Last month, Bill Gates announced that he would be giving an additional $80 million to Avahan - his foundation’s India AIDS initiative.
The money came close on the heels of a scathing article by Forbes on how the project “got lost between B-school and brothel.” The article called Avahan out on a “lack of practical experience at the top,” on failed out reach efforts, and on overspending on marketing, salaries and travel. It accused the organization of overshooting and stated that, although the effort had made a “dent in the problem,” the impact is “small in relation to the spending.”
The foundation responded stating that the article provided little evidence for its claims, was inaccurate, and misstated Avahan’s goals.
To learn more about how Gates’ $80 million will be use, and what Avahan’s plans for the future are, Mint talks to Ashok Alexander – Avahan’s country director.
What will Bill Gates’s $80 million contribution to Avahan be used for?
The contribution to Avahan will be used to fund and support HIV prevention programs in six Indian states and along national trucking routes. Avahan will continue to fund and support a wide range of partners, including government agencies and more than 100 NGOs, to enable them to reach people with HIV prevention services.
Is this money separate to the funds being allocated for transitioning Avahan’s functions over to the government?
It is part of the same funds, now valued at $338million.
Will Avahan continue to play a role in the future, or will all functions be transferred over to NACO?
We recognize that the fight to stop HIV/AIDS in India is far from over, and we are working with partners, including the government, to ensure that prevention efforts are sustainable. To help achieve that goal, we provide extensive technical support to help government agencies and NGOs effectively manage prevention programs.
Over the next five years, and in several phases, we anticipate that the government will take over the funding and management of several of Avahan’s current programmes, thereby reducing our day-to-day role in program implementation. We are working closely with the National AIDS Control Organization (NACO) on this transition, and we have been pleased by their enthusiasm and our strong partnership. We remain committed to the goals of the National AIDS Control Programme, Phase 3 – to halt and reverse the HIV epidemic in India.
Our shared goal is to transfer 10% of Avahan programs in 2009, a further 20% in 2011, and the remainder in 2012.
Are there parts of Avahan’s program that NACO (National Aids Control Organization) will phase out once the transition is made?
Very little of the Avahan program will be phased out once the transition has been made. Avahan funding and support has helped our NGO partners greatly expand and improve HIV prevention efforts, and has done so in conjunction with government agencies. One of the goals of Avahan was to catalyze others to take over and replicate the large-scale model. Now some of the programs are mature and robust, we feel they can sustain themselves.
How effective has Avahan been since its inception? There have been accusations that it has failed to make significant progress because the staff lack practical/on the ground health experience. What do you think about this?
The Gates Foundation established Avahan to help support India’s efforts to reduce the spread of HIV, and we are pleased with its progress to date.Every month, groups within the Avahan program reach hundreds of thousands of people with condoms, risk-reduction counseling, HIV testing, and other prevention services.
While it is too early to fully assess the impact of this prevention program, early signs are encouraging. For example, data from some of Avahan’s target areas suggest that sex workers have become more likely to use condoms and rates of sexually transmitted diseases amongst those at risk have decreased.
Avahan does have three goals, but they are not the ones the journalist stated. They are: a) Build an HIV prevention model at scale in India, b) catalyze others to take over and replicate the model, c) foster and disseminate lessons learned within India and worldwide.
We are confident that we have achieved the first goal, and a series of evaluations to be published later this year will detail our progress. We are currently working closely with government agencies and NGOs to achieve the second goal. Over the next five years, we anticipate that these organizations will gradually adopt some aspects of Avahan’s current work, and that we will reduce our day-to-day role in program implementation. To achieve the third goal, we will continue to publish and present research detailing our work and its impact.
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We have given grants for evaluation work to a consortium of foreign universities, international NGOs, and Indian academic institutions. Their work is overseen by an External Advisory group, constituted by the WHO. A separate evaluation of Avahan-supported programs is being conducted by the Institute for Health Metrics and Evaluation. The results of these evaluations will be published in a series of papers in 2009 and 2010. We anticipate that they will show significant increases in condom use and declines in sexually transmitted infections. Early results from one state show that HIV incidence among women at antenatal clinics – a good proxy for overall HIV incidence – has gone down. Additional evaluations will be conducted in two years, when even more data will be available.
On your other point of the staff’s lack of practical experience, I would say this is also inaccurate. Some staff members bring exemplary on-the-ground and technical health experience, and they are well balanced by others who bring with them years of experience in business backgrounds – all the better for designing and operating a complex program like Avahan.
What is Avahan’s biggest achievement to date?
While it is too early to fully assess Avahan’s impact on HIV risk behaviors and infection rates, the early signs are encouraging. Data from some of Avahan’s target areas suggest that sex workers have become more likely to use condoms, and that rates of sexually transmitted infections have decreased among people at risk.
And its biggest challenge?
We believe our programs are sustainable, but we recognize we can’t rest on our laurels until we can prove that they are so.
Is there a country or programme dealing with its HIV/AIDS issues particularly effectively – somewhere that India could perhaps model itself on?
We feel it’s the opposite -- so many other countries can learn from India’s response to the epidemic. It has a remarkable HIV plan -- a model plan for a core group epidemic. The country’s National AIDS Control Program Phase 3 concentrates its funding on prevention, particularly among high-risk groups.
Are there any new projects/initiatives that Avahan is working on?
In the next five years, the Gates Foundation will continue to focus on HIV prevention through its Avahan programme. The Foundation funds many other health and development projects in India, including maternal and child health programs, and we plan to continue this grant making.