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creating circles of support
intensive versus cost effective
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Page 4 of 5

intensive versus "cost effective"

Comparisons are made between projects that target a large number of individuals for a low cost per individual (such as mass media campaigns or once-off workshop interventions versus intensive ongoing programmes. TAI’s philosophy is as follows:

“Mass marketing” projects are compared with intensive programmes (like TAI’s) and the intensive programmes are labelled “not cost efficient” and “not replicable” due to the cost implications. There is a place for mass marketing projects, but they provide only a surface response that is most suited to individuals not highly at risk. It is long understood that mass marketing, events and once-off interventions do not promote long-term change on their own, but rather act as one component of a holistic response.
Individuals that are at risk and/or who could potentially place others as risk (such as young men, especially where South Africa has an extraordinary rape and gender-based violence prevalence rate) require long term, intensive support and engagement. Admittedly, this does not come cheap as a result of the extensive human resources required.
Another consideration is that the behaviours that place individuals at risk are intensively instilled from an early age. These beliefs are profound and deeply held, no matter how harmful they may be to self or others. Given the nature of these behaviours and beliefs, it is not conceivable that they can be significantly changed by anything other than long-term intensive programmes.
Where the true cost efficiency in intensive programmes lies is that we do not need to do intensive programmes with everyone – only enough individuals to achieve “critical mass”. If the transformation is profound enough, these individuals will advocate for and bring about changes in the individuals closest to them including friends, partners, family and children – now and in the future. This is, basically, how “the system” was established in the first place, through individuals convincing other individuals of the aptness of their norms.

tai in “cost effective” perspective

Of our annual budget of R4,4 million (2008/2009 projection):

6.37% is for office costs (including rent, communication, stationery, etc)
8.36% is for travel & subsistence (including travel to communities 3 hours away and a fully mobile VCT service)
34.14% is for staffing costs of 35 employees where TAI pays less than half of market across all salary gradings
On average, TAI programmes work on a ratio of about R6,700.00 per direct participant per year. This is increased in the case of projects that focus on children in distress as these project require more human and material resources than most.

This clearly indicates that TAI is committed to minimising running costs and maximising impact through programmes that work intensively with communities.

intensive change transmission model

figure 8: tai's intensive change transmission model

the cost of not doing intensive programmes

The tendency when working on “cost efficiency” is that you take the amount of currency and divide it by the number of direct beneficiaries and then that is used to judge the potential benefit of the programme. The less money you spend per individual the better. However, this exercise does not include the “human cost” because it is meaningless to try and attach monetary and quantitative value to such a subjective and qualitative concept. Despite it being a fairly ludicrous exercise, we are going to try…

For example: TAI contends that our intensive project work with young men will reduce the likelihood of these young men committing violent and sexual crimes. Mass marketing and once-off responses are not sufficient as evidenced by the visibility of campaigns like “16 Days of Activism” yet the child murder rate has increased and rape and violence against women and children continues to blight our nation. In stark contrast to the high numbers of mass marketing projects that target men, there are very few intensive programmes that work with men. So let us establish the possible “human and material cost” of a 10 year old boy being raped and contracting HIV as a result.

In this “hypothesis”, the young man will die at 30 as a result of intermittent access to ARVs and repeated re-infection through unprotected sex (12 years less than the average life span for KZN). The young man will not access counselling services or PEP. The young man will only find his HIV status after being repeatedly admitted to hospital for serious illness.

These is presented only to provoke thought and not under any scientific "basis". The amounts used are entirely subjective based on ultra-conservative estimates of how I value these aspects in my own life. In reality, the cost is immeasurable.

table 7: subjective human cost of rape, hiv infection and premature death
category	qty	unit	amount
Loss of innocence	1	R10,000,000.00	R10,000,000.00
Trauma of the rape	1	R1,000,000.00	R1,000,000.00
HIV Infection - loss of quality of life through ongoing debilitating illness / side effects of medication	20	R1,000,000.00	R20,000,000.00
HIV Infection - loss of potential life per year lost	12	R1,000,000.00	R12,000,000.00
Post traumatic stress - intensive for 6 months	6	R200,000.00	R1,200,000.00
Post traumatic stress - slightly lessened for 18 months	18	R150,000.00	R2,700,000.00
'Background' stress, flash backs, etc for 216 months	216	R75,000.00	R16,200,000.00
Reduced sexual pleasure - from sexual debut at 14 years x average of 10 sexual encounters per month	1920	R5,000.00	R9,600,000.00
Diminished emotional capacity to form close and meaningful relationships per year – the cost of loneliness	20	R200,000.00	R4,000,000.00
Total cost with HIV infection			R76,700,000.00

Numerous studies¹ indicate that a) paedophiles are more likely to have been sexually abused themselves and b) paedophiles who target both girls and boys average 27.3 victims. In this hypothesis, let’s say that this young man goes on to victimise a conservative estimate of 15 more male and female children. 5 of his victims become HIV positive as a result.

table 8: subjective human cost of rape without hiv transmission with average life expectancy
Category	Qty	Unit	amount
Loss of innocence	1	R10,000,000.00	R10,000,000.00
Trauma of the rape	1	R1,000,000.00	R1,000,000.00
Post traumatic stress - intensive for 6 months	6	R200,000.00	R1,200,000.00
Post traumatic stress - slightly lessened for 18 months	18	R150,000.00	R2,700,000.00
Post traumatic stress - 'background', flash backs, etc for 360 months	360	R75,000.00	R27,000,000.00
Reduced sexual pleasure - from sexual debut at 14 years x average of 10 sexual encounters per month	3360	R5,000.00	R16,800,000.00
Diminished emotional capacity to form close and meaningful relationships per year	32	R200,000.00	R6,400,000.00
Total cost			R65,100,000.00

table 9: subjective total human cost abuse cycle for 16 children
Category	qty	Unit	amount
Cost to first child	1	R76,700,000.00	R76,700,000.00
Children infected with HIV	5	R76,700,000.00	R383,500,000.00
Children not infected with HIV	10	R65,100,000.00	R651,000,000.00
Total cost to children			R1,111,200,000.00

Think we’re inflating costs?

So Ms. Bliskey, while pursuing her [rape] assailant in criminal courts, also filed a civil lawsuit against the Berry Property Management Inc., the company that managed her town house, which had refused to allow her to install a lock that could be opened from only the inside. Last month, after a jury trial, Ms. Bliskey won a judgment for more than $17 million in the 214th Texas District Court in Nueces County, in Corpus Christi.²

$17 million in 1991 is a 2008 equivalent of³: