NACO goes slow on Avahan transition

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Naco goes slow on Avahan transition

New Delhi: Recently, Naco entered into a memorandum of understanding with

Avahan, the Bill and Melinda Gates Foundation's India initiative for HIV/AIDS.

The pact was a reaffirmation of its commitment to HIV as well as the beginning

of the transition of Avahan's projects to Naco and other partners.

Avahan began work in India in 2003 with a commitment of $200 million (Rs930

crore now). This was later increased to $258 million and then to $338 million.

The foundation had three primary goals, one being to catalyse others to take

over and replicate its model.

But when the time came for the Indian government to take over the projects,

officials realized Avahan's costing was different and the scale of the

foundation's programmes was greater than its own projects. " We asked them to

hand over (the projects) in a systematic fashion. It meant a lot of negotiations

and we realized that many components of their TI projects would have to be

dropped, " said K. Sujatha Rao, secretary, ministry of health and family welfare,

and a former director general of NACO.

The success of Avahan's projects could not be ignored. The organization brought

a fresh approach to projects, focusing on the management design in targeted

interventions, scaling up projects and taking responsibility and accountability

for them for six years.

" We're pleased that every month, Avahan-supported organizations reach hundreds

of thousands of people with condoms, risk-reduction counselling, HIV testing and

other prevention services. And early signs are encouraging, " said Ashok

, director of Avahan.

Avahan, however, did not enter India with a strategy in place. admits

it was an ambitious programme and the organization had no clear plan. Avahan,

along with its partners, eventually evolved a structure in which high-risk

people are themselves the main implementors. " Now, they are the driving

`salesforce' of the programme, also leading the monitoring of the programme

(and) doing risk reduction counselling, " explained .

The programme did face criticism for the high cost of its projects and the high

salaries it paid its staff. " The average cost per beneficiary per year among

Avahan-supported programmes is $45. This is well below the UNAIDS guidelines of

$90-100 per beneficiary for high-risk groups, " admitted.

Government officials said criticism wasn't warranted. " Avahan has a different

costing and they have a right to salaries. Yes, when we take over, we cannot

give the same salaries. And they seem to have made an indent in certain areas,

but it's not something you can bring down in two days. They are as good or bad

as us, " says Rao.

A senior Naco official closely involved in the intervention programmes said

salaries in projects taken over from Avahan would have to be brought down. Naco

also has to bring the intervention projects in line with its guidelines, which

could take up to six months.

To assist the government and other partners in transitioning nearly 170

projects, Avahan, along with the government, decided to take a phased approach.

Between April and September, Naco took over 10% of Avahan's female sex worker

programmes. Over the next three years, until the completion of NACP III, Avahan

will hand over 30% of its programmes each year.

The government launched NACP III in 2007 with an aim to halt and reverse the

spread of HIV/AIDS in India over the next five years. " We have worked closely

with Naco to develop a sustainable plan to gradually transfer key aspects of

Avahan's work in a series of stages, starting in 2009 and ending in 2012, " said

.

On evaluating the intervention projects, Naco officials found many of these

needed hand-holding.

" We have now decided that for every 10 TIs, we will post one programme officer

who will help in the implementation of the projects...72 people have been

trained already, and some 300 TIs have been looked after in the last two

months, " said the Naco official mentioned earlier.

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