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Transitioning a Large Scale HIV/AIDS Prevention Program to Local Stakeholders: Findings from the Avahan Transition Evaluation

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  • Sara Bennett
  • Suneeta Singh
  • Daniela Rodriguez
  • Sachiko Ozawa
  • Kriti Singh
  • Vibha Chhabra
  • Neeraj Dhingra

Abstract

Background: Between 2009–2013 the Bill and Melinda Gates Foundation transitioned its HIV/AIDS prevention initiative in India from being a stand-alone program outside of government, to being fully government funded and implemented. We present an independent prospective evaluation of the transition. Methods: The evaluation drew upon (1) a structured survey of transition readiness in a sample of 80 targeted HIV prevention programs prior to transition; (2) a structured survey assessing institutionalization of program features in a sample of 70 targeted intervention (TI) programs, one year post-transition; and (3) case studies of 15 TI programs. Findings: Transition was conducted in 3 rounds. While the 2009 transition round was problematic, subsequent rounds were implemented more smoothly. In the 2011 and 2012 transition rounds, Avahan programs were well prepared for transition with the large majority of TI program staff trained for transition, high alignment with government clinical, financial and managerial norms, and strong government commitment to the program. One year post transition there were significant program changes, but these were largely perceived positively. Notable negative changes were: limited flexibility in program management, delays in funding, commodity stock outs, and community member perceptions of a narrowing in program focus. Service coverage outcomes were sustained at least six months post-transition. Interpretation: The study suggests that significant investments in transition preparation contributed to a smooth transition and sustained service coverage. Notwithstanding, there were substantive program changes post-transition. Five key lessons for transition design and implementation are identified.

Suggested Citation

  • Sara Bennett & Suneeta Singh & Daniela Rodriguez & Sachiko Ozawa & Kriti Singh & Vibha Chhabra & Neeraj Dhingra, 2015. "Transitioning a Large Scale HIV/AIDS Prevention Program to Local Stakeholders: Findings from the Avahan Transition Evaluation," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-16, September.
    • Handle: RePEc:plo:pone00:0136177
    DOI: 10.1371/journal.pone.0136177
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    References listed on IDEAS

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    1. Scheirer, M.A. & Dearing, J.W., 2011. "An agenda for research on the sustainability of Public Health Programs," American Journal of Public Health, American Public Health Association, vol. 101(11), pages 2059-2067.
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    1. Sachiko Ozawa & Suneeta Singh & Kriti Singh & Vibha Chhabra & Sara Bennett, 2016. "The Avahan Transition: Effects of Transition Readiness on Program Institutionalization and Sustained Outcomes," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-15, July.
    2. Sangram Kishor Patel & Saradiya Mukherjee & Bidhubhusan Mahapatra & Madhusudana Battala & Matangi Jayaram & Sameer Kumta & Yamini Atmavilas & Niranjan Saggurti, 2019. "Enhancing financial security of female sex workers through a community-led intervention in India: Evidence from a longitudinal survey," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-13, October.

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