Revising the Script: Taking Community Mobilization To Scale For Gender Equality

For those in the world of international human rights and development programming seeking to eliminate harmful social norms and practices at a global level, the steps to scale up seem relatively clear. Step one: Develop an innovative new approach to solve a pressing social problem. Step two: Prove the effectiveness of the approach through rigorous evaluation techniques. Step three: Having established the approach’s “evidence-based” credentials, share it widely!

Innovate, evaluate, scale up.

Of course, this is a heavily curtailed presentation of this process, which includes many additional steps, stresses, and potentially decades of demands on program teams. But its essence is undeniably compelling all the same, even common sense. New innovations are needed to solve unsolved problems. These innovations can only be proven to be effective if they are subjected to high scrutiny. And if they do work, then perhaps there is even an ethical or moral obligation to share them widely. In the case of a new vaccine for a widespread infection, for instance, this central script is tried and true. Previously devastating diseases have become historical footnotes thanks to some variety of “innovate, evaluate, scale up.” But not all innovations are as easily replicable as vaccines, of course, and practitioners and scholars in the human rights and development world are starting to uncover particular challenges in trying to follow this script for their innovations.

This brief exploratory study aims to inform the nascent conversation about the challenges of applying the “innovate, evaluate, scale up” script in one compelling field of recent innovation: community mobilization approaches to address socially and politically sensitive issues, particularly but not exclusively intimate partner violence. Intimate partner violence, for instance, is different in important ways from many other development and human rights challenges. This form of violence rest upon unequal power among the genders, and the central importance of power to this challenge makes preventing this violence more of a political issue than, for instance, eradicating polio. If ending intimate partner violence almost certainly requires transforming historic and deeply held social norms and power structures, what exactly does “scale up” mean? Who could or should undertake it?

Secondly, community mobilization approaches are likely effective precisely because of certain factors – among them, leadership by local activists and a central message of re-imagining power in society – that are difficult to reconcile with the realities of the public or private sectors that may be best placed to operate “at scale.” Ministries of health exist at least in part to support large-scale efforts to eradicate diseases, for instance; at least as yet, national governments don’t tend to feature Ministries of Dismantling the Patriarchy or Ministries of Gender Justice!

The authors of this study recognized that, at the outset, very little about these precise dilemmas had been written. As such, we set out to answer three guiding research questions at the heart of these dilemmas, with a balance of literature review and conversations with programmers who had faced similar challenges:

1. How have implementers of community mobilization initiatives attempted to “scale up” their efforts to shift attitudes about intimate partner violence and other socially and politically sensitive issues?

2. To what extent have any such approaches achieved success and effectiveness in “scaling up” to a national, regional, or international level?

3. What are the most salient obstacles, challenges, and lessons that have emerged from prior efforts to take these community mobilization approaches to scale?
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A cluster randomized-controlled trial of a community mobilization intervention to change gender norms and reduce HIV risk in rural South Africa: study design and intervention

Abstract
Background: Community mobilization (CM) interventions show promise in changing gender norms and preventing HIV, but few have been based on a defined mobilization model or rigorously evaluated. The purpose of this paper is to describe the intervention design and implementation and present baseline findings of a Cluster Randomized Controlled Trial (RCT) of a two-year, theory-based CM intervention that aimed to change gender norms and reduce HIV risk in rural Mpumalanga province, South Africa.

Methods: Community Mobilizers and volunteer Community Action Teams (CATs) implemented two-day workshops, a range of outreach activities, and leadership engagement meetings. All activities were mapped onto six theorized mobilization domains. The intervention is being evaluated by a randomized design in 22 communities (11 receive intervention). Cross-sectional, population-based surveys were conducted with approximately 1,200 adults ages
18–35 years at baseline and endline about two years later.

Conclusions: This is among the first community RCTs to evaluate a gender transformative intervention to change norms and HIV risk using a theory-based, defined mobilization model, which should increase the potential for
impact on desired outcomes and be useful for future scale-up if proven effective.

Trial registration: ClinicalTrials.gov NCT02129530

 

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Conceptualizing Community Mobilization for HIV Prevention: Implications for HIV Prevention Programming in the African Context

Introduction: Community Mobilization for HIV Prevention

 Community mobilizing strategies, designed to engage and galvanize community members to take action towards achieving a common goal [1], are increasingly recognized as essential components of HIV prevention programs. In the area of HIV prevention, community mobilizing interventions have demonstrated successes in increasing condom use [2-7], improving service access and quality [7,8], increasing social capital or social cohesion [7,9] and most recently in promoting uptake of HIV counseling and testing [10]. Beyond these demonstrated successes, community mobilization (CM) will play a key role in effective implementation of key bio-medical interventions in the future. For example, landmark trials have demonstrated the efficacy of early antiretroviral treatment (ART) for HIV positive individuals to prevent transmission to uninfected partners [11] and providing ARTs to high risk HIV negative individuals to prevent acquisition of the virus [12]. The success of treatment-as-prevention approaches hinges on developing CM strategies to inspire broad support for care and treatment for those living with or at elevated risk for HIV/AIDS, their providers, and their family and community networks. Unleashing the potential of community mobilization for HIV prevention is particularly critical in sub-Saharan Africa, which shoulders 70% of the global HIV epidemic [13].

Community mobilization interventions to prevent HIV have varied widely in tactics and focus. A number of CM efforts have included components that address the larger social and structural context surrounding HIV, including efforts to reduce discrimination against groups most vulnerable to HIV; to create social cohesion and extend social networks for disenfranchised communities; and to ensure community participation in prevention and care programming [14-17]. The best known HIV prevention mobilizing effort was undertaken by sex workers in Sonagachi (Kolkata), India. Over 15 years of evolving participatory prevention and organizing, condom use increased and remained high and HIV prevalence declined and remained low among sex workers in Kolkata as compared to sex workers in other Indian cities [3].

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