11Partnership 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

22Sharing of Avahan lessons with GOI to enable rapid scale up of MARPs program

Approach to MARPs programming • Microplanning tools• Community strengthening• Intensive peer led outreach• Robust MIS and feedback loop

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

© 2009 Bill & Melinda Gates Foundation |

2

Approach to MARPs programming incorporated into drafting NACO operational guidelines and training modules

Supervision and capacity building approach similar – through robust Technical Support Units, many with experience in donor programming

Ratio of 1:10 project officers: NGOs

Avahan lessons …incorporated by NACO

33GOI lessons incorporated by Avahan

Approach to MARPs programming • Focus on HIV testing

Cost savings• ‘programs’ can be managed at slightly

lower costs

© 2009 Bill & Melinda Gates Foundation |

3

Avahan incorporated HIV testing 2009 onwards

Avahan reduced program costs by 20% to be aligned with government costing structures

NACO lessons …incorporated by Avahan

44Program management: Strategic in-sourcing for quality assurance

NACP III recognised that it would benefit from taking advantage of technical capacity available with institutions with appropriate skills, flexibility & capacity.

Usually, the government tries to do it all!

Inputs into guideline development

Issuing guidelines, policy and planning

Funds release, administration, implementation

Developing appropriate

monitoring tools

Managing in-sourced units

Supportive supervision and

‘feel on the street’ quality

assurance

Inputs into guideline development

Issuing guidelines, policy and planning

Funds release, administration, implementation

Developing appropriate

monitoring tools

Managing in-sourced units

Supportive supervision and

‘feel on the street’ quality assurance

In-sourced supportGovernment Programme delivered

55Technical Support Units: Alignment with government structures

© 2009 Bill & Melinda Gates Foundation | 5

BMGF NACONTSU, TSGs

SLPs SACS TSUs

NGOs CBOs

Level 1: Policy setting, management and funding

Level 2: Management and implementationTechno-managerial implementation support, rigorous and regular reviews and financial

oversight

Level 3: ImplementationService delivery

Transfer

Avahan

State level

District level

Government

National level

NGOs CBOs

66The role of quality assurance and supportive supervision units/mechanisms

© 2009 Bill & Melinda Gates Foundation | 6

Role of government division

Issuing guidelines/policies

Administration

Reviews and ensuring support structures deliver

against mandate

Funds flows

Handling public inquiries

Role of support structure

Technical inputs into guideline and module

development

Developing appropriate tools and MIS to monitor program

Feet on the street supportive supervision

Oversight of implementing partners (NGOs/CBOs)

Strategic planning and ‘problem solving’ of

emerging issues

Imp

lem

enta

tio

n

Qu

ality assuran

ce

77Technical and management support in NACP III

© 2009 Bill & Melinda Gates Foundation | 7

National

State

District

National TSU Truckers TSG Condom TSG

State TSU State Training and

Resource Center

District AIDS Units

BMGF and USG BMGF BMGF and USAID

All donors Government/World

Bank, USAID, DfID

Government/World Bank

CDC

Support structure Source of support

TSU = technical support unit, TSG = technical support group

88Partnership 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

99Planned and phased handover through a Memorandum of Understanding between donor and government

© 2009 Bill & Melinda Gates Foundation | 9

20%10%

80%

2009 2010 2011 2012 2013

Avahan Phase II

20%

25%75%Condom social marketing interventions

Truckers interventions

High-risk group interventions 70%

1010Tight coordination with government at all levels to add pos role

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

SACS (public) TSU (private)

NGOs/CBOs

State Level Private Pubic Partnership National Level

NACO, State Nodal Officer

NTSU, Team Leader and Program

Officers

Field level Program Officer

1111

Technical support group for condoms resulted in disruptive growth in socially marketed condoms

11Condom Technical Unit initiated under NACP III

Millions of condoms

Growth – inflationary at 7-10%

Growth – 17-20%

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

339 384 439 635 722

886

545 639 639

835 844

825

884 1,023 1,078

1,470 1,566

1,711

Commercial Social Total