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Regional Office for South Asia

Project Summary

IND/G86

1.  Project Code and Sector

Number and Title

AD/IND/05/G86
Empowering communities for prevention of drugs and HIV in India

Proposed Starting date

August 2005

Thematic area

Drug Demand Reduction - reducing consequences of drug abuse -HIV/AIDS prevention

Duration

3 years (2005 - 2008)

Estimated UNODC contribution

US$1,168,000

2.  Project description (background and justification)

On 26 June 2004, UNODC and the Ministry of Social Justice and Empowerment, Government of India jointly launched the National Survey on the Extent, Pattern and Trends of Drug Abuse in India. [1]  It not only points to the problem of India's population having twice the global (and Asian) average prevalence of opiate consumption, but also shows that the treatment resources available are not commensurate with the 'burden of work' (number of dependent drug users).  This survey had multiple components, which provided a comprehensive picture of the extent, pattern and trends of drug abuse in India.

The National Household Survey (NHS) was carried out between March 2000 and November 2001 on a randomly selected nationally representative sample (males only, 12 to 60 years) across the country.  Altogether, 40,697 males were interviewed and data on various socio-demographic and drug use parameters was collected.  Alcohol, cannabis and opiates were found to be the three most common drugs of use.  The prevalence of current use (i.e., use within the preceding month) was as follows:

Based on the above data, it can be projected that currently in India, there are approximately:

• 62.5 million alcohol users
• 8.7 million cannabis users
• 2 million opiate users

It was observed that among current alcohol users, 17% were dependent users. Correspondingly, 26% of current cannabis users and 22% of current opiate users were dependent users.  These figures translate to 10 million alcohol-dependent individuals, 2.3 million cannabis-dependent and 0.5 million opiate-dependent individuals.  This can be considered as the 'volume of work' for India in terms of providing treatment services.

The abundant availability of both illicit drugs and drugs diverted from licit trade, the magnitude of the country with a population of almost one billion, a multitude of languages and a complex drug control situation, makes it difficult to address the drug abuse problem effectively.  This situation is compounded by a general lack of resources, lack of information on the nature of the problem and lack of knowledge and skilled personnel to address it effectively.

To successfully influence the situation, there is a need for a systematic, cost-effective and well-targeted approach, which can introduce up-to-date and innovative demand reduction techniques on a nation-wide scale.  This would include a need to strengthen the capabilities of the Government to expand and support demand reduction activities in a systematic fashion, and to strengthen the capabilities of NGOs, communities, private enterprises, employees' and employers' organizations as well as other UN agencies to carry out such activities.

In terms of a response, while the Ministry of Social Justice and Empowerment is supporting a large number of NGOs across the country, the current coverage of drug users is limited.  Despite the fact that the Ministry of Social Justice and Empowerment annually spends the equivalent of almost US$ 5.5 million for drug demand reduction activities, the programmes coverage is limited to urban areas and towns.  The national survey has clearly shown that the drug problem has moved out from the urban areas to the rural areas and moved on to injecting.  This, added to the increasing numbers of HIV positive people, makes for a worrying mixture.  The increasing spread of drug abuse, increasing injecting use, low coverage of drug users with existing institutions and approaches has created a sense of urgency among the policy makers. 

In order to have a wider coverage of services throughout the country and to improve demand reduction services, the Government is currently in the process of expanding the reach of its programmes and trying to bring about a qualitative improvement in their service delivery. However, there is still an acute shortage of manpower trained in demand reduction and, as a consequence, the delivery of services is less than satisfactory. The National Centre for Drug Abuse Prevention (NCDAP) at the National Institute of Social Defence (NISD) and the eight Regional Resource and Training Centres (RRTCs) established under project IND/E40 have been active in a capacity building processes. Despite that quality coverage for the training of service providers in the field of drug use prevention still needs concerted efforts. 

The Ministry of Social Justice and Empowerment in partnership with the Department of Education, Ministry of Human Resource Development, Department of Youth Affairs and the health sector have already expressed the need to capacitate and to use their large network and infrastructure to step up drug use prevention, and awareness efforts especially for children/adolescents in and out of school especially in the North Eastern and vulnerable states across the country.

The North Eastern states, with an estimated 100,000 users with over 50% injecting in some areas, is considered by many to be an epidemic area.  Added to this is the spread of HIV among this population and in some states from them to the larger population.  The previous projects have laid the groundwork for a community wide response.  There is now a need to actually move the pilots from the test stage to the community wide stage so that the larger community can add their strengths to the existing infrastructure and jointly impact change within the society.  The Ministry of Social Justice and Empowerment (MSJE) is already supporting more than 45 NGOs in the North East.  The project IND/E41 has supported the establishment of 3 RRTCs in North Eastern India.  This project has also established community-based processes like community-based detoxification, Self Help Groups (SHGs), Drop-in-Centres (DICs), vocational training for recovering users, peer educators and social mobilization of women's groups that are now ready for widespread rollout.  The RRTCs are supported by the MSJE and are technically capable of managing the scale-up.  The next move is to enable the scale-up across the four worst hit states in the northeast and in key vulnerable locations in select states in the country.  It is generally accepted that the existing infrastructure cannot meet the need and the previous project went ahead and established pilots that were then tested within select communities.  The project proposes to make use of the traditional cohesiveness of communities in the North East using adapted, community-based techniques, to empower them to be change makers themselves.

3.  Objectives and strategy

Drug control objective:  To prevent and reduce the abuse of drugs and spread of drug-related HIV in India.

Immediate objective, outputs and activities:   To strengthen the capacity of government and civil society organizations to prevent drug abuse and scale-up interventions, which reduce the harmful consequences of drug use.

Area of focus: the North Eastern states and other identified vulnerable areas in India.

Achievement indicator: Evidence provided indicating successful scale-up of effective interventions reaching 400 NGOs especially in the north eastern and high prevalence states across India. 

Output 1 - Drug abuse prevention in Schools

A drug abuse prevention programme launched for in and out of school children in India is piloted and launched in India.

Activities

1. In consultation with the Ministry of Social Justice and Empowerment and the Department of Education design, develop and disseminate Guidelines for management of drug abuse in schools and other educational and training institutions.
2. Design a drug prevention Module for in and out of school children based on life skills education and peer-to-peer learning approach.
3. Develop, review and produce training material for training of master trainers.
   • Develop agreement with the consultant organizations /consultants for developing training material
   • Develop the content providing -a) necessary background on dynamics of substance abuse and related school based interventions; b) experiential learning techniques for adult audience; c) HIV/AIDS and its relation to drug abuse.
4. Train a cadre of 50 master trainers from Department of Education and NGOs in implementation of the national guidelines.
5. • Determine a number of resource persons required to implement the training programme
   • Select resource persons.
   • Convene a workshop to present training material to resource persons and agree on an approach to implementation methodology.
6. Design guidelines for service providers engaged in prevention of drugs among school children.
7. Develop, print and disseminate guidelines for service providers engaged in prevention work in schools.
8. Train a cadre of 200 service providers from schools and NGOs for launching drug prevention programmes in schools.
   • Determine extent and scope of exercise.
   • Select NGOs to participate
   • Ensure availability of training material.
   • Develop training schedule.
   • Deploy resource persons
   • Implement training
   • Evaluate process
   • Follow-up training and support to reduce attrition.
   • Evaluate outcome.
9. Pilot 50 in-school intervention programmes across the country.
   • Determine the pilot areas (geographical spread)
   • Select schools to participate
   • Ensure appropriate selection of teachers to be trained.
   • Ensure availability of training material.
   • Develop training schedule.
   • Deploy training teams.
   • Implement training.
   • Organize the programmes for a period of one year in the school.
   • Evaluate the process and outcome.

Output 2 - Drug awareness programmes for youth

A drug abuse prevention awareness campaign for youth is piloted and launched in India.

This would be addressed through a two-pronged strategy:

• Community based drug awareness campaign
• Media for prevention campaign

Activities

Community based drug awareness campaigns

1. Develop culturally specific drug abuse prevention and treatment messages for launching an awareness campaign among young people in diverse settings.
2. • Identify a suitable professional organization/agency with expertise in social marketing or development communication
   • Develop and field-test the messages
   • Review and refine
3. Identify key influencers and opinion leaders from across the country to advocate and lead young people on making informed choices for reducing risk behaviours.
4. Organize a sensitization programme for the key influencers and opinion leaders.
5. Print and disseminate the messages among key stakeholders.
6. In partnership with Department of Youth Affairs and Sports, use existing networks for creating awareness among young people especially through the National Social Service (NSS) Schemes, Nehru Yuvak Kendra (NYK) infrastructure. Develop a comprehensive strategy for the campaign and work out the modalities.    
7. Organize two training programmes for coordinators of NYKs and NSS from northeast and high prevalence states.
8. Launch an awareness campaign by creating a cadre of 2,000 peer volunteers (who, in many cases can be derived from the UNODC projects) with special focus on engaging young people in the northeast and other high prevalence states for carrying forward the drugs and HIV prevention messages among their peers through the existing networks.

Media for Prevention campaign:

1. Organize a media workshop in partnership with the UNIC and Press Information Bureau to    sensitize the media on the drug demand reduction issues for launching a drug abuse prevention campaign
2. Design brochures for use by large networks of political parties, student groups, transport workers, women's groups, law enforcement officers and the tourist industry by using common message for drug use prevention.
3. Organize fundraising events in partnership with the Federation of Indian NGOs for Drug Abuse Prevention (FINGODAP) for sustainability of the awareness campaign in the country.
4. In partnership with private sector federations/confederations and other responsible corporate citizens launch campaigns in select states for prevention of drug use at workplace and developing voluntary codes of conduct for pharmaceutical companies and pharmacies to prevent the abuse of prescription drugs in the country.
5. Organize public events in selected states using messages for healthy lifestyle through sports, music, visual and other performing arts.
6. Monitor and evaluate process and outcome

Output 3 - Young Women's self-help groups

Establish 50 support groups (1 in each of the 50 MSJE-supported NGOs) in vulnerable states to provide support, organize self-employment activities and ensure psychosocial support for the women partners (or surviving spouses) of especially infected and affected partners of IDU and those who vulnerable to HIV/AIDS.

Activities

1. Identify affected localities in the North Eastern region and selected states.
2. 100 Peer educators are selected and trained.
3. Peer educators are placed in the communities.
4. Establish 50 Drop In Centres (DICs), which are managed by the NGOs with the help of peer educators.  (The DIC staff will be trained on motivational counseling for referral to treatment Centres, relapse prevention and management, abscess management, rapid assessment, universal precautions, VCTC, establishing linkages with existing facilities for other blood borne infections, tuberculosis other referrals services.)
5. Each peer educator in and around their communities will initiate 5 Self Help Groups (SHG).
6. Build technical capacities of SHGs to provide home based care and support especially in areas where there is increasing incidence of drug use as well as increasing incidence of widows and orphans as a result of drug related HIV/AIDS.
7. Support innovative interventions involving communities and seed assistance where required for self help groups.
8. Study and select, in close consultation with and the participation of clients/ beneficiaries, specific locally marketable income generation activities.
9. Train NGOs and CBOs in micro-credit, micro-finance and revolving fund management especially for management and monitoring of income activities operated by the recovering users and self help groups. 
10. Establish, in close consultation with and the participation of clients/ beneficiaries, monitoring systems and management training for users managing the programs.
11. Provide support to secretariat of the national network of NGOs to facilitate the networking process between the different networks for engaging with civil society partners and for advocacy at state and national level on the concerns of drug users.
12. Support an e-network of peer educators working in communities for prevention of HIV among drug using populations and drug demand reduction

Output 4 - Good practice recorded

The project achievements are well-documented and disseminated within and outside the South Asia region for advocating appropriate and cost-effective responses.

Activities

1. Evolve a participatory M&E mechanism with all stakeholders for process as well as outputs.
2. Commission the documentation of good practices and an impact assessment report for dissemination among policy makers, planners, civil society and service providers for replication and adaptation of approaches adopted for drugs and HIV prevention, treatment and rehabilitation, care and support.
3. Establish a mechanism for sub-regional and regional sharing of experiences.
4. Use the experiences for advocating policy and programme review.

4.  Counterpart, institutional setting and implementation arrangements

The project will be executed by UNODC.  The main government counterpart will be the Ministry of Social Justice and Empowerment.  In the process of project implementation, the Ministry of Social Justice and Empowerment will coordinate with the Ministry of Health and Family Welfare, Department of Education, the Department of Youth Affairs, Ministry of Human Resource Development and other concerned Ministries and Government agencies.  Responsibility for the day-to-day management of the project will rest with the Project Coordinator.  A Project Advisory Committee (PAC) will be established to provide guidance on substantive and technical matters relating to the execution and overall management of the project.  The Advisory Committee will comprise representatives of MSJE, National Institute of Social Defense (NISD), Ministry of Health and Family Welfare, Department of Education, Department of Youth Affairs and Sports, NACO, UNODC, and the Project Coordinator.