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Evaluation database

Evaluation report

2009 India: Assessment of Effectiveness of IEC Material at Integrated Counseling and Testing Centres



Executive summary

 

“With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System". Within this system, an external independent company reviews and rates all evaluation reports. Please ensure that you check the quality of this evaluation report, whether it is “Outstanding”, “Good”, “Almost Satisfactory” or “Unsatisfactory” before using it. You will find the link to the quality rating below, labelled as ‘Part 2’ of the report.”

Background:

India has a population of around 2.5 million people living with HIV/AIDS, aged between 15 and 49 . Most HIV infections in India occur through heterosexual transmission. Over the years the HIV/AIDS epidemic has moved from urban to rural India and from high risk to general population . Women due to their biological, socio – economic and cultural reasons are more vulnerable to HIV and therefore it is expected that the prevalence among women will continue to increase if underlying factor to their vulnerability is not properly addressed.

In order to halt and reverse the HIV epidemic in India, counseling and testing services were started in India in 1997. Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) programme was started in the year 2002. Under NACP-III, Voluntary Counseling and Testing Centres (VCTC) and facilities providing Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) services are remodelled as a hub or ‘Integrated Counseling and Testing Centre’ (ICTC) to provide services to all clients under one roof.

Under NACP III ICTCs have been envisaged as centres where information on HIV/AIDS and utilisation of ICTC services could be disseminated through various types and mediums of communication. At these centres information is shared through television, posters, sharing of booklets, and use of flip books by the counsellors etc.

Purpose/Objective:

The effectiveness of these materials would be assessed in terms of the availability, relevance, usage, understanding and recall of the messages, appropriateness, appeal, impact, gaps etc.
To assess the effectiveness of the IEC materials at the Integrated Counseling and Testing Centers (ICTCs)

The effectiveness of these materials would be assessed in terms of the availability, relevance, usage, understanding and recall of the messages, appropriateness, appeal, impact, gaps etc.


The present study was carried out by using both quantitative and qualitative research techniques. This involved observation of ICTC, photo documentation of ICTC, semi- structured interviews with service providers, exit interviews with clients and documenting few case studies of clients.

The three states covered under the present study were; Andhra Pradesh (with high prevalence of HIV/AIDS), Gujarat (with medium prevalence of HIV/AIDS) and Uttar Pradesh (with low prevalence of HIV/AIDS)

Methodology:

The present study was carried out by using both quantitative and qualitative research techniques. This involved observation of ICTC, photo documentation of ICTC, semi- structured interviews with service providers, exit interviews with clients and documenting few case studies of clients.

RESEARCH METHODOLOGY AND SAMPLING DESIGN
The present study was carried out by using both quantitative and qualitative research techniques. This involved observation of ICTC, photo documentation of ICTC, semi- structured interviews with service providers, exit interviews with clients and documenting few case studies of clients.

Findings and Conclusions:

Profile of the study populations and brief finding of the study have been presented here.
The chapter 4 presents findings on exposure of clients to various IEC materials under assessment like the posters, new flip book and booklet. Other than this it also reflects exposure to other IEC materials. Also exposure of service providers has been analyzed. In order to analyze the recall and understanding of the messages, the clients who had ever seen the IEC materials were further probed specifically on various aspects like appropriateness, appeal, relevance, clarity of these messages etc. Their suggestions to each of the IEC materials towards increasing effectiveness have also been presented.

Recommendations:

•Supply, utilization and exposure to IEC material in AP & Gujarat were good.

•Supply and use of IEC material in UP should be improved. Also there is need for monitoring of the same.

•Exposure to IEC material in AP and Gujarat was higher due to good supply and utilization of IEC material by the service providers. Also observations have reflected that posters were displayed in these states, whereas in UP hardly any posters were observed.

•IEC material should be in local language and reflect cultural sensitivity, so that the clients can identify themselves with the material. For instance the use of ‘bindi’ in the pregnant women and working women posters.

•Length of the flipbook should be reduced. This is recommended since the recall of messages from the flip book was lower than that of the other IEC materials, as it had too many messages.

•Posters should have rural look/ or could have two sets of posters – those with rural and urban look.

•IEC materials need to emphasize on the need for pregnant women to go in for HIV test, as only 17 % had ssuggested friends/relatives who were pregnant to seek counseling for HIV on seeing the “pregnant women poster “.

•Medical Officers and out reach workers need to improve their relationship with clients,
A very high percentage of clients felt that the counselors were very cooperative (95%), whereas in case of MOs and outreach workers much lower percentage felt the same (60% and 47% respectively). Also one can see that in case of counselors a very small percentage (3%)
did not want to opine on cooperativeness, whereas in case of the other health factionaries (MO -34%, lab tec- 28%, out reach workers - 31%) much higher percentage did not want to opine on cooperativeness. 15% of the clients felt that the out reach workers were not cooperative.

•Only half of the clients (51.5%) were aware that “to prevent the child from getting HIV from the HIV positive mother the doctor can give medicine called Nevirapine to the mother and baby” .Therefore there is a need to emphasize on this aspect through IEC.

•Though half of the clients (56.7%) felt that “HIV positive / lactating mothers should exclusively breast feed the new born for first six months to reduce the risk of getting HIV”, the other half did not feel the need for the same. Therefore IEC material needs to emphasize the need for exclusive breast feeding to the new born for the first six months to reduce risk of HIV,

•Though 67.5% believe that “HIV can not be transmitted through toilets, swimming pools, sharing, eating or drinking utensils, insect bites/ mosquito bite”, around one fourth ( 22.5%) still believed that HIV can be transmitted through these mediums. Therefore is a need to address such issues in IEC materials to reduce stigma.


Supply, utilization and exposure to IEC material in AP & Gujarat were good.

• Supply and use of IEC material in UP should be improved. Also there is need for monitoring of the same.

• Exposure to IEC material in AP and Gujarat was higher due to good supply and utilization of IEC material by the service providers. Also observations have reflected that posters were displayed in these states, whereas in UP hardly any posters were observed.

• IEC material should be in local language and reflect cultural sensitivity, so that the clients can identify themselves with the material. For instance the use of ‘bindi’ in the pregnant women and working women posters.

• Length of the flipbook should be reduced. This is recommended since the recall of messages from the flip book was lower than that of the other IEC materials, as it had too many messages.

• Posters should have rural look/ or could have two sets of posters – those with rural and urban look.

• IEC materials need to emphasize on the need for pregnant women to go in for HIV test, as only 17 % had ssuggested friends/relatives who were pregnant to seek counseling for HIV on seeing the “pregnant women poster “.

• Medical Officers and out reach workers need to improve their relationship with clients, A very high percentage of clients felt that the counselors were very cooperative (95%), whereas in case of MOs and outreach workers much lower percentage felt the same (60% and
47% respectively). Also one can see that in case of counselors a very small percentage (3%) ORG Centre for Social Research 11 did not want to opine on cooperativeness, whereas in case of the other health factionaries (MO -34%, lab tec- 28%, out reach workers - 31%) much higher percentage did not want to opine on cooperativeness. 15% of the clients felt that the out reach workers were not cooperative.

• Only half of the clients (51.5%) were aware that “to prevent the child from getting HIV from the HIV positive mother the doctor can give medicine called Nevirapine to the mother and baby” .Therefore there is a need to emphasize on this aspect through IEC.

• Though half of the clients (56.7%) felt that “HIV positive / lactating mothers should exclusively breast feed the new born for first six months to reduce the risk of getting HIV”, the other half did not feel the need for the same. Therefore IEC material needs to emphasize the need for exclusive breast feeding to the new born for the first six months to reduce risk of HIV,

• Though 67.5% believe that “HIV can not be transmitted through toilets, swimming pools, sharing, eating or drinking utensils, insect bites/ mosquito bite”, around one fourth ( 22.5%) still believed that HIV can be transmitted through these mediums. Therefore is a need to address such issues in IEC materials to reduce stigma.



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