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Moriarty P.,International Water and Sanitation Center | Batchelor C.,International Water and Sanitation Center | Laban P.,International Union for Conservation of Nature | Fahmy H.,CARE
Water Alternatives

This paper outlines the development of an approach (and a set of tools) for 'light' integrated water resources management (IWRM): that is, IWRM that is opportunistic, adaptive and incremental in nature and clearly focused on sustainable service delivery. The approach was developed as part of the EC funded EMPOWERS project in three middle-eastern countries: Egypt, Jordan and Palestine. Developed specifically for use at the intermediate and local levels (that is, sub-national and sub-basin) it is based on a facilitated process of stakeholder dialogue for concerted action supported by a strategic planning framework. The paper describes and discusses the justification for the approach, and sets out its main elements as well as experiences gained during its application. The main lesson of the EMPOWERS project is the seemingly simple - in fact, rather complex and time-consuming - work on facilitating dialogue, taking a structured approach to examining problems, collecting and sharing context-specific information, and helping to formulate a shared vision and strategies to achieve it all of which contribute to improved decision making. However, a major limitation to effective action is lack of appropriately decentralised finance, with local authorities reliant on financing from the national level that is often earmarked and over which they had very little control. © 2010 Water Alternatives. Source

Verma R.,Family Health International | Shekhar A.,Family Health International | Khobragade S.,Family Health International | Adhikary R.,Family Health International | And 9 more authors.
Sexually Transmitted Infections

Objective: Documenting the implementation of a public health programme as per its design is critical to interpretation of results from survey-led outcome and impact evaluation activities, the authors describe the scale-up and coverage of large-scale HIV-prevention services provided to female sex workers (FSWs) and high-risk men who have sex with men (HR-MSM) during the first 5 years of the Avahan programme in India. Methods: Implementing NGO partner-generated denominator estimates from 70 districts were used to estimate the programme's intended coverage. Routine programme-monitoring data until December 2008 were used to describe the service and commodity availability, service utilisation to generate internal estimates of coverage. Coverage was validated in few districts using data from a cross-sectional survey. Results: In December 2008, the estimated denominators for intended services were about 217 000 FSWs and 80 000 HR-MSM. By January 2007, 79% of eventual total clinics and 75% drop-in centres were established, and 83% of eventual peer educators were active. By month 48, sufficient condoms to cover all estimated FSW commercial sex acts were distributed free. By month 60, 75% of the estimated denominator intended to be covered was met monthly. 86% of FSWs and 67% of HR-MSM ever contacted had used sexually transmitted infections services at least once. Cross-sectional survey generated coverage results suggest that programme-monitoring data provide a proxy to coverage of services. Conclusion: Avahan's monitoring data show that Avahan achieved infrastructure scale by year 3 and high contact coverage through peers and with commodities by year 5 of implementation as per the design. Source

Galavotti C.,CARE | Wheeler T.,Bill and Melinda Gates Foundation | Kuhlmann A.S.,MANILA Consulting Group Inc. | Saggurti N.,Population Council | And 3 more authors.
Journal of Epidemiology and Community Health

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. Copyright Article author (or their employer) 2012. Source

Shadi S.,Emory University | Alex M.,CARE | Rheingans R.D.,Emory University

Despite the known health benefits of washing hands with soap, global handwashing rates are low. In Nyanza Province, Kenya, a follow-up of 55 pilot primary schools three years after the implementation of a safe water and hygiene intervention revealed that only 2 per cent (one school) provided soap for handwashing on the day of the assessment. After identifying barriers to soap provision, SWASH+ partners piloted a handwashing intervention using powdered soap mixed with water to create soapy water in place of bar soap in 11 schools. The first six months of unannounced visits showed high uptake (10 schools). A one-year follow-up visit revealed a decrease of soapy water use (four schools). This paper discusses the soapy water intervention, initial and follow-up monitoring findings, potential sustainability drivers of handwashing programmes in rural primary schools and next steps. © Practical Action Publishing, 2010. Source

Avent J.,CARE
Journal of Architectural Conservation

This paper looks at some of the challenges faced in the stabilization of ruins. It covers the approach to dealing with ruined masonry structures and the need to understand the structure before embarking on conservation strategies. It considers the process from initial survey through to the implementation of remedial works. Case studies are presented on a selection of ruined structures, including Piercefield House in South Wales, Astley Castle in Warwickshire, and sites in North Wales and Northern Ireland where in situ jacking techniques were used to stabilize the ruined masonry remains of St Malachy's Wall and Cymer Abbey. The works enabled these medieval structures to be protected with minimum intervention and avoided the need for alternative, more intrusive solutions. Source

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