6 Programme Management and Organizational Capacity-building
B. From rolling out services to improving coverage and quality During this stage of implementation the focus is on ensuring coverage of the community with services and improving quality. This roll-out stage is a continuous process in which management at all levels reviews progress against targets and adjusts strategies and tactics, as necessary. Mid-course corrections are made based on new data, new approaches or environmental or structural changes that affect programming. The intensity and the quality of coverage increases as staff become more skilled in their positions. It is during this phase that flexibility and continuous programme learning are extremely valuable. A strong monitoring system with regular reviews is essential to the successful roll-out of services. It also signals to funders and the government whether programming is being implemented successfully.
C. Aiming toward systems improvement, social norm change and increased sustainability The overall aim of programme implementation is to provide services to reduce HIV and STI transmission and to treat HIV and other related infections, while empowering sex workers to participate and progressively build their capacity to implement the programme, and addressing structural barriers through advocacy and policy change. This makes the programme more effective and potentially more sustainable. The ideal characteristics of such a programme include the following:
• Sex workers lead in implementing outreach, distributing condoms and lubricant and facilitating effective clinical referrals.
• Sex workers have enough individual and collective agency to address problems themselves with the police, the health system, the government and other sex workers.
• Sex workers have positions at local, district and national level on planning bodies for service delivery and violence response.
• Social norm change among sex workers and clients makes condom use routine.
• Sex workers are able to access health services without stigma and discrimination at the same frequency as the general population.
• Prevention commodity supplies are adequate, through both social marketing and strengthened country procurement and distribution mechanisms, and sex worker programmes are part of a commodity tracking system.
Programme implementation in this stage is a matter of strengthening systems, addressing structural barriers and empowering communities while simultaneously providing and measuring services. Some of the earlier intensive programme activities may be reduced as social norms regarding condom use and clinical service use change.
D. From expanding scope to adding services Once the infrastructure, community engagement and coverage have been established and the programme is functioning well, it is relatively straightforward to add services.
6.2.7 Establish a supervision system
Regularly scheduled supervision meetings help create a“ data use culture” that enables corrective action and continuous improvement at all levels, as well as independent problem-solving. Periodic meetings should be scheduled to review data at every level, from community outreach workers to NGO staff, to the state / provincial level, to central management. Visits by the supervision staff to the field also provide qualitative information on implementation to help interpret data and find solutions. As an example, a supervision and programme review system used by a large project in India is
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