Operating a Checkpoint

Participation and empowerment

Empowerment of the key population, in this case men who have sex with men, is a principle at the core of community-based health promotion, including voluntary counselling and testing services.

The involvement of MSM is central to the concept of community-based voluntary counselling and testing (CBVCT) services. Many CBVCT services for MSM have been initiated by the affected population themselves and then developed in collaboration with the other stakeholders.

Listening and responding to the needs of the key population is an essential part of the CBVCT approach.

You will find aspects of community involvement throughout this toolkit. This section focuses specifically on empowerment, governance, decision-making and volunteers.

Item Does your CBCVT have this in place? Is there a documented standard, guideline, plan, policy, procedure, contract or agreement? Is it adapted to local needs and conditions? Is it working as intended? Action
Empowerment principle
Description

Description

The principle of empowerment means that CBVCT services are provided ‘by, for and with MSM’. It translates into concrete structures and activities that the CBVCT uses to increase the power of MSM over their own health and lives.

 

Guidance

Guidance

The thought at the heart of empowerment is that marginalised people themselves know their needs best. In order to be put in practice, the principle has to be explicitly stated and promoted. This could be in the form of:

  • A list of guiding principles in the vision/mission statement of the CBVCT
  • As a separate overarching goal in the strategic and action plans of the organisation.

This includes maximising MSM participation in all routine activities as well as including specific activities to further empower MSM.

Empowerment means not only placing MSM at the centre of decision-making processes and interventions, but also proactively building the necessary knowledge, skills and capacity to exercise that central influence. It also means intervening to stop disempowering practices surrounding the CBVCT, e.g. in the health system.

CBVCTs can also contribute to the empowerment of MSM by providing information, training volunteers and collaborating with other community-based organisations. For example, even if not all who attend volunteer training end up working at the CBVCT, the overall level of knowledge and awareness in the MSM community will increase.

For example, ‘buddy projects’, where e.g. HIV positive MSM are trained to assist and guide newly diagnosed MSM during the first period after diagnosis, aim to empower both the MSM trained and the MSM who are paired up with a buddy. Knowledge about discrimination and legal rights as well as personal skills, e.g. communication, self-awareness and social networking, also contribute to empowerment.

 

Adaptation

Adaptation

Legislation and regulations may prevent empowerment principles from being implemented rigorously. For example, equal opportunity legislation may make it impossible to reserve elected positions on boards or to recruit staff of a particular gender or sexuality. Sometimes however, exceptions to such rules can be applied for and equally qualified MSM candidates can be given preference.

To adapt to local limitations, other options are:

  • Including additional selection criteria, e.g. ‘extensive knowledge of MSM issues and networks in MSM communities’ in job descriptions
  • Targeted advertising for board and staff positions in MSM networks and personally encouraging MSM candidates to apply
  • Including a quota or affirmative action clause in the constitution or rules of the organisation if legally possible (e.g. ‘at least 75% of the membership of the board must currently identify as gay or bisexual’)
  • Increasing the role and influence of advisory structures and specifying MSM expertise for membership.

How proactive empowerment strategies for MSM can be integrated into local CBVCT operations depends on a range of factors:

  • Maturity, size and capacity of the CBVCT to expand activities beyond testing
  • Available cooperation partners, e.g. LGBTIQ* organisations
  • Terms and conditions of funding agreements
  • Existing capacity of MSM to participate.

In some circumstances, where the level of marginalisation is very high, few MSM may have the capacity or feel safe to actively participate. Building up resources and capacity may need to begin with individual and group work interventions to increase knowledge, confidence and mutual support.

 

Quality Improvement

Quality Improvement

Question one of the Euro HIV EDAT Self-evaluation Grids focuses on a participatory context analysis of the health and needs of the key population. The Participatory Quality Development (PQD) tool is all about participation of key stakeholders – first and foremost the key population – and offers a theoretical framework as well as practical, step-by-step guides to participatory methods. These include advisory groups and methods to improve the quality of goals and strategies (e.g. the ZiWi method). The tool is available on www.qualityaction.eu.

 

Action plan

Action plan

This Action Plan helps you to work directly on the items identified as priorities (yellow and/or red fields in the Checklist). Please list actions that are as specific as possible. You can download your finished Action Plans for each section as an xlsx.-document and print it afterwards. The Action Plans form the basis for your further planning, implementation and evaluation.

The Action Plan shows a sequence of steps to be taken, or activities to be performed for a strategy to succeed. The Action Plan has four major elements: (1) what will be done (specific tasks), (2) by whom (responsibility), (3) by when (timeframe), and (4) how the implementation of the task will be monitored.

 


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Governance structure
Description

Description

Governance structures allocate influence, roles and responsibilities to stakeholders and describe how decisions are made.

 

Guidance

Guidance

Depending whether the CBVCT is a separate incorporated body or part of another organisation, as well as local laws and regulations, its governance structure will take different forms. Following the principle of empowerment, MSM need to be represented at all levels, especially where directions are set and decisions are made.

 

The leadership of an incorporated body determines the strategic direction of the organisation and embodies its legal rights and responsibilities. It usually takes the form of a board of directors or a management committee consisting of elected or appointed members. Its roles and responsibilities may include:

  • Articulating the vision, mission and strategic plan
  • Employing and directing the management team
  • Signing off on financial reports
  • Fundraising and promotion
  • Legal responsibility
  • Networking

 

This body may then delegate certain responsibilities and functions to other parts of the governance structure. Day-to-day operations are usually delegated to an executive director, general manager or management team who are employed by and responsible to the board of management. Its roles and responsibilities may include:

  • Managing operations
  • Action planning and drafting proposals for the board of directors
  • Preparing funding submissions, project plans, financial and technical reports
  • Human resource management, including volunteers
  • Public relations

In addition, the governing body may convene experts in a committee or group to provide specialist advice to the board/committee and/or management team. Its roles and responsibilities may include:

  • Providing technical advice and assistance
  • Proposing changes to methodologies and procedures
  • Networking with related organisations and service providers
  • Community and stakeholder representation

Boards and advisory committees may also include positions for community, staff and funding body representatives.

If the CBVCT is part of another organisation, it may have a representative on that organisation’s governing board or advisory committee, or it may be integrated at the level of the management team.

 

Adaptation

Adaptation

Organisational forms and structures are highly dependent on local laws, funding mechanisms and the individual history and size of the CBVCT.

Adapting governance structures to the needs and capacity of the CBVCT can be informed by the following questions:

  • What is the most appropriate legal form of incorporation, considering the goals and function of the CBVCT?
  • Who can contribute valuable expertise, influence and networks to the governing structure?
  • What is a workable size and level of complexity for the governance structure?
  • Which governance structure ensures the meaningful participation of the community?

Using an existing NGO as a parent organisation may be the most practical approach when establishing a new CBVCT. As a general principle, a governance structure that is only as complex as necessary to support the goals and work of the CBVCT can ensure that the administration serves the project, not the reverse.

 

Quality Improvement

Quality Improvement

The QIP and Succeed quality improvement tools contain sections on structure and responsibilities. The Participatory Quality Development (PQD) tool is all about participation of key stakeholders – first and foremost the key population – and offers a theoretical framework as well as practical, step-by-step guides to participatory methods, including advisory groups. All three tools are available on www.qualityaction.eu.

 


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MSM participation
Description

Description

Participation of the key population and the affected community in decisions means that they can be part of and exert influence at all levels of the CBVCT.

 

Guidance

Guidance

Although many CBVCTs working with MSM have been initiatives of MSM and their communities themselves, it is useful to be explicit about participation in decisions and make it transparent. This way, community members will know how they can contribute or who they can approach to advocate on their behalf.

Participation of key populations and communities can be enshrined in the constitution or statutes of an NGO, or in mission statements and strategic plans of organisations and services (see also Chapter Empowerment)

The governance and management structure of the CBVCT can then put the principle of participation of the key population and community into practice by including designated positions for members of the MSM community (see also Chapter Accountability).

 

Adaptation

Adaptation

How participation can be integrated depends on the flexibility of governance and management structures:

  • The board or management committee can reserve positions for key population and community representatives, or representatives from recognised advocacy organisations.
  • The duty statements and job descriptions of key positions within the CBVCT, such as managers, counsellors etc. can include detailed knowledge of MSM issues and existing networks in the MSM community. Depending on employment laws and regulations, ‘positive discrimination’ or ‘affirmative action’ policies may even allow organisations to require membership of the MSM community to ensure that managers and counsellors are peers from the key population.
  • If formal representation on boards and in management is not possible, a community or service user advisory committee can be another option providing participation. However, its terms of reference need to ensure decision makers actively consult with them and account for their decisions.

 

Quality Improvement

Quality Improvement

The PQD (Participatory Quality Development) tool offers theoretical articles about the principle of participation, useful descriptions of the various levels of participation in decision-making and how to put them into practice over time. The Circles of Influence method in the PQD toolkit offers is a straightforward exercise for teams to make visible how different stakeholders currently participate in decision-making and how this could be improved. The toolkit also contains step-by-step guides to other participatory methods such as Service User Advisory Committee.

To access PQD and online learning materials about the tool, go to  www.qualityaction.eu.

 


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Roles for volunteers
Description

Description

Volunteers from the key population taking on a range of roles in the CBVCT puts the principle of being based in the community into practice.

 

Guidance

Guidance

MSM community volunteers can play important roles in all aspects of setting up and running a CBVCT:

  • Advocacy – e.g. identifying and articulating a need, lobbying politicians, negotiating with policy makers, funders and regulators (see also Advocacy)
  • Governance – e.g. serving on boards and committees, contributing to strategic planning
  • Setting up services – e.g. contributing to action plans, participating in focus groups, acting as role models in communication and promotion (see also Communication)
  • Running the CBVCT – e.g. as trained testers/counsellors, support ‘buddies’, outreach workers, online counsellors etc.
  • Evaluation – e.g. as survey respondents and focus group participants.

It is useful to document the roles of volunteers, e.g. in the constitution of the organisation or the terms of reference of committees, implementation plans, organisational charts, evaluation plans etc.

To assist recruitment, all available volunteer roles can also be listed and described in promotion materials.

See also Human Resources for details about supporting and managing volunteers.

 

Adaptation

Adaptation

The level of volunteer involvement depends on locally applicable regulations (see also Regulatory and legal frameworks), insurance requirements and the availability and motivation of community members to become involved.

While involving volunteers to perform core duties can save on salaries and provide the advantages of a peer-based approach, recruiting and supporting them requires dedicated effort and skills.

The level of motivation in the MSM community to contribute as volunteers, especially to be trained to perform duties with a higher level of responsibility, e.g. as testers, counsellors or outreach workers, may vary. For example, hundreds of volunteers contribute to the expanding checkpoint services in Greece, where a great need for low-threshold testing for MSM exists. In other places, CBVCT services are more professionalised and carried out predominantly by paid staff.

Finding out about the willingness and capacity of potential volunteers is an important part of planning. Volunteer involvement can also build over time as the CBVCT becomes known and more MSM become interested in contributing.

 

Quality Improvement

Quality Improvement

The roles performed by staff and volunteers are reviewed as part of regular, structured quality improvement, e.g. using tools such as Succeed and QIP in order to assess whether they still match the knowledge and skills required to provide the service. The PQD (Participatory Quality Development) toolkit also offers participatory methods such as Guided Working Group and Service User Advisory Committee to work with staff and volunteers.

To access these tools and guidance on using them go to www.qualityaction.eu.

 


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Operating a Checkpoint
Participation and empowerment
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