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CONDOM PROMOTION

The National AIDS Control Programme (NACP III) condom promotion strategies recommended on
integrating the promotion of condoms for family planning and HIV/AIDS intensely across the entire
country using social marketing approaches. This integration will enable implementation of highly
focused social marketing programmes aimed at achieving the NACP III goal and of ensuring that every
sex act with risk of unwanted pregnancy and HIV/AIDS transmission is protected with condom use.
While translating this audacious goal into action the demand of condoms needs to grow from 2.2 billion
to 3.5 billion and number of outlets selling condoms need to grow from 1.1 million to 3 million by
2012. The number of social marketing programmes on the ground needs to grow from the existing 10
to 25. The analysis of the social marketing programmes indicated its attribution to growth in the
condom market and condoms. This led to the recommendations made by the working group of NACP
III for adoption of social marketing strategies under NACP III. NACO has constituted a Technical
Support Group towards development and implementation for condom social marketing programmes for
achieving NACP III objectives of condom promotion.
1.

Objectives of NACP-III relating to the Condom Promotion


1.1

Condom Promotion Objectives

a.

The condom promotion objectives aim to protect all sex acts that can put someone at the risk of
HIV and/or unwanted pregnancies. The specific objectives of the condom promotion in NACP III
are to enhance the demand of condoms from 2.2 billion to 3.5 billion and the number of outlets
selling condoms three-fold from 1.1 million to 3 million over the next two years. Emphasis will
be placed on opening new non-traditional condom outlets. The condom promotion objectives
should be achieved through concentrated efforts in increasing supply and demand for condoms
in the high risk areas and rural coverage for preventing unwanted pregnancies.

b.

It is envisaged that all the three channels of condom supply free distribution, social marketing
and commercial sales will work in a complementary manner, each providing products to
different target groups. The consumer base for socially marketed condoms will be increased by
using behaviour change strategies to move the current users of free condoms to socially
marketed condoms and to motivate current non-users to use condoms in all non-regular sex
acts. Free supply of condoms will be limited to the population at the greatest risk of HIV or
those who can not afford to buy socially marketed condoms such as population below poverty
line, female sex workers and men who have sex with men

1.2

Social Marketing Objectives


i. The social marketing programmes of NACO will contribute substantially to the HIV
prevention objectives of NACP III. The targeted growth trajectory for subsidized
condoms, marketed by the social marketing organizations, is to increase the
subsidized condom market to 2 billion from the current market of 843 million
[source: ORG retail off take survey- 2009) by the year 2012.
ii. Social marketing programmes will create access to condoms through saturated coverage
of high risk areas, and expanded access in the rural areas. Evidence-based
behaviour change activities will be an integral part of the social marketing
programmes. The mid-media activities of behaviour change communications will
increase demand for condoms through generic promotion of condoms and addressing
barriers to condom use.
iii.

The target population for the social marketing programme is men in the reproductive
age. Condoms will be promoted as a method for dual protections (providing
protection against HIV and other STIs, as well as against unwanted pregnancies)
through strategic communication approaches towards normalization of condoms. The
normalization of condoms would include (but not limited to) the concepts that
increase the perceptions of positive social support, social norms, self efficacy in
buying, carrying and use of condoms without embarrassment. The desired
behavioural outcomes of the programme are to:

a) Increase consistent use of condoms among men with the non-regular sexual
partners.
b) Increase consistent
encounters.

use

of condoms

among men

in commercial sex

c) Increase use of condoms for preventing unwanted pregnancies among


married couples.
The supply objectives of the condom social marketing programme are to:
a) Increase the retail off-take of social marketed condom to 2 billion by 2012.
b) Increase the number of condom outlets to 3 million by 2012
c) Increase the accessibility of condoms to make it available within 15 minutes of walking
distance from any location.
In order to achieve the above objective and to achieve operational efficiency, NACO has initiated the
Condom Social marketing Programme based on the prioritization of geography.
1. Prioritization of geography
a. In order to maximize the health impact, the priorities are to saturate the coverage of areas
that have generalized spread of disease. The high risk areas in the high prevalence districts
will receive a package of marketing services in order to increase supply and demand for the
prevention products.
b. The categorization of the districts is an evidence based decision to prioritize geography and
designing an intervention in response to the risk, need and demand in the district. BSS
2006, NFHS III, consumer off take surveys, population data, HIV surveillance data and rapid
household surveys are considered to prioritize the districts in each of the state. Appropriate
packages of social marketing program will be implemented for each strata of the district.
The districts has been categorized as below

Category

Definition

High prevalence and high family


planning need

Districts that are A or B category of HIV prevalence and

High Prevalence and low family


planning need

Districts that are A or B category of HIV prevalence and

Low prevalence and high family


planning need

Districts that are C or D category of HIV prevalence and


districts that have high fertility and high unmet need for
birth spacing and low condom use for family planning.

Low prevalence and low family


planning need

Districts that are C or D category of HIV prevalence and

Districts that have high fertility and high unmet need for
birth spacing and low condom use for family planning.

Districts that have low fertility and low unmet need for
birth spacing and high condom use for family planning.

Districts that have low fertility and low unmet need for
birth spacing and high condom use for family planning.

NACO Targeted Condom Social Marketing Programme


NACO has initiated the targeted condom social marketing programme in 2008 to saturate the coverage
of condoms at high risk areas. So far, NACO has successfully implemented two phase of condom social

marketing programme.The phase I of Condom Social Marketing Programme was implemented in 2008
across 194 high priority districts of 15 states. The second phase of Condom social Marketing
Programme in being implemented across 294 high priority districts.
The achievements of these two phases of condom socials marketing programme details
Scaling up of NACO Targeted Condom Social Marketing Programme Phase III
Based on the successful implementation of the earlier two phases of Targeted Condom Social Marketing
Programmes, NACO has decided to further scale up the condom social marketing programme.The
phase III of CSM would be starting from June 21 st,2010 and would be implemented across 370 high
priority districts .The programme would be implemented by eight identified SMOs.The major focus of
this programme would be to enhance the accessibility of condoms at high risk areas in high prevalence
states and rural areas in high fertility districts.
Innovative Approaches To Propel the Objective to a New Dimension
NACO has launched a number of innovative approaches to promote condom use. These are:
A-Condom Vending Machines (CVM)
NACO installed 11,025 CVMs in 10 states under a national programme in Phase I in 2005-07. The
CVMs provide anytime access to quality condoms in a non-embarrassing situation. Another 10,025
CVMs are being installed in four metros (Delhi, Mumbai, Kolkata and Chennai) and in two major towns
of UP and Orissa in Phase-II of the programme that began in 2008.
B-Female Condoms (FC)
The FC programme was implemented through selected NGOs in six high prevalence states.
The results from the pre-programme assessment indicated high levels of acceptance of FCs
among sex workers and close to 5% reduction in unprotected sex acts. Based on the
encouraging results from the FC pre-programming assessment in six states, NACO is funding
the FC scale up programme in four states of Tamil Nadu, Andhra Pradesh, West Bengal and
Maharashtra. Another FC scale up programme funded by UNFPA is being implemented in four
states of Bihar, Jharkhand, Orissa and Rajasthan. NACO is providing female condom at a
highly subsidized rate. Based on the learnings of the current FC programme, TSG has
proposed to scale up female condom programme on pilot basis in two to three districts of
another nine states each. So far NACO has procured 30 lakh female condoms, out of which
24
lakh pieces of FC
has
already
been
delivered to
the
implementing
agencies.
C-Special Condom for MSM
The prevention strategies of NACP III recommend innovations in condom attributes to
support coverage of MSM population for HIV prevention among MSM population. The MSM
interventions implemented under NACP II has articulated the limitation of the normal
lubricated condoms for MSM population. The product attributes specifically in terms of the
thickness and provision of additional lubricants in sachets along with the condoms have been
considered to address the needs of the MSM community. As a result, a thicker and more
lubricated condom brand "Spice Up" is being launched to cater to special needs of the highrisk groups i.e. MSM. These condoms will be socially marketed in the targeted intervention
sites. This specially designed condom will cater to the specific needs of the MSM.

Convergence Plan between NACP and DOHFW

Convergence between the National Aids Control Programme (NACP) and the Department
of Health and Family Welfare (DOHFW)

1. Introduction
1.
1

The HIV/AIDS epidemic in India is complex, with intense focal epidemics among sub groups (IDUs,
Sex workers, Truckers, Men who have sex with Men) in some states, situations where prevalence is over
1% in the general population, and low prevalence in some others states. In states like Andhra Pradesh,
Karnataka, Tamil Nadu, Maharashtra, Manipur, and Nagaland, prevalence among antenatal women
(based on sentinel surveillance data (2003) located in ANC clinics), considered representative of the
general population, is around 1.25%. Annexure 1 provides state wise HIV prevalence levels from 455
sentinel surveillance sites, for the year 2003. NACO has classified states as high prevalent, medium
prevalent, highly vulnerable and vulnerable states (Annexure 2). The index of vulnerability is based on
extent of migration, size of population, and poor health infrastructure. Among highly vulnerable states
are: Bihar, Rajasthan, MP, UP, Uttaranchal, Chhatisgarh, Jharkhand, Orissa, and Assam. This includes all
the EAG states of the DHFW.

1.
2

There is a pressing need to scale up prevention strategies based on factors of risk, vulnerability, and
impact, expand delivery of interventions and ensure that populations at risk and vulnerable groups are
reached. India is at a stage in the epidemic where all sexually active individuals must be offered
information and services on preventive interventions. Sexually active youth, particularly girls are at high
risk given the paucity of needs specific information and services. HIV/AIDS infection prevalence is
increasingly acquiring gender connotations. Sentinel surveillance data also show that women account for
more than half of all infections in rural areas (nearly 60%) and about two fifths of all infections in urban
areas. Sentinel surveillance sites are located mainly in either Antenatal clinics or in STD clinics. Given
the evidence that most STD clinic attendees are men, it can be assumed that most women who are
positive are also pregnant, a rather ominous portent for risk of transmission to newborns, and a
substantial justification to expand the number of sites offering PPTCT.

1.
3

Convergence between the National AIDS Control Programme (NACP) with over a decade of
experience and technical competence in HIV/AIDS prevention and care interventions and the Health
and Family Welfare programmes (HFW) with its infrastructure, human resources and capacity reach
to every village and community is critical to ensure scaling up and effective service delivery.

1.
4

Behavior Change, prevention/management of RTI/STI and condom promotion are the cornerstones of
HIV/AIDS prevention. All three areas have a significant degree of overlap with interventions in the
Reproductive and Child Health programme, since target groups and services fall in the same arena.
Other areas of prevention linked to HIV/AIDS interventions and which have implications for services in
the HFW are Voluntary Counseling and Testing, (VCTC), Prevention of Parent to Child Transmission
(PPTCT), and ensuring safety of blood and blood products. Comprehensive HIV/AIDS Programmes
include components of both prevention and care. VCTC and PPTCT are two areas of overlap between
prevention and care strategies. Areas of cross cutting importance that need to be addressed in prevention
and care strategies include: gender, private sector involvement, and reduction of stigma and
discrimination among health care providers and communities.
(Figure1)

2. Convergent Technical Strategies and Programmatic Interventions


of NACO and HFW
2.
1

The National AIDS Control Organization (NACO) is the implementing agency for the NACP. At the
state level, State AIDS Control Societies (SACS) implement HIV/AIDS interventions. Currently NACO
and the SACS support about 900 NGOs for targeted interventions aimed at reaching the so-called highrisk groups. (those with high numbers of sexual encounters increasing possibility of transmission, such
as Sex Workers, Truckers, Men who have sex with Men, Intravenous Drug Users, Adolescents, Migrant
men and women,). They also support behaviour change communication aimed at the general population
through variety of mechanisms. The reach of the NACP to men and in urban areas is significant.

2.
2

In the public sector, NACO and the SACS support RTI/STI management, VCTC, PPTCT, Blood Safety,
and several other interventions. However the reach of these interventions through the health system is
primarily through teaching hospitals and medical colleges, district hospitals and in the case of the six
high prevalence states, taluk hospitals as well. The SACS in the high prevalence states (most of which
are the ones with better health infrastructure and moderate to high care seeking) are also active in
implementing HIV/AIDS interventions.

2.
3

The Department of Health and Family Welfare at National and State levels (with state specific
variations) supports a range of services for improving primary (including reproductive) health care at
community, primary, secondary and tertiary levels. Community based interventions are primarily
provided by the Auxiliary Nurse Midwife located at the sub center. The coverage of the sub centre is
about 5000 (3000 in tribal areas) and covers about the area of three to four gram panchayats. Service
delivery is through the sub center on fixed days, supplemented by outreach visits to the coverage area.
At the village level, the Anganwadi Worker (AWW) and/or the Traditional Birth Attendant (TBA) often
assist the ANM. With the advent of the National Rural Health Mission it is expected that the ANM will
soon be supported by a female community health volunteer (ASHA), and assisted by the AWW and
TBA. Thus the potential reach of the system will be to every community and habitation. In addition to
the public sector health system, the DHFW supports NGOs (through the Mother NGO scheme) to
implement a range of RH interventions (Safe motherhood, family planning, adolescent health, RTI/STI
management, child health, and male involvement) in areas underserved or not served by the public
sector system. While the DHFW through its flagship RCH project does include enhancing male
responsibility as a key intervention, the emphasis is on women and children. Urban health is a
component of the RCH 2 programme.

2.
4

The following areas of convergence have been identified[1] for scaling up HIV/AIDS prevention
responses: RTI/STI management, Condom Promotion, Voluntary Counseling and Testing, Prevention of
Parent to Child Transmission, Behaviour Change Communication, Blood Safety, Training, and
Management Information Systems. In additionmale involvement and ensuring convergence of NACP
and DHFW through strengthening urban health infrastructure and reach are two additional
strategies, which are common to the major areas identified above.

2.
5

This paper provides a broad framework for action to address the major convergence areas. The
effectiveness of convergence of key interventions is dependent on several factors, but critical is the
operationalization of convergence within well functioning health systems and programme
management structures at all levels. RCH II has been designed to address reproductive and child
health interventions through a framework of health sector reforms at various levels. It is opportune that
NACO and DHFW jointly look for ways to improve reach, enhance access and coverage, provide
quality services, address synergistic intervention elements, and prioritize interventions based on
prevalence, infrastructure, current programme efficacy, and resources. It must be emphasized that
this framework is proposed at the National level and state level consultations with key stakeholders are
necessary to operationalize the plan in the context of state realities.

2.
6

Section 3 provides substantive details on each convergence area, with a brief technical background for
each area, highlights current interventions of NACO and DHFW, identifies points of convergence in
order to reach groups and communities that are at risk and vulnerable, and defines broad areas for
operationalizing these strategies. Section 4 includes operationalization of convergence and details
institutional mechanisms to facilitate convergence. Section 4 is supplemented by a matrix, which
summarizes key convergence areas, primary responsibility, and convergence aspects. Section 5 briefly
discusses next steps.

3. Opportunities and Issues for Convergence


3.1

RTI/STI prevention and management


3.1.1

Background: RTI/STI has a severe impact on the reproductive health of individuals as well as
significantly enhances the risk of transmitting or acquiring HIV/AIDS. Women are biologically
more vulnerable to acquiring RTI/STI and consequences of STI in women are more serious
(ectopic pregnancy, pelvic inflammatory disease, still births). Unequal gender relations
resulting in sexual coercion is more pronounced among women, and women often have limited
access to care. There is evidence that RTI/STI care is more often sought in the private sector
than in the public sector and in several places from untrained practitioners as well as chemists.
There is little published comparable and reliable data on RTI/STI in the country. Efforts at
programme planning have been based on micro studies conducted with different
methodologies, using varying criteria and for clinical and laboratory diagnosis.

3.1.2

DHFW strategies: The National STD control programme has been in place since 1946.
However, it was only in the RCH 1 programme, that RTI/STI management was included on a
national scale. Many donor-funded programmes in states have also supported RTI/STI services
through state health and family welfare programmes. While there are no formal evaluations to
assess the performance effectiveness of these efforts, anecdotal evidence suggests that several
lacuna hampered these efforts and they remained largely out of the reach of women and men in
need of services. Current policy guidelines stipulate that only medical officers are allowed to
prescribe RTI/STI drugs, thus limiting the reach of effective RTI/STI services.

3.1.3

NACP strategies: RTI/STI management has been attempted through several approaches:

NGOs working with High Risk Groups on targeted interventions are provided

with support for medical personnel, clinics, and Drugs for RTI/STI. In some instances
NGOs collaborate with the public health system or private providers to provide STI
diagnostic and treatment services.

Annual Family Health Awareness Campaigns are held across the country. These
are two week campaigns which are period of heightened activity at the district level and
below when the machinery of the HFW system is expected to conducts house to house
and group education, media and advocacy events and promote care seeking for
RTI/STI. Patients are referred to PHC and above, where RTI/STI are treated using the
syndromic approach. Annexure 3 provides details of the achievements of FHAC from
1999 to 2003. Coverage increased from 100 districts to 572 districts.

NACO has provided support to establishing STD clinics at hospitals upto and
including district hospitals. By the end of fiscal 2004, NACO had supported 735 STD
clinics in all medical colleges and in most district hospitals. Each STD clinic includes a
qualified STD specialist and laboratory support for diagnosis and treatment of STI.
NACO also ensures a continuous supply of STI drugs. (Annexure 4 provides details of
number of STD clinics in each state)

NACO supported training of a range of HFW providers (MO, ANM, LHV,


Laboratory technicians) in areas such as RTI/STI, universal precautions, nature and
content of HIV/AIDS programming, stigma and discrimination. Annexure 5 provides
details of personnel trained.
3.1.4

Core
Convergence
Recommendations
for
RTI/STI
:
From the above data it is clear that NACP interventions in the public sector system reach only
the district hospitals and are not programmed to be gender sensitive. Although Medical officers
have been trained in syndromic diagnosis, they are located in primary health centers and above.
Current utilization of PHCs is low. Thus the benefit of the knowledge and skills of the medical
officers does not reach communities in many parts of the country. The FHAC could do a good
job of spreading awareness but services are still provided at the district level, reducing reach.
DFW interventions are also primarily through medical officers. Grass roots workers such as the
ANM in most areas are not empowered to provide information and services for RTI/STI. There
is little by way of health education at the community level on RTI/STI, which highlights issues
of risk and vulnerability, male responsibility, and the use of condoms for dual protection. This
varies from state to state and in high prevalence states, awareness levels are high, but access to
services remains low. One of the challenges that needs to be taken into account while
converging the programme into the DHFW programme is that the reach to important core and
bridge groups such as: sex workers, men who have sex with men, men in the general
population, and youth. RCH II does include interventions to address youth, enhance male
responsibility, and health in urban areas and care must be taken to ensure that convergence
mechanisms address the inclusion of such groups.

Public Sector interventions from district to peripheral level for RTI/STI to be


implemented through DHFW, in line with the RCH II design document. RTI/STI

prevention, management of the client, partner notification, treatment, and follow-up are
the key components of an RTI/STI programme. Comprehensive RT/STI treatment will
be provided at CHC and 24 hour PHC (clinical and etiologic) and first line drugs at the
PHCs.

RTI/STI control among High Risk Groups through NGOs with funding support
for RTI/STI diagnosis and treatment, to continue through NACO and SACS, but

reporting also to HFW.

It is expected that ASHA will be provided with enough information/supplies to


support health education, prevention advice and treatment facilitation (through referral)
at the village level. Presently the closest possible site for services by trained personnel
is the sub center level. The ANM/Male MPW will be the frontline service providers for
RTI/STI management, MO/SN/LHV at the PHC level, and MO/Ob-Gyn. at the
CHC/FRU level. It is expected that over time, with strengthened Primary Health Care,
laboratory based management of RTI/STI will be the norm rather than the syndromic
approach. At the CHC level, basic screening tests for RTI/STI will be made available.
At the district level, RTI/STI will be managed by STD specialists supported by or
linked through referral to high quality laboratory services supporting the full
complement of laboratory tests for RTI/STI.

At the community health centers and district hospitals, RTI/STI management has
to be included in protocols in Ob/Gyn and Medicine departments. Medical and
paramedical professionals to be oriented to risk identification and referral to VCTC.

NGOs under HFW to include RTI/STI in their package of interventions, with


referral or services as appropriate.

Private providers (reached through Indian Medial Association (IMA) and


Federation of Obstetrics and Gynaecology-FOGSI ) to be part of RTI/STI management
strategy for training and to ensure appropriate reporting and notification, particularly in
the case of sexually transmitted infections and drug resistance surveillance. This will
also need to be implemented through DHFW.
3.2

Voluntary Counseling and Testing Centers (VCTC)


3.2.1

Background: Voluntary Counseling and Testing is now acknowledged as an efficacious and


pivotal strategy for prevention and care for HIV/AIDS. Counseling is an important skill and is
a necessary part of interventions for several areas within Family Welfare, family planning, safe
motherhood, RTI/STI, and in dealing with youth. It is also more cost effective to integrate VCT
into sexual and reproductive health services, rather than support them as freestanding sites.
Counseling requires specialized skills and attitudes, space to assure confidentiality, laboratory
services for testing, adequate reporting systems.

3.2.2

DHFW strategies: While counseling is an important element of several reproductive health

services, counselors are not part of the health provider cadre. ANM, LHV and other providers
have been trained in basic motivation, interpersonal skills, but these are not dealt with in any
depth, nor are they geared toward attitudinal change. It has thus far formed part of an
integrated training package. In some states donors have supported separate training to improve
counseling and motivation skills of ANM and LHV (UNFPA through IPD projects, USAID in
SIFPSA), but only in selected districts.
3.2.3

3.2.
4

NACP strategies: NACO and the SACS have established 650 VCTCs across the country with
about half of them located in high and medium prevalence states. They are primarily located in
medical colleges and district hospitals. Annexure 6 provides state wise details of numbers of
VCTC. Each VCT includes one male and one female counselor, and one laboratory technician.
NACO and SACS supply testing kits for these VCTCs. In the medical colleges, the VCTC are
located within the microbiology departments (with counselors reporting to the HOD,
Microbiology) and in charge of the Pathologist in a district hospital. Currently the view of the
State AIDS Control Societies is that VCTC utilization is low, particularly in the low prevalence
states.

Core Convergence Recommendations for VCTC

The NACP will manage the VCTC in collaboration with the key staff of the
facility in which the VCTC is located. Youth information centers to be established with
the VCTC to increase access of young people to information and referral for services

for a range of reproductive and sexual health issues.

NACP will support the staff of VCTC and supplies required with DHFW will
provide the physical infrastructure.

It is proposed that the district VCTC function as a satellite center to coordinate,


support and supervise operations of the VCTCs located in the CHC and 24 hour PHC.
This internal coordination is important for several reasons- to maintain quality of
services at all sites, to ensure uninterrupted supplies, link with PPTCT at district and
CHC levels, and to enable referral linkages of clients that test positive to appropriate
centers.

VCTC s will not function as sites for counseling of HIVAIDS alone. Counselors
in VCTC, particularly at secondary and primary health care levels should be able to
counsel for family planning, RTI/STI prevention, safe delivery, and male responsibility.
A cadre of counselors could be established who would serve the RH needs of women
and men, including HIV/AIDS, and the RH information and service for young people.
It is hoped that this measure will increase utilization of VCTC.

Expand the number of VCTC sites. The expansion should be informed by a rapid
assessment of VCTCs in low and high prevalence areas, and identify systems issues,
human resource training gaps, and logistics. The expansion is proposed in a phased
manner, and will be governed by the following: prevalence, physical

infrastructure, human resources, and community use of facilities.Fortunately the


high prevalence states also have better infrastructure and increased utilization (higher
rates of antenatal coverage, institutional deliveries, and overall increased care seeking
behaviour). As a long-term plan, (by 2012) it is expected that all PHCs will have VCTC
facilities that will cover a range of services beyond just HIV/AIDS counseling. The
expansion process is proposed as follows:
o
Phase 1: (2005-2008) In the high prevalence states, district hospitals, all
CHCs and all 24 hour PHCs will have Voluntary Counseling and Testing Centers,
staffed by a full complement of male and female counselors; separate space and
laboratory back up. In the low prevalence centers, VCTC could be located at the district
level and at all CHCs. In high prevalence districts within low prevalence states, the
choice of whether 24 hour PHCs could offer VCTC could be left to the state.
o
Phase 2: (2008-2010) All PHCs in high prevalence states and 24 hour
PHCs in other states will have VCTC.
o
Phase 3: (by 2012): PHCs, all CHCs and district hospitals, will offer
VCTC services.
o
Expansion will be based on review of past experience, utilization and
need.

Basics of Counseling for all cadres of staff (sub center to CHC) to be included in
training package, so that at the very minimum all staff have the skills to enable clients
to understand risk perception, motivate them to seek services, and finally be able to

facilitate informed referral.

Involvement of private providers and private laboratories, through IMA, FOGSI,


and pathologists Association, where testing takes place to ensure that their clients also
are counseled and their data is reported at district and state levels.

NGOs under HFW programme and NGOs working with High Risk Groups to
include information on VCTC functions and sites so that they can carry the message to
the community, and increase utilization as appropriate.
3.3

Prevention of Parent to Child Transmission (PPTCT)


3.3.1

Background: Core PPTCT interventions need action in the community, and depending on the
package of services offered, at the levels of the sub center, Primary Health Center and at the
Community Health Center. PPTCT interventions for HIV positive women relate to a range of
services provided in the HFW system: antenatal, delivery, and postpartum care, abortion
services, VCTC, Management of STIs in pregnancy, Antiretroviral therapy based on current
policies- (currently Nevirapine), Family planning counseling and easy access to services,
Expansion of well baby clinics, high quality education and information provision on nutrition,
breastfeeding, RTI/STI, and HIV/AIDS, male involvement in MCH care, and linkages to

community based care and support programs for HIV/AIDS.


3.3.2

DHFW Strategies: DHFW per se does not implement PPTCT interventions. Currently PPTCT
interventions are being provided in selected locations through the health facilities of HFW.
However, training, supplies and logistics, and drugs are primarily supplied through NACO.

3.3.3
.

NACP strategies: Currently NACO is providing PPTCT services in 273 units across the
country of which 234 are located in high prevalence states. Annexure 7 provides details of
PPTCT in the country presently. They are primarily located at the medical colleges of high and
low prevalence states and at district hospitals only in the high prevalence states. They are
located in the Ob/Gyn department. A counselor, mostly female and one laboratory technician
staff each PPTCT. Staff of PPTCT sites (PPTCT team- Ob/Gyn, Microbiologist, Paediatrican,
Staff nurse, and one health educator) are trained for five days. Counselors of PPTCT are
trained for a ten-day period. Sensitization training of other staff in the facility where the
PPTCT site is located is also conducted.

3.3.4

Core Convergence Recommendations for PPTCT

The management of PPTCT sites should continue to be with the NACP, since all
clients of the PPTCT will need to be followed up for care and support. At the institution
level, the PPTCT staff will continue to report to the Head of Ob/Gyn. PPTCT at the
district level will function as the hub or satellite center to coordinate quality, supplies,

reporting and facilitation of referral.

NACP will fund the counselor and laboratory technician in the PTCT and the
supplies required for the PPTCT programme. The PPTCT will be located in the Ob/Gyn
department of the CHC and will function through existing staff.

PPTCT sites should be expanded in a phased manner. Since PPTCT is a function


of the obstetric department, and since RCH II is focusing on improving/strengthening
access and quality of institutional deliveries, PPTCT can be implemented within the
framework proposed for RCH II.
o
Phase 1 (2005-2008): All district hospitals and CHCs to offer PPTCT,
regardless of prevalence.
o
Phase 2 (2008-2010) In high prevalence states, 24 hour PHCs, should also
offer PPTCT.
o

Phase 3(by 2012 years): 24 hour PHCs in all states to offer PPTCT

services, based on prevalence, utilization, and need.

At the community level, ASHA/ANM will be trained through health education


and motivation among women and men for risk perception, risk identification,
facilitation in accessing VCTC, and thus identifying positive women in need of PPTCT.
Para medical and medial providers at the PHC level will also be trained in similar areas
to facilitate referral to PPTCT and enable follow up.

Positive women will be followed up through pregnancy by ANM/ASHA and

encouraged to opt for institutional delivery in district or CHC/FRU.

PPTCT programmes should establish linkages with the Integrated Management


of Neonatal and Childhood Illnesses (IMNCI) component of RCH II, to address issues
of infant feeding, nutrition, and infections.

All providers would need sensitization on issues of stigma and discrimination, so


that positive women do not fear institutional deliveries. PPTCT teams should be
specially trained in areas of infection prevention, and stigma and discrimination
attitudes, as well as the specific technical aspects of PPTCT

Institutions to be strengthened to adopt universal precaution measures and waste


management. Delivery kits to be made freely available under the PPTCT programme.

Orientation and sensitization of private providers (through IMA, FOGSI, Indian


Health Care federation, Hospital forums and associations) and involvement of private
hospitals in VCTC and PPTCT as appropriate.

NGOs supported by DHW and NGOs working with high-risk groups to be


provided with information on location of PPTCT sites and encouraged to facilitate
referral and follow up.
3.4

Behavior Change Communication


3.4.1

Background: Changing individual and community behaviour is critical to HIV prevention In


order to impact the epidemic it is necessary to target behaviour change interventions at the
individual level to increase knowledge, enhance risk perception, and develop safe sex skills.
These are primarily through interpersonal communication and small group discussions and
peer education. Such efforts at the individual level need to be reinforced by community level
interventions to increase understanding of a supportive environment to reduce risk and
vulnerability, and influence societal norms. Messages that are targeted to sexually active
individuals include: postponing age of sexual activity, using condoms correctly and
consistently, decreasing number of sexual partners, increasing STI and TB treatment seeking
and prevention behaviors.

3.4.2

DHFW strategies: HFW has not integrated HIV/AIDS messages in BCC material till date.
However, in the past few months, efforts are on to integrate HIV/AIDS prevention messages in
some initiatives of the HFW department- wall calendar and diary for 2005 of the MOHFW
includes HIV/AIDS messages. Adolescent health education and life skills programmes have
included HIV/AIDS content quite substantially, especially in the adolescent friendly health
clinics, piloted by MOHFW.

3.4.3

NACP strategies: At the National level, NACO frames guidelines for IEC activities
countrywide and undertakes multimedia campaigns along with political and media advocacy.
NGOs working with high-risk groups for targeted interventions develop their own BCC
strategies. SACS in each state have mass media campaigns and other activities for general
population- varied across states and school AIDS Education programmes.

3.4.4

Core Convergence Recommendations for BCC

Create a mechanism to ensure that the leadership for developing BCC strategies

and programmes for DHFW and NACP is vested with one authority.

Joint (NACO, DFW) behaviour change communication strategy to be developed


based on commonality of target groups, and tailored for reach of general as well as
high-risk populations. This needs to take place at state level as well between State AIDS
Control Societies and State IEC bureaus.
3.5

Condom promotion
3.5.1

Background: Currently the male condom is the most widely available effective protection
method against HIV and other STI. Condom distribution can be through free or social
marketing channels. They could be through community based distribution systems, depot
holders, health facilities, pharmacies, and village stores. For any scaled up prevention response
it is important to improve access and availability of condoms to all communities (rural and
urban) and groups.

3.5.2

DHFW Strategies: In the family welfare programme, male condoms are promoted as a
method of contraception. In order to improve the use of condoms as a contraceptive, several
initiatives at social marketing and distribution through government and NGOs are being
undertaken. Thus DFW is the repository of substantial experience in promoting condom use as
well as condom procumbent and distribution. However the use of condoms as a method of dual
protection has not been promoted so far. About 25% of the overall condoms procured are
distributed as free supplies with 75% being programmed though social marketing agencies. Of
these 25 %, over three quarters are channeled to NACO for distribution to HRG through
NGOs.

3.5.3

NACO strategies: Currently NACO procures and supplies condoms to the NGOs working
with HRG. Primarily NACO and the SACS obtain their supplies through the DHFW. NGOs
also directly access social marketing agencies. NACO and SACS ensure hat there is adequate
supply of condoms in STD clinics, VCTC, and Ob/Gyn clinics. SM condoms are made
available at outlets situated near state highways and in areas where TI projects are underway.
NGOs are encouraged to use a mix of free and SM approaches.

3.5.4

Core Convergence Recommendations for Condom promotion

Create a mechanism to ensure that condom programming for NACP and DHFW
is managed within a single entity to provide leadership and direction. This integration
will greatly facilitate streamlining the condom promotion strategy between the FW and

HIV/AIDS programmes.

Joint development of a strategy on condom procurement and distribution to meet


the needs of sexually active women and men as a contraceptive method, as a method of
dual protection and to meet the needs of high-risk groups.

Condom supplies for NGO s involved in TI to be through NACO and SACS.

HFW to promote condoms as dual protection method through improved

distribution channels.

Pilots to promote female condom use among general population as well sex
workers both as a contraceptive and barrier method.

3.6

3.7

Safety of blood and blood products


3.6.1

Background: In addition to ensuring blood safety, other strategies to reduce transmission


include: reducing the need for transfusions, educating and motivating low risk individuals to
donate blood.

3.6.2

DHFW strategy: Currently blood banks are located at state and at district levels. Stringent
guidelines for blood banks are in place. In the RCH II programme, DHFW has planned blood
storage centers at FRU level. However the procurement of blood will be primarily from the
blood banks certified by NACO, so quality control appears to be taken care of.

3.6.3

NACP Strategy: NACO has been involved in developing a blood safety policy and guidelines
for blood banks. Annexures 8 and 9 provide state wise details of blood banks supported and
strengthened by NACO respectively.

3.6.4

Core Convergence Recommendations fro Blood Safety

3.6.5

It is recommended that this policy be continued so that stringent quality controls are
maintained at the district levels, and high quality blood is available at secondary levels of care.

Training
3.7.1

DHFW strategies: In RCH 1, Medical Officers, Staff Nurses, Lady Health Visitors and ANMs
were trained for periods of between 4 to 6 hours (depending on job profiles) in the area of
HIV/AIDS and RTI/STI. In RCH II, four core committees are currently reviewing the content
of training for each level of provider.

3.7.2

NACP strategies: NACO, SACS (and partner agencies- NGOs) have developed modules for
training in a range of areas- prevention, universal precautions care and support, PPTCT for all
providers. These have been implemented separately from the HFW trainings.

3.7.3

Core Convergence Recommendations for training

NACP to designate an officer to coordinate with the groups responsible for


ongoing module development for RCH II and ensure that HIV/AIDS training inputs

cover all areas of concern adequately.

Joint finalization of areas of training with respect to content, duration, mix of


knowledge and skills, for all cadres of health and community workers.

NACO and DHFW to jointly develop a specific plan to train staff of PPTCT and
VCTC to ensure that these functions include other HFW elements as well.

Finalized modules to be shared with private sector and NGO partners supported
by HFW and NACP.
3.8

Management Information Systems


3.8.1

DHFW strategies: As part of the RCH II programme a Management Information System is


being designed. An Integrated Disease Surveillance Project is also underway. Both these
systems will essentially capture data on an ongoing basis at all levels for programme
implementation and ongoing monitoring. Small and large scale surveys such as the NFHS and
District level HH surveys are also conducted periodically.

3.8.2

NACP strategies: The nationwide sentinel surveillance system captures data on an annual
basis from about 455 sites across the country. In addition, VCTC, blood banks and PPTC serve

as a reporting base. Programme supported NGOs also report on STI treated, condoms
distributed and coverage of high-risk groups.
3.8.3

Core Convergence Recommendations for Management Information Systems

Joint working group to review data needs, assess ongoing sources, and finalize
requirements to fit into RCH II MIS, so that all facilities report service performance on
RTI/STI, VCTC and PPTCT as part of routine reporting, while maintaining

confidentiality.

State and national level surveys (NFHS III, DLHS) designed to provide
information on KAP related to RTI/STI/HIV/AIDS

Research and prevalence studies to assess nature of STIs to develop suitable


management protocols and assess antibiotic resistance patterns. Need to explore
linkages with integrated disease surveillance programme.

Mechanisms to ensure periodic reporting on sti/hiv/aids by private providers

3.9

Include NGO reports as part of district level reporting.

Male involvement: The case to promote male participation in improving reproductive and sexual
health for women has been articulated in several documents and is being implemented through several
community-based initiatives. However, the reach of programmes of the DHFW to men is low. NACP
on the other hand, (given that men are the predominant target group in the general population) has
significant experience in approaches to reach men, through condom promotion, STI clinics, and mass
media. In RCH II, it is proposed to provide gender sensitization training for all providers. Specific
BCC interventions will implemented to increase demand for male contraceptive methods, male RH
services, and to heighten awareness about mens responsibility in support of womens sexual and
reproductive health.
Core Convergence Recommendations to improve male involvement

Ensure that NACP and DHFW training include male responsibility as a key area

BCC strategies for both NACP and DHFW to address the area of male responsibility
and shared action for improved womens RH as a major issue- includes partner notification,
drug compliance, safe sexual practices and condom promotion.

3.10

Strengthening urban health services to improve convergence: Urban health particularly among the
poor presents a special challenge to the DHFW. While overall health indicators in rural areas may be
better than in rural areas, they mask significant disparities. The reach of the poor to good health care is
limited, and they are often served by the private sector, poorly regulated and offering care of
questionable quality. Given the increase of slum populations, migrants, and street children, and that
these groups are identified as high risk groups for HIV/AIDS, it is essential that their access to the
services such as RTI/STI, VCTC, PPTCT, condom promotion and BCC interventions be improved.
The NACP supports several targeted interventions in urban areas, primarily through NGOs, and
targeted at marginalized, high-risk groups, and not often general population based. NACP also support
STI clinics, VCTC and PPTCT in large medical colleges/teaching hospitals. However primary and
secondary health care facilities in urban areas are not as clearly structured or organized as in rural
areas. RCH II proposes a two-tier facility an urban health center for a population of 50,000- to address

primary health care needs of the population, particularly the vulnerable, and a second tier (mix of
private and public sector) to serve as referral sites.
Core convergence Recommendations to improve reach of urban health

Strengthening urban health infrastructure, including training of urban providers will

have benefits for urban RCH and NACP.

Involvement of urban private sector practitioners in training programmes, through


involvement of IMA and FOGSI. .

Referral information on sites where RTI/STI, VCTC, and PPTCT are available to be
widely disseminated to both general and high risk populations through NGOs, private sector,
and IEC efforts.

UHC and Referral sites to offer a range of RCH services without discrimination and in
an equitable manner to general populations and populations at risk.

4. Operationalization of Convergence
4.
1

Of the key areas identified for convergence, RTI/STI management for the general population could be
integrated within the DHFW. VCTCs and PPTC still need to be managed by NACO and the SACS to
retain focus and ensure referral linkages to care and support. In the area of blood safety, it is
recommended that NACO continue to ensure safe blood supplies at district levels, and that blood storage
units at secondary levels of care procure supplies from the district. In the areas of behaviour change and
condom procurement/distribution, it is recommended that the leadership for the programmes be
entrusted to one entity to ensure overall guidance of both areas for Health, Family Welfare and the
National AIDS Control Programme. Male involvement needs to be woven into all components.
Strategies to improve services in rural areas must be replicated/adapted for urban areas. Joint working
groups are recommended at national and state level to ensure that the training plans and monitoring and
reporting systems of the DHFW and NACO (and corresponding groups at the state levels) are well
coordinated, reflect shared concerns and are synchronized at the delivery levels.

4.
2

Recommended Institutional Mechanisms


4.2.
1

At the National level a NACP-HFW convergence committee is to be set up at DHFW to provide


policy inputs and oversight to the convergence between NACP and DHFW. The Convergence
Committee will be chaired by Secy, HFW and co-chaired by Project Director NACO.

4.2.
2

At the National level, two joint working groups are visualized comprised of technical and
programme mangers from NACO and DHFW. They include:

Joint working group on convergence of RTI/STI, VCTC and PPTCT into DHFW

infrastructure and services. (NACO/DDG/MH)

Joint working Group on Training and MIS. (NACO/DC Training, and CD,
Statistics)
Broadly the roles of the JWG are to review quarterly performance from each state and jointly
review and prepare a report on performance coverage and quality. Reporting formats would be
developed in conjunction with existing formats or those proposed for larger programmes so that

programme managers at state and district levels are not burdened. It is expected that the NACPHFW Convergence Committee, which meets every quarter, will obtain reports from each of the
National JWG, provide feedback and serve as a problem solving mechanism.
4.2.
3

It is recommended that at the state level, a similar mechanism be set up, so that the state and
central level review and monitoring, and information needs and flow are co-ordinated.

4.2.
4

At the district level, NACO is considering the appointment of a convergence facilitator who could
ensure coordinated inputs between those programmes directly implemented by NACO/SACS,
between various NGO managed programmes, and finally between those interventions that depend
upon the DHFW resources for effective operationalization. In addition this individual would
follow up on the training plan for the district as well as the MIS to ensure that there is
convergence. This individual would report to the SACS and to the CMO at the district level. At
the district level, the District Health Mission (where all other programmes of HFW are
integrated), will include a sub- group to review HIV/AIDS and HFW convergence in the major
service areas (RTI/STI, VCTC, PPTCT) and NGO functioning.

Social exclusion

Exclusion consists of dynamic, multi-dimensional processes driven by unequal power relationships interacting across
four main dimensions - economic, political, social and cultural - and at different levels including individual, household,
group, community, country and global levels. It results in a continuum of inclusion/exclusion characterised by unequal
access to resources, capabilities and rights which leads to health inequalities.
The Social Exclusion Knowledge Network (SEKN) examined the relational processes that lead to the exclusion of
particular groups of people from engaging fully in community/social life. These processes operate at: the macro-level
(access to affordable education, equal employment opportunity legislation, cultural and gender norms), and/or the
micro-levels (income, occupational status, social networks - around race, gender, religion).
It examined the linkages between social exclusion and proximal concepts such as social capital, networks and
integration. The nature and operation of such processes and their association with population health status and health
inequalities were analyzed in a diversity of country contexts, chosen to reflect the impact of differing structural (political,
economic and social) constraints.

Social exclusion or social marginalization is social disadvantage and relegation to the fringe of society. It is
a term used widely inEurope, and was first used in France.[1] It is used across disciplines
including education, sociology, psychology, politics andeconomics.

Social exclusion is the process in which individuals or entire communities of people are systematically blocked from
(or denied full access to) various rights, opportunities and resources that are normally available to members of a
different group, and which are fundamental to social integration within that particular group [2] (e.g., housing,
employment, healthcare, civic engagement, democratic participation, and due process).
Alienation or disenfranchisement resulting from social exclusion can be connected to a person's social class, race,
skin color,educational status, childhood relationships,[3] living standards, or personal choices in fashion. Such
exclusionary forms ofdiscrimination may also apply to people with a disability, minorities, LGBT people, drug users,
[4]

institutional care leavers,[5] the elderly and the young. Anyone who appears to deviate in any way from perceived

norms of a population may thereby become subject to coarse or subtle forms of social exclusion.
The outcome of social exclusion is that affected individuals or communities are prevented from participating fully in
the economic, social, and political life of the society in which they live.

Social inclusion[
Social inclusion, the converse of social exclusion, is affirmative action to change the circumstances and habits that
lead to (or have led to) social exclusion. The World Bank defines social inclusion as the process of improving the
ability, opportunity, and dignity of people, disadvantaged on the basis of their identity, to take part in society.[24]
Social Inclusion ministers have been appointed, and special units established, in a number of jurisdiction around the
world. The first Minister for Social Inclusion was Premier of South Australia Mike Rann, who took the portfolio in
2004. Based on the UK's Social Exclusion Unit, established by Prime Minister Tony Blair in 1997, Rann established
the Social Inclusion Initiative in 2002. It was headed by Monsignor David Cappo and was serviced by a unit within
the department of Premier and Cabinet. Cappo sat on the Executive Committee of the South Australian Cabinet and
was later appointed Social Inclusion Commissioner with wide powers to address social disadvantage. Cappo was
allowed to roam across agencies given that most social disadvantage has multiple causes necessitating a "joined
up" rather than a single agency response.[25] The Initiative drove a big investment by the South Australian
Government in strategies to combat homelessness, including establishing Common Ground, building high quality
inner city apartments for "rough sleeping" homeless people, the Street to Home initiative [26] and the ICAN flexible
learning program designed to improve school retention rates. It also included major funding to revamp mental health
services following Cappo's "Stepping Up" report, which focused on the need for community and intermediate levels
of care[27] and an overhaul of disability services.[28] In 2007 Australian Prime Minister Kevin Rudd appointed Julia
Gillard as the nation's first Social Inclusion Minister.
Six Sigma is a set of techniques and tools for process improvement. It was introduced by engineer Bill Smith while
working at Motorola in 1986.[1][2] Jack Welch made it central to his business strategy at General Electric in 1995.
[3]

Today, it is used in many industrial sectors.[4]

Six Sigma seeks to improve the quality of the output of a process by identifying and removing the causes of defects
and minimizing variabilityin manufacturing and business processes. It uses a set of quality management methods,
mainly empirical, statistical methods, and creates a special infrastructure of people within the organization, who are
experts in these methods. Each Six Sigma project carried out within an organization follows a defined sequence of

steps and has specific value targets, for example: reduce process cycle time, reduce pollution, reduce costs,
increase customer satisfaction, and increase profits.
The term Six Sigma originated from terminology associated with statistical modeling of manufacturing processes.
The maturity of a manufacturing process can be described by a sigma rating indicating its yield or the percentage of
defect-free products it creates. A six sigma process is one in which 99.99966% of all opportunities to produce some
feature of a part are statistically expected to be free of defects (3.4 defective features per million opportunities).
Motorola set a goal of "six sigma" for all of its manufacturing operations, and this goal became a by-word for the
management and engineering practices used to achieve it.

Doctrine[edit]
Six Sigma doctrine asserts:

Continuous efforts to achieve stable and predictable process results (e.g. by reducing process variation) are
of vital importance to business success.

Manufacturing and business processes have characteristics that can be defined, measured, analyzed,
improved, and controlled.

Achieving sustained quality improvement requires commitment from the entire organization, particularly from
top-level management.

Features that set Six Sigma apart from previous quality-improvement initiatives include:

A clear focus on achieving measurable and quantifiable financial returns from any Six Sigma project.

An increased emphasis on strong and passionate management leadership and support.

A clear commitment to making decisions on the basis of verifiable data and statistical methods, rather than
assumptions and guesswork.

The term "six sigma" comes from statistics and is used in statistical quality control, which evaluates process
capability. Originally, it referred to the ability of manufacturing processes to produce a very high proportion of output
within specification. Processes that operate with "six sigma quality" over the short term are assumed to produce
long-term defect levels below 3.4 defects per million opportunities (DPMO).[5][6] Six Sigma's implicit goal is to improve
all processes, but not to the 3.4 DPMO level necessarily. Organizations need to determine an appropriate sigma
level for each of their most important processes and strive to achieve these. As a result of this goal, it is incumbent
on management of the organization to prioritize areas of improvement.
"Six Sigma" was registered June 11, 1991 as U.S. Service Mark 1,647,704. In 2005 Motorola attributed over US$17
billion in savings to Six Sigma.[7]
Other early adopters of Six Sigma include Honeywell (today's Honeywell is the result of a "merger of equals" of
Honeywell and Allied Signal in 1999) and General Electric, whereJack Welch introduced the method.[8] By the late
1990s, about two-thirds of the Fortune 500 organizations had begun Six Sigma initiatives with the aim of reducing
costs and improving quality.[9]

In recent years, some practitioners have combined Six Sigma ideas with lean manufacturing to create a
methodology named Lean Six Sigma.[10] The Lean Six Sigma methodology views lean manufacturing, which
addresses process flow and waste issues, and Six Sigma, with its focus on variation and design, as complementary
disciplines aimed at promoting "business and operational excellence".[10] Companies such as GE,[11] Verizon,
GENPACT, and IBM use Lean Six Sigma to focus transformation efforts not just on efficiency but also on growth. It
serves as a foundation for innovation throughout the organization, from manufacturing and software development to
sales and service delivery functions.
The International Organization for Standardization (ISO) has published in 2011 the first standard "ISO 13053:2011"
defining a Six Sigma process.[12] Other "standards" are created mostly by universities or companies that have socalled first-party certification programs for Six Sigma.

Difference between related concepts[edit]


Lean management and Six Sigma are two concepts which share similar methodologies and tools. Both programs
are of Japanese origin, but they are two different programs. Lean management is focused on eliminating waste and
ensuring swift while Six Sigma's focus is on eliminating defects and reducing variability.

Methodologies[edit]
Six Sigma projects follow two project methodologies inspired by Deming's Plan-Do-Check-Act Cycle. These
methodologies, composed of five phases each, bear the acronyms DMAIC and DMADV.[9]

DMAIC ("duh-may-ick", /d.me.k/) is used for projects aimed at improving an existing business process.[9]

DMADV ("duh-mad-vee", /d.md.vi/) is used for projects aimed at creating new product or process
designs.[9]

DMAIC[edit]

The five steps of DMAIC

Main article: DMAIC


The DMAIC project methodology has five phases:

Define the system, the voice of the customer and their requirements, and the project goals, specifically.

Measure key aspects of the current process and collect relevant data; calculate the 'as-is' Process
Capability.

Analyze the data to investigate and verify cause-and-effect relationships. Determine what the relationships
are, and attempt to ensure that all factors have been considered. Seek out root cause of the defect under
investigation.

Improve or optimize the current process based upon data analysis using techniques such as design of
experiments, poka yoke or mistake proofing, and standard work to create a new, future state process. Set up
pilot runs to establish process capability.

Control the future state process to ensure that any deviations from the target are corrected before they result
in defects. Implement control systems such as statistical process control, production boards, visual workplaces,
and continuously monitor the process.

Some organizations add a Recognize step at the beginning, which is to recognize the right problem to work on, thus
yielding an RDMAIC methodology.[13]

DMADV or DFSS[edit]

The five steps of DMADV

Main article: DFSS


The DMADV project methodology, known as DFSS ("Design For Six Sigma"),[9] features five phases:

Define design goals that are consistent with customer demands and the enterprise strategy.

Measure and identify CTQs (characteristics that are Critical To Quality), measure product capabilities,
production process capability, and measure risks.

Analyze to develop and design alternatives

Design an improved alternative, best suited per analysis in the previous step

Verify the design, set up pilot runs, implement the production process and hand it over to the process
owner(s).

Quality management tools and methods[edit]


Within the individual phases of a DMAIC or DMADV project, Six Sigma utilizes many established qualitymanagement tools that are also used outside Six Sigma. The following table shows an overview of the main
methods used.

5 Whys

Statistical and fitting tools

Analysis of variance

General linear model

ANOVA Gauge R&R

Regression analysis

Correlation

Scatter diagram

Chi-squared test

Axiomatic design

Business Process Mapping/Check sheet

Cause & effects diagram (also known as fishbone or Ishikawa diagram)

Control chart/Control plan (also known as a swimlane map)/Run charts

Cost-benefit analysis

CTQ tree

Design of experiments/Stratification

Histograms/Pareto analysis/Pareto chart

Pick chart/Process capability/Rolled throughput yield

Quality Function Deployment (QFD)

Quantitative marketing research through use of Enterprise Feedback Management(EFM) systems

Root cause analysis

SIPOC analysis (Suppliers, Inputs, Process, Outputs, Customers)

COPIS analysis (Customer centric version/perspective of SIPOC)

Taguchi methods/Taguchi Loss Function

Value stream mapping

Implementation roles[edit]
One key innovation of Six Sigma involves the absolute "professionalizing" of quality management functions. Prior to
Six Sigma, quality management in practice was largely relegated to the production floor and to statisticians in a
separate quality department. Formal Six Sigma programs adopt a kind of elite ranking terminology (similar to some
martial arts systems, like Kung-Fu and Judo) to define a hierarchy (and special career path) that includes all
business functions and levels.
Six Sigma identifies several key roles for its successful implementation. [14]

Executive Leadership includes the CEO and other members of top management. They are responsible for
setting up a vision for Six Sigma implementation. They also empower the other role holders with the freedom
and resources to explore new ideas for breakthrough improvements by transcending departmental barriers and
overcoming inherent resistance to change.[15]

Champions take responsibility for Six Sigma implementation across the organization in an integrated
manner. The Executive Leadership draws them from upper management. Champions also act as mentors to
Black Belts.

Master Black Belts, identified by Champions, act as in-house coaches on Six Sigma. They devote 100% of
their time to Six Sigma. They assist Champions and guide Black Belts and Green Belts. Apart from statistical
tasks, they spend their time on ensuring consistent application of Six Sigma across various functions and
departments.

Black Belts operate under Master Black Belts to apply Six Sigma methodology to specific projects. They
devote 100% of their valued time to Six Sigma. They primarily focus on Six Sigma project execution and special
leadership with special tasks, whereas Champions and Master Black Belts focus on identifying
projects/functions for Six Sigma.

Green Belts are the employees who take up Six Sigma implementation along with their other job
responsibilities, operating under the guidance of Black Belts.

Special training is needed[16] for all of these practitioners to ensure that they follow the methodology and use the
data-driven approach correctly. This training is very important [citation needed].
Some organizations use additional belt colours, such as Yellow Belts, for employees that have basic training in Six
Sigma tools and generally participate in projects and "White belts" for those locally trained in the concepts but do not
participate in the project team. "Orange belts" are also mentioned to be used for special cases. [17]

Certification[edit]
Main article: List of Six Sigma certification organizations
General Electric and Motorola developed certification programs as part of their Six Sigma implementation, verifying
individuals' command of the Six Sigma methods at the relevant skill level (Green Belt, Black Belt etc.). Following this
approach, many organizations in the 1990s started offering Six Sigma certifications to their employees. [9][18] Criteria
for Green Belt and Black Belt certification vary; some companies simply require participation in a course and a Six
Sigma project.[18] There is no standard certification body, and different certification services are offered by various

quality associations and other providers against a fee.[19][20] The American Society for Quality for example requires
Black Belt applicants to pass a written exam and to provide a signed affidavit stating that they have completed two
projects or one project combined with three years' practical experience in the body of knowledge. [18][21]

Etymology of "six sigma process"[edit]


The term "six sigma process" comes from the notion that if one has six standard deviations between the
process mean and the nearest specification limit, as shown in the graph, practically no[not in citation given] items will fail to
meet specifications.[5] This is based on the calculation method employed in process capability studies.
Capability studies measure the number of standard deviations between the process mean and the nearest
specification limit in sigma units, represented by the Greek letter (sigma). As process standard deviation goes up,
or the mean of the process moves away from the center of the tolerance, fewer standard deviations will fit between
the mean and the nearest specification limit, decreasing the sigma number and increasing the likelihood of items
outside specification. One should also note that calculation of Sigma levels for a process data is independent of the
data being normally distributed. In one of the criticisms to Six Sigma, practitioners using this approach spend a lot of
time transforming data from non-normal to normal using transformation techniques. It must be said that Sigma
levels can be determined for process data that has evidence of non-normality.[5]

Graph of the normal distribution, which underlies the statistical assumptions of the Six Sigma model. The Greek letter (sigma)
marks the distance on the horizontal axis between the mean, , and the curve's inflection point. The greater this distance, the
greater is the spread of values encountered. For the green curve shown above, = 0 and = 1. The upper and lower
specification limits (USL and LSL, respectively) are at a distance of 6 from the mean. Because of the properties of the normal
distribution, values lying that far away from the mean are extremely unlikely. Even if the mean were to move right or left by 1.5
at some point in the future (1.5 sigma shift, coloured red and blue), there is still a good safety cushion. This is why Six Sigma
aims to have processes where the mean is at least 6 away from the nearest specification limit.

Role of the 1.5 sigma shift[edit]


Experience has shown that processes usually do not perform as well in the long term as they do in the short term.
[5]

As a result, the number of sigmas that will fit between the process mean and the nearest specification limit may

well drop over time, compared to an initial short-term study.[5] To account for this real-life increase in process
variation over time, an empirically based 1.5 sigma shift is introduced into the calculation. [5][22] According to this idea,
a process that fits 6 sigma between the process mean and the nearest specification limit in a short-term study will in
the long term fit only 4.5 sigma either because the process mean will move over time, or because the long-term
standard deviation of the process will be greater than that observed in the short term, or both. [5]

Hence the widely accepted definition of a six sigma process is a process that produces 3.4 defective parts per
million opportunities (DPMO). This is based on the fact that a process that is normally distributed will have 3.4 parts
per million outside the limits, when the limits are six sigma from the "original" mean of zero and the process mean is
then shifted by 1.5 sigma (and therefore, the six sigma limits are no longer symmetrical about the mean). [5] The
former six sigma distribution, when under the effect of the 1.5 sigma shift, is commonly referred to as a 4.5 sigma
process. However, it should be noted that the failure rate of a six sigma distribution with the mean shifted 1.5 sigma
is not equivalent to the failure rate of a 4.5 sigma process with the mean centered on zero. [5] This allows for the fact
that special causes may result in a deterioration in process performance over time and is designed to prevent
underestimation of the defect levels likely to be encountered in real-life operation. [5]
The role of the sigma shift is mainly academic. The purpose of six sigma is to generate organizational performance
improvement. It is up to the organization to determine, based on customer expectations, what the appropriate sigma
level of a process is. The purpose of the sigma value is as a comparative figure to determine whether a process is
improving, deteriorating, stagnant or non-competitive with others in the same business. Six sigma (3.4 DPMO) is not
the goal of all processes.

Sigma levels[edit]

A control chart depicting a process that experienced a 1.5 sigma drift in the process mean toward the upper specification limit
starting at midnight. Control charts are used to maintain 6 sigma quality by signaling when quality professionals should
investigate a process to find and eliminate special-cause variation.

See also: Three sigma rule


The table below gives long-term DPMO values corresponding to various short-term sigma levels. [23][24]
These figures assume that the process mean will shift by 1.5 sigma toward the side with the critical specification
limit. In other words, they assume that after the initial study determining the short-term sigma level, the longterm Cpk valuewill turn out to be 0.5 less than the short-term Cpk value. So, for example, the DPMO figure given for 1
sigma assumes that the long-term process mean will be 0.5 sigma beyond the specification limit (C pk = 0.17), rather
than 1 sigma within it, as it was in the short-term study (Cpk = 0.33). Note that the defect percentages indicate only

defects exceeding the specification limit to which the process mean is nearest. Defects beyond the far specification
limit are not included in the percentages.
Sigma

Sigma (with 1.5

level

shift)

0.5

0.5

1.5

DPMO

691,46

Percent

Percentage

Short-term

Long-term

defective

yield

Cpk

Cpk

69%

31%

0.33

0.17

31%

69%

0.67

0.17

66,807

6.7%

93.3%

1.00

0.5

2.5

6,210

0.62%

99.38%

1.33

0.83

3.5

233

0.023%

99.977%

1.67

1.17

4.5

3.4

0.00034%

99.99966%

2.00

1.5

5.5

0.019

0.0000019%

99.9999981%

2.33

1.83

308,53
8

Software[edit]
Main article: List of Six Sigma software packages

Application[edit]
Main article: List of Six Sigma companies
Six Sigma mostly finds application in large organizations.[25] An important factor in the spread of Six Sigma was GE's
1998 announcement of $350 million in savings thanks to Six Sigma, a figure that later grew to more than $1 billion.
[25]

According to industry consultants like Thomas Pyzdek and John Kullmann, companies with fewer than 500

employees are less suited to Six Sigma implementation or need to adapt the standard approach to make it work for
them.[25] Six Sigma however contains a large number of tools and techniques that work well in small to mid-size
organizations. The fact that an organization is not big enough to be able to afford Black Belts does not diminish its
abilities to make improvements using this set of tools and techniques. The infrastructure described as necessary to
support Six Sigma is a result of the size of the organization rather than a requirement of Six Sigma itself. [25]

Criticism[edit]
Lack of originality[edit]
Quality control analyst Joseph M. Juran described Six Sigma as "a basic version of quality improvement", stating
that "there is nothing new there. It includes what we used to call facilitators. They've adopted more flamboyant
terms, like belts with different colors. I think that concept has merit to set apart, to create specialists who can be very
helpful. Again, that's not a new idea. The American Society for Quality long ago established certificates, such as
for reliability engineers."[26]

Role of consultants[edit]
The use of "Black Belts" as itinerant change agents has fostered an industry of training and certification. Critics have
argued there is overselling of Six Sigma by too great a number of consulting firms, many of which claim expertise in
Six Sigma when they have only a rudimentary understanding of the tools and techniques involved or the markets or
industries in which they are acting.[27]

Potential negative effects[edit]


A Fortune article stated that "of 58 large companies that have announced Six Sigma programs, 91 percent have
trailed the S&P 500 since". The statement was attributed to "an analysis by Charles Holland of consulting
firm Qualpro (which espouses a competing quality-improvement process)".[28] The summary of the article is that Six
Sigma is effective at what it is intended to do, but that it is "narrowly designed to fix an existing process" and does
not help in "coming up with new products or disruptive technologies."[29][30]
Over-reliance on statistical tools[edit]
A more direct criticism is the "rigid" nature of Six Sigma with its over-reliance on methods and tools. In most cases,
more attention is paid to reducing variation and searching for any significant factors and less attention is paid to
developing robustness in the first place (which can altogether eliminate the need for reducing variation). [31] The
extensive reliance on significance testing and use of multiple regression techniques increases the risk of making
commonly unknown types of statistical errors or mistakes. A possible consequence of Six Sigma's array of P-value
misconceptions is the false belief that the probability of a conclusion being in error can be calculated from the data
in a single experiment without reference to external evidence or the plausibility of the underlying mechanism. [32] One
of the most serious but all-too-common misuses of inferential statistics is to take a model that was developed
through exploratory model building and subject it to the same sorts of statistical tests that are used to validate a
model that was specified in advance.[33]
Another comment refers to the often mentioned Transfer Function, which seems to be a flawed theory if looked at in
detail.[34] Since significance tests were first popularized many objections have been voiced by prominent and
respected statisticians. The volume of criticism and rebuttal has filled books with language seldom used in the
scholarly debate of a dry subject.[35][36][37][38] Much of the first criticism was already published more than 40 years ago.
Refer to: Statistical hypothesis testing#Criticism for details.
Articles featuring critics have appeared in the NovemberDecember 2006 issue of USA Army Logistician regarding
Six-Sigma: "The dangers of a single paradigmatic orientation (in this case, that of technical rationality) can blind us
to values associated with double-loop learning and the learning organization, organization adaptability, workforce
creativity and development, humanizing the workplace, cultural awareness, and strategy making."[39]

Nassim Nicholas Taleb consider risk managers little more than "blind users" of statistical tools and methods. [40] He
states that statistics is fundamentally incomplete as a field as it cannot predict the risk of rare events something
Six Sigma is specially concerned with. Furthermore, errors in prediction are likely to occur as a result of ignorance
for or distinction between epistemic and other uncertainties. These errors are the biggest in time variant (reliability)
related failures.[41]
Stifling creativity in research environments[edit]
A BusinessWeek article says that James McNerney's introduction of Six Sigma at 3M had the effect of stifling
creativity and reports its removal from the research function. It cites two Wharton School professors who say that
Six Sigma leads to incremental innovation at the expense of blue skies research.[42] This phenomenon is further
explored in the book Going Lean, which describes a related approach known as lean dynamics and provides data to
show that Ford's "6 Sigma" program did little to change its fortunes. [43]
According to an article by John Dodge, editor in chief of Design News, use of Six Sigma is inappropriate in a
research environment. Dodge states[44] "excessive metrics, steps, measurements and Six Sigma's intense focus on
reducing variability water down the discovery process. Under Six Sigma, the free-wheeling nature of brainstorming
and the serendipitous side of discovery is stifled." He concludes "there's general agreement that freedom in basic or
pure research is preferable while Six Sigma works best in incremental innovation when there's an expressed
commercial goal."

Lack of systematic documentation[edit]


One criticism voiced by Yasar Jarrar and Andy Neely from the Cranfield School of Management's Centre for
Business Performance is that while Six Sigma is a powerful approach, it can also unduly dominate an organization's
culture; and they add that much of the Six Sigma literature in a remarkable way (six-sigma claims to be evidence,
scientifically based) lacks academic rigor:
One final criticism, probably more to the Six Sigma literature than concepts, relates to the evidence for Six Sigmas
success. So far, documented case studies using the Six Sigma methods are presented as the strongest evidence
for its success. However, looking at these documented cases, and apart from a few that are detailed from the
experience of leading organizations like GE and Motorola, most cases are not documented in a systemic or
academic manner. In fact, the majority are case studies illustrated on websites, and are, at best, sketchy. They
provide no mention of any specific Six Sigma methods that were used to resolve the problems. It has been argued
that by relying on the Six Sigma criteria, management is lulled into the idea that something is being done about
quality, whereas any resulting improvement is accidental (Latzko 1995). Thus, when looking at the evidence put
forward for Six Sigma success, mostly by consultants and people with vested interests, the question that begs to be
asked is: are we making a true improvement with Six Sigma methods or just getting skilled at telling stories?
Everyone seems to believe that we are making true improvements, but there is some way to go to document these
empirically and clarify the causal relations.
[31]

1.5 sigma shift[edit]


The statistician Donald J. Wheeler has dismissed the 1.5 sigma shift as "goofy" because of its arbitrary nature. [45] Its
universal applicability is seen as doubtful.

The 1.5 sigma shift has also become contentious because it results in stated "sigma levels" that reflect short-term
rather than long-term performance: a process that has long-term defect levels corresponding to 4.5 sigma
performance is, by Six Sigma convention, described as a "six sigma process." [5][46] The accepted Six Sigma scoring
system thus cannot be equated to actual normal distribution probabilities for the stated number of standard
deviations, and this has been a key bone of contention over how Six Sigma measures are defined. [46] The fact that it
is rarely explained that a "6 sigma" process will have long-term defect rates corresponding to 4.5 sigma
performance rather than actual 6 sigma performance has led several commentators to express the opinion that Six
Sigma is a confidence trick.[

Social inequality occurs when resources in a given society are distributed unevenly, typically through norms of
allocation, that engender specific patterns along lines of socially defined categories of persons. Economic inequality,
usually described on the basis of the unequal distribution of income or wealth, is a frequently studied type of social
inequality. Though the disciplines of economicsand sociology generally use different theoretical approaches to
examine and explain economic inequality, both fields are actively involved in researching this inequality. However,
social and natural resources other than purely economic resources are also unevenly distributed in most societies
and may contribute to social status. Norms of allocation can also affect the distribution of rightsand privileges, social
power, access to public goods such as education or the judicial system,
adequate housing, transportation,credit and financial services such as banking and other social goods and services.
[1]

While many societies worldwide hold that their resources are distributed on the basis of merit, research shows that
the distribution of resources often follows delineations that distinguish different social categories of persons on the
basis of other socially defined characteristics. For example, social inequality is linked to racial inequality, gender
inequality, and ethnic inequality as well as other status characteristics and these forms can be related to corruption.

Gap Analysis
Categorized in: Six Sigma Implementation, Six Sigma Tools & Metrics
Gap analysis is a Six Sigma quality control tool that compares actual performance with the potential
performance of a business. Gap analysis detects the level of underperformance in a business due to poor
utilization of resources and helps marketing managers decide on the marketing strategy that yields the best
results.
Focused organizations should have an organized way of data collection and analysis. Data on its own is not
worth much, as the analysis of data is the most important part of quality control and the entire Six Sigma
Process. Collecting and compiling data for gap is done for various reasons as outlined in this article.
Benchmarking: Benchmarking is a Gap analysis tool used to better understand current performance in a
business. A Benchmark point is established (normally the cycle time of a process) so that a product or
service can be set up against organizations with a similar process. Benchmarking helps determine the effect

Six Sigma has on a business and the variation between the where we are and the where we need to be
scale. In benchmarking there are cycles, seasonal factors, and other internal and external factors that should
be taken into consideration. It is best if averages of data are compared over a period of time, reducing error
due to external and internal factors.
One major flaw of Benchmarking is focusing on a single performance metric. When a company focuses on
one aspect of the business the other arms fall short leading to no net improvement or change in
performance. When benchmarking is done for a Six Sigma project, a historical variation is completed (data
collected from various gap analysis over multiple periods of time) before gap analysis is carried out.
Data Analysis: Data analysis brings out the full potential in a company by reorganizing the way work is
done in an organization. The aim of data analysis is to increase output while saving on cost by comparing
previous data collected over the years with current data. Six Sigma projects make major improvements in
service and staff efficiency by using statistical data to reduce defects in a process and measures what is
actually going on. Sound data collection is one of the most important parts of the Six Sigma Process.
Prediction: Data can be used to make prediction for a business using regression analysis. Gap analysis can
forecast output based on current and previous data collected and the input made toward a project
Monitoring: Based on market conditions, many aspects of a business can be monitored and necessary
adjustments made through this process. Gap analysis ensures that minimal variance is recorded in current
input to the expected output. Any business process in statistical control will have a common cause variance
and alternate solutions are needed to improve the system.
A gap analysis further defines improvement and the direction the improvement should head. Monitoring
ensures that all processes are on target and measures performance variance. Strategic planning is achieved
in Six Sigma projects through adequate monitoring and reporting

Gap analysis
From Wikipedia, the free encyclopedia

For gap analysis in wildlife conservation, see Gap analysis (conservation).

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In management literature, gap analysis involves the comparison of actual performance with potential or desired
performance. If an organization does not make the best use of current resources, or forgoes investment in capital or
technology, it may produce or perform below its potential. This concept is similar to an economy's being below
theproduction possibilities frontier.
Gap analysis identifies gaps between the optimized allocation and integration of the inputs (resources), and the
current allocation-level. This may reveal areas that can be improved. Gap analysis involves determining,
documenting, and approving the difference between business requirements and current capabilities. Gap analysis
naturally flows from benchmarking and from other assessments. Once the general expectation of performance in an
industry is understood, it is possible to compare that expectation with the company's current level of performance.

This comparison becomes the gap analysis. Such analysis can be performed at the strategic or at the operational
level of an organization.
Gap analysis is a formal study of what a business is doing currently and where it wants to go in the future. It can be
conducted, in different perspectives, as follows:
1. Organization (e.g., Human Resources)
2. Business direction
3. Business processes
4. Information technology
Gap analysis provides a foundation for measuring investment of time, money and human resources required to
achieve a particular outcome (e.g. to turn the salary payment process from paper-based to paperless with the use of
a system). Note that "GAP analysis" has also been used[by whom?] as a means of classifying how well a product or
solution meets a targeted need or set of requirements. In this case, "GAP" can be used as a ranking of "Good",
"Average" or "Poor". (This terminology appears in the PRINCE2 project management publication from the OGC
(Office of Government Commerce).)
The need for new products or additions to existing lines may emerge from portfolio analysis, in particular from the
use of the Boston Consulting Group Growth-share matrixor the need may emerge from the regular process of
following trends in the requirements of consumers. At some point, a gap emerges between what existing products
offer and what the consumer demands. The organization must fill that gap to survive and grow.
Gap analysis can identify gaps in the market. Thus, comparing forecast profits to desired profits reveals
the planning gap. This represents a goal for new activities in general, and new products in particular. The planning
gap can be divided into three main elements:[clarification needed]
Contents
[hide]

1Usage gap

2Existing usage

3Product gap

4Gap analysis to develop a better process

5See also

6References

7External links

Usage gap[edit]
The usage gap is the gap between the total potential for the market and actual current usage by all consumers in
the market. Data for this calculation includes:

Market usage

Existing usage

Existing usage[edit]
Existing consumer usage makes up the total current market, from which market shares, for example, are calculated.
It usually derives from marketing research, most accurately from panel research, but also from adhoc work.
Sometimes it may be available from figures that governments or industries have collected. However, these are often
based on categories that make bureaucratic sense but are less helpful in marketing terms. The 'usage gap' is thus:
usage gap = market potential existing usage
This is an important calculation. Many, if not most, marketers accept existing market sizesuitably projected
their forecast timescalesas the boundary for expansion plans. Though this is often the most realistic
assumption, it may impose an unnecessary limit on horizons. For example: the original market for videorecorders was limited to professional users who could afford high prices. Only after some time did the
technology extend to the mass market.
In the public sector, where service providers usually enjoy a monopoly, the usage gap is probably the most
important factor in activity development. However, persuading more consumers to take up family benefits, for
example, is probably more important to the relevant government department than opening more local offices.
Usage gap is most important for brand leaders. If a company has a significant share of the whole market, they
may find it worthwhile to invest in making the market bigger. This option is not generally open to minor players,
though they may still profit by targeting specific offerings as market extensions.
All other gaps relate to the difference between existing sales (market share) and total sales of the market as a
whole. The difference is the competitor share. These gaps therefore, relate to competitive activity.

Product gap[edit]
The product gapalso called the segment or positioning gapis that part of the market a particular
organization is excluded from because of product or service characteristics. This may be because the market is
segmented and the organization does not have offerings in some segments, or because the organization
positions its offerings in a way that effectively excludes certain potential consumersbecause competitive
offerings are much better placed for these consumers.
This segmentation may result from deliberate policy. Segmentation and positioning are powerful marketing
techniques, but the trade-offagainst better focusis that market segments may effectively be put beyond
reach. On the other hand, product gap can occur by default; the organization has thought out its positioning, its
offerings drifted to a particular market segment.
The product gap may be the main element of the planning gap where an organization can have productive
input; hence the emphasis on the importance of correct positioning.

Gap analysis to develop a better process[edit]


A gap analysis can also be used to analyze gaps in processes and the gulf between the existing outcome and
the desired outcome. This step process can be illustrated by the example below:

Identify the existing process: fishing by using fishing rods

Identify the existing outcome: we can manage to catch 20 fish per day

Identify the desired outcome: we want to catch 100 fish per day

Identify and document the gap: it is a difference of 80 fish

Identify the process to achieve the desired outcome: we can use an alternative method such as using a
fishing net

Develop the means to fill the gap: acquire and use a fishing net

Develop and prioritize Requirements to bridge the gap [1]

A gap analysis can also be used to compare one process to others performed elsewhere, which are often
identified through benchmarking. In this usage, one compares each process side-by-side and step-by-step and
then notes the differences. One then analyzes each deviation to determine if there is any benefit to changing to
the alternate process. The results of this analysis (in the context of the benefits and detriments of changing
processes) may support the maintenance of the current process, the wholesale adoption of an alternate
process, or a fusion of different aspects of each process.

Gap Analysis Template: The 3 Key Elements


of Effective Gap Analysis
JULY 25, 2013 BY KASIA MIKOLUK

Gap analysis compares the gap between an


organizations actual performance against its potential performance. In gap analysis, you
typically list out the organizations current state, its desired state, and a comprehensive
plan to fill out the gap between these two states. This analysis can yield a lot of insights
into an organizations performance and functioning. It is pertinent for businesses as well
as more organic organizations such as school classrooms and communities.
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This beginner course on Microsoft Excel 2010 will help you get started.

Gap analysis is more organic and flexible than SWOT (Strengths, Weaknesses,
Opportunities and Threats) analysis, which typically follows a four quadrant pattern. gap
analysis may be highly quantitative or conceptual, using either Excel worksheets or
flowcharts. The analyst has much more freedom in choosing what to focus on. At the same
time, every gap analysis template must have a few essential components, as shown below:
I. State Descriptions

The first step in gap analysis is identifying your current and future desired state. This can
be done by describing the following:
1. Your Current State

Every gap analysis starts with introspection. Your gap analysis template should start off
with a column labelled Current State wherein you list out all the attributes youd like to
see improved. Your focus can be as wide (ex: the whole business) or narrow (ex: HR
policies within CRM division) as the objective demands. The analysis can be quantitative
(currently get 50 orders per day), qualitative (lack of diversity in workplace) or both. The
key thing is to be specific and factual with an emphasis on identifying weaknesses.
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2. The Future State

The future state represents the ideal condition youd want your organization to be in. This
state can be highly specific (ex: increase order count to 100 per day, decrease
absenteeism by 25%), or generic (create more inclusive work culture). Your gap analysis
template should record all the idealized attributes as they correspond to the current state.
Sometimes, you may not even have a clear conception of an idealized future state and
might be conducting a gap analysis as an exercise towards self-improvement. In this case,
you can record N/A under the future state column.
II. Bridging the Gap

This is where you identify and describe the gap before finding ways to remedy it.
1. Gap Identification

The next column in your gap analysis template should record whether a gap exists between
the current and future state. A simple Yes or No can suffice (a description of the gap will
be made in the next column).
2. Gap Description

The gap description should record all the elements that make up the gap between the
current and future state. The description should be consistent with the current/future
state. It can be qualitative (lack of clear HR policies for employee termination) or
quantitative (50 orders/day difference between current and ideal state). This should only
serve as a description, not a remedy.
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III. Factors and Remedies

This is where the rubber hits the road and you identify the factors responsible for the
difference between your current and future performance. You can then use this data to
come up with a remedies and action plans to tackle the performance gap.
1. Factors Responsible for Gap

The next part of your gap analysis template should list all the factors responsible for the
gap identified in the previous column. This list should be specific, objective and relevant
(ex: poor employee pre-screening can be one reason for high workplace absenteeism).
2. Remedies, Actions and Proposals

The last step in the gap analysis is listing out all the possible remedies for bridging the gap
between the current and ideal state. These remedies should directly address the factors
listed in the column above (ex: video pre-screening for all candidates before interview can
be one remedy for employee pre-screening issues). The remedies must be action oriented
and specific (tie up with new payment processor to reduce shopping cart abandonment,
not just effect measures to reduce shopping cart abandonment). You can learn how to
create more compelling, action-oriented remedies in this course on business planning.
Gap analysis can be an effective tool for analyzing and understanding organizations. It is
particularly applicable in a new business setting, of course. New businesses will find it
especially useful for gaining insights into how to organize and allocate resources. if you are
starting a new business, this course will teach you how to create an awesome business
plan.
How do you do your gap analysis? Share your secrets in the comments below