Community Research and Development Information Service - CORDIS


DIFFER Report Summary

Project ID: 282542
Funded under: FP7-HEALTH
Country: Belgium

Periodic Report Summary 3 - DIFFER (Diagonal Interventions to Fast-Forward Enhanced Reproductive Health)

Project Context and Objectives:
The DIFFER Project (Diagonal Interventions to Fast-Forward Enhanced Reproductive Health) aims at improving access to sexual and reproductive health (SRH) services for the most vulnerable by identifying best practices in delivering comprehensive packages of SRH care and a better linkage between interventions targeted at female sex workers (FSW) and the general health services. It applies a ‘diagonal’ strategy, incorporating both ‘horizontal’ health systems strengthening and more targeted ‘vertical’ approaches. Horizontal programmes can reach large numbers of women, while vertical programmes target high-risk populations, difficult to reach through a horizontal approach. The study is designed as a set of case studies, with the ‘case’ being a well-defined geographical area where sex work is common. These are Mysore, India; Mombasa, Kenya; Tete, Mozambique; and Durban, South-Africa. The project has a duration of 5 years and applies a methodological framework for health systems research, starting with a detailed situation and policy analysis that informs the development of site and context-specific packages of interventions to strengthen SRH service delivery. These packages are then implemented and at the end the feasibility, acceptability, effectiveness, cost-effectiveness and sustainability of the intervention package are studied, combining qualitative and quantitative research methods.

Project Results:
The project initiated in October 2011 and during the first 54 months the following activities were developed:
During the first year and a half a thorough policy and situational analysis was conducted. A review of national policy and strategic documents, and interviews with key informants provided information on the national SRH and sex work policy environment, and a literature review of facility-based SRH services for FSW in Africa and India placed it in an international context. An assessment of the health facilities offering SRH services in each of the 4 cities, including facilities specifically targeting FSW, that comprised interviewing health managers and providers, assessing the conditions in which SRH services are offered and their cost, and interviewing service users, provided insight on what SRH services are currently available and to what extent they are adapted to the needs of FSW. Finally, focus group discussions with FSW, interviews with FSW key informants and a cross-sectional survey among 400 FSW in each city provided information on the current use of SRH services by FSW, their satisfaction, the level of equity and empowerment, and the remaining gaps.
Based on the baseline analysis, a generic package of interventions was developed that was consequently adapted to each country-specific context and discussed with local stakeholders. Four country-specific intervention action plans were designed and from the third year of the project onwards each of the 4 sites implemented the intervention. Interventions comprised (1) the mapping of SW hotspots, (2) strengthening peer outreach and community mobilisation, (3) strengthening clinical SRH services targeted at FSW, by expanding the package of services offered and their geographical reach; (4) making general SRH services more accessible and FSW-friendly; and (5) establishing linkages and referral systems between targeted interventions and the general health services, such as for example accompanied referrals, health care navigators and focal points. At the end of 2015, 18 months after having initiated the intervention package, each country condcuted the final evaluation of the feasibility, acceptability, sustainability, effectiveness, cost-effectiveness and equity of the package. The activities that had been implemented, their outputs and their cost were carefully documented; all relevant community outreach and health facility statistics were collected; the cross-sectional survey was repeated to quantify changes; focus group discussions were held with FSW to assess beneficiaries’ satisfaction; key informant interviews were conducted to assess practicability, sustainability and acceptability from the provider and policy perspective; and, where relevant, health facility audits and client exit interviews were done.
An important component of the project is the south-south exchange between our Indian partner, Ashodaya, and the three African partners. India is much further advanced in mobilising and involving FSW in projects addressing their needs and this experience was being transferred to Africa through capacity building in India and exchange visits to Africa.
Local ownership and translation of the research findings into policies is ensured through mechanisms such as local policy and community advisory boards, and periodic stakeholders meetings and workshops. Internal coordination among the six consortium partners is done through annual project management meetings and monthly skype calls. A project website was developed (, and key results from the baseline policy and situational analysis were presented at relevant conferences and are being published in peer reviewed journals. A DIFFER Newsletter was annually distributed.

Potential Impact:
During the remaining 6 months of the project, the consortium will analyse all data collected during the course of the intervention and the final evaluation. Each country will hold a participatory workshop with local and national stakeholders to discuss the results and their relevance for policy making. The key results will also be presented and discussed among the consortium partners, and with external national and international stakeholders, at a final conference in Brussels, Belgium, in September 2016, and disseminated through presentations at international conferences and publications in scientific journals. It is expected that based on the findings of the final evaluation, and the comparison of the findings among the 4 sites, lessons can be learned on what are the strengths and weaknesses of different models to provide essential services to an extremely vulnerable population such as FSW. This will inform policy makers in each of the 4 countries, as well as on an international scale, and hopefully lead to better policies, strategies and guidelines for the provision of SRH services to FSW and other key populations.

List of Websites:

Related information


Katherine Muylaert, (Administrative Project Manager)
Tel.: +3293323564
Fax: +3293323867


Life Sciences
Record Number: 189389 / Last updated on: 2016-09-20