • To identify the number of idus at each site • To estimate required risk reduction materials (like N/S & condoms) for adequate & uninterrupted supply • To facilitate effective individual tracking vis-à-vis service access & behaviour modification • To collect information for effective action plans • To enhance participation of idus in programme planning

3. What is outreach planning? • Outreach planning is a process using various tools that facilitate individual level planning and follow up of service uptake, based on individual risk and vulnerability profiles of IDUs • Outreach planning gives a visual picture of the site that a PE is managing. • It helps to understand the reach of general & programme services (if started) among IDUs, identify and monitor problem areas

4. Outreach planning team Project Coordinator/ Programme Manager ORW 1 ORW 1 ORW 1 PE 1 PE 2 PE 3 PE 4 PE 1 PE 2 PE 3 PE 4 PE 1 PE 2 PE 3 PE 4 IDU IDU IDU

5. Key questions to consider: • How many IDUs are there in the target area? • Can we reach all? • How many regular injectors are there in the IDUs? • Can we meet them according to their accessibility rather than on the basis of their risk/vulnerability? • How many N/S or condoms do we need in a month to cover risk occasions? • Does the outreach timing suit the IDUs? • Can we track each individual?

6. Outreach planning process There are six basic stages in the outreach planning process • Social mapping • Spot analysis • Contact mapping • Risk/vulnerability assessment • Work plan • Individual level tracking (monitoring)

7. 1. Social mapping A Social map is a map showing places: • where IDUs live (hotspots/congregation point /Injecting Sites etc.) and • where services for IDUs are available Purpose: • To establish a dynamic understanding of IDUs for complete coverage through Outreach in the project site

8. Social mapping is useful to: • Learn about locations where IDUs live • Identify places where IDUs often go (including work) and why they go there • Identify which services are available for IDUs & their locations • Services include: referral, health care, NSE, condom supply, ICTC, STI etc. • Identify gaps in services for IDUs and their partners

9. Developing Social Map • Social mapping can be conducted as either a field or DIC activity by PE and ORW involving (IDU). The PM can act as facilitator of the process • Social map should be updated regularly • Inclusion of (IDU) in social mapping and discussions will: • Ensure views of (IDU) are represented since they know better than outsiders

10. A social map

11. Group work • Participants will divide into groups of 5-6 • Develop a social map showing all the places you think are important to you. • Discuss your map thoroughly for next step • (Previous slide on Social Map will be displayed for reference)

12. 2. Spot analysis - group work • Once the social map is constructed, • Hotspots mapped will be divided among ORW • The assigned ORW will lead his/her team of PE and key informants (IDU belonging to that hotspot) to the location • Information will then be collected on: • Volume of clients (no of IDUs in the hotspot)

13. Spot analysis - group work • Profile of IDUs: age group, sex, typology (heroin/ brown sugar / SP / pharmaceutical drugs, etc.) • Frequency of injections – daily, weekly, monthly • Timing of congregation / use • After collection of the above information, the ORW and PE team will share this information with the other teams through a presentation or discussion

14. Spot analysis

15. 3. Contact mapping- group work • Aim: to help participants map contacts they have with IDUs in each spot and plan for outreach based on these contacts • Use the spot analysis to derive number of IDUs in a particular hotspot • The assigned PE/ ORW will list out the number and names of all IDUs known by each ORW and PE of the assigned hotspot

16. Contact Mapping

17. Contact Mapping

18. 3. Contact mapping- group work • Once the exercise is completed, ask following • Questions: • How many contacts in each spot? • In which spot are the contacts limited? • What are the reasons for limited contacts? • What should be done in those locations where contacts are limited? • Is there a duplication of names in the contact list?

19. 4. Risk/ Vulnerability assessment • The ORW / PE should collect following information from each IDU post mapping • The risk/ vulnerability parameters should, at the minimum, include: • Types of drug injected • Frequency of injection • Sharing of N/S or other injecting equipment • Sexual behaviour: frequency of sexual intercourse, protected /unprotected sex • Sensitivity about disclosure (to family/ others about their drug use/sex work)

20. 5. Work plan • The next step is to develop a work plan to optimise scaled coverage by PE so as to address needs of the IDU • Using information from the social mapping and risk/ vulnerability assessment of IDU, outreach teams should plan a week-on-week target for outreach to the IDU of each area

21. Work plan Contd. • These work plans should be documented in order to focus activities (by referring to them) in the following week • Weekly plans should vary from week to week depending on the service uptake/ outreach patterns • Weekly plans should tie into other activities designed to increase IDU engagement or service utilisation

22. 6. Individual Tracking (Monitoring) • Information of day-to-day outreach and other service delivery provided to IDU should be recorded in ORW/ PE log book /diary; this should be subsequently transferred to a grid for tracking individual contacts over time • Daily contacts by PE and ORW should be documented within 48 hours of contact for quality data • These paper formats should be used to update individual tracking grids weekly

23. Individual Tracking (Monitoring) Contd. • A standard set of services/ types of contacts should be tracked by all PE/ ORW. Initially this data should include: • N/S distribution • Condom distribution • Clinic referral and attendance, referrals made-ICTC/ART/others • Experiences of violence or harassment especially by pressure group and police • BCC contacts

24. Individual Tracking (Monitoring)

25. 6. Individual Tracking (Monitoring) Contd. ORW and PE should conduct routine meetings to: • Review targets and achievements of previous week • Review individual tracking grid and reprioritize IDU that should be reached in the coming week and • Identify strategies for outreach/ uptake of service delivery that worked or that still needs to be developed

26. CONDUCTING OUTREACH

27. STEPS IN CONDUCTING OUTREACH • Step 1: Building rapport with the IDU and general community • Step 2: Delivering services in the field; referrals to DIC and other services • Step 3: Creating enabling environment for effective delivery of and access to services • Step 4: Documenting and analysing collected data for re-planning/re-strategising outreach

28. CONDUCTING OUTREACH - STEP 1 • Building rapport/trust with both the IDU and general community is a critical prerequisite to conducting street/community outreach. • This is a time consuming task and an ongoing process. • A good rapport will enable the outreach team to deliver services effectively without the interference of the general community

29. CONDUCTING OUTREACH - STEP 2 • Delivery of Services • Ensure outreach plan is ready • Before initiating outreach services, the outreach team should analyse the outputs of the ‘Outreach Plan’ (refer to Outreach Planning) • On the basis of the analysis, timing of services, area of delivery, delegation of PE etc. should be decided

30. CONDUCTING OUTREACH - STEP 2 • Delivery of Services (cont’d) • Every effort should be made to cover each and every IDU with services • IDU should be tracked periodically to ensure consistent use of safe N/S and condoms through individual tracking mechanism • Details on each of the services may be found in relevant chapters (e.g. NSE, referrals, etc.)

31. CONDUCTING OUTREACH - STEP 2 • Delivery of Services (cont’d) • The following are provided during outreach: • Risk reduction sessions/messages (through IPC) • Materials (including needle/syringe and condom) • Services including BCC, return of used N/S, referrals, abscess management (if simple), OD management/prevention

32. CONDUCTING OUTREACH - STEP 3 • Creating Enabling Environment • A conducive environment is required for effective delivery of services and assisting the IDU to access available services without fear or stigma • An analysis of the barriers / impediments to conducting outreach should be conducted with peers and community • An enabling environment can be created by carrying out community advocacy

33. CONDUCTING OUTREACH - STEP 4 • Documentation and Analysis • Outreach conducted (data) should be documented using tools provided by PM • A weekly analysis of the data should be done by ORW with PE and IDU • The analysis should focus on: • Whether all IDUs are being covered • Whether all IDUs are being covered regularly

34. CONDUCTING OUTREACH - STEP 4 • What are the barriers to accessing services? • How to strengthen service uptake? • Outcome of the analysis should be shared with relevant staff • In case the outreach team is unable to address gaps, help should be sought from the PM and other senior staff • Joint periodic reviews should be conducted to avoid duplication of coverage

35. CONCLUSION • Outreach (planning and conducting) is the most important activity of a TI programme • Outreach requires careful planning and coordination among staff of the TI • The quality of outreach determines outcome of the programme • Constant monitoring and re-planning (of outreach) is required to reflect & address the changing patterns & needs of IDU