Sonagachi Project: The Health Promotion Program Essay (Critical Writing)

Introduction

HIV/AIDS has become a serious infection in India. It has impaired not only India’s economy but also the welfare of Indian population. In India, sexually transmitted infections and HIV/AIDS are mainly through heterosexual behaviour. The most affected population group is the sex workers. They have formed the main conduit of transmission. As a result, most intention strategies are aimed at these groups.

Sonagachi Project was initiated to help the sex workers. The project is undertaken in Calcutta red light district. Red light district has over fifty thousand sex workers. It is the largest sex house in Southern and South Eastern Asia.

This paper analyses the scope of running Sonagachi Project through collaborative and individual contributions. The paper is based on the Sonagachi Project, which is an example of an excellent health promotion program. Consequently, it shows how different groups, both inside and outside players contribute to shaping a health intervention. In the study, the issue of how outside powers influence internal management of Sonagachi Project has been analysed. From the study, it is possible to determine the best policies for running community programs.

Community HIV prevention in Sonagachi

The culture of Indians does not allow a woman to have multiple partners. As a result, the most at risk population in India are the sex workers. Intervention measures are mainly focused on the at risk population. HIV/AIDS Intervention in Sonagachi project owes its strength to the sex workers. The project relies on peer group influence to achieve its goals. Peer education programs are rolled out, which engage the sex workers in training programs. The sex workers are then employed in health promotion fields. In advanced level, sex workers union has been developed. The union fights for the sex workers to hold the leadership of their projects for the benefit of the locals. Consequently, sex workers advocate for social and legislative changes to provide them with better working environment. The strength of the Sonagachi project has been the funds for HIV/AIDS.

Sex workers in Sonagachi live in abject poverty and face a lot of social stigma. The working conditions are unfavourable through harsh mangers ‘madams’ and ‘pimps’. HIV pandemic was so high that in 1992, the Sonagachi project was initiated. The project started by offering peer education. It developed into community development project, which offers crisis resolution between the sex workers and their employers. Sonagachi project empowers sex employees to develop under the philosophy of respect, reliance and recognition. According to Jana, the 3R philosophy was based on “That is respect of sex workers and their profession; recognising their profession, and their rights; and reliance on their understanding and capability” (Jana et al. 2004, p.11).

To strengthen the philosophy, most of the project top management positions are taken by sex workers themselves. Additionally, the sex workers are the occupants of administrative and decision making roles in the project. Elections of problems solving committee in red light district for community development are done among the women sex workers. The women have an organisation, a sex workers’ organisation, Durbar Mahila Samanwaya Committee (DMSC) – in English, this translates to ‘Unstoppable Women’s United Committee’. The committee organises weekly and monthly meetings to solve cases. Apart from solving cases, the committee laid strategies for creating political awareness, enhancing stigma management and developing collecting bargaining methods in their work.

As a result of this project, condom use has significantly increased. Consequently, there has been a decrease in sexually transmitted infections. In his research, Basu notes, “A recent two-community controlled trial replicating the Sonagachi model outside Kolkata showed that condom use increased significantly in the intervention site (Basu et al. 2004, p.848). Sonagachi project is one of the best examples of community speared projects. It has succeeded in health intervention and promotion programs, creating sustainable development in the community, mobilising the community members and having a long life span of over fourteen years. Most of the achievements of the project are owed to its management system and partnership with non sex workers (Wingood et al, 2010).

Contemporary health program approach identifies communal leadership and ownership of health promotion interventions among marginalised groups. Nevertheless, the communities might not be in a position to manage and run successful programs based on complexities of some projects. This paper examines a pure community led program in Calcutta. The paper conceptualises the scope of participatory system. This project was initiated as a promotion of health services among sex workers. Among the main goals of the project was to reduce HIV/AIDS incidences and STI infections. Sex workers propagated information on promotion of behaviour changes. The group also referred their fellows to medical clinics. Their participation was not limited healthcare; they empower sex workers to fight for their rights and better working condition.

Clubs Relations

Sonagachi project is not the only sex workers organisation in the area. Several sex workers clubs are trying to imitate Sonagachi. Since red light district is made up of people in low social class, they try through creation of organisations to fight for their rights. However, most of these clubs are managed by men. As a strengthening machine, they have political parties, which are mainly men elected. Most of these men harass and exploit sex workers through their political influences. Sex workers have suffered under these political parties while seeking their protection (Cooke & Kothari 2001).

Sonagachi project has transformed the clubs. The project has not interfered with sex workers business or politically influenced the clubs voting system. Sonagachi project leaders’ invites clubs’ managers to their meetings and training programs. They ensure health promotion activities are carried out in most of the clubs in the red light district (Cornish & Ghosh 2007). The project has taken initiative of collaborating with the clubs as their clinic areas. Mostly, they erect tents and carry out health promotion activities. On the other side, they solve disputes between the management of the clubs and their employees. As a result of these intervention strategies, in 2005, most of the club managers felt that they were being neglected by their employees. Most of the employees were running to Sonagachi project for assistance (Evans & Lambert, 2008).

Community participation in Sonagachi Project

From its initiation stage, community participation was framed to counter inequalities coming from top-down project managements (Cohen et al. 2011). For example, the World Bank introduced its participatory idea, which contrasted the “external expert system.” Since the external experts come with their own priorities in developing programs, involvement of local communities encouraged egalitarian and democratic system. The system catered for the local people’s priorities and needs (Centers for Disease Control and Prevention 2011). As a result, the program reduced unequal and undemocratic development in Sonagachi. It eliminated health intervention inequalities through prioritisation of the local groups own needs. This approach was people centred and Sonagachi community taken as homogenous Community (UNAIDS 2002). The community values have been communicated to the stakeholders in effective terms that promote participation, empowerment and engagements (Busza 2004).

According to research carried out by Shiffman, “participatory projects has revealed that groups who wield greatest power, including the state, development professionals, and local elites, continue to dominate” (Shiffman 2002, p. 89). Despite the locals’ priorities, such projects as HIV/AIDS preventions usually fall into financial constraints (National AIDS Control Organisation, 2004). When external bodies overpower the local communities, they employ external professionals who draw their plans without consideration of immediate community needs (Balaji et al. 2009). As a result, the powerful groups normally take advantage of the locals. Most such projects have shown the misappropriation of funds. According to Cooke and Kothari, “in the light, the prospects for genuine community leadership seem dismal, and the notion of participation appears as a misleading ‘tyranny’” (Cooke &Kothari 2001, p.112).

Sonagachi project is a well ground of studying effective community participatory approach in health prevention and empowerment. It is rooted on cultural and historical growth of the community (Shannon & Montaner 2012). However, researches have also shown that some interventions without strong external expert leadership have failed. In respect to Sonagachi project, the limits of community participation in health intervention include project implementers, marginalised social classes, experts, interested groups and health policy makers (Apondi et al, 2011)

Conceptual Approach

Sonagachi community project can be understood either as people of the same geographical region or who share interest and identities (Shiels et al. 2011). As a result, the community is founded under homogeneity of members. They are equal in health intervention needs. They form the marginalised and target group, the sex employees. As a result, participation in intervention programs is very crucial (Jana et al 2004, p.411).

Through their collusion, the community has managed to build its own power of interest. Sex workers in red district are interdependent and, as such, share many common interests. This is normally the expectation of many community approaches. This is supported by “What holds community members together is not simply the fact that they live in the same locality, nor that they necessarily share an identity, nor that they are equals, but that they are a part of an interdependent system in which their actions have effects on each other by virtue of their participation in a joint activity” (Van Vlaenderen, 2001, p.14).

Public Health Care Intervention Strategies

The Sonagachi Project has been developed on the basis of public health needs assessment and prioritisation. Its success has been attributed to focus on individual as well community aspects in health care provision. Since the community members have active participation in the project, priorities have been to their advantages. Consequently, the decision making body of the project also lies with the sex workers themselves (Kelly 1999). Sonagachi has taken active promotional and educational preventative measures as the best public approach in dealing with the sex workers situation rather than curative measures. Going by public health principles, a lot can be achieved through preventative measures than a curative approach (National AIDS Control Organisation, 1999).

Additionally, the Sonagachi project is founded on strong collaboration with different partners. The government actively participates by provision of enabling legal systems and findings. Sonagachi is among few projects that have faced limited or no political interference, as a result of enabling environment created by the government. Many organisations have been accommodated in the project including the United Nations partners and the Centre for Disease Control and Prevention. Sonagachi also works with many local partners such as the public health department, environmental management bodies, clinical departments and church based organisations. At the community level, Sonagachi project has close ties with almost all the clubs in the red district. On the other hand, the project carries out community wide outreach programs that makes it closely tied with most groups in the red district.

Sonagachi Project was initiated and spearheaded by sex workers. There has been also significant outside interventions from the government and other organisations. The program is a peer group outreach. Statistics such as UNAIDS have shown a significant decrease in STI and HIV/AIDS prevalence. Moreover, condom use has been on increase among sex workers. Sonagachi Project has achieved goals like formation micro-credit centres, offering vocational training programs and sex workers having unions. Sonagachi Project has depended on professional agencies and funding partners. As a result, the community has expanded beyond the sex workers alone. Given the nature of HIV/AIDS infection, outside assistance was necessary for project success. Outside assistance has also increased sex workers participatory interests. Most project planning are done by outside bodies, however, the sex workers actively implement the plans.

The acceptance of Sonagachi project in the red district is a sign that the project has effectively involved the community. The project resource allocation is determined by the community prioritised needs. Resources are channelled to basic needs such as management of condom distributions and sponsoring mentoring clinics (Parker, 2002). The project managers have maintained high standards of accountability and transparency. As a result, they have attracted many donors into their projects. Sonagachi adoption of expert team advisors has help the project break more grounds in managing their projects (Bandyopadhyay & Banerjee 1999).

Conclusion

Sonagachi Project has remained one of the most successful community led public health program. Its success has been recorded in various fields such as the increase condom use has been on increase among sex workers, formation micro-credit centres, offering vocational training programs and developing sex workers unions. The project has enhanced its promotional and educational programs in the target groups. While most organisations fail in managing their funds and falls in short run, Sonagachi has survived for 14 years with high accountability and transparency in their resource management.

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