Partnership between BMGF and GOI to scale and sustain
programs- a comprehensive sustainability approach
1. Aligned policies: NACO continues focus on
scaled prevention with MARPs as key prevention
strategy
2. Aligned approaches, scaled programs and
strengthened organizational systems within
government: NACO scales up coverage and
quality of its own prevention programs with MARPs
3. Transferring fiduciary and management
responsibility of Avahan interventions to
government in a phased manner
Focus of
today’s
discussion
1
Sharing of Avahan lessons with GOI to enable
rapid scale up of MARPs program
Avahan lessons
2
…incorporated by NACO
Approach to MARPs programming
• Microplanning tools
• Community strengthening
• Intensive peer led outreach
• Robust MIS and feedback loop
Approach to MARPs programming
incorporated into drafting NACO
operational guidelines and training
modules
Supervision and capacity building
approach
• ‘Mother NGOs’ with role to strengthen
programs through on-site mentoring
• Intensive field presence of project officers
to mentor NGOs
• Ratio of 1:6 project officers: NGOs
Supervision and capacity building
approach similar – through robust
Technical Support Units, many with
experience in donor programming
Ratio of 1:10 project officers: NGOs
© 2009 Bill & Melinda Gates
Foundation
|
2
GOI lessons incorporated by Avahan
NACO lessons
3
…incorporated by Avahan
Approach to MARPs programming
• Focus on HIV testing
Avahan incorporated HIV testing 2009
onwards
Cost savings
• ‘programs’ can be managed at
slightly lower costs
Avahan reduced program costs by
20% to be aligned with government
costing structures
© 2009 Bill & Melinda Gates
Foundation
|
3
Program management: Strategic in-sourcing for
quality assurance
Inputs into guideline
development
Issuing
guidelines,
policy and
planning
Funds release,
administration,
implementation
Developing
appropriate
monitoring tools
Managing insourced units
Supportive
supervision and
‘feel on the street’
quality assurance
Usually, the government tries to do it all!
NACP III recognised that it would benefit from taking
advantage of technical capacity available with institutions
with appropriate skills, flexibility & capacity.
Inputs into guideline
development
Issuing
guidelines,
policy and
planning
Funds release,
administration,
implementation
Developing
appropriate
monitoring tools
Government Programme delivered
Managing insourced units
Supportive
supervision and
‘feel on the
street’ quality
assurance
In-sourced support
4
Technical Support Units: Alignment with
government structures
5
National level
Level 1: Policy setting,
management and funding
NACO
NTSU, TSGs
BMGF
State level
Level 2: Management and implementation
Techno-managerial implementation support,
rigorous and regular reviews and financial
oversight
SLPs
SACS
TSUs
Level 3: Implementation
Service delivery
District level
NGOs
CBOs
Avahan
Transfer
NGOs
CBOs
Government
© 2009 Bill & Melinda Gates Foundation
|
5
Role of government
division
Role of support
structure
Issuing guidelines/policies
Technical inputs into
guideline and module
development
Administration
Developing appropriate
tools and MIS to monitor
program
Reviews and ensuring
support structures deliver
against mandate
Feet on the street
supportive supervision
Funds flows
Oversight of implementing
partners (NGOs/CBOs)
Handling public inquiries
Strategic planning and
‘problem solving’ of
emerging issues
6
Quality assurance
Implementation
The role of quality assurance and supportive
supervision units/mechanisms
© 2009 Bill & Melinda Gates Foundation
|
6
Technical and management support in NACP III
7
Source of support
Support structure
National



National TSU
Truckers TSG
Condom TSG



BMGF and USG
BMGF
BMGF and USAID
State


State TSU
State Training and
Resource Center


All donors
Government/World
Bank, USAID, DfID

District AIDS Units

Government/World
Bank
CDC
District
TSU = technical support unit, TSG = technical support group

© 2009 Bill & Melinda Gates Foundation
|
7
Partnership between BMGF and GOI to scale and sustain
programs- a comprehensive sustainability approach
1. Aligned policies: NACO continues focus on
scaled prevention with MARPsas key prevention
strategy
2. Aligned approaches, scaled programs and
strengthened organizational systems within
government: NACO scales up coverage and
quality of its own prevention programs with MARPs
3. Transferring fiduciary and management
responsibility of Avahan interventions to
government in a phased manner
8
9
Planned and phased handover through a
Memorandum of Understanding between donor
and government
Avahan Phase II
2009
High-risk group
interventions
Truckers
interventions
Condom social
marketing
interventions
2010
10%
20%
75%
2011
2012
20%
70%
2013
80%
25%
© 2009 Bill & Melinda Gates Foundation
|
9
Tight coordination with government at all levels to add
pos role
State Level Private Pubic Partnership
SACS (public)
TSU (private)
Project Director
Team Leader
Joint Director, Targeted
Interventions
Team Leader, Targeted
Interventions
Additional project
director + Joint
Directors
Team Leader, Capacity
Building
Project Director and
Additional project
Director
Team Leader, Strategic
planning
NGOs/CBOs
Field level
Program Officer
10
National Level
NACO, State
Nodal
Officer
NTSU,
Team
Leader and
Program
Officers
11
Technical support group for condoms resulted in
disruptive growth in socially marketed condoms
Commercial
Social
Total
Millions of condoms
Growth – 17-20%
1,566
1,470
Growth – inflationary at 7-10%
1,023
1,711
825
1,078
835
844
884
545
639
639
339
384
439
2005-06
2006-07
2007-08
635
2008-09
722
2009-10
886
2010-11
Condom Technical Unit initiated under NACP III
11