Abstract

BackgroundDuring 2009-2012, Avahan, a large donor funded HIV/AIDS prevention program in India was transferred from donor support and operation to government. This transition of approximately 200 targeted interventions (TIs), occurred in three tranches in 2009, 2011 and 2012. This paper reports on the management practices pursued in support of a smooth transition of the program, and addresses the extent to which standard change management practices were employed, and were useful in supporting transition.ResultsWe conducted structured surveys of a sample of 80 TIs from the 2011 and 2012 rounds of transition. One survey was administered directly before transition and the second survey 12 month after transition. These surveys assessed readiness for transition and practices post-transition. We also conducted 15 case studies of transitioning TIs from all three rounds, and re-visited 4 of these 1-3 years later.ResultsConsiderable evolution in the nature of relationships between key actors was observed between transition rounds, moving from considerable mistrust and lack of collaboration in 2009 toward a shared vision of transition and mutually respectful relationships between Avahan and government in later transition rounds. Management practices also evolved with the gradual development of clear implementation plans, establishment of the post of “transition manager” at state and national levels, identified budgets to support transition, and a common minimum programme for transition. Staff engagement was important, and was carried out relatively effectively in later rounds. While the change management literature suggests short-term wins are important, this did not appear to be the case for Avahan, instead a difficult first round of transition seemed to signal the seriousness of intentions regarding transition.ConclusionsIn the Avahan case a number of management practices supported a smooth transition these included: an extended and sequenced time frame for transition; co-ownership and planning of transition by both donor and government; detailed transition planning and close attention to program alignment, capacity development and communication; engagement of staff in the transition process; engagement of multiple stakeholders post transition to promote program accountability and provide financial support; signaling by actors in charge of transition that they were committed to specified time frames.

Highlights

  • During 2009-2012, Avahan, a large donor funded Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) prevention program in India was transferred from donor support and operation to government

  • If the health services provided by donor-funded programs are to be sustained, at some point in their lives such projects will need to transition to local ownership, meaning that responsibilities for both funding and running the program will be taken over by local actors

  • Findings are organized around the five practical themes for change management identified above

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Summary

Introduction

During 2009-2012, Avahan, a large donor funded HIV/AIDS prevention program in India was transferred from donor support and operation to government. If the health services provided by donor-funded programs are to be sustained, at some point in their lives such projects will need to transition to local ownership, meaning that responsibilities for both funding and running the program will be taken over by local actors. The stimuli for such transitions vary: perhaps economic growth means that the country no longer needs donor support, or donor priorities have shifted to other issues. While a smooth transition is not the ultimate goal of transition, it appears likely to be on the critical pathway to sustainability, in the sense that services may never recover from disruptive transition processes

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