December 2002

The Value of Collaboration
An interview with an NGO scale-up partner in Calicut

Dr. Gopal Krishnan, director of the NGO Shelter in Calicut. Photo credit: Chris Castle

Dr. Gopal Krishnan, a 42-year-old physician, is both the chief executive officer/director of Medical & Allied, Inc., a private business concern, and director of Shelter, a Calicut NGO created in 2000 to provide improved and expanded care, treatment, and support services to PLHA and their families.

Like many of the scale-up partners involved in the study, Dr. Gopal distinguished himself by his dedicated and energetic commitment to the capacity-building program. His recognition of the importance of collaborating with existing organizations and services rather than having Shelter shoulder all responsibilities has led to a successful and resourceful adaptation of the YRG CARE model that has resulted in better access and outreach to key populations affected by HIV/AIDS.

The Horizons Report interviewed Dr. Gopal in September 2002.

Horizons Report: Before you created Shelter, what were your experiences with HIV/AIDS?

Dr. Gopal: We had had HIV-positive patients referred to our laboratory for special testing and confirmatory diagnosis of HIV. But we lacked pre- and post-test counseling for our clients because we weren’t aware of its importance.

One tragic experience stands out in my memory, when blood samples from an entire family were brought to a lab I had worked at earlier for confirmation of HIV infection. The husband, wife, and two of three very young children were all found to be HIV-positive. When we sent back the results, the messenger reported them to the villagers.

The next day I opened the local newspaper and saw a huge block headline: “Entire Family Thrown Out of House and Village Because of HIV.” I was quite sure that this was the family whose reports we had sent out without thinking about the consequences. This was not willful negligence on our part but rather lack of knowledge about the critical importance of guaranteeing confidentiality.

HR: Your scaling-up strategy involved building networks and collaborating with other NGOs, rather than enlarging your own organization. Why did you feel this was the best way to achieve your goals?

Dr. Gopal: I don’t have the huge infrastructure or financial capacity to run a big NGO, but at the same time I want clients to have access to all the services they need, so the only option left to me is to build partnerships and networks to deliver services and ensure follow-up. It’s cost-effective, avoids duplication of services, and doesn’t waste manpower. This kind of scale-up strategy also allows you to share your skills and knowledge with many others, which benefits a lot more patients and builds community capacity.

HR: How have you built up the network of service providers to whom you refer clients?

Dr. Gopal: First we identify groups that are working with the populations we want to target, such as men who have sex with men in Calicut, to whom we gained access through the Indian Youth Association/Partnership in Sexual Health (IYA/PSH). While this organization helps us reach these men for confidential treatment, we also help it by providing them with service guidelines.

We’ve built similar relationships with organizations that give us access to migrant labor communities and other vulnerable groups. One way we work with these groups is to extend our services to their premises free of cost.

HR: How can Shelter guarantee a high standard of care and a patient-centered philosophy when there are so many different providers?

Dr. Gopal: All the organizations that work with us already have working experience as medical providers in the field of HIV/AIDS, despite their lack of experience with care and support. But we constantly monitor the quality of their care and services.

HR: How useful were the capacity-building activities and training in which Shelter participated with YRG CARE and the International HIV/AIDS Alliance?

Dr. Gopal: They were extremely useful. The very idea of focusing on networking with organizations with similar interests originated at one of the workshops on community-based care and support. The scaling-up process was very important to building our capacity and skills and help expose us to other professionals in the field of HIV/AIDS.