11 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

22 Sharing 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

33 GOI 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

44 Program 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

55 Technical Support Units: Alignment with government structures © 2009 Bill & Melinda Gates Foundation | 5 BMGF NACO NTSU, TSGs SLPsSACS TSUs NGOs CBOs Level 1: Policy setting, management and funding Level 2: Management and implementation Techno-managerial implementation support, rigorous and regular reviews and financial oversight Level 3: Implementation Service delivery Transfer Avahan State level District level Government National level NGOs CBOs

66 The role of quality assurance and supportive supervision units/mechanisms © 2009 Bill & Melinda Gates Foundation | 6 Role of government division Issuing guidelines/policiesAdministration Reviews and ensuring support structures deliver against mandate Funds flowsHandling 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 Implementation Quality assurance

77 Technical and management support in NACP III © 2009 Bill & Melinda Gates Foundation | 7 NationalStateDistrict  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

88 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

99 Planned and phased handover through a Memorandum of Understanding between donor and government © 2009 Bill & Melinda Gates Foundation | 9 20% 10% 80% Avahan Phase II 20% 25%75% Condom social marketing interventions Truckers interventions High-risk group interventions 70%

10 Tight coordination with government at all levels to add pos role Project DirectorTeam 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

11 Technical support group for condoms resulted in disruptive growth in socially marketed condoms 11 Condom Technical Unit initiated under NACP III Millions of condoms Growth – inflationary at 7-10% Growth – 17-20%