Final Evaluation
HIV/AIDS IMPACT Mitigation through 
Mobilizing Affected Communities Project
Kanchanpur District
Nepal
Submitted to the Save the Children USA, 
Himalayan Field Office
Submitted By:
Brian Gilligan
Dr. Pulkit Choudhary
July 17, 2003
1
Table of Content
Executive Summary...................................................................................................................... i
Acknowledgements.....................................................................................................................vi
Acronyms ...................................................................................................................................vii
1. Introduction ............................................................................................................................ 1
1.1 Project in Brief............................................................................................................... 1
1.2 Evaluation Purpose and Scope .................................................................................... 1
1.3 Evaluation Methodology................................................................................................ 2
1.4 Evaluation Limitations and Challenges......................................................................... 3
1.5 Organization of the Report............................................................................................ 3
2. Project Description................................................................................................................. 4
2.1 Background ................................................................................................................... 4
2.2 Disbursements to Date.................................................................................................. 5
2.3 Monitoring and Reporting.............................................................................................. 5
3. Relevance.............................................................................................................................. 6
3.1 Findings and Recommendations .................................................................................. 8
4. Effectiveness/Efficiency....................................................................................................... 10
4.1 Findings and Recommendations ................................................................................ 16
5. Impact................................................................................................................................... 18
5.1 Findings and Recommendations ................................................................................ 20
6. Sustainability ........................................................................................................................ 21
6.1 Findings and Recommendations ................................................................................ 23
7. Conclusion ........................................................................................................................... 25
Appendix A: People, Groups and Facilities Visited................................................................... 26
Appendix B: Summary of Deliverables to Date......................................................................... 28
i
Executive Summary
In May 2003, evaluators were engaged by Save the Children USA (SC/US) to conduct a final 
evaluation of the HIV/AIDS IMPACT Mitigation through Mobilizing Affected Communities 
Project in Kanchanpur District, Nepal. SC/US undertook this evaluation as a part of their 
funding agreement with the United States Agency for International Development (USAID) and 
to document the project’s experiences and lessons learned. 
The HIV/AIDS IMPACT Mitigation through Mobilizing Affected Communities Project in
Kanchanpur District was funded from June 14, 2001 to June 13, 2003 by USAID, to reduce 
the susceptibility and vulnerability of children and families to HIV/AIDS in communities from 
where male migration to India is endemic. This was attempted through capacity building, 
community mobilization, development of community program options, creation of referral and 
linkage systems, and the initiation of care and support activities. The implementation of this 
project was undertaken by SC/US in partnership with two local non-governmental 
organizations (NGOs): the Nepal Red Cross Society (NRCS) and the Nepal National Social 
Welfare Association (NNSWA). 
To help assure a systematic exploration of project performance, an evaluation matrix using 
four accepted criteria was developed to organize key questions and data collection: (1)
Relevance, (2) Effectiveness/Efficiency, (3) Impact, and (4) Sustainability. The findings 
and recommendations of this evaluation are organized by these four criteria.
Relevance:
The evaluation findings…
1. The project was relevant to a growing need for HIV/AIDS community-based impact
mitigation in Kanchanpur District. It was also successful in developing synergies with 
other relevant projects, bodies and activities in the district.
2. The building of district- and community-level support for this project through awareness 
raising and sensitization was a pre-condition of success for this project. Had the project 
attempted to mitigate the impact of HIV/AIDS at the community level without first dealing 
with the existing levels of ignorance, denial, stigma and discrimination, the project would 
not have been successful. 
3. Given the project’s success in eliminating stigma and discrimination, there is now an 
opportunity to more fully engage affected households. Given increased partner skills in 
engaging with these households, this can be done in a manner that does not create 
unrealistic expectations of project delivery.
4. Original misunderstandings of the purpose of the project were related in part to the project 
being unable to deal with priority issues (i.e. income generation, support for affected 
households) identified by the target communities in the rapid assessment.
5. The project would have benefited from an initial planning workshop for partners to develop 
and agree upon a shared understanding of the project, including the key concepts of 
“impact mitigation” and “care and support”, and to develop a communication plan for 
disseminating this understanding to stakeholders and the wider community. 
6. The relevance of referral and linkage systems are related to whether the systems can put 
people in contact with the services that they require (i.e. care and support, VCT, income 
ii
generation). When such systems are developed, they must not only include available 
services but also consider the inclusion of services identified and required by the
communities. 
7. Prevention activities must be integrated in HIV/AIDS impact mitigation projects as a part of 
a prevention to care continuum.
The evaluation recommendations…
1. Any future major impact mitigation project in Kanchanpur should build upon and continue 
the awareness building and sensitization work of this project.
2. Any future major impact mitigation project in Kanchanpur should include a size estimation 
of the households affected by HIV. It is also recommended that a study be undertaken of 
the sexual behaviors of migrant men while residing in Kanchanpur.
3. Any future impact mitigation project in Kanchanpur should engage affected households 
and their members in needs identification, and project design and implementation. 
Involvement in implementation could include both governance and delivery. 
4. Any future impact mitigation project should ensure clarify of its objectives with beneficiary 
communities and stakeholders prior to implementation. This should include clarification of 
the project’s relationship with those who are affected by what are considered HIV/AIDS 
opportunistic infections (e.g. TB, ARI, diarrheal diseases) and require care and support but 
who may or may not have HIV/AIDS.
5. Any future major impact mitigation project in Kanchanpur should work to ensure that 
community needs for on-going prevention services, VCT, expanded care and support, and 
income generation opportunities are met either within or outside the project. 
Effectiveness/Efficiency:
The evaluation findings…
1. The project has successfully achieved its deliverables and reached the targeted
beneficiaries. This success can be attributed to the project’s strategy of awareness 
building, mobilization, and development of district bodies, community organizations, and 
care providers throughout the life of the project. This was essential to develop district and 
community level support and advocacy for the project. The building of partner and care 
provider capacity, the use of experienced local partners, and the efforts expended on 
coordinating stakeholders were also important factors.
2. The project, through its work to reduce stigma and discrimination, has created an
opportunity for people who are HIV+ and their families to become fuller participants in the 
process of both defining their status as beneficiaries and determining their needs. 
3. Because of the large number of stakeholders involved and the use of referrals and
linkages to match affected households with needed services, large coordination efforts 
were required.
4. Any project that mobilizes FCHVs should also mobilize Maternal and Child Health Workers 
(MCHW), as the primary support structure for the FCHVs.
iii
5. There is an opportunity for a community-based impact mitigation project to provide
affected households with “legacy support”, helping terminally ill parents to plan for their 
children’s well-being and future (e.g. guardianship, inheritance, family unity).
6. Pilot projects need to be explicitly designed as such: formalizing and documenting
learning. Without this explicit understanding, project staff is committed to the
implementation of project activities, without the parallel obligation to reflect on their
implementation in an organized and systematic manner. 
The evaluation recommendations…
1. The project staff of the HIV/AIDS Impact Mitigation through Mobilizing Affected
Communities Project should conduct a facilitated review exercise to analyze and
document the experiences of this project, and suggest how the programming approaches 
used could be replicated or expanded. Such a review should also identify the unmet 
needs of affected and vulnerable households.
2. Any future major impact mitigation project in Kanchanpur should include (1) a needs 
assessment of care and support requirements, (2) the development of a shared
understanding of community-based care and support, and (3) a framework to assist
communities to develop their own options and to set priorities for resource allocation. A 
clear linkage should also be established with VCT and prevention programming. 
Such a future project must be built upon a base of aware, supportive and mobilized 
communities and district stakeholders. 
3. Any future major impact mitigation project in Kanchanpur should include the development 
and availability of technically proficient and experienced staff to train and support
community- and home-based care-providers (including counselors). Such expertise could 
be developed either within district-based project staff or within the office of the DPHO. 
There is a need for the counseling centre at the Mahakali Zonal Hospital to become more 
accessible and physically welcoming, and able to offer prevention services.
4. Any future impact mitigation project in Kanchanpur should include the capacity building of 
MCHWs and the development of “legacy support”. Any future referral system should 
include links to adjacent Indian testing and treatment facilities. This would be particularly 
important for Chandani and Dodhara VDCs, where people normally access Indian health 
services because of their proximity.
5. Any future impact mitigation project Kanchanpur should involve affected households in 
project implementation, including governance and delivery. Specific activities for
consideration include the employment of people with HIV in the project, the use of HIV+ 
volunteer peer workers, the establishment of a project advisory group of affected
households, and the use of participatory monitoring and evaluation methodologies with 
beneficiary affected households.
6. Any future major impact mitigation project in Kanchanpur should integrate the lessons 
learned from this project on the use of local partners, including role delineation.
7. Any future major impact mitigation project in Kanchanpur should develop and apply
standard project management tools and ensure partner compliance with these tools.
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Impact:
The evaluation findings…
1. The project has appeared to reduce the vulnerability of affected households and increase 
their well-being. Partner NGOs and community bodies exhibited newly developed
capacity to support community efforts to assist affected households.
2. The project’s work to reduce stigma and discrimination was critical to developing the 
enabling environment required for communities to mitigate the impact of HIV/AIDS. The 
use of PLA and PRA methodologies were an important component in increasing
awareness, and reducing stigma and discrimination. This has created an opportunity for a 
fuller involvement of people with HIV and their families in the project.
3. Involvement of local government and community bodies was important to create
ownership of community-based impact mitigation activities.
4. An unintended impact of the project’s awareness building and stigma and discrimination 
reduction efforts was an increased community demand for VCT and increased care and 
support, including drugs for opportunistic infections.
5. An unintended impact of the project’s community mobilization activities was the desire of 
community bodies (i.e. VACC/MACC) to engage in impact mitigation activities using their 
own resources. It would be important next step to develop the capacity of these bodies to 
formally engage their communities to assess needs, set priorities, and make plans on how 
to best use their limited resources. It would also be important to further develop their 
capacity to coordinate with community and external bodies.
The evaluation recommendations…
There are no recommendations specific to this section.
Sustainability:
The evaluation findings…
1. Community and local government bodies have expressed willingness and demonstrated 
an ability to carry on the work of the project (with the exception of the central counseling 
centre) within the limits of their capacity and resources. There remains some concern of 
the planning capacity of community bodies to assess community needs, set priorities, and 
commit resources.
2. There is a need for more time and resources to “set” the project’s successes. 
3. There are concerns about the ability of poor communities to deliver impact mitigation 
services, including community-based care and support, as the epidemic increases in size. 
Community reliance on fund raising and a charity model may not be sustainable given the 
limited funds available in the community. There are also concerns about the level of 
responsibility that can be placed on community volunteers to deliver services.
4. Sustainability of the project is threatened by a lack of income generation and employment 
opportunities.
v
5. If the project were to be expanded, there would be a need to systematically develop the 
services required by the community and to ensure their delivery either within or outside the 
project. 
6. With the project focus on the creation of an enabling environment, it is inevitable that 
community demand for impact mitigation will increase. As such, the sustainability of this 
project is linked to the ability to expand the project to include these needed services. The 
replication of this project in other parts of Kanchanpur District would also result in
increased demands for these services.
7. Despite past challenges, there is a need to fully engage the public health system. The 
ongoing operationalization of the National HIV/AIDS Strategy may provide some direction 
and support in the areas of prevention of HIV/AIDS among migrants and their families, 
VCT, PMTCT, protocols on the management of opportunistic infections, and social
protection for people who are HIV+ and their families.
The evaluation recommendations…
1. Any future impact mitigation project in Kanchanpur District should continue to build the 
capacity of community bodies to plan. This includes the capacity to assess needs, set 
priorities and commit resources, as well as coordinate with stakeholders.
2. Any future major impact mitigation project in Kanchanpur should assess the capacity of 
poor communities to support an increasing number of affected households. An
assessment should also be conducted on the level of responsibility that should be placed 
upon community volunteers and what support systems are required.
3. Any future major impact mitigation project in Kanchanpur should review the linkages 
between the project and the public health system, including the NCASC. As elsewhere, 
there is the dilemma of whether to build the capacity of an under-performing system or to 
build local capacity outside or parallel to the public system. This includes questions of 
whether communities should be generating funds for OI treatment, or NGOs should be 
delivering care and support, counseling and VCT services. These issues go far beyond 
this project but should be addressed in the absence of a response from the public health 
system. The project should be prepared to create synergies with the impending
operationalized National HIV/AIDS Strategy.
4. Any future impact mitigation project in Kanchanpur should move community bodies and 
volunteers from a primary focus on fund raising, to one that includes advocacy and the 
promotion of self-help, better using existing community resources. Following the example 
of Daijee VACC, more analysis is needed on the use of community resources to pay for 
the drugs required for opportunistic infections and palliative care.
5. Any future impact mitigation project in Kanchanpur should be an expansion and not a 
replication of this project. Given increasing awareness and the resulting increasing 
demand for services, an expanded project should ensure that VCT, prevention services, 
expanded community-based care and support, and income generation and employment 
opportunities are available. Such an expansion should be built upon the awareness, 
acceptance, built capacity, and mobilization of the current project, but should also involve 
a more systematic needs assessment, a framework for service delivery of community￾based care and support, and technical support to care providers.
vi
Acknowledgements
This evaluation would not have been possible without the cooperation of a great number of 
people. The evaluators would like to firstly thank Tara Karki Chettry of the Kathmandu Field 
Office of Save the Children USA for her assistance in organizing the evaluation and field visit. 
Secondly, the success of the field visit would not have been possible without the assistance 
and candor of the Project Coordinator, Lok Raj Bhatta. The observers from Family Health 
International, Jesper Svendsen and Barat Mani Pant provided the evaluators with valuable 
input on HIV/AIDS care and support. The Project Coordinators for the partner NGOs, Manoj 
Bhatta of the Kanchanpur chapter of the Nepal Red Cross Society (NRCS) and Bhim B. Simal 
of the Nepal National Social Welfare Association (NNSWA) also provided the evaluators with 
access to all aspects of project implementation and gave freely of their time and opinions. 
Many project staff from the NRCS and the NNSWA, as well as local government officials and 
community leaders were also generous with their time and opinions, and allowed us to
observe their work. Finally, a sincere and humble acknowledgement of the many community 
members, particularly those living with HIV/AIDS and their families, who welcomed us into 
their lives and homes, and shared patiently and with dignity, their stories on the impact of 
HIV/AIDS on their communities.
It is our intention and hope, as evaluators that this report presents the information and views 
received during our field visit, with the same honesty and respect that were accorded to us.
vii
Acronyms
AIDS Acquired Immune Deficiency Syndrome
BCC Behaviour Change Communication
DACC District AIDS Coordination Committee
DPHO District Public Health Officer
FCHV Female Community Health Volunteer
GIPA Greater Involvement of People with AIDS
HIV Human Immuno-deficiency Virus
HIV+ HIV Positive
J/YRCC Junior/Youth Red Cross Circle
MACC Municipal AIDS Coordination Committee
MCHW Maternal and Child Health Worker
NCASC National Centre for AIDS and STD Control
NGO Non-Governmental Organization
NNSWA Nepal National Social Welfare Association
NRCS Nepal Red Cross Society
OI Opportunistic Infections
OVC Orphaned and Vulnerable Children
PASC Project Advisory and Support Committee
PE Peer Education/Educator
PHC Primary Health Centre
PLA Participatory Learning and Action
PMTCT Prevention of Mother-to-Child Transmission
P/NGO Partner Non-Governmental Organizations
PRA Participatory Rural Appraisal
PW Peer Worker
SC/US Save the Children USA
STD/STI Sexually Transmitted Disease/Infection
USAID United States Agency for International Development
VACC Village AIDS Coordination Committee
VDC Village Development Committee
VCT Voluntary Counseling and Testing
WBS Work Breakdown Structure
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 1
1. Introduction
In May 2003, Brian Gilligan and Dr. Pulkit Choudhary were engaged by Save the Children 
USA (SC/US) to conduct a final evaluation of the HIV/AIDS IMPACT Mitigation through 
Mobilizing Affected Communities Project in Kanchanpur District, Nepal. SC/US undertook 
this evaluation as a part of their funding agreement with the United States Agency for 
International Development (USAID) and to document the project’s experiences and
lessons learned. 
1.1 Project in Brief
The HIV/AIDS IMPACT Mitigation through Mobilizing Affected Communities Project in 
Kanchanpur District, was funded from June 14, 2001 to June 13, 2003 by USAID, to 
reduce the susceptibility and vulnerability of children and families to HIV/AIDS in
communities from where male migration to India is endemic. This was attempted through 
capacity building, community mobilization, development of community program options, 
the creation of referral and linkage systems, and the initiation of care and support
activities. As a short-term project, intended to pilot community-based HIV/AIDS mitigation 
approaches, it was limited to half of the wards in four Village Development Committees 
(VDCs) and one municipality.
The implementation of this project was undertaken by SC/US in partnership with two local 
non-governmental organizations (NGOs): the Nepal Red Cross Society (NRCS) and the 
Nepal National Social Welfare Association (NNSWA). The funding for this project was 
US$266,660 of which US$200,000 was provided by USAID as a grant. The period of 
funding for the local partners was from December 1, 2001 to June 13, 2003, for 18 months 
of programming. 
1.2 Evaluation Purpose and Scope
The primary purposes of this evaluation were to assess the impact of the project, highlight 
the lessons learnt, and serve as a basis for any future planning to undertake related 
projects.
The scope of the evaluation included community mobilization, male involvement as 
educators, effectiveness of the District, Village and Municipal AIDS Coordinating
Committees (DACC, VACC and MACC), home-based care, counseling, referral networks, 
behavior change communication, capacity of partner NGOs, advocacy, sustainability, and 
linkages. 
The objectives of the evaluation, as listed in the terms of reference, included instructions 
to:
· Assess the changes in communities knowledge, attitude and behavior and compare 
this knowledge with baseline knowledge from the rapid assessment
· Identify gaps, barriers and constraints of implementation, and determine why these 
gaps/barriers/constraints occurred, and how they can be resolved
· Assess the impact of the program in the communities – in terms of care and support, 
stigma and discrimination, and VCT implications. Determine which strategies were 
most effective in changing knowledge, attitude and behavior of target groups,
stakeholders and key decision-makers. WHY were these strategies most effective?
· Assess quality of program management of SC/US and P/NGOs, including supervision, 
monitoring and assessment of feedback given by both parties
· Assess how the program has addressed sustainability. 
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 2
· Assess capacity of NGOs and determine which capacity building activities were most 
effective. Determine additional capacity building needs.
· Identify lessons learned in the project, suggesting reasons for particular successes 
and failures. Suggest mechanisms and approaches to share lessons learned with a 
wider audience. Suggest how these lessons learned can be used in other districts.
· Assess the appropriateness of project management, project resource use. 
1.3 Evaluation Methodology
The evaluation began with a desk review of project documents and interviews with key 
SC/US staff in Kathmandu, as well as with members of the Nepal office of Family Health 
International (FHI). FHI staff, at the request of USAID, accompanied the evaluation team
to the project site.
Between June 1 and June 6, 2003, guided by an approved evaluation work plan, the 
evaluation team (1) interviewed the SC/US Regional Program Manager in Nepalgunj, (2) 
interviewed SC/US, NNSWA and NRCS project staff in Kanchanpur, (3) interviewed local 
public officials, community leaders, activists, service providers and recipients, (4)
conducted focus group discussions with community members, and (5) visited project sites. 
Table 1: Summary of Interviews/Focus Groups and Site Visits
Participants Involved and Sites Visited Number
Save the Children USA 5 staff; 3 sites
Family Health International and Care Nepal 4 staff
Nepal Red Cross Society 3 staff; 2 sites
Nepal National Social Welfare Association 2 staff; 3 sites
6 Mothers’ Groups – Focus Group Discussions 125 members; 6 sites
Jhalari VDC Female Community Health Volunteers – Focus Group 
Discussion
24 FCHVs
Female Community Health Volunteers 3 FCHVs
Heads of Households affected by HIV/AIDS 9 (8 women; 1 man)
Mahakali Zonal Hospital 2 staff
Main Counseling Centre and 2 Peripheral Counseling Centres 2 staff; 3 sites
Chief District Officer, Local Development Officer, District Public Health 
Officer
3 staff
4 Village AIDS Coordinating Committees 45 members; 4 sites
Traditional Healers 2 healers; 2 sites
Male Peer Workers 13 members; 2 sites
3 Youth/Junior Red Cross Circles and Teachers – Focus Group 
Discussion
62 members; 2 sites
A complete schedule of those interviewed and the sites visited is included in Appendix A. 
The evaluators were able, following the work plan, to meet with a range of people involved 
in the projects and gain a broad view of its work and impact, as well as its lessons learned. 
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 3
To assure these inquiries systematically explore project performance, an evaluation matrix 
using four accepted criteria was developed to organize key questions and data collection.
Relevance: Is there a need for the project?
Effectiveness/Efficiency: Did the project deliver what it said it would to its intended 
targets? Was the delivery efficient, making the best use of project staff, funds and time?
Impact: What are the project’s lasting results, intended and unintended?
Sustainability: Ability of project partners, stakeholders and beneficiaries to continue the 
work of the project? Is there potential for the project to be “scale-up” and expanded?
1.4 Evaluation Limitations and Challenges
In delivering this evaluation, the evaluators identified several limitations and challenges.
1. This evaluation was intended as a final evaluation with an expressed goal of
measuring the impact of a project that only delivered 18 months of programming. 
While it was recognized that this was to be a qualitative assessment, it was also 
expected that impact would be assessed. In the absence of an initial baseline study, 
all conclusions drawn by the evaluators are only indicative of possible impact.
2. While SC/US staff clearly stated that this was a “pilot project”, intended to engage local 
governments, communities and care providers, and to test approaches to community￾based impact mitigation, the project documentation did not articulate this approach. 
3. During the project design period, the key terms “impact mitigation” and “care and 
support”, as well as delivery targets, were not defined. In addition, several important 
project management tools were never developed, making it complicated to measure 
project delivery and results achievement. 
The evaluators were unable to meet with out-of-school peer educators and private care 
providers due to time limitations. It is felt that this did not adversely affect the report.
1.5 Organization of the Report
Table 2: Report Organization
Executive Summary
Acknowledgements
Abbreviations
1. Introduction
1.1. Project in Brief
1.2. Evaluation Purpose and Scope
1.3 Evaluation Methodology
1.4 Evaluation Challenges
1.5 Organization of the Report
2. Project Description
2.1 Background
2.2 Disbursements to Date
2.3 Monitoring and Reporting
3. Relevance
4. Effective/Efficient
5. Impact
6. Sustainability
7. Conclusions
Appendices
A People, Groups and Facilities Visited
B Summary of Deliverables to Date
Placed throughout this document are text boxes with the title “Lesson Learned”. These indicate areas of 
learning identified by project staff. To acknowledge the project’s ownership of these lessons, they have 
been placed in text boxes.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 4
2. Project Description
2.1 Background
The project’s stated objective was to minimize the impact of HIV and AIDS on children and 
families of men who migrate to India from Kanchanpur District. This was to be
accomplished through community mobilization, capacity building, the development of
program options for working with communities, and the initiation of community-based care 
and support activities for people with HIV/AIDS and their families. The unstated objective 
was to pilot approaches to achieve the above.
The strategies identified for use in this project included:
· Awareness raising
· Community consciousness, participation and mobilization
· Male involvement
· Integration of pre-existing structures, systems and programs
· Partnership with NNSWA, NRCS and local government
· Direct work with children and adolescents
· Capacity building
· Advocacy and creation of a non-stigmatizing and non-discriminatory environment
These strategies were implemented by SC/US’s local partners: NNSWA and NRCS, with 
SC/US providing a capacity building and coordination function. Three project coordinators 
from SC/US, NNSWA and NRCS and ten community mobilizers from the NNSWA and 
NRCS undertook the work, supported by numerous community volunteers, as well as 
public and private health and social welfare service providers. The long histories of the 
partners in Kanchanpur and their established presences were viewed as critical to project 
success.
The implementation of the project occurred in approximately half of the wards in
Chandani, Dodhara, Daijee, and Jhalari VDCs, and in Mahendra Nagar Municipality. In 
implementing the project, the partners were to work with existing structures, organizations 
and volunteers; public, private and traditional health service providers; and, local
governments, in order to find synergies and linkages with existing projects and services to 
most efficiently use available resources to mitigate the impact of HIV/AIDS on the targeted 
communities.
In designing the project, a number of conditions were placed on the project:
· Funding was for 18 months of programming (24 months with the rapid assessment).
· No baseline study of HIV prevalence or risk behaviour was conducted.
· No provision of prevention or income generation programming.
· Use of existing structures to deliver community-based care and support activities.
· No provision of Voluntary Counseling and Testing (VCT); community members were 
not to be encouraged to investigate their HIV status through private laboratories.
· Support for community-created options for home-based care and support was not to 
include the provision of drugs or medical supplies for opportunistic infections (OI).
These conditions created several expected and unexpected challenges for the project as it 
attempted to achieve the project’s Intermediate Results and Expected Outcomes, within 
the 18-month project period. These results and outcomes were:
Intermediate Results:
1. Program options to work with families vulnerable to HIV/AIDS identified by migration.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 5
2. Increased capacity of local NGOs to facilitate and support community efforts to provide 
care and support for people living with HIV and their families, including children.
3. Increased capacity of the community to support households affected by HIV/AIDS.
Expected Impact (at the end of 2 years):
1. Increased access and utilization of counseling and care (institutional and home based) 
services by PLWHAs and their families
2. VACCs have developed and instituted (structures and systems in place) realistic plans 
for protection, care and support of vulnerable and/or affected households
3. District level and peripheral level counseling services and referral system set up
4. DACC/DDC replicate the project approaches in other VDCs of Kanchanpur District.
Implementation challenges in the initial months of the project required considerable
rethinking on the project’s purpose. Faced with district level resistance and denial, limited 
community awareness of HIV/AIDS, and high levels of active discrimination against those 
who were HIV+ and their families, the project refocused its initial efforts on building
awareness (including for prevention) and combating community-level fears and
misconceptions about HIV/AIDS. Without building a solid base of aware and supportive 
communities, the project would not have been able to mobilize communities to generate 
and implement options to mitigate the impact of HIV/AIDS on affected families, including 
home-based care and support. There was also an unexpected requirement to “re￾mobilize” many of the Mothers’ Groups that the project had expected to use, as many of 
these groups had become inactive since the completion of an earlier CARE Nepal project.
2.2 Disbursements to Date
The USAID grant disbursements were divided into two phases: June 14, 2001 to
September 30, 2002, and October 1, 2002 to June 13, 2003. In Phase 1 US$100,948.14
was spent, while in Phase 2, US$99,051.86 was spent, giving a total expenditure of 
US$200,000.
2.3 Monitoring and Reporting
As a result of the absence of several standard management tools and systems, the 
monitoring of project and its performance was uneven and difficult to follow.
In the planning documents there was no work done to link the long list of process and 
outcome indicators in the Monitoring and Evaluation Framework to specific results. There 
was also no creation of a work breakdown structure (WBS), or division of project activities 
into components, activity sets or work packages. In the quarterly reports, without a WBS it 
was difficult to understand the organization of activities. In addition, the lack of cumulative 
reporting and activity-based financial reporting made it difficult to track progress over time.
The absence of such tools and systems did not appear to adversely affected
programming, though there would have been some loss of project efficiency. This was 
probably due to the project’s small size. Any decision to expand this project, however, 
would require a much more rigorous approach to project management, including the
development and use of standard project management tools. This is discussed in more 
detail on Page 15.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 6
3. Relevance
Is there a need for the project? How was the initial situation assessed?
It is prudent to begin by noting that in the absence of complete national HIV/AIDS
surveillance data, no definitive statements can be made on the general prevalence of HIV 
in Kanchanpur, or even among families affected by labour migration to India. The
project’s initial rapid assessment, in determining the needs of those infected and affected 
by HIV in Kanchanpur, was only able to locate 23 self-identified suspected HIV+
individuals willing to discuss their situations. There remains a considerable need for sero￾and behavioral surveillance of migrants and their families both in India and Nepal. 
However, given the current projections from the National Centre for AIDS and STD Control 
(NCASC) and an accepted link between migration and HIV/AIDS1
, it can be assumed that 
there is a considerable risk of HIV infection among Kanchanpur communities affected by 
male migration to India, particularly Mumbai. The real figure, while unknown, is
undoubtedly more that the Mahakali Zonal Hospital’s 101 confirmed cases of HIV/AIDS. 
Given both the probable large number of HIV infections in Kanchanpur and the project’s 
objective, it does appear noteworthy that only a small number of people have been
identified by the project as infected or affected by HIV over the last 18 months (38 families, 
including 90 children). In discussions with project staff, this “shortfall” was explained in the 
following ways:
· Firstly, an initial lack of awareness and high levels of stigma, stopped people from 
seeking support; in turn, the project needed to focus its initial efforts on building a more 
supportive community environment in which HIV status could be safely disclosed.
· Secondly, the project was instructed not to actively seek out those people who were 
potentially infected or their family members. 
· Thirdly, as it was a pilot project, focusing on the building of an enabling environment 
and engaging local governments and service providers, it was believed that the project 
was developing a foundation for a larger response to a growing epidemic. 
18 months after the beginning of the project, Kanchanpur District officials and target 
communities are unanimous in their belief that HIV/AIDS is now a significant health, social 
and economic issue, and support SC/US’s focus on developing impact mitigation
approaches at a community level. The mobilization and active participation of DACC, four 
VACCs, and the MACC in the project would appear to confirm this belief.
While there appears to be some weaknesses with the initial rapid assessment, particularly 
on the need for the project, it was probably sufficient given the conditions in Kanchanpur 
District in 2001 (i.e. lack of awareness, district and community resistance, stigma and 
discrimination) and the limitations placed upon the project. It was noted that little effort 
was made during the assessment or the project to apply the Greater Involvement of 
People with AIDS (GIPA) principle in project planning and implementation. The reasons 
given were the level of community stigma at the beginning of the project and the resulting 
unwillingness of those infected or affected by HIV/AIDS to play such a role. Several staff 
also expressed reservations about involving affected households as full participants
because they feared creating unrealistic expectations of what the project could deliver.
 
1
 In discussions with the four project VACCs, it was estimated that between 40% of 60% of males in 
their VDCs were migrant workers in India.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 7
Were the project’s objectives sufficiently clear?
While discussions with some local government officials revealed some misunderstandings 
of project objectives, for the most part, communities expressed a consistent and accurate 
understanding of the project. Initially, there was a significant expectation by community 
members and leaders that the project would provide income generation opportunities and 
financial support for vulnerable households; a need clearly identified in the rapid
assessment. The adjustment of this expectation required significant effort in the initial 
months of the project.
Project staff raised several concerns with regard to the project’s objectives and the
unplanned efforts that were initially required to build awareness (including prevention), 
reduce stigma and discrimination by community members and health workers, and,
mobilize communities and local government bodies. It was also felt, in retrospect, that the 
project should have dealt more directly with the poverty of vulnerable households, as 
identified in the rapid assessment.
An additional concern on clarity of objectives was the relationship of the project to those 
community members who were not HIV+ but were suffering from illnesses normally
termed “opportunistic infections” (i.e. tuberculosis, acute respiratory infections, etc…). 
While community members appeared to have access to care for these illnesses,
regardless of their HIV status, this idea was not developed in the initial project
documentation. It is an important concept at this stage in Nepal’s HIV epidemic, as most 
people who suffer from these ailments are not HIV+, and most people who are HIV+ do 
not have a confirmed (i.e. tested) sero-status. This issue would appear to be related to 
the lack of VCT facilities in Kanchanpur.
Given the pilot project nature of the project, it would seem normal to invest considerable 
staff time in reviewing the project’s purpose and work, during the project’s lifetime. It does 
not appear, however, that a process was established to formalize, document and
disseminate the many important lessons learned. It also appears that a shared
understanding was never developed of the key project concepts “care and support” and 
“impact mitigation”.
Was there a synergy between the project and other relevant projects, bodies and 
activities in the region?
Given the limited time and resources of this project, as well as its various conditions, it 
was critical to coordinate with other stakeholders and to create links to their activities, in 
order to efficiently access resources and build support for common purposes. The 
project’s referral and linkage systems were intended to connect families affected by HIV 
with the necessary health, counseling and social (i.e. education, job training) services. It 
was evident during the field visit that considerable efforts had been made in developing 
these synergies. 
· Project Advisory and Support Committee (PASC): Able to search and exploit
opportunities for synergies. The PASC included the chair of DACC, the SC/US, NRCS 
and NNSWA project coordinators, one Village AIDS Coordinating Committee (VACC) 
chair, and a representative from the CARE Nepal Child Survival Project. 
· District AIDS Coordination Committee (DACC): DACC helped the project to work 
with Mahakali Zonal Hospital, as well as connect affected households to education and 
skill development funds and projects. 
· Enhanced Support for HIV Prevention in Nepal Project: This NEDA-funded project 
provided prevention support to the project until its completion in September 2002.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 8
· CARE Nepal’s Child Survival Project: Synergies with the training of Female
Community Health Volunteers (FVHV) and Maternal Child Health Workers on some 
opportunistic infections, antenatal care, hygiene/sanitation, and nutrition.
· Highway Project: The establishment of “storefront” STI clinics by this project,
increased access to STD services for Kanchanpur residents.
· Adolescent Reproductive Health Project: Training links for peer educators with this 
other SC/US project.
· SC/US – NNSWA Partnership – Sponsorship Program: The pre-existing 
relationship between SC/US and NNSWA in the management of SC/US’s Sponsorship 
Program in Kanchanpur, facilitated the project to access the community development 
and education components of the sponsorship program.
· Miscellaneous Linkages: Project synergies with the District Education Office and skill 
development centres provided resources to affected families.
In reviewing these linkages, two issues were clear. The first was that many links were 
dependent upon donor-funded projects of limited duration. The second was that the limits 
of district level support for affected and vulnerable families remain uncertain, particularly in 
the face of a widening HIV/AIDS epidemic. 
The relevance of a project that desires to create referrals and linkages will be undermined 
if needed services identified by the community in the initial assessment (i.e. income
generation) or during the life of the project (i.e. VCT, drugs for opportunistic infections) are 
neither available nor accessible. The success of the project in building awareness and 
reducing stigma and discrimination created a demand for increased community-based 
care and support services. If these services cannot be offered in the near future in a 
sustainable manner to the people who require them, the referral and linkage systems 
established by the project may lose their relevance.
The relevance of the project is also potentially undermined by the absence of an ongoing 
and accessible source of prevention services. While the project was able to build upon 
and provide referrals to the Enhanced Support for HIV Prevention in Nepal Project, this 
point in the referral system was removed with its completion in September 2002.
Lesson Learned:
A care and support system should be developed in the context of a prevention 
to care continuum. HIV/AIDS referral systems must have access to
prevention programming.
3.1 Findings and Recommendations
The evaluation findings…
1. The project was relevant to a growing need for HIV/AIDS community-based impact 
mitigation in Kanchanpur District. It was also successful in developing synergies with 
other relevant projects, bodies and activities in the district.
2. The building of district- and community-level support for this project through
awareness raising and sensitization was a pre-condition of success for this project. 
Had the project attempted to mitigate the impact of HIV/AIDS at the community level 
without first dealing with the existing levels of ignorance, denial, stigma and
discrimination, the project would not have been successful. 
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 9
3. Given the project’s success in eliminating stigma and discrimination, there is now an 
opportunity to more fully engage affected households. Given increased partner skills 
in engaging with these households, this can be done in a manner that does not create 
unrealistic expectations of project delivery.
4. Original misunderstandings of the purpose of the project were related in part to the 
project being unable to deal with priority issues (i.e. income generation, support for 
affected households) identified by the target communities in the rapid assessment.
5. The project would have benefited from an initial planning workshop for partners to 
develop and agree upon a shared understanding of the project, including the key
concepts of “impact mitigation” and “care and support”, and to develop a
communication plan for disseminating this understanding to stakeholders and the
wider community. 
6. The relevance of referral and linkage systems are related to whether the systems can 
put people in contact with the services that they require (i.e. care and support, VCT, 
income generation). When such systems are developed, they must not only include 
available services but also consider the inclusion of services identified and required by 
the communities. 
7. Prevention activities must be integrated in HIV/AIDS impact mitigation projects as a 
part of a prevention to care continuum.
The evaluation recommendations…
1. Any future major impact mitigation project in Kanchanpur should build upon and
continue the awareness building and sensitization work of this project.
2. Any future major impact mitigation project in Kanchanpur should include a size
estimation of the households affected by HIV. It is also recommended that a study be 
undertaken of the sexual behaviors of migrant men while residing in Kanchanpur.
3. Any future impact mitigation project in Kanchanpur should engage affected households 
and their members in needs identification, and project design and implementation. 
Involvement in implementation could include both governance and delivery. 
4. Any future impact mitigation project should ensure clarify of its objectives with
beneficiary communities and stakeholders prior to implementation. This should
include clarification of the project’s relationship with those who are affected by what 
are considered HIV/AIDS opportunistic infections (e.g. TB, ARI, diarrheal diseases) 
and require care and support but who may or may not have HIV/AIDS.
5. Any future major impact mitigation project in Kanchanpur should work to ensure that 
community needs for on-going prevention services, VCT, expanded care and support, 
and income generation opportunities are met either within or outside the project. 
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 10
4. Effectiveness/Efficiency
Did the project deliver what it said it would to its intended targets?
In general, the project achieved its planned deliverables.
Table 3: Summary of Project Deliverables Achievement
· DACC, MACC, and VACCs formed and/or mobilized.
· Mothers’ Groups, male peer workers, youth and junior red cross 
circles, and out-of-school peer educators formed and/or
mobilized.
· Counseling and home-based care and support capacity built
among FCHVs, affected families, and public and private service 
providers.
· District officials, traditional healers, teachers, and journalists 
oriented on the project, and the needs for care and support.
· Referral system for linking affected families to medical services 
and psychosocial counseling, and linkage system to link affected 
families to education and skills training support established.
· One counseling centre in Mahakali Zonal Hospital and four
peripheral counseling centres established.
· Limited home-base care and support available to affected families
· Existing district and community structures used for delivery.
· Public health system engaged in community-based care and
support.
· Partner capacity built to support community-based HIV/AIDS
impact mitigation.
It is apparent that the project’s strategies, particularly those that built awareness, reduced 
stigma and discrimination, and mobilized communities, were successful in building an 
enabling environment for impact mitigation. Without this environment, a community-based 
care and support system would be difficult to implement. The direct involvement of
community leaders in the VACC/MACCs, the support to existing community bodies, and 
the use of community members (i.e. Mothers’ Groups, male peer workers, Red Cross 
Circles) as community “change agents”, were successful in supporting the work of the 
project.
Another apparent success for the project was its ability to engage with district level 
officials and public service providers, particularly in the health and social services sectors, 
in support of community-based impact mitigation. This was done through the DACC, and 
through the continual efforts of project staff to involve district and public sector
stakeholders.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 11
Functioning referral (e.g. medical, counseling) and linkage (e.g. protection, education, skill 
development) systems exist. This was confirmed through the existence of referral slips 
and demonstrated on several occasions when different stakeholders demonstrated their 
knowledge of how others were working together with the same affected households, or 
how one referred a household to another2
. The base of the referral system is the FCHV 
who links an affected household to the required service. As discussed in the previous 
section, the effectiveness of these systems is limited by the existence, quality and
accessibility of services. 
The project appears to have developed a number of critical skills among its partners, and 
various community bodies and service providers. These skills range from basic
Participatory Learning and Action (PLA) training for Mothers’ Groups, allowing them to 
discuss HIV/AIDS, stigma and discrimination, and the role of the community in supporting 
households affected by HIV/AIDS, to technical training for care providers on the
management of opportunistic infections and palliative care. The care and support training 
provided to FCHVs and members of affected families on hygiene/sanitation, when to seek 
medical attention for opportunistic infections (OI), lay counseling, nutrition, and basic 
medical care, seemed appropriate to the needs and capacities of community members. 
The mobilization of male peer educators, many of whom were Red Cross Volunteers, also 
appeared to be effective.
It is important to re-emphasize that it was not the purpose of this project to engage directly 
with those infected or affected by HIV/AIDS. Rather, it was to mobilize communities and 
local governments, and engage with service providers in the development of community￾based care and support options. As such, it was the decision at the time of project ”start￾up” to not deal with VCT, prevention, income generation, and care and support that
included drug and medical supplies provision. However, it is now important that the 
project revisit the issue of community-based care and support and consider how, in light of 
a more supportive environment and increased care provider capacity, it might develop a 
more complete and integrated care and support framework. Such a framework, based 
upon a review of work done to date, an assessment of community needs and service 
provider capacity, and the development of a shared conceptual understanding, would
allow for a more structure approach to care and support and assist in the project’s 
expansion. This framework must also deal with the demand for VCT, particularly since 
VCT has apparently recently been introduced at the Mahakali Zonal Hospital3
, and may 
use project trained counselors for pre- and post-test counseling. The demand for income 
generation services should also be considered.
Lesson Learned:
A care and support system should not be developed without access to VCT.
1. By building community awareness about HIV/AIDS care and support, the
project generated a demand for VCT in Kanchanpur District.
2. VCT should be used as an entry point to a care and support system, as well as 
for HIV prevention services, depending on the outcome of the test.
 
2
 In separate interviews, project staff, a FCHV and a sub-health port health professional all showed 
knowledge of the work of the other care providers with several affected households in Daijee.
3
 It remains unclear as to whether VCT is offered by Mahakali Zonal Hospital as the answers given by 
hospital staff were unclear. It does appear that 200-300 test kits were sent to hospital in May 2003 by 
NCASC but whether these were for VCT or surveillance was not made clear. Counseling Centre staff 
has not been trained in pre- and post-test counseling.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 12
The field visits to the central counseling centre at the Mahakali Zonal Hospital and the 
Dodhara Primary Health Centre (PHC) showed greatly different environments. The centre 
at the hospital was relatively difficult to access, physically unwelcoming, and offered no 
prevention services, while the centre in Dodhara was well set-up, friendly, accessible, and 
offered prevention services. These differences should be reviewed if the counseling
centre at the hospital is to become the VCT centre for Kanchanpur. A review of the 
counseling training offered to project participants also indicates that it is not sufficient for 
pre- and post-test counseling, yet it appears likely that project trained counselors in
Mahakali Zonal Hospital have/will provide this service when VCT is offered. The
counseling function would benefit from access to counseling supervision and technical 
support.
Given these concerns about the structure of care and support, and its technical delivery, 
project staff has said that communities have generated many useful and replicable ideas 
on care and support. As discussed, an important next step is the development of these 
ideas into a care and support package or system for dissemination and wider application. 
While no behaviour change communication (BCC) materials have yet been developed by 
the project, pamphlets designed through a joint care provider/people with HIV workshop 
are currently being printed. The NNSWA has also developed the “Mayako Thaili” (Bag of 
Love) for wives to send to their migrant husbands. It contains a letter containing good 
wishes and a cassette tape with prevention information.
Did SC/US, NNSWA and NRCS provide the necessary leadership, innovation and 
creativity for project success? Did project staff have the expertise and experience 
to carry out the planned activities?
As mentioned above, SC/US, NNSWA and NRCS have demonstrated strong skills in 
creating enabling environments for HIV/AIDS impact mitigation at the community level. 
Project staff has shown expertise at engaging district level officials and service providers 
in support of the project’s objectives. In the areas of community mobilization and
coordination and in capitalizing on opportunities for synergies with other projects and
bodies, project staff has also shown leadership, innovation and creativity.
One deficiency in the expertise of project staff was their lack of technical knowledge and 
experience in both care and support, and counseling. Given their depth of training, they 
were limited in their abilities to provide technical support to care providers in the
management of opportunistic infections, nutrition, palliative care and counseling. This 
needed technical capacity should be seen as the “referral system” for frontline care
providers who need information, mentoring or support. Whether such expertise is
developed within the project staff or with the office of the District Public Health Officer 
(DPHO) is an issue for discussion.
Did the project’s structures and processes support project operations and the
achievement of expected results? Were responsibility efficiently divided between 
SC/US, NNSWA and NRCS?
It was generally observed that the project structures and processes supported project 
operations. Activities were planned and delivered in a coordinated manner. Project staff 
from SC/US, NNSWA and NRCS understood and supported the roles and work of each 
other. Several stakeholders commented on this positive aspect of the project, including 
the Local Development Officer for Kanchanpur District, who said that the HIV/AIDS 
IMPACT Mitigation Project was the “…most coordinated project in the district”.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 13
The involvement of the NNSWA and NRCS was also noted as a positive factor in project 
success because of their experience and high profile in Kanchanpur. This was a definite 
factor in the ability of the project to quickly mobilize communities. It was also noted that 
both partners went to some effort to integrate this project into their other activities, though 
this did cause some coordination concerns.
Several project staff commented that the coordination aspects of the project took
considerable effort, and while they recognized its benefits, wondered whether there was 
not a simpler way. There were also concerns about the clarity of the NRCS and NNSWA 
roles (within the project and also with each organization’s other work) as both share 
similar skills. This had led to some tension, particularly in cases where one partner felt 
that they had the ability to deliver a needed service but was restricted from doing so by the 
project. This is the situation that currently confronts the project over NRCS’s possible 
involvement in home-based care and support. The project has so far showed an ability to 
manage these issues. The decision to move PLA training from the NNSWA to the NRCS 
is an example of maximizing partner skills for the benefit of the project.
Lesson Learned:
There is a need to clearly delineate the project roles of project partners when both 
partners have similar skills. There is also a need for an understanding between 
project partners on the coordination of activities, which occur outside of the project.
Some concerns were expressed that tasks were divided between the partners on the 
basis of past experience and not on project needs. An example of this was the project’s 
decision to use the NRCS to mobilize the Mothers’ Groups and the NNSWA to build 
capacity in the FCHVs (FCHVs are members of Mothers’ Groups). This caused some 
confusion at the community level and coordination difficulties for SC/US. Joint delivery by 
partners to both FCHVs and Mothers’ Groups or a single delivery partner would avoid this 
issue.
Lesson Learned:
Any project that wishes to mobilize Mothers’ Groups and the Female Community 
Health Volunteers towards the same objectives must ensure that this mobilization is 
coordinated. 
Another significant lesson learned by project staff was the error of not involving Maternal 
Child Health Workers (MCHW) in the project. From a sustainability perspective, their 
involvement is critical as they are the frontline community-based service providers who 
support the FCHVs.
Lesson Learned:
Any project that depends on the work of Female Community Health Volunteers, must 
also mobilize the professionals that support them: Maternal and Child Health
Workers.
Did local communities and governments understand their role in the project? Did 
the project have an appropriate strategy to strengthen the capacity of local
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 14
institutions? Did they participate in the selection of beneficiaries and the
determination of needs? 
As discussed earlier, there was an initial mistaken expectation on the part of both
communities and local governments, that the project would provide income generation 
opportunities and direct support to affected families. There was also considerable initial 
reluctance on the part of Kanchanpur district and community leaders to accept HIV/AIDS 
as a priority issue. These misunderstandings and lack of awareness required the project 
staff to invest considerable effort in building awareness within the DACC, MACC and 
VACCs, orient them on the activities and objectives of the project, and build capacity in 
support of HIV/AIDS community impact mitigation. These efforts appear to now be paying 
dividends in terms of support, participation, and advocacy on behalf of the project at 
district levels. With the exception of some district staff, most people interviewed,
particularly at the VACC level, communicated an informed view of the project and their 
role in it.
As mentioned earlier, there appears to be considerable success at the use of PLA and 
PRA tools in building the capacity of groups like Mothers’ Groups and male peer workers.
While the evaluation has questioned the lack of a formal role for people who are HIV+ and 
their families in the project, it is clear that the VACC/MACC have articulated the needs of 
people who are HIV+, and proposed activities to address these needs. All of the VACCs 
interviewed, also had Mothers’ Groups members on the committees, and were well
connected with the project activities occurring within their VDCs.
On the issue of Greater Involvement of People with AIDS principle, project staff said that 
(1) people who are HIV+ and their families were initially reluctant to come forward because 
of fear of stigma, and (2) that they feared that the needs of affected households were 
beyond the resources of the project. The project staff did see the benefit, in principle, of 
greater future involvement of infected and affected persons in project activities.
Lesson Learned:
Develop the awareness and the capacity of MACC/VACC to support community-based 
care and support before initiating care and support activities.
How did different communities respond to the development of care and support 
options and stigma and discrimination activities?
Project staff felt that different communities (e.g. high caste, Dalit, Tharu) did not appear to 
demonstrate different responses to the project or to community-based care and support. It 
was observed (except for one Tharu Mothers’ Group) that the Mothers’ Groups were a 
mixture of castes, and formed on the basis of proximity (neighbours). 
Several project staff discussed the idea of “double discrimination” – that those who are 
HIV+ are more likely to face stigma discrimination if they are from a lower caste or a 
marginalized ethnic group, or are impoverished. This would indicate that people of
different caste/ethnic backgrounds, or who are poor experience HIV/AIDS in different
ways.
Did the project identify programmatic options for working with vulnerable and 
affected families? Were people living with HIV/AIDS satisfied with the care and 
support that they received?
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 15
It appears that the project was able to identify and implement a range of program options 
for families affected by HIV/AIDS. These options included education bursaries, job
training, community provision of shelter, clothing, blankets and food, fund-raising 
schemes, and home-based care and support for those who are HIV+. These options were 
built upon the solid foundation of a positive enabling environment, created by the project’s 
efforts to build awareness, reduce stigma and discrimination, develop capacity, and
mobilize communities, local governments and care providers.
As yet, the project has not systematically reviewed and documented these options, in 
order to standardize their application. As discussed, this would be an important step 
should the project wish (1) to be a model for other projects or (2) to replicate and expand 
its own work.
The evaluators met with nine heads of households affected by HIV/AIDS. All expressed 
satisfaction and appreciation for the support that they had received including education 
support for their children, food, clothing and shelter, and training in home-based care and 
support. Many also stated that as a result of the project, they no longer faced the
discrimination that they once did from their wider families and neighbours. They went on 
to give examples of how they were able to participate fully in community activities and live 
openly as a family affected by HIV/AIDS.
An unmet need of affected households was drugs for opportunistic infections. Another 
consistent concern of HIV+ parents was the future of their children, following their deaths. 
A future project, with some legal assistance, could provide “legacy support” to affected 
households. 
The issue of drug provision is more complex. Given the known capacity of the public 
health system and the unknown but limited capacity of poor communities to protect their 
most vulnerable members, the provision of drugs through community-based mechanisms 
should be studied. Already, Daijee VACC is using its funds to support drug costs for 
affected households. While these funds are limited, this is an important decision by a 
community body about its comparative advantages and priorities. 
Did the project effectively monitor its operations and the expected results?
As discussed, the management of the project would have benefited from a results
framework and a monitoring and evaluation framework, which reflected its “pilot project” 
nature.
In addition, the development and use of several standard project management tools would 
have increased the ability of staff to manage the project and to monitor its progress. 
These include the linking of indicators to specific results, the development of a Work 
Breakdown Structure (WBS) and numerically ordered work packages, standardized
reporting tools for partners, cumulative reporting, and financial reporting against the work 
packages. 
Given the small size of the project, it is not felt that these issues negatively impacted the 
quality of the project’s activities, though the use of these tools could have increased the 
efficiency of project management. These tools would be essential should the project be 
expanded.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 16
4.1 Findings and Recommendations
The evaluation findings…
1. The project has successfully achieved its deliverables and reached the targeted
beneficiaries. This success can be attributed to the project’s strategy of awareness 
building, mobilization, and development of district bodies, community organizations, 
and care providers throughout the life of the project. This was essential to develop 
district and community level support and advocacy for the project. The building of 
partner and care provider capacity, the use of experienced local partners, and the 
efforts expended on coordinating stakeholders were also important factors.
2. The project, through its work to reduce stigma and discrimination, has created an 
opportunity for people who are HIV+ and their families to become fuller participants in 
the process of both defining their status as beneficiaries and determining their needs. 
3. Because of the large number of stakeholders involved and the use of referrals and 
linkages to match affected households with needed services, large coordination efforts 
were required.
4. Any project that mobilizes FCHVs should also mobilize Maternal and Child Health 
Workers (MCHW), as the primary support structure for the FCHVs.
5. There is an opportunity for a community-based impact mitigation project to provide 
affected households with “legacy support”, helping terminally ill parents to plan for their 
children’s well-being and future (e.g. guardianship, inheritance, family unity).
6. Pilot projects need to be explicitly designed as such: formalizing and documenting 
learning. Without this explicit understanding, project staff is committed to the
implementation of project activities, without the parallel obligation to reflect on their 
implementation in an organized and systematic manner. 
The evaluation recommendations…
1. The project staff of the HIV/AIDS Impact Mitigation through Mobilizing Affected
Communities Project should conduct a facilitated review exercise to analyze and
document the experiences of this project, and suggest how the programming
approaches used could be replicated or expanded. Such a review should also identify 
the unmet needs of affected and vulnerable households.
2. Any future major impact mitigation project in Kanchanpur should include (1) a needs 
assessment of care and support requirements, (2) the development of a shared
understanding of community-based care and support, and (3) a framework to assist 
communities to develop their own options and to set priorities for resource allocation. 
A clear linkage should also be established with VCT and prevention programming. 
Such a future project must be built upon a base of aware, supportive and mobilized 
communities and district stakeholders. 
3. Any future major impact mitigation project in Kanchanpur should include the
development and availability of technically proficient and experienced staff to train and 
support community- and home-based care-providers (including counselors). Such 
expertise could be developed either within district-based project staff or within the 
office of the DPHO. There is a need for the counseling centre at the Mahakali Zonal 
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 17
Hospital to become more accessible and physically welcoming, and able to offer
prevention services.
4. Any future impact mitigation project in Kanchanpur should include the capacity building 
of MCHWs and the development of “legacy support”. Any future referral system 
should include links to adjacent Indian testing and treatment facilities. This would be 
particularly important for Chandani and Dodhara VDCs, where people normally access 
Indian health services because of their proximity.
5. Any future impact mitigation project Kanchanpur should involve affected households in 
project implementation, including governance and delivery. Specific activities for
consideration include the employment of people with HIV in the project, the use of 
HIV+ volunteer peer workers, the establishment of a project advisory group of affected 
households, and the use of participatory monitoring and evaluation methodologies with 
beneficiary affected households.
6. Any future major impact mitigation project in Kanchanpur should integrate the lessons 
learned from this project on the use of local partners, including role delineation.
7. Any future major impact mitigation project in Kanchanpur should develop and apply 
standard project management tools and ensure partner compliance with these tools.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 18
5. Impact
Has the health and well-being of targeted households improved? Has the
vulnerability of targeted households been reduced?
While it is too early to quantitatively judge the project’s impact on the health and well-being 
of affected households, it is apparent from discussions with affected households that there 
has been a positive impact. Household heads described reduced stigma and
discrimination, and increased acceptance from the community and wider family members, 
as well as renewed participation in community life. They also described the importance of 
the counseling, and the care and support that their households received, as well as the 
support to meet basic household needs. One FCHV described how a Mothers’ Group had 
recently confronted a teacher about his discriminatory behaviour towards the children of 
an infected woman who was also a member of their group. Such support appears to 
maintain family unity and reduce vulnerability to opportunistic infections, the spread of 
HIV, school absence, family fragmentation, and child labour.
Household vulnerability was also addressed by the decisions of local government bodies 
to increase public funding for community-based impact mitigation activities, primarily
funding from the DCC to the DACC and VACC/MACCs. The actions of these bodies 
appear to indicate a high priority given to impact mitigation.
This reduction of household vulnerability also appears to be evident through the requests 
of participating VDCs to expand the project into their jurisdictions, and the desire of the 
DACC and other VDCs to replicate the work of this project throughout Kanchanpur. 
Affected households and community members described a growing demand for VCT and 
the drugs required to treat opportunistic infections. Community bodies and project staff 
said that this is a result of mobilizing communities and is an unintended impact of the 
project.
An overall lack of community resources is the largest limitation to reducing the vulnerability 
of affected households. The lack of prevention services, particularly for migrant men, also 
increases the vulnerability of all households to HIV/AIDS.
Do local NGO partners have an increased capacity to facilitate and support
community efforts to provide care and support to people with HIV/AIDS and their 
families, including children?
As discussed, it is evident that NRCS and NNSWA have the capacity to mobilize and 
support communities to develop the enabling environments required to help communities 
mitigate the impact of HIV/AIDS. It is also clear that partner capacity was developed to 
support the provision of community-based care and support to affected families, including 
counseling. There are, however, some concerns about the level of partner technical 
expertise required to sustain a community-based care and support system, including 
counseling.
Have there been positive changes in the communities’ behavior regarding stigma 
and discrimination?
There is evidence that the project significantly reduced the stigma and discrimination 
experienced by affected families, through its awareness and mobilization activities. The 
nine households interviewed were explicit in the their descriptions of the stigma they felt 
and the discrimination they suffered prior to the project, and how the work of the project 
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 19
had allowed them to rejoin their communities and families. This process of rejoining 
meant the ability to live openly with HIV in their community, to participate in community 
events, and to feel free of shame and discrimination, which had included physical and 
social isolation and the threat of violence. Discussions with VACCs and Mothers’ Groups 
also revealed that many have women from affected families as members.
Community members who were not directly affected, indicated that the awareness building 
done by the project had brought them to the position where HIV/AIDS was seen as a 
disease and not as a judgment on the morality or value of the affected households. The 
evaluators were also able to meet with community members, who, as a result of
awareness building, were now directly assisting affected households. It should be noted 
that these community members were people who had had some interaction with the 
project and it is impossible, without the use of survey techniques, to definitively determine 
wider community behaviour.
However, the evaluators observed people living openly in their communities, as infected 
and affected people, something that was not possible at the beginning of the project. This 
change creates future opportunities to engage such people as peer educators and staff in 
an expanded community-based care and support project, and to mobilize self-support 
groups for infected and affected people.
Do communities have an increased capacity to support households affected by 
HIV/AIDS?
There are numerous encouraging signs that communities have increased their capacity to 
support households affected by HIV/AIDS.
Table 4: Summary of Achievements in Building Community Capacity
· The DDC and VDCs have increased the level of funding to the DACC 
and VACCs. The DACC and VACCs have increased their programming 
and in the case of the VACCs, they are raising money from their
communities.
· Male peer workers are raising community funds to assist affected
families.
· A group of teachers are proposing the establishment of a fund
comprising of 2% of teachers’ salaries to support orphaned and
vulnerable children, many of whom would be affected by HIV/AIDS.
· DACC and the VACCs/MACC meet regularly and discuss ways in which 
the communities can be mobilized to support households. This includes 
advocating for increased funding and making linkages to resources
(e.g. educational bursaries) and paying for drugs to assist affected 
families.
· Community members, including male peer workers and the Mothers’ 
Groups/FCHVs are using the skills developed through PLA and PRA
training to assist affected families and to build awareness in the wider 
community.
· FCHVs have increased skills to support home-based care and support 
and to refer people with HIV to medical and counseling services.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 20
The development of increased community capacity to support affected household has 
created some concerns about coordination and the ability of community groups to set 
priorities and plan. This is a natural outcome of building awareness and supporting
mobilization – communities wanting to act, using their resources. However, it is apparent 
that many VACCs still need to develop their abilities to assess needs, and to make 
choices on how best to use their limited resources. The building of planning capacity 
should be a logical next step.
Given the poverty of the project’s target communities, it would also be advisable to better 
understand the limits of support that poor communities can provide to vulnerable
households. This task could be included in a future initial assessment.
5.1 Findings and Recommendations
The evaluation findings…
1. The project has appeared to reduce the vulnerability of affected households and 
increase their well-being. Partner NGOs and community bodies exhibited newly
developed capacity to support community efforts to assist affected households.
2. The project’s work to reduce stigma and discrimination was critical to developing the 
enabling environment required for communities to mitigate the impact of HIV/AIDS. 
The use of PLA and PRA methodologies were an important component in increasing 
awareness, and reducing stigma and discrimination. This has created an opportunity 
for a fuller involvement of people with HIV and their families in the project.
3. Involvement of local government and community bodies was important to create
ownership of community-based impact mitigation activities.
4. An unintended impact of the project’s awareness building and stigma and
discrimination reduction efforts was an increased community demand for VCT and 
increased care and support, including drugs for opportunistic infections.
5. An unintended impact of the project’s community mobilization activities was the desire 
of community bodies (i.e. VACC/MACC) to engage in impact mitigation activities using 
their own resources. It would be important next step to develop the capacity of these 
bodies to formally engage their communities to assess needs, set priorities, and make 
plans on how to best use these limited resources. It would also be important to further 
develop their capacity to coordinate with community and external bodies.
The evaluation recommendations…
There are no recommendations specific to this section, though recommendations on 
involvement of affected households, community and stakeholder involvement and
mobilization, reduction of stigma and discrimination, increased community demand for 
more services, and sustainability of community mobilization, are found in the Relevance, 
Effectiveness/Efficiency, and Sustainability sections of this evaluation report.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 21
6. Sustainability
Was the project’s strategy appropriate and sustainable? What would make it more 
sustainable?
As a “pilot project” of 18 months duration and limited funding, it is difficult to discuss 
sustainability. However, it does appear that the project’s strategies have achieved
considerable success in building awareness, creating supportive and non-judgmental 
community environments, mobilizing communities and local governments, and building 
partner, community and care giver capacity. These successes, though, have only recently 
been realized, and may fade without more resources and time to “set” these results in the 
communities. There is also a need to document and standardize the approaches and 
lessons of this project, if it is to be expanded in Kanchanpur or replicated elsewhere.
There are several challenges with regard to sustaining the positive results of this project.
1. The capacity of poor communities to support vulnerable and affected households will 
continue to be tested. While the project has done a commendable job on helping 
communities to find the resources to deal with the current numbers of affected
households, it is uncertain what number of households could be supported in the 
future, as the number of HIV infections grows. This issue should be considered in the 
development of any future community-based impact mitigation project.
2. With reference to the caring capacity of poor communities, there is a need to caution 
against reliance upon a charity model. While it is commendable the local bodies are 
focusing on fund raising, it is questionable whether this is sustainable. A self-help 
model, where community members are encouraged to both increase their advocacy 
efforts and provide for their vulnerable neighbours using resources readily available in 
the community – food, building materials, and labour, as well as money if available, is 
more sustainable.
There is a ongoing need to build the capacity of community bodies to assess local 
needs, set priorities, and plan for the use of their limited resources, in a manner which 
increases impact and supports sustainability. To this end, the sole focus of allocating
funds for the assistance of individual affected households, while commendable, is not 
necessarily the best use of these funds. A community need identified in this evaluation 
was drugs for opportunistic infections and palliative care. Following the lead of Daijee 
VACC, other VACC/MACCs might also be encouraged to establish funds to pay for a 
stock of necessary and commonly used drugs. Funds could also be established to 
support the work of the FCHVs, and to sustain their mobilization.
3. The ability to mitigate the impact of HIV/AIDS is limited without income generation and 
employment opportunities. The Chief District Officer emphasized this point.
4. The mitigation of the impact of HIV/AIDS on families is limited in the absence of
Prevention of Mother-to-Child Transmission (PMTCT) guidelines and access to
PMTCT treatment. The evaluators met several families with children under the age of 
four, whose parent(s) had already died of (suspected) AIDS, and were themselves 
exhibiting AIDS symptoms. It is expected that the NCASC will soon release PMTCT 
guidelines and that a funded national program will make PMTCT treatment available to 
pregnant women who are HIV+.
5. There are limits to the use of community volunteers, particularly FCHVs, in the delivery 
of care and support activities. The sustainability of this project depends upon the 
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 22
ability to use this resource in an efficient manner. There is a need to look at the 
capacity of the VACCs to support volunteers (e.g. ability of VACCs to reward FCHVs). 
6. There is a need to engage the public health system on the provision of resources and 
personnel4
. This presents several challenges that extend far beyond this project, and 
focus on the absence of a functioning public health system in many parts of Nepal. 
District and community leaders made several comments on the lack of an ongoing 
relationship with NCASC. This must be built, as the National HIV/AIDS Programme is 
operationalized, and DACCs are given increasing responsibility and funds.
7. Several district and community leaders recognized the need to deal with increasing 
numbers of orphaned and vulnerable children (OVC). However, their focus was on the 
development of institutional care and not on keeping children in their communities. 
While institutional care is important, it should always be a temporary or final option. As 
discussed, a project such as this, has an opportunity to develop “legacy support” 
options and to work with affected families to plan for the future of their children.
8. There is an opportunity for the project to now take a more systematic approach to the 
provision of community-based care and support, to document the lessons learned, and 
propose a model or framework based upon the project’s experiences. There is also a 
need to sustain such work with the future provision of technical support in care and 
support, and counseling. Access to VCT, and access to drugs for opportunistic 
infections and palliative care, are also required to sustain the referral system.
To what extent has the project established sustainable linkages among local
groups?
To the extent that it could be observed, sustainable linkages were established among local 
groups. Affected family members were participating in Mothers’ Groups and VACCs. 
FCHVs, Mothers’ Groups members, and male peer workers were sitting as members of 
the VACCs. The project also appeared to have been well integrated into the other work of 
the partner NGOs, including the local Red Cross chapters.
FCHVs often meet at the VDC level. There is now an association of Kanchanpur FCHVs.
To what extent will the project partners and beneficiaries be able to take charge of 
the project’s objective after the project is completed and funding withdrawn? Is the 
phase-out strategy appropriate and supportive of other strategies?
At the community level (VACCs, Mothers’ Groups, FCHVs, male peer workers), there is a 
consistent opinion that the work of impact mitigation will continue, within the limits of 
community resources. The project is credited with developing this capacity. This would 
include continued awareness raising, fund raising, mobilization activities, and limited
community-based care and support. DACC, VACC/MACCs, Mothers’ Groups, male peer 
workers, and Red Cross Circles will continue to meet and plan community awareness and 
mobilization activities, local funds will continue to be solicited, and FCHVs will continue to 
deliver home-based care and support. However, the lack of community resources will 
restrict the scope of their work. Many expressed the opinion that 18 months was not 
 
4
 A consistent concern of FCHVs was the unstable nature of public care owing to high staff transfer 
rates and public health staff who were not at their posts. These issues speak to systemic problems, 
which go far beyond this project.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 23
enough time to sustain the results. In addition, it appears that the DACC and
MACC/VACCs still need to build their capacity to plan activities and allocate resources.
All four project VACCs now have annual budgets greater than the NR 10,000 required in 
the Monitoring and Evaluation Framework, ranging from NR 20,000 to NR 50,000.
The DPHO said that counseling services at Mahakali Zonal Hospital, now supported by 
the project, would not be supported by the district’s budget in the future.
There is no phase-out strategy for this project. SC/US is currently proposing a three￾month extension from its own funds to search for resources to continue and expand the 
project.
Could this project be replicated elsewhere? Could it be “scaled-up” or expanded? 
The district has requested that the project be replicated throughout Kanchanpur, with 
differing views as to the process5
. The project has been unable to support this growth due 
to funding restrictions, though some limited replication has occurred in one VDC next to 
Jhalari. 
Replicating the current project could probably be accomplished with only a small increase 
in the current resources. This replication would also continue the focus on community 
mobilization and capacity building. It would also, most probably, generate a similar
increased demand for VCT and a broader community-based care and support program.
The expansion or “scale-up” of the project would require a larger investment and longer 
period of time. It would need to be based on a similar model of community mobilization 
but should also include (1) VCT, prevention and income generation components (and 
referral and linkage systems to them); and, (2) a broader care and support component 
with an initial needs assessment, a framework for service delivery, and strong technical 
support. 
6.1 Findings and Recommendations
The evaluation findings…
1. Community and local government bodies have expressed willingness and
demonstrated an ability to carry on the work of the project (with the exception of the 
central counseling centre) within the limits of their capacity and resources. There 
remains some concern of the planning capacity of community bodies to assess 
community needs, set priorities, and commit resources.
2. There is a need for more time and resources to “set” the project’s successes. 
3. There are concerns about the ability of poor communities to deliver impact mitigation 
services, including community-based care and support, as the epidemic increases in 
size. Community reliance on fund raising and a charity model may not be sustainable 
given the limited funds available in the community. There are also concerns about the 
level of responsibility that can be placed on community volunteers to deliver services.
4. Sustainability of the project is threatened by a lack of income generation and
employment opportunities.
 
5
 Some believe that the project should be quickly expanded to the entire district while others, including 
the CDO, want an initial expansion to four-five VDCs on the Indian border.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 24
5. If the project were to be expanded, there would be a need to systematically develop 
the services required by the community and to ensure their delivery either within or 
outside the project. 
6. With the project focus on the creation of an enabling environment, it is inevitable that 
community demand for impact mitigation will increase. As such, the sustainability of 
this project is linked to the ability to expand the project to include these needed 
services. The replication of this project in other parts of Kanchanpur District would 
result in increased demands for these services.
7. Despite past challenges, there is a need to fully engage the public health system. The 
ongoing operationalization of the National HIV/AIDS Strategy may provide some
direction and support in the areas of prevention of HIV/AIDS among migrants and their 
families, VCT, PMTCT, protocols on the management of opportunistic infections, and 
social protection for people who are HIV+ and their families.
The evaluation recommendations…
1. Any future impact mitigation project in Kanchanpur District should continue to build the 
capacity of community bodies to plan. This includes the capacity to assess needs, set 
priorities and commit resources, as well as coordinate with stakeholders.
2. Any future major impact mitigation project in Kanchanpur should assess the capacity 
of poor communities to support an increasing number of affected households. An 
assessment should also be conducted on the level of responsibility that should be 
placed upon community volunteers and what support systems are required.
3. Any future major impact mitigation project in Kanchanpur should review the linkages 
between the project and the public health system, including the NCASC. As
elsewhere, there is the dilemma of whether to build the capacity of an under￾performing system or to build local capacity outside or parallel to the public system. 
This includes questions of whether communities should be generating funds for OI 
treatment, or NGOs should be delivering care and support, counseling and VCT
services. These issues go far beyond this project but should be addressed in the 
absence of a response from the public health system. The project should be prepared 
to create synergies with the impending operationalized National HIV/AIDS Strategy.
4. Any future impact mitigation project in Kanchanpur should move community bodies 
and volunteers from a primary focus on fund raising, to one that includes advocacy 
and the promotion of self-help, better using existing community resources. Following 
the example of Daijee VACC, more analysis is needed on the use of community 
resources to pay for the drugs required for opportunistic infections and palliative care.
5. Any future impact mitigation project in Kanchanpur should be an expansion and not a 
replication of this project. Given increasing awareness and the resulting increasing 
demand for services, an expanded project should ensure that VCT, prevention
services, expanded community-based care and support, and income generation and 
employment opportunities are available. Such an expansion should be built upon the 
awareness, acceptance, built capacity, and mobilization of the current project, but 
should also involve a more systematic needs assessment, a framework for service 
delivery of community-based care and support, and technical support to care
providers.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 25
7. Conclusion
It is the view of the evaluators that the project has, with the exception of the replication of 
project approaches throughout Kanchanpur District, substantially achieved the objectives 
set for it in the initial project documents, as articulated in the Immediate Results and 
Expected Impacts listed below.
Intermediate Results:
1. Program options to work with families vulnerable to HIV/AIDS identified by migration.
2. Increased capacity of local NGOs to facilitate and support community efforts to provide 
care and support for people living with HIV and their families, including children.
3. Increased capacity of the community to support households affected by HIV/AIDS.
Expected Impact (at the end of 2 years):
1. Increased access and utilization of counseling and care (institutional and home based) 
services by PLWHAs and their families
2. VACCs have developed and instituted (structures and systems in place) realistic plans 
for protection, care and support of vulnerable and/or affected households
3. District level and peripheral level counseling services and referral system set up
4. DACC/DDC replicate the project approaches in other VDCs of Kanchanpur District.
The main accomplishment of the project was the development of a “platform” upon which 
to build a community-based care and support program. Without efforts to build
awareness, reduce stigma and discrimination, build capacity, and community mobilization, 
it is unlikely that a sustainable community HIV/AIDS impact mitigation response could ever 
be built. Having said this, it should also be recognized that a sustainable response is an 
expanded response, including HIV/AIDS prevention, income generation, and a more
systematic approach to the development and delivery of community-based care and 
support services.
It is critical that project staff take immediate steps to document their efforts and to analyze 
the successes of their work and the challenges that they faced. Such an analysis should 
be developed in the context of lessons learned for similar future projects.
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 26
Appendix A: People, Groups and Facilities Visited
Prior to Field Visit
People/Group/Site Location
Tara Karki Chettry, HIV/AIDS Program Officer, SC/US SC/US Office, Kathmandu
Naramaya Limbu, Health Team Leader, SC/US SC/US Office, Kathmandu
Keith Leslie, Director, Himalayan Field Office, SC/US SC/US Office, Kathmandu
Dr. Jesper Svendsen, Senior Technical Officer, FHI FHI Office, Kathmandu
Stephanie Sulowatsky, Program Coordinator, FHI FHI Office, Kathmandu
Sunday June 1, 2003
Lok Raj Bhatta, Project Coordinator, SC/US SC/US Regional Office, Nepalgunj
Ganga Thakali, Regional Program Manager, SC/US SC/US Regional Office, Nepalgunj
Monday, June 2, 2003
Manoj Bhatta, Project Coordinator, NRCS NRCS Office, Mahendra Nagar
Lev Dav Joshi, Blood Bank Technician, NRCS NRCS Office, Mahendra Nagar
Ashok B. Jairu, Executive Director, NNSWA NNSWA Office, Mahendra Nagar
Bhim B. Sinal, Project Coordinator, NNSWA NNSWA Office, Mahendra Nagar
Dr. Dil B. K.C., Director, Mahakali Zonal Hospital Mahendra Nagar
Khagindra Bhatta, Health Officer/Counselor, Counseling 
Centre, Mahakali Zonal Hospital
Mahendra Nagar
Dr. Subesh Raj Kyastha, Physician, Mahakali Zonal Hospital Mahendra Nagar
Dr. Bal Bahadur Mahat, DPHO, Kanchanpur District Mahendra Nagar
Jaya Mukand Khanal, CDO, Kanchanpur District Mahendra Nagar
Binod Singh, LDO, Kanchanpur District Mahendra Nagar
Affected Family (5 – grandmother and four grandchildren; 2 
youngest grandchildren suspected of being HIV+)
Bankatti, Mahendra Nagar
Bhari Singh and Sita Singh, FCHVs Bankatti, Mahendra Nagar
Mothers’ Group (22) Bankatti, Mahendra Nagar
Tuesday, June 3, 2003
Mothers’ Group (23) Chandani VDC
Male Peer Workers (4) Chandani VDC
Affected Woman and Mothers’ Group member Chandani VDC
Woman suspected of being HIV+ (2) Chandani VDC
Peripheral Counseling Centre, Primary Health Centre Dodhara VDC
Youth Red Cross Circle, Laxmi School (28) Dodhara VDC
VACC (14); Chair: Sher Bahadur Budha Dodhara VDC
VACC (17); Chair: Ragu Nath Sunar Chandani VDC
Traditional Healer Chandani VDC
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 27
Wednesday, June 4, 2003
Mothers’ Group (18) Daijee VDC
Woman suspected of being HIV+ and her 4 children; youngest 
child is also suspected of being HIV+
Daijee VDC
Bishna Khadka, Community Mobilizer, NRCS Daijee VDC
Mothers’ Group (21) Daijee VDC
Woman suspected of being HIV+ and Mothers’ Group member Daijee VDC
Community members and neighbours of woman above (8) Daijee VDC
Sataya Devi Sunar, FCHV Daijee VDC
VACC (10); Chair: Indra Bahadur Malla Daijee VDC
Ganesh Joshi, Counselor/Nurse, Peripheral Counseling Centre, 
Health Post
Daijee VDC
NNSWA Field Office Jhalari VDC
VACC (14); Chair: Chet Raj Bhatt Jhalari VDC
Male Peer Workers (9) Jhalari VDC
Traditional Healer Jhalari VDC
FCHVs (24) Jhalari VDC
Mothers’ Group (20) Jhalari VDC
Affected Family; uncle and the 4 children of his brother and 
sister-in-law confirmed dead of HIV/AIDS; youngest 2 children 
suspected to be HIV+
Jhalari VDC
Thursday, June 5, 2003
Mothers’ Group (21) Ward 7, Mahendra Nagar
One widow suspected of being HIV+ and one woman with a 
husband confirmed HIV+; members of Mothers’ Group
Ward 7, Mahendra Nagar
Youth/Junior Red Cross Circles (34) Tilachour, Mahendra Nagar
Bhim B. Simal, Project Coordinator, NNSWA NNSWA Office, Mahendra Nagar
Sher Bahadhur Rana, Project Manager, CARE Nepal Care Nepal Office, Mahendra Nagar
Manoj Bhatta, Project Coordinator, NRCS NRCS Office, Mahendra Nagar
Stakeholder Debriefing Mahendra Nagar
Friday, June 6, 2003
Lok Raj Bhatta, Project Coordinator, SC/US Mahendra Nagar
HIV/AIDS Impact Mitigation through Mobilizing Affected Communities – Final Evaluation 28
Appendix B: Summary of Deliverables to Date
Deliverable Number
Mothers’ Groups Mobilized 200
Mothers’ Groups Members 4000
FCHV Mobilized – Care and Support 200
FCHV Mobilized - Counseling 100
Male Peer Workers Mobilized 160
Youth/Junior Red Cross Circles Oriented 40
Red Cross Circle Teacher Leaders Oriented 80
Out-of-School Peer Educators Mobilized 12
Traditional Healers Oriented 50
Public Health Care Providers Oriented and Trained – Care and Support 20
Public Health Care Providers Oriented and Trained - Counseling 8
Private Health Care Providers Oriented and Trained 24
People with HIV or Family Members Trained in Home-Based Care 30
DACC,VACC/MACC Members Mobilized 47