Process Evaluation of Community Care Centers Providing Care, Support, and Treatment to People Living With Human Immunodeficiency Virus in India

Context: Since 2007, the concept of community care centers (CCC) has evolved to provide care, support, and treatment services to the people living with human immunodeficiency virus in a community-based environment so as to bridge the gap between secondary/tertiary level institutional and home-based care. Monitoring and evaluation, including process evaluation (PE), are integral parts of this scheme. Objective: This article presents the design of the "PE" for CCC and the results pertaining to the gaps and constraints in the implementation of the scheme. Design: The CCC PE was conducted in 197 of the 273 CCCs that have been functioning for at least 1 year as on November 30, 2009. Data were collected by structured observations and individual interviews through checklists and semistructured tools. Participants: The targeted population for PE was inpatient/outpatient beneficiaries, caregivers, and service providers of CCCs. Results: The findings revealed that of 197 CCCs evaluated, 55, 57, 52, and 33 were graded as A, B, C, and D, respectively. Of the 33 grade-D CCCs, 22 were from 4 high-prevalence states (Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu). There was dearth of good nongovernment organizations in the Northeastern region of the country with more nongovernment organizations in C and D category. The PE indicated some critical constraints in the services, such as shortage of medicines for treatment of opportunistic infections, poor coordination with anti-retroviral treatment centers, and transportation for referral cases. In spite of various constraints in the scheme, the majority of the patients were satisfied with the services available at CCC. Conclusion: The PE had provided an invaluable base to improve the CCC scheme, which will enhance the quality of service delivery system. The results of our experience may help other researchers and managers plan similar and more improved assessment.