For the Bill and Melinda Gates Foundation (BMGF), India has been the largest recipient of its funds; its HIV control initiative here is a big global headline-grabber.
The BMGF, in an official response, talked of a phased withdrawal. To quote: “We recognise that the fight to stop HIV/ AIDS in India is far from over, and we are working with our partners to ensure that prevention efforts are sustainable. To help achieve that, we’re providing extensive support and training to help government agencies and NGOs effectively manage prevention programmes. Over the next five years, we anticipate that these organisations will gradually adopt some aspects of Avahan’s current work, and that we will reduce our day-to-day role in programme implementation.”
BMGF has spent nearly $260 million (Rs 1,300 crore) since 2003 on “targeted intervention” in India. However, reports from the local NGOs in six states (Karnataka, Maharashtra, Nagaland, Manipur, Tamil Nadu and Andhra Pradesh) say a large chunk of the projects it started were not successful and did not make the kind of impact they should have. Some blame it on poor monitoring and coordination of the programme by Avahan; others say the intervention was misdirected. For example, in Manipur, it concentrated on condom usage when it should have focused on IV drug users.
Besides, the average cost per beneficiary per year among Avahan-supported programmes was $45, well below the ADB-UNAIDS guidelines of $90-100 per beneficiary for high-risk groups in Asia. According to NGOs, Avahan was unable to extend its reach beyond the six states it started out in. The country as a whole never came into their net. Instead, they even halved the number of focus sites that they had started within the six states. Why was Avahan’s programme not effective? Here are some reasons put forward by AIDS activists:
BMGF has also come under the scanner for the high salaries and allowances it pays its executives, at par with international business organisations (many of them are from that background). People in similar positions in other international NGOs and those with the National AIDS Control Organisation (NACO) are not even paid half the amount. For example, an information officer in Avahan is said to have been paid anywhere between Rs 75,000 and 1.5 lakh a month while a NACO official in the same grade gets Rs 25,000-40,000. bmgf also spends lavishly on travel and glossy publications like AIDS Sutra. Annual reports is another area where a good chunk of their money goes.
Accepting that not all efforts did as well as they had planned, bmgf is now spending a large amount of money to research what worked and, more importantly, what did not. “Good research is expensive and the Gates foundation will add a major source of knowledge for HIV in India. They are facing criticism for putting so much money into this but for intensive programmes like the ones they have, it is important to pinpoint what didn’t work and why it didn’t work. The effectiveness has to be measured,” says Dr Charles Gilks, country head, UNAIDS. “However,” he adds, “it would have been nice if Mr Gates had been slightly more generous to what has already been his largest globally supported intervention. Avahan should stay a little longer here.”
The other area bmgf wants to focus on is to set up a model for the government to follow for targeted intervention. But the government itself fears bmgf is leaving behind a defunct machinery and millions of wasted dollars. “There has definitely been an element of uniformity and standardisation,” Aradhana Johri, a joint secretary in the health ministry, told Outlook. “They have developed several intervention models and their intensity did have a lot of richness which is not replicable. There is an issue of sustainability now that they want to hand over the project. While some of their programmes are doing well, others are not. We have done a study on the effect of bmgf’ work in four of the six states. Different organisations have different costings for the same projects so we’ll look into how we can carry these on.”
But bmgf feels the government is ready, “India’s is a Phase III National AIDS Control Programme and has ample funds for HIV prevention,” it says in an official response. “The foundation and Avahan partners are providing extensive support to help government agencies and NGOs effectively manage the prevention programmes they fund. We have worked closely with NACO to develop a sustainable plan to gradually transfer key aspects of Avahan’s work in a series of stages, and over the next five years, we anticipate these organisations will gradually adopt many aspects of Avahan’s current work, and that we will reduce our role in supporting programmes.”
The news of the handover has already had its impact locally. “There is a lot of confusion about how we’ll receive projects and funds once the foundation leaves,” says a member of an international NGO working with Avahan. “The government will definitley trim the allocations and the quality of services will suffer due to lower salaries and incentives.”
Bill Gates couldn’t have done better than abandoning his foundation’s efforts to fight aids in India (Exit All Windows..., Jul 27). Analysis of any such welfare project—implemented by government or voluntary groups—will reveal that no more than 25-30 per cent of the outlay finally reaches the people it’s meant for. It’s a pity Gates didn’t know what Indians are capable of. Samiranjan, Portland, US
It isn’t surprising that Bill Gates’s foundation has withdrawn from its anti-aids project in India, where organisations end up costing more to run than the money spent on the cause they represent. One way out would be to train young girls pushed into prostitution in some vocation and eventually organise them into self-help groups whose services people can hire. Dr Sanjay Kapoor, Lucknow
Seventy per cent of the Bill & Melinda Gates Foundation money actually goes to a handful of developed nations. They’ve also invested heavily in major pharma companies who supply drugs for programmes through their foundation. Prakash Joseph, Oakville, Canada
Indian millionaires should take a few lessons in charity from Bill Gates. Praful R. Shah, Houston
I read with disappointment the article Exit All Windows... (Jul 27) about the Bill & Melinda Gates Foundation’s work in hiv/aids prevention in India. The article contains significant errors and mischaracterises many aspects of the initiative. Outlook suggests the Indian government is reluctant to take over the programme, yet we’re working closely with the Indian government and other organisations to ensure prevention efforts continue over the long term. Moreover, it is a gradual transition over the next five years; it is anything but a sudden exit. Based on the latest evidence, we are seeing declining or stable hiv trends in the states where we work, not rising as you stated. You talk about poor monitoring and coordination of the programme, yet our interventions are evaluated by a consortium of foreign universities, international ngos and Indian academic institutions. Their work is overseen by an external advisory group, constituted by who. We anticipate that these evaluations will show significant increases in condom use and decline in sexually-transmitted infections. Outlook says we were unable to extend our reach, but we never planned to expand beyond the six states we currently target. Your article, poorly researched and short on facts, does a disservice to the thousands of people from vulnerable groups who work on Avahan. Ashok Alexander, Director-Avahan, India aids Initiative, Bill & melinda Gates Foundation
Outlook stands by its story. We got our information from the foundation’s India office and bureaucrats in the health ministry.
Your article Exiting All Windows (Jul 27) says that “In Manipur, Avahan focused on condom usage when it should have concentrated on intravenous drug use”. I’d like to clarify. Avahan does concentrate on IV drug use, but recognises condom distribution to be necessary for hiv prevention in Manipur. A study a few years ago showed that up to 45 per cent of spouses of Injecting Drug Users (idus) are hiv-positive, and most have no partners other than their spouses. So, condoms do continue to play an important role in the hiv epidemic among idus. Also, the needle syringe programme has never been neglected. In 2008-09, over 35 lakh needles and syringes were distributed through 25 Avahan-supported ngos in Manipur and Nagaland. They cater to nearly 20,000 idus. Around the same time, some 50 lakh condoms were distributed.
It is sad to see the media, including Outlook, gloat over the supposed decision of Bill Gates to drop the AIDS programme (Exiting All windows, Jul 27). We glibly quote Rajiv Gandhi on “loss in transit” of goodies transferred from the Centre to the states, instead of feeling bad about it.
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