Empty rituals? A qualitative study of users' experience of monitoring & evaluation systems in HIV interventions in western India.

In global health initiatives, particularly in the context of private philanthropy and its 'business minded' approach, detailed programme data plays an increasing role in informing assessments, improvements, evaluations, and ultimately continuation or discontinuation of funds for individual programmes. The HIV/AIDS literature predominantly treats monitoring as unproblematic. However, the social science of audit and indicators emphasises the constitutive power of indicators, noting that their effects at a grassroots level are often at odds with the goals specified in policy. This paper investigates users' experiences of Monitoring and Evaluation (M&E) systems in the context of HIV interventions in western India. Six focus groups (totalling 51 participants) were held with employees of 6 different NGOs working for government or philanthropy-funded HIV interventions for sex workers in western India. Ten donor employees were interviewed. Thematic analysis was conducted. NGO employees described a major gap between what they considered their "real work" and the indicators used to monitor it. They could explain the official purposes of M&E systems in terms of programme improvement and financial accountability. More cynically, they valued M&E experience on their CVs and the rhetorical role of data in demonstrating their achievements. They believed that inappropriate and unethical means were being used to meet targets, including incentives and coercion, and criticised indicators for being misleading and inflexible. Donor employees valued the role of M&E in programme improvement, financial accountability, and professionalising NGO-donor relationships. However, they were suspicious that NGOs might be falsifying data, criticised the insensitivity of indicators, and complained that data were under-used. For its users, M& E appears an 'empty ritual', enacted because donors require it, but not put to local use. In this context, monitoring is constituted as an instrument of performance management rather than as a means of rational programme improvement.

From brothel to boardroom: prospects for community leadership of HIV interventions in the context of global funding practices.

The empowerment of marginalised communities to lead local responses to HIV/AIDS is a key strategy of funding agencies' globalised HIV/AIDS policies, given evidence that disempowerment is a root source of vulnerability to HIV. We report on two multi-level ethnographies at the interface between HIV prevention projects for sex workers in India and their funding environment, examining the extent to which the funding environment itself promotes or undermines sex worker empowerment. We show how the 'new managerialism' characteristic of the funding system undermines sex worker leadership of HIV interventions. By requiring local projects to conform to global management standards, funding agencies risk undermining the very localism and empowerment that their intervention policies espouse.

Persuading, protesting and exchanging favours: strategies used by Indian sex workers to win local support for their HIV prevention programmes.

Given that the communities which are most vulnerable to HIV often have little control over their own lives and their health-related behaviour, HIV prevention policies increasingly recommend that HIV prevention projects work to build relationships with powerful external groups (i.e., build "bridging social capital"). To aid conceptualisation of how community organisations may build such social capital, this paper outlines a typology of strategies for influencing local stakeholders. We present a study of two successful Indian sex workers' organisations, VAMP and DMSC, focusing on how the organisations have influenced three groups of stakeholders, namely police, politicians and local social organisations. Interviews with project employees (45), with representatives of the three groups of stakeholders (12) and fieldwork diaries recording 6 months of observation in each site provide the data. Three approaches emerged. "Persuading" refers to the practice of holding information-giving meetings with stakeholders and requesting their support. It appears to build "weak social ties". "Protesting" entails a collective confrontation with stakeholders, and appears to be useful when the stakeholder has a public image to protect that would be tarnished by protest, and when the protestors can stake a legitimate claim that their rights are being denied. In "exchanging favours", the sex workers' organisations find creative ways to position themselves as offering valued resources to their stakeholders (such as useful information on criminal activities for the police, a stage and audience for politicians or a celebration for local social organisations) as incentives for their support. In conclusion, we discuss the strengths and weaknesses of each approach, the implications for social capital theorising and implications for community HIV prevention.