Re: Bill Gates Blew $258 million in India's HIV Corridor

[Guest guest]

Dear FORUM,

Re: /message/10346

I have been waiting for an article or report like this one for the past three

years and here it is finally. I am an Anthropologist and joined AVAHAN funded

project after my University training. Later, I worked for an American University

as a researcher.

I always wondered why everyone failed to see few things which were obvious and

starting at our faces to just be noticed. Right from day one, even though the

objectives and intentions of AVAHAN program were good, they got lost during

translation from Gates Foundation to their Partners, from there to the NGOs and

finally to the community.

Most of the time, people who were (and are) working in the Avahan dont seem to

ask few basic questions.

What ever work they are doing, I don't think most of them asked themselves, in

what way the action or work that I am going to do will help in reducing the HIV

prevalence.

I have seen many people at the grassroot level NGOs who have no clue about what

they are working for.

For most of the AIDS workers, it was a good way to make money rather than

working for a cause. I am not saying everyone should just work for the HIV cause

and no money, but for most at the grassroot level, it was just a way of living

(which is perfectly fine, its not their fault) and its the fault of the partner

NGOs (at state and national level) of Avhan who failed to transfer that

information.

I think that every health and behaviour related prevention always needs to take

a wholistic approach. It is not just good enough to provide access to condoms

and make someone say infront of you all the information about safe sex and STDs.

We should address the core problems underlying Sex work/Drug usage/Homosexuality

etc.

One major shortcoming on Avahan's part, (this is based on my interaction with

several Avahan and its partner NGOs, correct me if I am wrong) is that I have

never heard anyone really talking about Health Belief Systems and how they play

a major role in AIDS prevention programs.

Avahan's project is more of a Management/Social Work/STD clinic/Behaviour

Change/Sustainability etc program.

Unless you use the data and theories available on Health Belief Models, the data

available from the Social Sciences theories with regard to bringing change in

behaviour etc, and use all the Manage, ent/Social Work/.....etc concepts

together, I don't think that we can really bring any change.

Btw, I dont think establishing offices in Villages will do any good at all.

Seriously, does anyone think that Ashok sitting in a village is going

to make any difference? If it really does, I am sure entire Avahan staff will be

ready to do that. I agree that there can be many areas where one can cut the

costs and use the money in much more efficient manner, but setting up offices

in villages is not the answer.

Regards,

Prem Garudadri

E-MAIL: <premchaco@...>

[Guest guest]

Dear Forum,

Re: /message/10346

What Raj expressed is very correct. We at Malegaon ( Dist-Nashik) are

working at grass-root level in the field of Anti-AIDS Campaign for last 22

years.

We have seen & witnessed the changes in patterns of anti-AIDS work very

closely. If the agencies working ( especially who provide grants) in AIDS field,

take advantage of our vast & basic experience, it will be definitely useful.

Many a times we see that those who are not in touch with  actual (ground level)

work & grass root realities are given the PLANNING posts.

(A C Room Culture). Their planning is to be followed by Actual worker. It should

be other way round. The planners MUST be ground level workers or their opinion

must be considered

while planning.

Lots of funds are wasted in salaries to higher authorities, costly paperworks,

posters, seminars ( mostly in star hotels) etc.

Still there is HOPE. Lets learn & change accordingly.

 

Dr Dilip Bhavsar M.D.(Path)

e-mail: <dgbhavsar@...>

[Guest guest]

Dear all,

Re: /message/10346

I have been an outsider and observer to the Avahan Experiment in India. I am

therefore speaking from an observer's perspective, for whatever it is worth.

I do not have the finer details like Avahan's accounts to make a value

judgement. But I belong to a community that Avahan has claimed to work with for

years now and I certainly have a grasp of the community's perceptions.

Money is Money, it does not matter where it comes from. To say that BMGF's money

is Bill Gates own is wrong. It comes from a foundaton that enjoys tax breaks in

USA an other places, and therefore a large part of this is actually public money

and members of the public have a right to seek accoutability if it is wasted or

misused.

Having said that let me also add that money breeds arrogance. And of that there

has been enough example from Avahan. A few years back Bill Gates Visited India

and invited a select group of HIV leaders to dinner with him.

In that list was one of the veteran MSM activist of the region, who has spent

years trying to develop MSM CBOs that address their own HIV, human rights, and

development issues. He started much before either Avahan or BMGF was formed.

certainly before anyone in the HIV universe had even heard of Ashok .

At this dinner a few small speeches were made, including by

Ashok . And one of Mr. 's implications was that it was Avahan

that started MSM HIV work in India. It was not only insulting, unfair, false,

and arrogant, it showed a clear willful disregard of the history of HIV movement

in India and an unwillingness to engage with it. No wonder that the things

described in this article has come to pass.

Money also breeds pressures that often leads to false representation of results

where it does not exist. Around the same time as the above incident, Melinda

Gates was also in India and wanted to visit a few projects in Karnataka that

work with Jogtas (Traditional Male transgendered temple prostitutes).

A close friend on mine was at that time in Karnataka doing a

small consultancy for Avahan and was witness to this incident. In

anticipation of the meeting with Melinda Gates, Jogtas from a few projects

assembled at the proposed meeting venue in their best fineries.

However the security detail of Melinda Gates decided at the last minute that she

would actually go to another project and not the proposed venue. Frantic

phonecalls ensued amongst the Avahan officials on site, and in the hour or so

that it took Ms Gates to reach the new venue, Kothis from that project were made

to wear 'Satla' (makeup and female's costume), and were then

presented to Ms Gates as Jogtas. Albeit faux Jogtas.

I have often wondered if this is indicative of the way results are represented

in Avahan's activities as well.

The so called composite projects that Avahan has followed as a model have been

disastrous for community development in most areas that they have worked in.

Any organisation that claims to work for HIV prevention of MSM,

but does not let MSM have any tangible say in the organisation, the

intervention, and social development aspects, and only provides tokenistic

presence of a few MSM workers whose 'Large' wages make them keep quiet and

accept any dictat, is certainly not what I understand a community oriented

rights based approach to HIV prevention to be.

However the presence of these composite projects have been used by the state and

NACO to deny support to MSM CBOs in these areas, thus shutting out all avenues

of community social empowerment. It obviously has ramification on success of HIV

prevention and

control in these areas amongst communities.

I had hoped that the NACP-3 strategy of asking NGOs (Like those controled by

Avahan Money) to nurture CBOs over a period of time and then ensure their

independence, and thereafter passing on the responsibility of HIV prevention

amongst communities to these CBOs, would encourage Avahan to nurture MSM and

other CBOs in the areas where they are working. However latest intelligence from

within the power structures speak of Avahan's resitence to this and increasingly

the fond hope of yesterday is turning to be belied.

It seems like edifices that navigates around these requirements of NACP-3 are

hastily being erected. Again, this is not good for either community empowerment

or for HIV prevention.

There is a risk that Avahan's records may be sullied further unless the strategy

is changed soon.

There are enough big and small CBOs that can partner with Avahan in this

endeavour. There is still time to make a meaningful change. But for that to

happen, Avahan will have to climb down from its perch of arrogance and speak

with communities, in their language, using their help, taking them into

confidence.

This cannot be done through graphs and power point presentations. This can only

happen if investment is directed at community development for, of, and by the

communities themselves.

It cannot be through vested NGO interestes for whom communities are nothing but

commodities that are traded for continued funding support from Avahan.

But then all these are difficult tasks and often cannot satisfy boardrooms in

Delhi that are looking for a bang for their buck and blowing up big holes in the

process.

Best regards to all,

Aditya Bondyopadhyay

e-mail: <adit.bond@...>

[Guest guest]

Dear FORUM,

Re: /message/10346

Those responsible for initiating these projects need to be questioned.

Dr Ranjit Singh Virk,MD

Specialist in Public Health, Nutrition,and HIV/AIDS

Mobile:09872749268

e-mail: <ranjit_virk@...>

[Guest guest]

Dear Forum,

Re: /message/10346

Now-a-days working in social development sector with a private sector experience

is becoming a fashion (work in style!).

People who get huge funding from donors like BMGF is in a look out for a guy

from a private sector with readiness to make handsome salaries (in Lakhs/Month).

What has happened in the previous phase of Avahan programme they tried to reduce

the prevalence of HIV through a PPP model but when it got scaled up in six high

prevalent states the SUPER goal got diluted and they tried all possible efforts

on a trail and error method using the GIANTS from private sectors.

 

Since the whole programme is a self selecting mechanism not involving the

existing Health Care System in any of the state to deliver the services, as a

result of this after 5 years funding many of the activities got truncated

abruptly (transition did not happen).

 

Many of the time we tend to applaud many new innovative ideas, yes!

It should be appreciated and welcomed because advocating the good work through

media is one of the key important activities that we need to ensure as part of

gaining the acceptance from the community but the concern is that it should not

be the ONE DAY AFFAIR or a BLIND EFFORT (which can't get the desired result).

 

At times we tend to misunderstand that huge funding for an agency means huge

spending and scaling up of the activity means scaling up of the SALARIES,

Overhead charges and Travel charges but we miserably failed to understand that

large scale of programme means LARGE PORTION OF TARGET AUDIENCE TO BE RECAHED

for the intended purpose showing the clear intended result/outcome.

Since most of the heads at top level are from so called CORPORATE

industries/financial institutions, they may not be well versed with the basics

of the core area/underlying social problem and existing way to handle them and

also various theories related to that.

It is presumed globally, especially in this Social Development Sector that

anybody from other discipline can do a better job here and not necessarily they

should have basic qualification or experience.

As a result of this they keep trying many initiatives claiming that THEY ARE ALL

INNOVATIVE and everybody knows for sure it would not yield any result at the end

of the day and it is proved in Avahan programme (would it not suffice? Or you

are ready for another trail to burn millions of dollar?).

 

If you can clearly learn/understand from the recent experiences especially on

HIV/AIDS front, need of the hour is not a guy who speaks hifi English and a good

looking from a corporate sector rather than we need people who have basic

relevant qualification with an appropriate experience as POLICY MAKERS at top

level.

What is the need to pay close to a 10000000+ /P.A for an individual when the

actual work doesn’t need so especially in this sector (need to keep in mind it

is not something we are spending from our own pocket, on the other hand it is

coming from an individual or a corporate/government as a donation for a serious

cause).

We do not require a number game with PPT presentations and high quality paper

works with complicated chi square calculations to persuade the donor but on the

other hand we would want the real bottom line healthy impact through a

sustainable model integrating the existing Public Health Care System.

This would be possible only if we have policy makers with an appropriate

qualification and relevant experience on top level. If we fail to make this

happen we would keep talking about this type of issues in the forthcoming years

too!

It's a high time that Social scientist, Sociologists, Anthropologists, big

donors like BMGF etc should start thinking of combating the situation or else it

would cause more damage to the Public Health Care System leaving a huge portion

of money in vain.

Regards

Abraham

e-mail: <lingan_abraham@...>

[Guest guest]

Dear friends,

(Please pass it to Ashok and if possible and if they can contact me

too), 

 

Re: /message/10346

I very much agree with your observations and i have been waiting even longer. I

will like to add following as per our experiences esp. for all the hype for

millions given by Bill and Melinda Gates Foundation or similar big funders as

per our experiences-

1. It takes long time for changing the attitude and habits of people, which

these funders never think or give time for or do not want to understand/know.

Most of them have their own agenda rather. 

2. Most of such help is business oriented and they like to give only if they can

get more returns through business.

3. Most of the money goes to their agents/consultants or middle men/working

businesses/companies or gets wasted into administrative expenses as well high

remunerations, perks, travel by first and business class and luxurious offices,

while people working on grass root level do not get even minimum for what they

are doing or if they want to do.    

4. We must have written/requested so many times, submitted enquiries wasting our

time for making projects etc. etc. but never received single penny from any one

of these big organisations or funders.

These were returned with computer generated replies or with regret letters for

having committed funds already or having different areas for priority etc. etc.

(For Gates Foundation esp.

I was surprised when I was asked to submit the enquiry as per their date given

with on going enquiries as per their last declaration of 100 million dollars for

HIV programme in India and within two days I got a reply saying all funds, have

already been committed and when I asked to whom and how did they come to that

decision within such a short time, I never received reply).

I remember few years before when Gates, were asked by a reporter that how much

money have they spent for HIV work in India, they did not know even whether it

was seventy or forty or hundread

million (Bill and Mellinda were disputing figures with each other as per

reports), perhaps they being billionaires and richest person, hundreads of

millions being guzzled away do not matter and it goes on with same hype,

publicity and campaign for their programmes all over the World whether it is

work for Malaria or vaccines or research, whether it is in India or Africa or

any where else. 

 

We continue within our limited resources as much we can but only regrets are to

know that even a decimal fraction of those millions could have made such a

difference in our region for working there if they have just bothered to hear

us. But that is how business is run and I am not a business man.

I wonder if I could have e mail id of   Flock and Ashok ,

director of the the Bill & Melinda Gates Foundation's Indian HIV-prevention

project or please guide me how to contact them or if this mail is forwarded to

them and if they may like to know more. 

With regards and best wishes,   

Dr.B.K.Sharma,

For Gwalior Childrens Hospital Charity (Regd. Charity No. 1063694), Snehalaya

Trust & GHECT (India),

14,Magdalene Road, Walsall, West Midlands. WS1 3TA (U.K.)

Tel. +44(0)1922 629842   Fax. 01922 632942   Mobile.  07729929982

Email: Gwalior.Hospital@...

Website: www.helpchildrenofindia.org.

[Guest guest]

Dear FORUM,

Re: /message/10350

I agree with Sudipta, that this is a gigantic project unprecednted in the

history of HIV prevention in India. Let us not talk about the reputed

universities doing the monitoring and evaluation cause I haven't seen any useful

report so far which talks about numbers which is out there in the public for

Indian audiance.

With all due respect, as far as I know, all that they are bothered are about how

they can apply their own relavent theories to what is happening in India and

write more papers.

Coming to the robust M & E system, I am ignorant of any publicly available numbers

from these so called M & E date and please forgive me for that.

If you can share with this forum the reports and numbers available for any state

or any region where Avahan has worked and where it can clearly show how much

progress has been made, we all will be enlightend.

If good progress has been made, we will all hail BMGF/Avahan and we all will be

happy. You have to understand no one here is against BMGF/Avahan, but what we

feel is overall, Avahan could have done little bit more difference to our

country.

Avahan made contributions to the HIV cause in India, but not significant enough

so far and the whole point of this thread is coming up with various ways in

which it can imporve.

I think what is happening here is constructive criticism and I dont see any

point in stopping that.

Regards,

Prem Garudadri

e-mail: <premchaco@...>

[Guest guest]

Dear FORUM,

Re: /message/10346

Flock notes in this article that " One study, which sought to determine

whether Avahan was responsible for the decline in HIV prevalence in Karnataka,

failed to prove that it played a key role " .

I believe that the study she is referring to is the one published in the

December 2008 AIDS supplement, entitled " Impact of an intensive HIV prevention

program for female sex workers on HIV prevalence among antenatal clinic

attenders in Karnataka state, south India: an ecological analysis " (AIDS 2008;

22(Suppl 5):S101-8).

In fact, this study demonstrated that in the districts in Karnataka where an

intensive HIV preventive intervention program for female sex workers and MSM was

implemented under the Avahan program, there was a decline in HIV prevalence

among antenatal clinic attenders between 2003 and 2007 of over 50% (HIV

prevalence data from NACO sentinel surveillance). This was much greater than in

other districts.

Significant declines in the prevalence of HIV and other sexually transmitted

infections has also been observed among the sex workers themselves. It is not

clear why this was mis-represented in the article.

Dr. Moses

University of Manitoba

E-MAIL: <smoses@...>

[Guest guest]

Dear FORUM,

Re: /message/10346

I totally agree with Meenal ji, that Avahan funded NGOs and most importantly,

CBOs have very good outreach in mobilizing the community for service uptake. The

concept of Community Mobiliztion is something I have learned through Avahan and

I completely believe in that.

The bigger question is, DOES COMMUNITY MOBILIZATION ALONE WORK TO TACKLE THE HIV

PROBLEM IN INDIA?

We all know the positive side of Avahan, otherwise, I myself would have filed

countless PILs against all the NGOs working under Avahan.

No one is disputing that, this is a discussion to take things forward.

Talking about numbers being manipulated by NGOs, I have seen it myself happening

many times. The NGOs also can not be blamed for this, their donor agencies need

numbers otherwise they cannot get the money so they fudge the numbers. As I have

mentioned in my first mail, the actual problems lies in the assumption that a

serious behaviour issue like using condom and the ideas about HIV/AIDS can be

changed in five or ten years.

When a wholistic approach is followed getting inputs from all the relevant

diciplines/people from the grassroot levels, intervetions can be planned in much

better ways and probably we can achieve better results.

I agree with you that all these funding agencies have complimented NACOs efforts

in a way that was unimaginable six or seven years ago. We definetly have come a

long way, but, there is still a long way ahead of us.

Regards,

Prem Garrudadri

e-mail: <premchaco@...>

[Guest guest]

Dear Friends,

Re: /message/10346

I really do not know if its just me .............. but I get a distinct

feeling that jealousy is a major issue here. The large salaries that the Avahan

project was willing to pay appear in various comments time and again.

I think it is time we accepted that Public Health need not be a

vocation. It can be a profession and therefore it should be ok to demand (and

accept) your worth in cash terms.

And before you think of me as a money changer - kindly remember that I

have spent the better part of my life facing hardships and living in

conditions that most people would consider inhuman, while I all I got

for my cares were platitudes about " serving the nation " . I therefore

perceive that there is nothing wrong in demanding and receiving your

worth!

Lt Col (Dr) Anil Paranjape, Retd.

Pune

e-mail: <anilvparanjape@...>

[Guest guest]

Dear Dr.Paranjpe,

Re: /message/10346

Your illustrious career in the Indian Army and equally important roles played in

the containment of HIV/AIDS with great competence,full commitment and utmost

dedication are before all of us.

The expertise and experince have to be effectively utilized in a professional

manner asquality has a price which can and should never be compromised.

Regards and best wishes,

Dr.Rajesh Gopal

e-mail: <dr_rajeshg@...>

[Guest guest]

Dear Dr Paranjape,

Re: /message/10346

I do not know about others that you mention, but I only tried to raise 2 issues

about the salary structures of Avahan:

1] When Avahan belives that its projects will be taken over by NACO

eventually, there is a justification in insisting that the project staff of

Avahan be paid salaries that are commensrate with NACO guidelines, and those

guidelines are not unfair, they were prepared with due community consultations.

If this does not happen there can be no seamless takeover, and will lead to

eventual project failure due to staff resentment.

2] That when in a 'Composite Project' only a token person is employed to be the

'face' of MSM work being done by a project, a high salary is a way of ensuring

that that token community rep does not raise any contentious issue of community

concern, and accept everything quietly.

It becomes a way of purchasing silence.

I continue to feel that both these points about salary remmain relevant,

irrespective of any jealousy factor that you mention.

Best,

Aditya Bondyopadhyay

e-mail: <adit.bond@...>

[Guest guest]

Dear Forum,

Re: /message/10346

I think I agree with Dr.Paranjape.

Jealousy is one of the reason for BMGF programs being criticised.

Those who cannot manage to get through the competition despite experience and

knowledge would find it difficult to appreciate it.

Regards

Minal

Meenal Mehta

e-mail: <Meenalmehta@...>

[Guest guest]

[Editors reply to Dr. Deepak Batura. Please don't shoot the messenger. AIDS

INDIA do not facilitate any discussion particularly on AHVAHAN officers. The

original article on AVAHAN has appeared on the FORBS magazine. This is an open

FORUM, all are welcome to present their views, including AVAHAN staff. Even

senior officials of Government of India do express their views on this FORUM.

The question is not about the salary package of any project. One of the basic

concerns presented here by many readers is lack of transparency and public

accountability of Gates work in India. It is strange, the King of Information

Technology, do not even have a web page listing the projects supported by them

in India. This speaks volumes about their respect to the stakeholder’s right to

know what is going on in the name of AIDS]

_________________________

Dear FORUM.

Re: /message/10396

I am inclined to agree with Anil. I think it is only fair to allow the officers

of Avahan to be allowed to present their point of view before we subject them to

a trial by media and I do think AIDS India should actually facilitiate this in

order to reach the truth.

I have no synergies/conflicts of interest to declare.

Dr Deepak Batura

e-mail: <d_batura@...>

[Guest guest]

Dear friends,

 

Re: /message/10346

Probably jealousy may play a role but it does not mean that the big funders like

these are right in doing what they do or as they like or should not review their

modus operandi. 

 

As per our experiences, rather than jealousy, I feel it is disappointment and

frustration for failures in doing some thing which a genuine organisation wanted

to do for minimal money when they see that millions going for high salaries,

luxuries, perks, middle men, consultants etc. rather than majority being used

for the actual work on ground. 

Just visit the offices of UNICEF, WHO and other organisations in Delhi (at least

I feel that way) to see the luxuries they enjoy as compared to people for whom

they are supposed to work for or getting paid for doing so.

Why can't they avoid wasting money for all the luxuries and such high salaries

for their overstaffed executives doing nothing but mostly sitting in their

airconditioned offices with secretaries, servants and all luxuries, a common

person can not imagine even, rather than using that money to provide for poor

people, I am sure it will make a difference.   

 

But having said all that by all of us for whatever reasons, I don't think it is

going to make any difference to them. We can continue to talk whatever we like

on this forum or any forum but it is not going to make any difference to " them " .

They are elephants, who will continue to move on their own path as per their

agenda rather than listening to common people and of course they are capable to

buy silence from common people as well voice from all the media, unless of

course any of them gets " awakening call "  like The Gautam Buddha or The Emperor

Ashoka. With best wishes, 

BK

Dr.B.K.Sharma,

For Gwalior Childrens Hospital Charity (Regd. Charity No. 1063694), Snehalaya

Trust & GHECT (India),

14,Magdalene Road, Walsall, West Midlands. WS1 3TA (U.K.)

Tel. +44(0)1922 629842   Fax. 01922 632942   Mobile.  07729929982

Email: Gwalior.Hospital@...

Website: www.helpchildrenofindia.org.uk and updates on

http://gchvols.pbwiki.com 

[Guest guest]

Dear Forum

Re: /message/10346

What has happended as outcome of HIV AIDS program is awareness about condom

is uniformly hastened.We need to document if condom uptake is improved due to

HIV AIDS intervention.

I am reminded of the study conducted by Aastha (a BMGF funded program)

intervention in Mumbai about condom usage at last sexual activity. The results

could tell us a little bit about improvement in condom uptake.

The forum has driven all of us to answer basic questions about Behavior change.

Again the analysis from BCC session, condom uptake , service uptake etc under

Avahan at large will help us know the outcome. I am sure they have these

findings.

Periodic press releases from Avahan through forums likes these about the

efforts and outcome could have reduced the knowledge gap.

Most of us feel interested in the bigger programs run by

NACO,WHO,USAID,BMGF,GFATM,FHI and are not able to visit the website or network

with them and self educate.

Regards

Minal

Meenal Mehta

e-mail: <Meenalmehta@...>

[Guest guest]

Dear Forum,

Re: /message/10346

It is in-appropriate to say " Bill Gates Blew $ 258 million in India's HIV

Corridor "

If at all it has happened it should be called upon to all the involved stake

holders thus better to quote " We Blew ........donated by Bill Gates " .

The accountability lies with the program implementer, community and all those

directly involved in program. It is better if we understand problem well. If the

money is waste risk of HIV is with us only and not those who donated money.

 

Thanks

Rama

Rama Pathak

E-MAIL: <pathakrkant@...>

[Guest guest]

Dear forum members

Re: /message/10350

I have been reading the views of different members with some interest and

thought I should share my views for what ever worth they are.

I started my work in HIV/AIDS in India in early 1996 with the DFID (then ODA) in

what was then the West Bengal Sexual Health Project. Subsequently, I was the

State Director (for around three years starting from early 2004) in one of the

State Lead Partners (an INGO working exclusively on HIV/AIDS prevention and

control) of Avahan since the latter’s inception. I was managing not only one of

the larger Avahan sub grants in the State, but also an older multi-country

HIV/AIDS grant from the BMGF, which pre-dated the Avahan.

Further, between 1996 and 2007, I was in the national design teams of successive

phases of NACP and have also been in the drafting committees of successive State

Project Implementation Plans in West Bengal and Andhra Pradesh.

I have since moved on and am currently an expatriate Indian, working with one of

the biggest global child rights organizations as their country director for

Bangladesh. Suffice to say, at present, I have nothing to do professionally or

personally with either the BMGF or the Avahan and would like to think that I am

well positioned to bring in a certain level of institutional history,

understanding, detachment and objectivity into this discourse.

1. First and foremost, irrespective of where the money is coming from, whether

it is private or public - as long as it is being spent for a public cause (which

Avahan certainly is), the public has a right to know what is happening and as a

corollary, those who are spending the money (Avahan management as well as the

grantees and sub-grantees under the project), have an obligation to proactively

let the public know, according to standard norms of transparency and

accountability - where and how the money is being spent and what impact it is

having.

The AIDS India forum is one of the few forums available for open discourse and

it is only natural that these issues should be discussed in this forum. I would

like to congratulate the moderators of this forum on this as well as many

contributors.

2. I fully understand there are genuine concerns / questions about Avahan with

respect to its management (including communication) style, what social impact

(positive or negative) it is creating on the communities and to what extent it

has been transparent and accountable to the communities it is working with, as

well as the wider public. These are important issues that have rightly been

raised by different members in this forum.

However I would like to emphasize that these are issues for analysis, reflection

and corrective action as necessary, and should not be used as instruments of

“blame”, “accusations” or “disgrace”.

Since the inception of NACP–I in early 90s, we have been raising our voices

about inadequate funding for the national AIDS response. Since early 2000,

funding from BMGF and GFATM has significantly bolstered the finances of the

national response – something that we are in general very happy about. In this

case, since we are talking of an overseas donor (and I would like to add, a very

generous one) who would generally not operate at this scale in the country

unless invited, we need to discuss these issues objectively and challenge the

donor with dignity and grace.

3. It is distressing to read the title of this discussion which indicates that

the BMGF have wasted its money through Avahan. Having been a part of the

national response, before and after Avahan, I hold that nothing could be further

from the truth.

We cannot deny what Avahan has achieved in terms of standardization, rapid scale

up of coverage, saturation, quality of services and even community participation

in many areas. Although the community level work that NGOs, CBOs and activists

have done before Avahan arrived in the scene was formidable (as rightly pointed

out by my good friend Aditya) and had laid the foundation to the subsequent

scaled up national response, with respect to Avahan, we simply cannot deny the

following:

3.1 What Avahan has achieved in the last 3-5 years in terms of rate of coverage

of key populations, we hadn’t achieved in 10 years preceding Avahan. We need to

acknowledge this gracefully.

3.2 Although a full set of evidence is yet to be collected and it might still be

early for that, it is difficult to accept that Avahan has not reduced the

incidence of HIV infection. An early study done in Karnataka already indicates

that Avahan has made a positive impact. With improved surveillance and coverage

of services, reporting is expected to increase.

It is too early to fully assess the full impact of Avahan, but I expect, on the

whole, Avahan interventions would have made a very significant impact on

reducing new infections. I am quite hopeful that future evaluations and

epidemiological trends will establish Avahan’s contribution in arresting the

epidemic in India. Having said that, let’s not judge the outcome either way,

before the evidence is out. It is neither fair nor truthful and certainly not

helpful to any.

3.3 Saying that Avahan has taught us “community mobilization” would be a

travesty of sorts and disrespectful of the path-breaking work that preceded

Avahan and of the pioneers (most of whom I have known personally - I won’t even

attempt a list of names here since it is quite long) who were already in the

scene. On the contrary, I know for sure that Avahan has learnt significantly

from the work that preceded it. In fact the rest of the world has learnt a lot

from the early community mobilization and empowerment work that has taken place

in India, often with minimum or no external support. I don’t think Avahan has

any pretensions on this either.

However one cannot deny the fact that Avahan has in many ways challenged status

quo and pre-existing approaches to HIV/AIDS programming for the better. In my

view, Avahan has built on some of the finest aspects of community level

interventions and empowerment that preceded it (which has been alluded to by

Aditya) and has added to it a milestone and results based management approach

which was largely lacking earlier.

In many ways, Avahan has changed the basic paradigm of HIV program planning and

management and brought in added professionalism (mainly evidence based planning

and results based management) in NGOs it is supporting. Simply put, in many

aspects, Avahan has “raised the bar” and denying this tantamount to denying the

truth and refusal to learn from good practice.

3.4 We also cannot deny that Avahan has contributed significantly to State and

National level planning and has striven hard to achieve coordination and

convergence. Having been involved in the design of three successive NACPs, the

last one in which Avahan participated actively, I can confidently say that

Avahan has significantly contributed to the quality of national and state level

planning and well as facilitated state level coordination, coherence and

convergence. This needs to be acknowledged.

3.5 Communities addressed under any program (HIV/AIDS or otherwise) are not

homogenous – they cannot be. There are multiple interest groups and factions (I

don’t mean to use this work in its pejorative sense) within communities and

often external support (which includes injection of funds) tends to change

community dynamics, often for the better in terms of greater empowerment and

mobilization but sometimes for the worse, when it leads to greater polarization

and social fracturing.

It is a risk any development program faces and is a risk that has to be

recognized and mitigated. Although things might have gone wrong in some places,

one cannot deny the fact that Avahan is truly committed to mobilization and

empowerment of communities and that there have been outstanding success in many

sites. I also know that Avahan has striven hard to create enabling environments

for communities through advocacy at different levels. This cannot be brushed

aside.

I am sure there are shortcomings in Avahan just as there are in any other

development program and more so those that are as ambitious and bold as Avahan

is. Given this, the discourse needs to be taken to a different level. We need to

raise the game so that we can be more constructive and supportive in our

critique.

Shumon Sengupta

Dhaka, Bangladesh

e-mail: <shumon24@...>

[Guest guest]

Dear Forum,

Re: /message/10350

All these five years NACO was there and SACS was there. What were the officials

who were coordinating with these AVAHAN implementers doing. They could have

worked out a sustainability plan at the start of the NACP III period. No point

in blaming gates foundation.

I would like to bring it to the kind notice of all the forum members that most

of the SACS have not implemented the NACP III fully. Can NACO give a report on

the progress of NACP III in the interest of the general public / tax payers /

funders / PLHA community...

Regards

Ramesh

e-mail: <ramesh.aids@...>

[Guest guest]

Dear Forum,

Re: /message/10346

I found the article on Avahan to be, as a colleague put it, " yellow

journalism. " (Forbes:

http://www.business.in.com/article/cross-border/how-bill-gates-blew-$258-million\

-in-indias-hiv-corridor/852/0)

Any large public health institution is bound to have its inefficiencies and

bureaucracy. But compare Avahan to many UN agencies and large NGOs and it

becomes a shining star.

I do not have the firsthand knowledge to speak to the issue of how

much Avahan pays its salaries, but I do know that they make an effort

to hire professionals from the private sector. People from the private

sector are paid more. What other incentive would they have to switch

over or to stay?

A lack of business & management expertise is, as I see it, the #1

problem with health and development organizations today.

NGOs and Foundations are still businesses that must raise revenue. The

difference is that they re-invest the revenue into their operations

and services instead of making a profit.

Having worked at the UN and then in close collaboration with them for

6 years now, I can attest to the enormous amounts of money and human

resources wasted on useless international meetings and endless,

jargon-filled reports that gather dust on people's desks. The money

simply does not reach CBOs and very rarely the people. There is no

meritocracy, sustainability of programs or accountability- only

nepotism, grandiloquent speechmaking and power-seeking.

I think that Avahan has achieved an enormous amount within the few

years they have been in existence. NACO could never have achieved so

much. Even if NACO cannot take over all of its clinics and assets,

Avahan has changed the rules of the game.

Is it Avahan's " fault " if people do not utilize the services? Perhaps to some

degree, as with the shiny, new, suspicious-looking mobile outreach vans. That is

something an org can learn only by trial and error. However, much of it has to

do with perceptions and behaviors amongst Indian citizens. Attitudinal shifts

take decades, if not generations, to occur.

I agree with Mr. Sengupta that Avahan has institutionalized

professionalism and evidence-based interventions on the Indian AIDS

scene, and that " has significantly contributed to the quality of

national and state level planning and well as facilitated state level

coordination, coherence and convergence. "

I do believe it is an accountable institution, and hope that dialogues such as

this one can help Avahan to improve its communication with civil society at

large- not just partners & consumers who are the main stakeholders.

Furthermore, I do not fully trust in the measures that are being used

to evaluate Avahan's performance. Firstly, given that AIDS is a

relatively new disease & social phenomenon (compared to, say,

Smallpox, which took over two centuries to halt and eradicate), I

wonder how Avahan could have done any better in terms of the

progressiveness of their approach. Would any other organization have

the knowledge, expertise & resources to do any better?

Secondly, I know from my own experience that it's almost impossible to

accurately measure behavior change, especially on issues of condom use

and number of sexual partners in a conservative, hush-hush society

like India.

India's data are notoriously unreliable, not the least because people rarely

tell the truth when self-reporting about their sexual proclivities. We all

should know the difficulties of accurate

surveillance, as we have seen from the dramatic change in UNAIDS #s on

HIV prevalence (contrasted to the many claims on this forum that the

numbers were gross underestimates prior to 2006).

It's very easy to criticize, but when one is actually involved in such

an undertaking, it becomes clear the complexities of working with a

diverse range of issues, people and partners who have complex and

competing interests.

I, for one, feel that a certain amount of gratitude is owed to the Gates Fdn.

They have spent more $ on India than in any other country, more than any other

donor.

Instead of rancorous smears that can only discourage further investment in

India's AIDS response by other donors & agencies, public health experts should

make an attempt to assist Avahan to improve its efforts.

Thank You & Best Wishes,

Joya Banerjee

+919619529501

Co-Founder, Global Youth Coalition on HIV/AIDS

www.youthaidscoalition.org

PUKAR Research Associate

www.pukar.org.in

Harvard School of Public Health

e-mail: <joya@...>

[Guest guest]

Dear Forum

Re: /message/10346

Let me thank the journalist who has attempted to write what she had decided to

write even before going in to the communities where Avahan program.

This article has created a space for those who always wanted to say something

but could not do so for variuos reasons.

We too create social spaces for our communities so that they say and listen to

others.

As a program implementing person in the partner organization of Avahan for over

four years this article and the response to it have raised some questions in my

mind

#1 Do we expect that the funding agencies should fund the programs for ever are

their any standardized time frame that can guide such Public Health programs

about thier expected duration on any land like India?

#2. When we appreciate interdisciplinary efforts in most social development and

other programs why do we do exception of Avahan program?

#3.How many Public Health programs have strived to strengthen the so called

beneficiaries or clients to aspire to be partners and owners of the programs?

# 4 Do we have many examples of program of this extend to use evidences in the

field and quickly respond to them by showing growing proactive actions to allow

required changes in the program?

#5 . Are there many examples of considering government as a key partner in not

only implementation of the program but comprehensively dealing with the core

issue of prevention and control of HIV/AIDS?

On many of these fronts Avahan has been trying its best by giving leadership to

its partners. It would certainly have many cracks that would need some efforts.

And I am sure guys there would be aware of them or learn from experts.

I have been in the field for over two decades and been witnessing that Avahan is

one of those program who has genuinely tried to bring affected community at

center of the affairs of managing the program.

I know hundreds of small group leaders and community members who would not

understand the jargons used in these discussions but would vouch for the fact

that the Avahan program has ignited the light in them which will not only help

them to help themselves but will guide them for rest of their life whether

Avahan or such other programs exist or not.

Pramod Nigudkar

e-mail: <p_nigudkar@...>

[Guest guest]

Dear FORUM,

Re: /message/10346

I have been reading the series of responses that have appeared on the AIDS India

site on the Forbes Article and in some cases I feel disappointed with the level

of debate and discussion that is taking place.

Obviously, it has to do with the nature of the report, not to overlook the fact

that it has appeared in an internationally reputed magazine and of course none

of us can miss some of the holier-than-thou attitude many of us tend to adopt

when we get a chance to do just that.

And at the end of the day, it is disheartening to find that we do not critique

the work but end up by getting personal and giving vent to our bottled up

feelings.

I have always had my share of reservation about the Avahan Project. I have had

problem with the approach that only prevention matters and that some of us who

are involved in the arduous job of providing care and support are relegated to

the not-to-be-touched portfolio etc.

But that does not mean that the kind of work that Avahan Project did in

partnership with a host of NGO and CBO and most critically with the support of

peer educators, community guides and outreach workers drawn from key populations

groups was not important.

It is so important that we need to raise concerns and particularly concerns

about handing over the project or transitioning the project to the community or

government. These are laudable ideas that sound good but do not happen the way

it is meant to and we have innumerable instances when after years of hard work

the projects which were handed over to the government just vanished, leaving not

even a trace of its earlier glory and commitment.

As usual we are ready to fall prey to anything that appears " critical " and

" adversarial " and do not realize that we often end up by throwing the baby with

the bathwater. Are we saying that all the personal and collective risks that the

representatives of the community faced to reach out to their peers, distribute

condoms, accompany them to clinics, protect them from the violence of the goons

and partners are not worth the investments made?

We know that many of these processes are resource intensive. And this is equally

true for care and support interventions.

It is in this context that we need to impress upon the donors that if they

decide to support part of the problem and ignore others they will end up by

compounding the problems rather than engaging with it.

This does not mean that they do not prioritize but must do so in active

collaboration with others to ensure that all components get equal attention and

support.

Anjali Gopalan

Executive Director

Naz Foundation ( India ) Trust

New Delhi

e-mail: <gopalan.anjali@...>

[Guest guest]

Dear All,

Re: /message/10346

First of all kudos to Anjali for bringing in some rational perspective to this

rather insidious debate on weather Bill Gates

blew up 258 million USD in India through " Avahan "

I agree with Anjali wherein she points out that rather than critique the

program, the debate has become a bit personal.

As the various credible reports and publications indicate, it its own selective

sense Avahan has had some impact and cannot be discounted as a TOTAL failure or

as debated USD 258 million down the drain ! where " Avahan " missed the bus was

its disconnect with ground realities and foresight to programmatically link

prevention to care, support and treatment as a continuum.

I do hope as it happens with ALL program initiatives that this critique is seen

as a learning curve and appropriate measures are incorporated and the Avahan

project is re strategized to address the learnings and gaps.

As pointed out by Anjali we have had far too many instances of highly impact

interventions that are non existent today or the impact negated totally due to

envisaging the magical principal of handing over to communities or governments.

Some of us have had the courage and foresight to venture into care and support

(1994) as an entry point to then link Prevention Care, and treatment, experience

does show us that this has also had an impact to de stigmatize and provide hope

for a better quality of life, and gone a long way in bringing in some

rationality in normalizing the disease.

On a slightly different count, I am a bit disappointed on the debate going on

about the kind of salaries of the employees of the Avahan project. While I do

not want to comment on the same without knowing the facts, we must understand

that in today's world qualified and technically sound professionals do not come

cheap. rather than question the salaries of personnel of projects like Avahan,

we need to question our governments,and donors on the relatively low salary

budgets for the similar kind of personnel. It must be understood that NGOs are

evaluated with the same yardstick to measure performance and impact for

programs.

Best Regards

Dr.Ashok Rau

Executive Trustee/CEO

Freedom Foundation-India, Nigeria, and Botswana

(Centers of Excellence- Substance Abuse & HIV/AIDS)

Head Office: 180, Hennur Cross, Bangalore - 560043, India

Phone (O) +91 80 25440134, 25449766, 25430611, (Direct) 25443114

Fax (O) +91 80 25440134

email:freedom@...

[Guest guest]

Dear Forum,

Re: /message/10346

All these five years NACO was there and SACS was there. What were the officials

who were coordinating with these AVAHAN implementers doing.

They could have worked out a sustainability plan at the start of the NACP III

period. No point in blaming gates foundation.

I would like to bring it to the kind notice of all the forum members that most

of the SACS have not implemented the NACP III fully. Can NACO give a report on

the progress of NACP III in the interest of the general public / tax payers /

funders / PLHA community?

Regards

Ramesh

E-mail: <ramesh.aids@...>