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The Context

VIEWS: 88 PAGES: 30

									5th Global Forum on Re-inventing Government Innovation and Quality in the Government of the 21st Century
Mexico City, Mexico 3-7 November, 2003

Innovations in Decentralised Governance & Human Development
UNDP “Leadership for Results” Programme Decentralized Transformative Leadership Approaches to HIV-AIDS
Nepal 2002-2003
UNDP‘s HIV-AIDS ―Leadership for Results‖ capacity development programme (L4R) is providing an innovative opportunity for individuals, institutions, and communities to explore strengths and weaknesses, individual and societal motivations, plans and commitments in the area of HIV-AIDS. The strategy is simple yet effective: bring together key change agents and community influencers; offer them the opportunity to perceive and respond to the epidemic in a deeper and more systematic way; invest in developing their ability to lead in compelling, innovative ways; and expand their capacity to coordinate and manage large-scale, multisectoral programmes.

Decentralised Transformative Leadership Approaches to HIV-AIDS *DTAH/A*
A component of the L4R Programme, DTAH/A initiated a nation-wide approach (with representation from each of the five Nepali regions) to strengthen decentralized HIVAIDS leadership, planning and coalition building. The Districts of Morang and Sunsari in eastern Nepal hosted the seminars, drawing upon their initiatives as the learning lab site. At the beginning of the process of change, the project was designed to eventually be able to expand to the national level, and, at the same time, to reach the community level. The innovative approach resulted in the expansion of leadership assuming responsibility for expanding the HIV-AIDS response, two District AIDS plans and the formation of district networks and robust cross-regional coalitions.

“Never doubt that small groups of thoughtful, committed citizens can change the world – indeed, they may be the only thing that ever has.” Margaret Mead

UNDP ―Leadership for Results‖ Programme Decentralized Transformative Leadership Approaches to HIV-AIDS Nepal 2002-2003 Seminar Series Report

Table of Contents
I. The Context II. An Innovative Response: III. Reflections on the DTAH/A in Nepal
pg. 3

pg 5

Decentralized Transformative Leadership Approaches to HIV-AIDS
pg.17

LIST OF ANNEXES:
Annex A Leadership For Results Frameworks and Methods Annex B Charts Of The Two Pilot District Plans pg. 21

pg. 28

This report was prepared by Jan Sanders and Tatwa Timsina, consultants to BDP and UN Nepal, and draws upon the fuller report they collaborated with Serra Reid, consultant to BDP HIV-AIDS Group in writing. The views in this paper are those of the authors and do not necessarily reflect the official views of UNDP. For further information, please contact: robertson.work@undp.org, or janetasanders@hotmail.com .

Glossary of Acronyms

BDP CBO CSW DDC DDAC DTAHA L4R NCASC NGO UNDP UNGASS

Bureau Development Policy Community Based Organisations Commercial Sex Workers District Development Committee District Development AIDS Committee Decentralised Transformative Approaches to HIV-AIDS Leadership For Results National Centre for AIDS and STD Control Non-Governmental Organisation United Nation Development Program United Nation General Assembly Special Session

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VDC

Village Development Committee

I. The Context
Twenty years on, the HIV-AIDS epidemic continues to spread without respite – with nearly 70 million persons infected since its beginning, 42 million people are now estimated to be living with HIV and AIDS, and well over 20 million have already died of the disease. Among the 40 million people in developing countries living with HIV, less than 0.2% have access to Highly Active Antiretroviral Treatment (HAART). True innovation is required to meet the challenges of this disease. Innovation is easy to say, but much less easy to do. The Decentralized Transformative Leadership Approaches to HIV-AIDS in Nepal provides an innovative response that has resulted in specific actions in Nepal. The DTA reshapes traditional thinking on leadership and brings people together to plan and initiative new responses.

HIV-AIDS in Nepal
The first cases of AIDS were reported in Nepal in 1988. Although surveillance data is scarce, limited data indicate that HIV prevalence is currently around 0.5 percent in the general population. As of February 2003, the Ministry of Health has reported 631 cases of AIDS and 2,392 HIV infections. It is very likely that the actual number of cases is higher. UNAIDS/WHO estimate for 2002 around 60,018 people living with HIV-AIDS and 2958 AIDS related deaths in that year alone. The AIDS virus is infecting 30 Nepali people a day. It is growing faster than the responses. It is now evident that Nepal has entered a concentrated epidemic stage. That is, HIVAIDS prevalence consistently exceeds 5% in one or more sub-groups. While the disease is still primarily focused among the most vulnerable sub-population groups of intravenous drug users (IDUs), sex workers, and returning sex workers from India, there is reason to believe that, as in so many other countries, there are formally unrecorded signs of movement into the general population. Most of the 60,000 people living with HIV-AIDS (PLWHA) do not know they are infected and many of them may be engaging in unsafe practices. Pervasive stigma and discrimination prevent these people and others in the high-risk groups from practicing safe sex, undergoing testing, and if they know they are infected, from seeking treatment and care. The fundamental underlying causes of the HIV-AIDS epidemic in Nepal are the national level of income (GDP US$285) and a general unawareness of the HIV-AIDS virus and epidemic. The low income level contributes to inadequate funding of government HIVAIDS programs, poor to non-existent medical care for PLWHA, a male migrant worker population, a sub-culture of drug use, and a significant pattern of trafficking of females across the southern border as commercial sex workers (CSWs). Public ignorance of HIV-AIDS is responsible for the under-reporting of the number of cases nationally and for recognition of the disease only in advanced stages or at death.

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The response to date has been fragmented. It is a major challenge for district officials to know what programs are currently happening in their geography. This problem hampers coordination, the development of programs of scale and the ability to build upon the capacity of local leaders and practitioners. Gaps in service and pockets of infection are not targeted consistently, nor are lessons being shared or up scaled. The growing number of HIV cases in Nepal, the spread of the epidemic into the general population, and the resulting burden on many different sectors may threaten much of the nation‘s socio-economic progress. Nepal‘s situation demands that HIV-AIDS not just be confined to the realm of public health. Rather, the inter-connectedness of HIV with factors such as poverty, governance, education, gender discrimination and health must be clearly communicated and understood by all stakeholders. Such a comprehensive and holistic approach necessitates a comprehensive scaling up and scaling out of the response – and requires that leaders at all levels and across all sectors, in every part of the country, be enabled to create and sustain positive change.

The United Nations Response to HIV-AIDS
A key lesson of the last decade is that strong political commitment is a common thread in all countries with positive experiences in responding to HIV-AIDS. From the highest national authorities to those at community levels, successful leadership is most effective when it is inclusive and proactive, ensures allocation of adequate domestic resources, and has courage to take risks, expand implementation, overcome obstacles, and empower others to take effective action against the epidemic. The development community must provide strong support for this type of leadership. A handful of countries, Brazil, Uganda, Senegal, Thailand and Cambodia, are achieving measurable results in reversing the epidemic by demonstrating and encouraging this approach to leadership In June 2001, at the Special Session of the General Assembly (UNGASS), the member states of the United Nations created a landmark Declaration of Commitment on HIV-AIDS, calling for a fundamental shift in the response to HIV-AIDS. The UNGASS Declaration stresses, “Strong leadership at all levels of society is essential for an effective response to the epidemic. Leadership involves personal commitment and concrete action”. In response to the UNGASS declaration, UNDP‘s HIV-AIDS Group developed the Leadership for Results Programme. The development of the capacity of leaders, institutions and the communities they serve to create sustainable responses to key development issues is at the heart of UNDP‘s historical mandate. This particular programme works to develop countries‘ capacity to achieve sustainable results within a development paradigm that addresses the social, political, and economic factors fuelling the epidemic, based on three broad categories of action: 1. Leadership and Capacity Development 2. Development Planning, Implementation and HIV-AIDS Responses 3. Advocacy and Communication for Development Effectiveness

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UNDP‘s Leadership for Results is a programme that addresses both ―making the case‖ for HIV-AIDS as a development issue, and ―generating the response‖. The programme works to positively impact national responses to HIV-AIDS at both policy and servicedelivery levels through the strengthening of capacities for effective leadership, strategic planning, large-scale programme management, and coalition building. As part of this strategy, UNDP has supported capacity development of leaders from all levels and sectors in countries around the world. The first 6 ―flagship‖ Leadership for Results Programme countries -- including Cambodia, Ethiopia, Nepal, South Africa, Swaziland, and Ukraine -- completed the first yearlong phase of the Programme throughout 2002. The pilot initiative Decentralised Transformative Approaches to HIV-AIDS, launched in Nepal in Fall 2002, is a component of the Leadership for Results Programme.

II. An Innovative Response: Decentralised Transformative Approaches to HIV-AIDS (DTAH/A) in Nepal
Ultimately the national strategy has to be translated into a programme with concrete actions. The biggest risk for not achieving the goals of the strategy (and thus failing to stop the epidemic) lies in the weak implementation and management capacity at all levels. Nepal‘s National HIV-AIDS Strategy, 2003. The Decentralized Transformative Approaches to HIV-AIDS is a process to create leadership that is generated from within the individual and expressed in action that impact other individuals, groups, social systems and structures. Decentralisation is a challenging and complex process that requires patience and dedication on the part of all stakeholders, but it also promises to be a mechanism for improved democratic governance and sustainable human development. (Overview of
Decentralisation Worldwide: A Stepping Stone to Improved Governance and Human Development)

Some of the opportunities included in decentralisation are:  increased participation of individuals in assuming responsibility for initiatives  increased efficiency in determining the real situation and service demands  flexibility in the face of changing circumstances  capacity to tailor situations to local needs  wide diversity of innovations that can feed into policy and programming responses  promotion of a knowing and acceptance of various cultures within a geographic setting  the ability to take successful local initiatives and scale them out to other communities  the ability to effectively tap local resources  the innovations that result from decentralization often benefit local governments through increased global communications and international and regional networking.

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While decentralization sounds promising, it must be approached with some caution. The assumption of new responsibilities through decentralization often requires improved planning, budgeting and management practices; the adoption of new tools; and the development of improved human resources to operate the decentralized programmes. Some of the dangers include the capture by local elites of the resources, lack of human capacities including planning, management, motivation, and having the mandate but not the resources to carryout the tasks. Decentralisation always involves changes of relationships between and among different societal actors, social sectors and geographic areas. These changes can be threatening or can be seen as enabling for all parties – a win-win situation. In designing decentralisation strategies it is necessary to think through the most effective approaches to making changes in relationships of power, authority and responsibility based on the motivation and self-interest of the various parties involved and the common objectives shared by all groups and individuals. It is necessary to empower and build the capacities of the weaker actors and to provide incentives for each party to make the desired changes. Nepal was originally selected for this joint initiative because of its previous work in decentralisation at the political, administrative and financial levels. One of the longest UNDP efforts to support decentralisation has been running in Nepal for over 12 years. The country passed the Local Government Act in 1991 and updated that Act in 1999. UNDP along with the Ministry of Local Development (MLD) and the National Planning Commission (NPC) supports the decentralisation through two programmes Local Government Programme (LGP) and Participatory District Development Programme (PDDP). Between the two they cover most of the districts in Nepal. The end of 2003 will incorporate these two programmes into a single programme focused on capacity building assistance. This attention to the changes in relationships characterizes the DTA project. The three spheres of HIV-AIDS, Decentralised Governance and Leadership were woven into this approach. The following diagram shows the intended outcomes of all three.

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Decentralised Transformative Approaches to HIV-AIDS
"Generating an Extraordinary Nation-wide, Multi-sector, Gender Sensitive Response, with Results" Goal: Halting and Reversing The Spread of the HIV-AIDS Epidemic by 2015

Decentralised Governance Outcomes:


Decentralised Governance

HIV-AIDS Outcomes: HIV-AIDS
Creation of an Enabling Environment in order to produce concrete results in the following 4 key areas:   Prevention of new infections Provision of improved care, support and treatment of those infected and affected by HIV-AIDS Reduction of vulnerability Mitigation of the social and economic impact of HIV-AIDS

Stronger links between three levels of government: National, District, Local Three Sectors: Government, Civil Society and Business planning and working together District Level plans created and implemented with community dialogue All initiatives based on characteristics of 'Good Governance'  Accountability  Transparency  Rule of law  Responsiveness 



Transformative Leadership



Transformative Leadership Outcomes
Developing leadership capacities such as:  Self awareness  Self management  Social awareness; and  Relationship management Deeper Understanding of Current Situation:  Societal Systems, institutions, policies  Social Culture; values, assumptions  Individual Behaviour  Individual Mindset, emotions Willingness to pursue actions individually and in the family, workplace and society, to halt and reverse the epidemic Demonstrated commitment to empowering women's leadership roles in society  









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The Nepal Project in brief
The Decentralized Transformative Approaches to HIV-AIDS programme series, launched in Nepal Fall 2002, leverages the strength of Nepal‘s established decentralized governance system and builds upon the growing political will among Nepal‘s leaders to address HIV-AIDS as a development issue of nationwide importance. Before the project, there were already many building blocks in place to address the epidemic, including inventive responses at the local level. However, there was a lack of functional coordination and networking among government and non-government organizations. District Development Committees (DDC) were beginning to pick up the mandate of response to the epidemic through the devolution of health powers. The large number of NGOs and INGOs involved in the response to HIV-AIDS in Nepal were slowly being integrated with, government policy and agencies. The nation of Nepal was chosen for this District Decentralized Transformative Approach because of its past history of decentralization, the level of the epidemic, the stigma attached to and isolation imposed upon those living with HIV-AIDS, and the current critical demand for effective multi-sector intervention. For the project, three 10-day capacity development modules focused on leadership development and dynamic planning were conducted between June 2002 and July 2003, facilitated by leadership expert Janet Sanders and co-facilitators Tatwa Timsina and Narayan Pradhan. The events were hosted in Morang and Sunsari District selected to be ‗teaching districts‘ because of the level of HIV-AIDS activities already occurring. Existing activities could be scaled out to other parts of the districts and across other regions and these districts could enter into creative dialogue with national actors on policy and programme initiative. This approach builds on the courageous initiatives already in place to combat HIV-AIDS, strengthens district leadership and participatory multi-sector planning, seeks to clarify the district government response and creates nationwide networks to effectively respond to HIV-AIDS. Twenty-two outstanding contributors to Nepal‘s district-level HIV-AIDS response were recruited as resource persons for the seminars and were trained to continue facilitating the development of transformative HIV-AIDS leadership in Nepal – leadership that envisions possibilities and creates opportunities previously unimagined, and brings voice to those previously unheard. Over 200 participants (overall), from NGOs, CBOs, women‘s groups, youth groups, PLWHA, media, national and sub-national government (District Development Committees) were guided through task-focused individual and team work towards developing an informed, empowered and committed leadership base at the District Level that engages all available socio-political resources in order to achieve nationwide results in the reversal of the epidemic. The approach worked through His Majesty Government Ministry of Health and the National Centre for AIDS and STD Control (NCASC) and the United Nations Country Team on HIV-AIDS.

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The National Strategic Plan (2003) of HMG/Nepal Ministry of Health, through the National Centre for AIDS and STD Control and the National AIDS Council, calls for the decentralisation of health and the participation of multi-sectors in implementation.

Morang and Sunsari Districts in Eastern Nepal were selected as the two ‗labs‘ for the approach. For national coverage participants came from one district in each region. These included Dadeldhura, Banke, Parbat, Baktapur, and Saptari –marked with a

Measurable outcomes of the Nepal project include:
   


113 district-level leaders from all 5 regions of Nepal with enhanced and diversified HIV-AIDS leadership competency, actively engaged in actions within the context of a nation-wide response; 22 trained Nepali facilitators prepared to promulgate the Leadership for Results capacity development approach at district and regional levels; A district AIDS plan in both Morang and Sunsari districts, harmonized with and key national response objectives and beginning to be implemented; Morang and Sunsari districts each building a results-oriented network of 90 people committed to work together to respond to HIV-AIDS; Linkages created with national level response of the National Centre for STD and AIDS, the Ministry of Health, and UN system.

The richer picture - additional outcomes include:  The leadership development aspect of this initiative supported the strategic development of leaders in the response to HIV-AIDS at the district level, supported the emergence of new leaders, created and strengthened networks and partnerships within and across regions. Simultaneously, leaders‘ overall HIV-AIDS competency increased through specific modules designed to strengthen understanding of HIV as a development issue and highlighted critical crosscutting themes like gender and human rights.



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

Greater social mobilization on HIV-AIDS issues nationwide was initiated through support to leaders from all 5 regions and different sectors of Nepali society. Leaders demonstrated their new skills through ‗Practice of Commitment‘ initiatives. The decentralized governance component of the programme focused on strengthening district planning capacity in response to HIV-AIDS, supporting the development of 2 district AIDS plans with implementation launched, strengthened linkages and built synergy between the district and national level response to HIVAIDS.



Phase 2, 2003-2004
The strategy for Phase 2 is to intensify the HIV-AIDS strategy implementation in Morang and Sunsari Districts including the District Networking and input into the national policies and programme. The second aspect is to bring the capacity-building approach to other regions in Nepal, to support them in achieving similar breakthroughs in the creation of an enabling environment to halt and reverse the epidemic in Nepal.

The Nuts and Bolts: The Application of the DTA
There are four key, linked components to the DTAHA: A. B. C. D. Transformation Leadership Seminars and Facilitator Training Dynamic Planning and Implementation Formation of District Networks Practice of Commitment

DECENTRALISED TRANSFORMATIVE APPROACH TO HIV-AIDS

FRAMEWORK
SEPTEMBER Facilitator Training S C A L I N G U P JANUARY Facilitator Training APRIL Facilitator Training

TLS
TRANSFORMATION LEADERSHIP SEMINAR

90 Persons 5 days

SUNSARI MORONG District District Planning & Dynamic Networking Plan & 3 Days Network Networking 3 Days/ 90

TLS
90 Persons 3 Days

PRACTICE OF COMMITTMENT 10

A. Transformation Leadership Seminars

Finding the centre of strength within ourselves is in the long run the best contribution we can make to our fellow humans. R. Walsh The transformation leadership seminars build upon the conclusions of the UNGASS conference calling for the courage to take risks, innovate, and expand interventions on a scale never before achieved in order to reverse the spread of HIV-AIDS. This challenge requires leaders to look deep within themselves for inner strengths and resources and also to understand all of the underlying factors and far reaching consequences of the epidemic, thus addressing the true depth and breadth of the issue. Three leadership seminars DTAHA provided the opportunity for a cross-section of participants from seven districts to focus on individual introspection, acquire skills for planning and action, and build a trusting, cross-sectoral network for on-going dialogue, collaboration and action. Seminars included time for both work on "Inner Leadership" and "Leadership in Action"

Seminar Frameworks1:
In order to intervene at different levels of systems, UNDP in their Leadership for Results Programme, has adopted an advocacy and capacity-building approach that uses mental models and frameworks to help generate a more complex understanding of the epidemic. This more comprehensive understanding helps to generate multi-layered and multisectoral responses. Mental models are useful to help deepen understanding. They help create alignment by providing a common framework amongst partners who may have different areas of expertise and frames of reference in the response to HIV-AIDS, yet nonetheless are working towards the same goals. Common frameworks help create an effective response by providing a ―big picture‖ perspective upon which to orient attention and energy, aid effective communication between actors, and improve coordination based on shared ―language‖ or conceptual understanding. The Transformation Leadership Seminars were informed by the following frameworks:  The Emotional Intelligence Framework was used for participants to examine their own strengths, resources, values, beliefs, and self-confidence. They formed a vision of themselves as leaders and focus on developing the social, selfmanagement and relationship skills to acquire a new leadership style. Through introspection and reflection they empowered themselves to realize their full potential as change agents of human development.

1

The conceptual frameworks behind Leadership for Results are briefly outlined in Appendix A.

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

Ken Wilber‘s Four-Quadrant Framework allowed the participants to develop a complex holistic understanding of the HIV-AIDS epidemic. The holistic framework allowed leaders to ask the right questions, see the bigger picture and work towards sustainable results. The model let the leaders see the links between individual and group attitudes, norms and values, and the consequent behaviour and actions. Strategic Reflection and Planning Process: helped leaders to develop the capacity to facilitate large group planning processes using ToP (Technology of Participation) and the Appreciative Inquiry methods. Systems thinking, the role of the leaders in organizations, and the Principles for ‗Action at Scale‘ were included in the agenda. The leaders built a shared leadership network of District actors, based on horizontal links of individual initiative and collaboration following the Lickert model. They developed their ―external leadership‖ through learning skills in the areas of leading groups in conversations, workshops and dynamic planning. HIV and Me provided the framework for exploring individual responses to the virus, participants‘ sexual practices, depth understanding on the causes of the spread, empathy for those living with the virus and their families, and innovative responses.







B. Dynamic Planning and Implementation
Effective strategic planning processes, to successfully respond to the rapidly changing features of the epidemic, must be dynamic and flexible enough to allow for innovative applications across a wide variety of settings and constituencies. This particular planning process is able to meet these challenges. It is an empowering, highly interactive and inclusive, dynamic cycle of reflection and action. The District Development Committees of Morang and Sunsari each sponsored a Dynamic Planning Process, an empowering, highly participatory process of dialogue, reflection and action. The dynamic planning and implementation process builds upon current strengths and assets, allows participants to envision a possible future, analyses the complex nature of the factors which fuel the spread of the virus and to work in partnership to design and implement a multi-sectoral response. Throughout the process the 90 participants from a cross section of the district challenge themselves expanding their commitment and leadership capacities. Principles for good governance were incorporated, including accountability, transparency, and responsiveness. The results are a district strategic framework for HIVAIDS and a network with a mandate for sustained coordinated action. In the planning the participants interacted with those from the National Centre for AIDS and STD Control (NCASC) and the National HIV-AIDS Strategy. The Plan incorporated initiatives at the individual, organisational and institutional levels. Following the three-day session an advisory committee was set-up to review the plan and put it into a logical framework for submission to the District Development Committee on AIDS. The advisory taskforce presented the completed plan to a one-day gathering of the HIV-AIDS district network for review and comment. A final draft was presented to each District Development Committee for AIDS who has shared it with the

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Ministry of Health, NCASC and the National Planning Commission for their review and acceptance. The DDC pledged 15% of the financing of the plan and committed to securing finances for the remaining components. The following diagram illustrates the planning process.

Discover Strengths Reflect and Review Envision The Future

Dynamic Planning Process
  

ACT
Individually Organisations Structures

Co-create the Response

Map Current Reality

*The Dynamic planning process builds both upon the pioneering work of the Institute of Cultural Affairs work
in „Technology of Participation‟ and the Appreciative Inquiry Methods.

Key elements of success in the Dynamic Planning Process          Sponsorship by key government stakeholder (s) Leaders trained through Transformation Leadership Seminars Breadth and depth of recruitment across sectors, geography, ages. Move beyond the usual stakeholders. Beyond recruitment, all stakeholders need to play prominently in decision-making including people living with HIV-AIDS and women. Opportunities for small group dialogue to allow all voices to be heard, to engage thoughts, to share own accomplishments and eventually, to develop group voice Create opportunities for individual commitments and coordination of responses Provide adequate time for the planning process. Model new style of leadership through planning process The Dynamic Plan incorporate strategies that would be implemented by individuals, organisation and the district government

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C. Formation of District Networks
Programs, individual commitments and organizational promises can fall apart in the absence of ongoing networks. Interest flags, individuals and organizations can feel isolated, and the opportunities for collaboration and ongoing learning, so essential for affecting change, can be lost. In the Nepal project, two District Networks were formulated allowing government, NGOs and the private sector to build bridges toward each other. These networks will also be vehicles to continue to look at the ‗big picture‘ of AIDS in the district, flag emerging issues, champion emerging responses and hold accountability. These networks were developed during the Transformational Leadership Seminars. The leaders built a shared leadership network of District actors, based on horizontal links of individual initiative and collaboration following the Lickert model. They developed their ―external leadership‖ through learning skills in the areas of leading groups in conversations, workshops and dynamic planning. Anticipated Outcome of District Networks  Transparency and accountability to process  On-going gathering and deepening of insights surround HIV-AIDS  Development of a constantly learning society; able to see emerging patterns of infection, energy and resources for response  ―Dynamic‖ used in planning process so it can be changed, updated as necessary  The District networks can assist in coordinating activities and building partnership; there is potential for avoiding duplication or working at ‗cross-purposes‘  The network can have both linkages throughout the sectors in the district but also to the national actors  Networks can assist in information dissemination and technology transfer  Network can continue with capacity development Concerns with District Networks  The networks will require core of leadership with continued balance from each of the sectors  Currently there is no to little funding for networks; funding mechanism are also not related to the networks

D. Practice of Commitment
In order to encourage leaders to practice new skills and perspectives through action learning, and to empower team collaboration on planning processes, participants were asked to develop individual Practices of Commitment. These were each leader‘s personal commitment and contribution to an extraordinary response to HIV-AIDS. Each commitment was to stretch the individual‘s leadership capacities and initiate actions towards the four HIV-AIDS strategies. After the Dynamic Planning the Practice of Commitments were to launch or support an initiative in the plan. Participants created a networked community of fellow leaders to provide support between sessions. This regular, sustained inter-sessional activity supported initiatives with the depth and breadth to make a positive impact on the nationwide response.

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The following chart provides an overview of the initiatives made by individuals between the first and second sessions. The numbers beside each initiative indicates the number of people who engaged in that initiative. This list is a very concrete way to show the impact that the practice of commitment can have.
OUTREACH TO DIVERSE COMMUNITIES AND STAKEHOLDERS--41
                     


Credit Groups -4 Community, VDC-18 Woman's Groups-6 Agricultural-2 Genera-6 Private Sector (factories, unions, hotels)-5 AIDS Day-20 Condom Day and Human Rights Day-9 Colleagues at Work-13 Friends, Family-8 Youth and School-17 Youth Counselling-5 Street Drama -20 Facilitator Training-2 Use of New Frameworks-6 Wilber Quadrants for analysis-4 Networking & establish new networks PLWHA-3 Sex Workers-3 HIV-AIDS Rights-2 Outreach and Drop-In services Data, Research and articles
Posters, Condoms, Syringes, Pamphlets

SPECIAL OBSERVANCES--29 OUTREACH TO FRIENDS, FAMILY, WORK--21 YOUTH & SCHOOL PROGRAMMES--42

CAPACITY DEVELOPMENT--12

NETWORK DEVELOPMENT - 10 WORKING WITH VULNERABLE GROUPS--8

COUNSELLING PROGRAMMES--6 NEWSPAPERS--4 MATERIALS DISTRIBUTION—15

While such an overview can be helpful, often the individual stories can be very powerful. The following stories outline six individuals and how their individual responses to HIVAIDS changed through their practice of commitment. Madan Raj Bista, Bhaktapur,
HIV response prior to program: He did not work in this field at all. He had some idea about decentralized planning but not HIV-AIDS and transformative leadership. Practice of commitments responding during the program: Motivating the Local Development Officer and DDC team to incorporate HIV-AIDS in the district plan.

Parbati Bista, Dadeldhura,
HIV response prior to program: She never worked in this field. She used to consider HIVAIDS as the problem of only bad people.

Practice of commitments responding during the program: She committed to work in the large gathering such as village fair and door-todoor campaign.

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Practice of commitment since the program: Incorporating HIV-AIDS component in the district development activities Organising National Network of Facilitators

Practice of commitment since the program: She organized a ‗letter campaign‘ in the district. Dadeldhura is one of the most affected districts. She put messages about HIV-AIDS in a letter and gave them to the families who have relatives working outside. They also put their feelings in the letter and sent through post. Ms. Bista also goes to the villages talking about HIV-AIDS.

Yuba Raj Paudel, Parbat,
HIV response prior to program: He had no idea about HIV-AIDS. He used to read about it but never paid attention to cover it a journalist. Practice of commitments responding during the program: He published more than two dozen articles and news items in local and national newspaper regarding HIV-AIDS. Practice of commitment since the program: Being a journalist related to a national level government owned tabloid, Mr. Paudel talks about HIV-AIDS wherever he goes for reporting. With his initiation Parabt and Myagdi districts have developed community board and popularized the issues locally. Recently he organized open-air cultural programme on HIVAIDS in an isolated village in the district where more than 4 thousand people attended.

Arun Mehata, Sunsari
HIV response prior to program: As an administrator, he dealt HIV-AIDS but with low priority. Practice of commitments responding during the program: He tried his best to incorporate HIV-AIDS in district development activities. Practice of commitment since the program: He undertook the responsibility as the focal person for HIV-AIDS at the district level. His main role now is to coordinate and facilitate such activities. He also actively contributes to DACC.

Bishnu Sharma Acharya, Morang
HIV response prior to program Organizing treatment programme to STD affected people Practice of commitments responding during the program She linked her job to HIV-AIDS minimization. She believes that if STD is cured in time, there is also lower chance of getting HIV-AIDS.

Durga Adhikari, Parbat
HIV response prior to program Not at all interested.

Practice of commitments responding during the program Realized the problem and mobilized local youths towards HIV-AIDS.

Practice of commitment since the program Moving one village to another to cure STD affected people.

Practice of commitment since the program: Organized many village meetings on HIV-AIDS issues.

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III. Reflections on the Decentralized Transformative Approaches to HIV-AIDS in Nepal
The DTAHA leveraged the strength of Nepal‘s established decentralized governance system and built upon the growing political will among Nepal‘s leaders to address HIV/AIDS as a development issue of nationwide importance.

Key Aspects of Success
What follows are the highlights of successful aspects of the approach— used in the Nepal project.  Practice of Commitment o At this stage, the individual practice of commitments was the most successful aspect of the approach. Participants initiated actions in areas of the country, which had previously seen little to no movement in HIV-awareness or care and support strategies. Government officials saw where they could begin to initiate programmes through the efforts in which they were already engaged. Those working in the field of HIV-AIDS had a new network of people, renewed enthusiasm and, as some reported, a gentler, more compassionate approach. Educators understood their roles in promoting HIV-AIDS awareness. o Towards the end of the programme the participants held a discussion if they could sustain the responses achieved through the P of C. Both an on-going network in the two districts and a nation-wide network were deemed essential to continue the initiatives and keep people connected. P of C is one avenue for change but it also needs to be linked with organisational and governmental responses. Practice of Commitment is the recognition of the accumulation of individual acts to develop the ‗social capital‘ surrounding HIV-AIDS and to ‗tip‘ the response of society and governmental systems.  Personal stories from participants who are living with AIDS; and eventually, the participation of their families in the seminars and planning.  Careful selection of participants to get balance from sectors, geography, gender and ages. Another time we would also focus on who were potential implementers in the key strategy areas.  We were delivering a new style of curriculum and it was both helpful to test it out on a facilitator group and have them play key role in leading teams during the TLS and strategic planning. This also enabled them to gain valuable practice before they presented the new formats in their own settings  Using two districts as ‗teaching districts‘ both highlighted local initiatives and enabled the development of expanded approaches throughout the district and into other regions. National level leaders were surprised by the amount of local implementation.  Development of a new story of HIV and AIDS through the creation of songs, poems, drama, and media stories enabled the shift from stigma and alienation to a deeper understanding of the causes of HIV-AIDS and the links to poverty, youth alienation, and human rights.  Training geared to various learning styles. Learners were relaxed, enjoyed themselves, and stimulated both analytical and creative sides of the brain. The training style engaged leaders in new and exciting ways and built on their current capabilities.  The global spotlight on the two districts played a role in developing individual responses. Through various UN staff presentation, participants could see and

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







touch the globe and get a sense of the magnitude of the spread of HIV-AIDS, thus highlighting the necessity for action at the local level. A dynamic link was made between global, national, district and local levels. Even though decentralisation is often thought of as a national government undertaking, district leaders from various levels of government and society saw that they could play a crucial role in energizing decentralization and local government programmes and policies. Technical and financial support for programmes came after the Dynamic Planning where district leaders understood the issues surrounding HIV-AIDS more deeply and passionately voiced their recommendations to each of the national strategies. Outside resources need to re-enforced the response rather than leading it. Often social mobilization is separated from the rigorous district planning processes. In the dynamic planning, an education and inquiry component was part of the district planning process. Following the Dynamic Planning a writing team composed of NGO‘s, heads of government departments, and key government officials took the strategic framework from the dynamic planning and incorporated the directions into a logical framework which was presented back to the district network for review. (Legally, all Nepali district plans must be in the logical framework format.) At the review session, participants indicated how through their own initiatives they were initiating aspects of the plan. It was essential to incorporate initiatives at the individual, organizational and institutional levels. Most government plans only have the institutional response. The first year demonstrated that the district leaders were hungry for what else they might do to respond to the spread of HIV-AIDS, concerned as to what funding might be tapped, in light of already stretched budgets and searching for connections both to the national and local leaders.

Another word about decentralization:
The DTA: Nepal created geographical networks with a coordinated plan. The uniqueness of the Collaboration between the UNDP HIV-AIDS Group and Decentralisation Governance is found in the principles of decentralisation. This project is a complex weave of the national, district and local actors. The main area of activity or entry point was the district level. A shift in perspective would begin to see the three levels on a horizontal plane, each with its own unique role.

National

District

Local

The district level‘s key strength is its links to both the local and the national levels.

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Local groups, implementing real activities with concrete results, leverage their efforts and resources through coordination in the district network. The silo walls between NGO and CBO (community based organizations) programmes have the potential to disappear in the district network with initiatives becoming mutually reinforcing. The shared leadership (decentralisation) at the district level allows for customizing the national programmes and resources to meet the needs of the specific issues in their geography. At the national level, policy, funding priorities and public advocacy are informed by the real situation through input from the local through the district networks. With superior training, the district/local actors become the experts. Leadership comes from the field.

Recommendations
All actors involved in a decentralised response from local community, NGO, CBOs and local government to central government and international donors are making the effort to learn from experiences. The following are both recommendations for their role in general and some specific next steps. All levels must ―work together in creative and mutually supportive ways‖ to make the response to HIV and AIDS more effective.
Recommendations at the district level

     

Finalize new structures within the DDAC (District Development AIDS Committee) for multi-sector participation Implement plan components, which are within the scope of the individuals and districts. Secure authorization of district government components of the plan from National Centre for AIDS and STD Control Engage in resource development and mechanisms for district networks to receive funding from donors Provide active support to PLWHA, media group, women and youth Bring Network together for further sharing of insights relative to HIV-AIDS, responses and problem solving. Provide technical support to districts on initiatives which are government responsibility/mandate Develop formula for subsidies and grants to districts Co-host a gathering of practioners in sharing innovative responses to HIV-AIDS (best practices) Include recommendation at district level for government, NGO‘s, local citizens in forums and networks which focus on education, service development and mutual support Make recommendation to donors for the support of networking & coalition building at the district level Provide official recognition of initiatives happening in the Districts Recognize the long-term role to be played in working in partnership with government at the district level

Recommendation at the National Level

      

Recommendation for Donors

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 

Enable district dialogue and networking to happen through resource allocation and policies that support interaction at local level with district government Understand the benefits of promoting a decentralised whole-system approach to HIV and AIDS rather than piecemeal actions

Conclusion
Decentralised Transformative Approach to HIV-AIDS is an innovate way of ―generating the response‖ to halting the spread of the HIV Virus and caring for those infected and affected. According to the participant reports and follow-up commitments, the leadership development components created or strengthened in leaders a sense of hope, empowerment, and agency -- the belief that it is possible to stem the epidemic through their actions. It also offered valuable tools and skills with which to act upon that commitment; and directly contributed to learning lessons from a global perspective on what has worked (and what hasn‘t) in HIV/AIDS responses to date. The approach can positively impact national policy and service-delivery levels through clear national-district linkages. The facilitators group has formed its own network and is assisting in capacity development to national leaders based on their district experiences.
Special thanks must be given to the following people who without their vision, commitment and support, this programme could not have been successfully implemented. Henning Karcher, UN Resident Coordinator, Nepal Alessandra Tisot, UNDP Deputy Resident Representative, Nepal Bharati Silawal-Giri, UNDP Assistant Resident Representative, Nepal Anjani Bhattarai, UNDP Programme Officer, Social Development, Nepal Michael Hahn, UNAIDS Country Programme Advisor, Nepal Dr. Bal Krishna Suvedi, Director, National Centre for AIDS and STD Control, Nepal Mr. Nirmal Rijal, Consultant to the National Centre of AIDS and STD Control Dr. Malcolm Steinberg, Consultant to National Centre for AIDS and STD Control Mr. Ram Krishna Pokhrel, Senior Advisor Local Governance Programme Monica Sharma, Team Leader, BDP HIV/AIDS Group (UNDP Special Initiative) Robertson Work, Principal Advisor, Decentralised Governance, IDG/ BDP Sonam Yangchen Rana, Regional Coordinator HIV-AIDS & Development, SW Asia Mr. Anil Kumar Thakur, Local Development Officer of Morang DDC Mr. Daya Ram Thakur, Local Development Officer of Sunsari DDC NATIONAL FACILITATORS 1. Durga Raj Adhikari 2. Kamananda Jha 3. Usha Koirala 4. Rekha Subba 5. Madan Bista 6. Prabhakar Bhattarai 7. Pratima Rai 8. Khadga Bdr. Basnet 9. Pamfa Kafle 10. Sabita Kiorala 11. Mandira Koirala 12. Bishnu Sharma 13. Narayan Pradhan 14. Balkrishna Sharma 15. Ram Pd. Yakha 16. Arun Kumar Mehata 17. Dharmendra Shakya 18. Deependra Pokhrel 19. Santosh Kumar Dev 20. Dharma Raj Bhatta 21. Lila Raj Limbu 22. Sheila Wagle

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A.

Leadership for Results Frameworks

“The world, which we have made as a result of the level of thinking we have done thus far, creates problems that we cannot solve at the same level at which we created them”. Albert Einstein

Frameworks for Generating Deeper Understanding and Alignment: The following conceptual models form the basic underlying structure for Nepal‟s Leadership for Results Programme: 1. Transformational Leadership Competencies 2. Likert’s Levels of Organizational Development 3. Emotional Intelligence Framework 4. Four- Quadrant Framework –Holistic Thinking 5. Dynamic Planning Process (see section II)

1. Transformational Leadership Competencies
Leadership is a conscious process, starting with clarity about one‘s own personal goals and how these fit with the mission of the organization and with the strategy. Leadership requires that a person be highly self aware, able to manage one‘s self in stressful and complex environments, able to ‗read‘ other people, empathize with their needs and lead others to get the job done. Leaders need to know what inhibits effective individual and team performance and how to address these blocks. In other words, leadership requires a deep understanding of how social systems – and the people in them—must work together to achieve complex and challenging goals. What separates leaders from followers is the language they use, the environment they create, the meaning they make of the current situation, and how they communicate that to others. Therefore, when faced with challenging, perhaps even overwhelming situations, such as the HIV/AIDS pandemic for example, effective leaders draw upon tools that help them perceive the situation differently and enable others to respond based on the opening they create. Awareness of these kinds of competencies and distinctions are critical for leaders in today‘s demanding workplace, especially so for leaders that work in the response to HIV/AIDS, in which no magic bullet formula or road map yet exists.

Transformational Leadership: Generating Shared Commitments towards a Shared Future      Leadership is Being, Speaking, Listening, and Acting in a way that enables a community to effectively meet the challenges it faces Transformation occurs when you recognize, acknowledge, and give up an automatic ―way of being‖ in favour of making something new possible The certainty with which a leader acts comes from their commitments Transformational Leadership is cantered in self; expressed in community To build successful coalitions, listen for what goals there are in common, instead of attending to what‘s different

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Self-Directed Leadership: A Journey of Discovery
One cannot be mandated to learn or develop their leadership capabilities, they must be selfdirected if the process is to really work. This type of leadership development means getting a clear image of the type of leaders you want to be and an accurate picture of your real self. Change often means shifting habits, which have been learned early in life. Developing new capabilities takes time and practice until the behaviour becomes automatic. The following are the five discoveries or stages one goes through in developing new capabilities.

First Discovery: Second Discovery: Third Discovery: Fourth Discovery: Fifth Discovery:

My Ideal Self—Who do I want to be? My Real Self—Who am I? Strengths/Weaknesses My Learning Agenda: Build on Strengths; Reduce Gaps Experiment with new behaviour, thoughts and feeling Developing supportive and trusting Relationships that make change possible

Primal Leadership: Realizing the Power of Emotional Intelligence, By Daniel Goleman, Richard Boyatzis and Annie McKee The Courage to Lead by Brain Stanfield for exercises used in the five discoveries

Kamananda, a newly appointed community health worker is one example. He was a shy person. After the first training session, he has initiated and conducted 10 training sessions. She asked him, ―What image of yourself did you have when you first came to the TLS?‖ He replied that he was afraid to initiate things because he might be called a foolish person. ―Now what kind of image do you have of yourself? He said, ―I have gained confidence. I am not afraid to take the lead now. I began by giving presentations here and when I went back to my community and began practicing with family members who needed to hear the causes of HIV-AIDS.‖

2. Likert’s Levels of Organization Development The Rensis Likert Scale, a model of organizational development (see graphic), describes how organizations and institutions evolve through different stages, and how they— through strategic and conscious effort—can change their focus, goals and operating structures to become more self-aware, principled and effective. Every level that is achieved incorporates the strengths and lessons learned of the previous levels, but transcends their limitations to operate at a more integrated and effective level.

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Levels of Organizational Development

Unorganized Coercive - Autocrat Rules & Roles - Manager
1

2 3 4

Pragmatic - Leader Principled - Facilitator

Perspectivist
5
1. COERCIVE (also called Authoritarian Exploitative) The most primitive form of organization, exploitative and despotic. Attitude of the leader (as dictator) is that employees are animals and machines to be used up; more can be found to replace them. 2. RULES & ROLES (also known as Benevolent Authoritarian) Brute bureaucracy at its lowest form, benevolent in a paternalistic sense. Bosses are managers (micro-manage) creating the typical bureaucratic environment and rules: play it safe (risk aversion), look good (not necessarily be or do good), obey rules no matter what (no initiative or creativity), and don’t make mistakes. Positive aspects can be continuity and reliability. 3. PRAGMATIC Focused narrowly on results vs. narrowly on process as above. The desired result is the objective, sometimes ruthlessly and expediently achieved -- the end justifies the means. There are often unintended consequences. Boss appears charismatic and heroic leader, guides by example, and consult extensively with their teams. 4. PRINCIPLED Leaders position reverses – leader is now not at the forefront, but at the back, acting as a facilitator. The means are as important as the ends – how you achieve results is as important as getting the result. There is attention to sustainability and development. Organization and leadership is values-based. Leader’s job is to empower others and facilitate their development.

5. PERSPECTIVIST Involves intellectual humility, the ability to see through multiple lenses and apply different solutions to different problems without attachment to one approach or perspective. Principles are important but not adhered to blindly or dogmatically. At stage 4, we may become blinded by our values and become intolerant, believing that our values are “the truth”. In this stage, the intellectual and philosophical perspective can shift to respond to the needs of the situation. Leadership totally decentralizes and only appears when needed. It explains how organizations, as entities, tend to be governed by certain ground rules and assumptions. It describes how organizations and institutions evolve through different stages, and how they—through strategic and conscious effort—can change

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their focus, goals and operating structures to become more self-aware, principled and effective. Likert‘s model for organisational development also applies to human and leadership development. Understanding the ―personality‖ or ―style‖ of an organization or institution helps us better understand the roles we play as members of that community, and provides us with the opportunity to contribute to the transformation of that organization into one that is more able to achieve the goals it sets for itself. Using this model helps leaders at all levels of society become aware of leadership styles and approaches, and works as a framework in taking the next step towards a more developed stage as more effective and responsible leaders. 3. Emotional Intelligence

―Great leaders move us. They ignite our passion and inspire the best in us.”
Primal Leadership: Realizing the Power of Emotional Intelligence Daniel Gole man, Richard Boyatzis and Annie McKee Harvard Business School Press March 2002

Emotional intelligence2 describes abilities distinct from, but complementary to, academic intelligence or the purely cognitive capacities measured by IQ, enabling leaders to better deal with their own internal responses and state of mind, as well as how they deal with others. Specifically, emotionally intelligent leaders are able to do the following effectively:    Act in ways that leave the people around them (partners, team members, employees, community members, etc) feeling stronger and more capable; Manage themselves effectively under stress and/or when dealing with ambiguous circumstances; remain calm and stay focused; and Stay intensely in touch with what the people they lead are thinking and feeling, to motivate and energize them. EMOTIONAL INTELLIGENCE FACTORS SELF-AWARENESS Emotional Self-Awareness Accurate Self-Assessment Self-Confidence SELF-MANAGEMENT Self Control Transparency Adaptability Achievement Initiative Optimism
2

SOCIAL AWARENESS Empathy Organizational Awareness Service RELATIONSHIP MANAGEMENT Inspiration Influence Focus on Developing Others Change Catalyst Conflict Management Teamwork and Collaboration

Primal Leadership: Realizing the Power of Emotional Intelligence by Daniel Goleman, Richard Boyatzis and Annie McKee

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Innovative Techniques and Tools The following will be mentioned briefly as additional innovations in the seminars. Tools were used for developing emotional intelligence capabilities of the leaders.  Brainstorming and Mind Mapping  Varieties of group discussion Methods  Mental Rehearsal/Applied Imagination  Creativity Exploration—The Art of Possibility  Self-Awareness Practices  Social and Learning Styles  Four Levels of Inner Space—Dr. Jean Houston

4. Holistic Thinking: The Four-Quadrant Framework Aligning Values and Action The Four-Quadrant Framework3 helps facilitates awareness of the interaction between different domains of experience: Attitudes and actions, individual and group, social systems and societal structures. It deepens understanding of the HIV/AIDS epidemic by demonstrating the links between the individual and group attitudes or norms and consequent actions by individuals and groups. In planning for an expanded, extraordinary response, at individual, community and societal levels, it is important that we understand and employ these dynamics in our strategies to produce the desired results. The Four-Quadrant Framework lends itself very well to mapping exercises that graphically plot current reality from the perspective of 4 distinct domains: 1) 2) 3) 4) Individual attitudes that fuel the epidemic Individual behaviour Our values, norms and culture The systemic and sectoral response Four-Quadrant Framework Deepening Understanding: Aligning Values and Action Inner Realities Individual – attitudes and values External Realities Individual – behaviour and skills

Collective – culture and norms

Collective – systems and structures

3

Adapted from the work of noted social scientist Ken Wilber

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Mapping current reality allows us to put the HIV/AIDS epidemic in its social, economic and cultural context within a given country or locale. Mapping exercises look specifically at situations that may be relevant to HIV, the factors that favor the acceleration or impede its spread, and the factors that favor or impede achieving the best possible quality of life for those living with HIV/AIDS or for their families, friends and communities. For example, it is vital that we consider societal and individual values and actions in our strategic planning. The strategic planning process can be both a technical exercises and a truly effective, empowering and transformative process that aligns values and actions. Practice of Commitment Reflection using Wilbur Framework Context: Often when we debrief a project we focus on the external outcomes: What happened? What did we accomplish? Who was involved? In our debriefing we wanted to look at the internal outcomes both on the individual level and to those who participated (collective). These questions are for suggestions—others might be added or subtracted. Reflective Questions using the Wilbur Framework

I—Internal
    What were you feeling in the midst of the project? High Points? Low points What were your lessons? What insights did you gain to your own leadership capabilities?   

I—External
What did you do? What was easy to do? What challenges did you have to overcome?

Practice of Commitment Debrief
What was the experience  Who else was involved? of people who  What happened? participated?  What was the ‗ripple effect‘ or HIV-AIDSWhat shifts in attitude and ME  resonance of this project? happened?  What ‗new‘ messages GENDER, SEX, AND HIV/AIDS: Dialogue within Talking Circles were sent? 

WE-Internal The purpose of this session was to have a discussion on gender, sex and HIV/AIDS

WE—External

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TALKING CIRCLES The facilitator from her work in Indigenous cultures, shared with the seminar participants the ‗talking circle‘ as a way to reflect at a deeper level on the topic of HIV/AIDS as it relates to your experience. The process, creates ‗safe space‘, to enable participants to talk about their lives openly and completely. It is intended to be simple, yet profound. It is a time of listening deeply to oneself and each other from a place of understanding not from judgement or trying to ‗fix them‘. It provides a slower pace for reflection and shared understanding. An object such as stone or stick is used to designate the speaker. The person holding the object speaks and the other members of the circle listen. When the speaker finishes, the object is passed to the next person in the circle. This process continues until all members of the circle have spoken. No one is to interrupt the words of the speaker. It is possible to speak more than once by having more than one round in your group. Each person is given the opportunity to ―speak from the heart‖. All content is confidential and not to be shared outside the circle unless permission is given by the speaker.

Summary Sample of Participant Learning Statements            I realized that if individually we all do something on HIV/AIDS, then together we could reach our goal. This practice raised my own sense of responsibility. We can use the new techniques to reach less engaged stakeholders. My learning was in self-confidence, optimism and creativity. Internal result was self-awareness, positive thinking; external result was initiation of group work, decision to make VDC network and share information about HIV/AIDS I learned that most people do not know about HIV/AIDS, and I want to change that. It is much more effective to work in coordination with other organizations. I saw people change their attitudes about HIV/AIDS. I learned that to control the epidemic, we have to focus on simple things like using razor blade to shave men‘s beard. 95% of men were using a common knife to shave beard and it is now decreased through our awareness efforts. It is essential that we network with those organizations that are working in my area. I realized that we should change our traditional concepts about HIV/AIDS. Mostly the HIV/AIDS programs are conducted in the 5-star hotels of Kathmandu city. It will be more effective to conduct those programs in other areas of Nepal as well.

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APPENDIX B: CHARTS OF THE TWO PILOT DISTRICT PLANS

MORANG DISTRICT

(draft)

STRATEGIC ACTIONS DIRECTIONS Establish and expand counsellin g centre Expand incomegenerating Education Easily accessible blood test & medical treatment facility Training for health workers

STRATEGIC

Expand Treatment Facilities

Collection and updating of information and data with emphasis on implementation of plan

Policymaking, research and implementation based on HIV/AIDS district data

Sound management of district HIV/AIDS control cooperation branch

Accurate Information Branches

Education and skill development concerning HIV/AIDS

Develop manpower for organizational development

HIV/AIDS Organisational Development

Use of local resources through multi-sectoral participation and social mobilization.

Local Resource Mobilisation

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SUNSARI

DISTRICT

(draft)

STRATEGIC ACTIONS Harm reduction among primary risk group

STRATEGIC DIRECTIONS Accessibility and increase of quality service and facility

Reducing Harm among Primary Risk Groups

Sound management and expansion of counselling centre and service provided by infected people

Organising movement of self-awareness through integrated partnerships

Organisational development for the rights of survival of HIV/AIDS

Running Quality Counselling & Rehab Centres

Formation of committee at the local level, multisectoral participation and collaboration for problem identification, planning, implementation, monitoring and evaluation Awareness programme in the community involving infected people

Develop networking of the organisations working in the field of HIV/AIDS

Launching Integrated HIV/AIDS Effort

Behaving equally to the infected people, no stigma

Effective implementation of sex education through the curriculum

Implement Sex Education in Curriculum

Establishing HIV/AIDS information centre, data collection, updating and effective monitoring and evaluation of programme

Establish Effective Monitoring & Evaluation

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