After a decade of funding HIV/AIDS control programmes in India since 2003, the Bill and Melinda Gates Foundation has decided to stop funding it by June 2013 and will then only provide technical assistance to the Indian government. While there is no doubt the programme may have helped curb HIV transmissions, there are skeptics who have argued it may have done less than claimed and no more than the government had done already.
“We can’t fund the programmes forever. It is always better to hand over the responsibility to the government and the community. We have already started withdrawing from a lot of programmes,” Ashok Alexander, the foundation’s country director was quoted as saying by PTI.
Alexander said that the foundation would completely stop funding its initiative Avahan, started to check the spread of HIV in India, by 2013.
The programme which was promised $200 million by the foundation entered into a MoU with National AIDS Control Organisation (NACO) in 2009, marking the beginning of the transfer of its projects to NACO and other partners. The programme which worked in over six states covered around two lakh people.
Bill Gates in a recent column for the Huffington Post said that one of the reasons they had invested in Indian health was that the government was an effective partner:
One of the first programs we worked on in India was called Avahan, an HIV prevention program that’s now reaching millions of the people most at-risk for contracting and spreading the virus. With many international partners, we helped launch the project, refining it and measuring its impact along the way. After the first 10 years, the government of India has decided to take it over.
This is a great example of what collaboration between funders and governments can achieve. Avahan is saving lives, and it would not exist if we hadn’t provided funding and technical assistance to test out a promising new idea. However, the Indian government is scaling and sustaining the effort over the long-term. This pattern has been repeated across the country over the past several decades, and aid has steadily become a smaller and smaller portion of the national economy.
The programme according to its director had three objectives: build an HIV prevention model at scale in India, campaign for others to replicate the model and spread the lessons learned. It also had chess grandmaster Vishwanathan Anand as its ambassador.
Among the campaigns run by Avahan included needle exchanges, safe—sex counselling, condom distribution and other interventions to reach vulnerable groups.
The Union Health Ministry hasn’t shared Gates’ optimism and is reportedly keen on his foundation continuing its financial support but the Microsoft founder had reportedly made it clear last year that it would not continue to pump in funds into the schemes.
While there have been studies that claimed that over a lakh lives had been saved due to the programme, there have been skeptics who have argued that the programme had spent funds on schemes that the government had already started and may not have had as much impact as studies and the foundation claimed.
There were also doubts raised about how well the government would be able to carry out the programmes Avahan was handing over, given it did not have as much money to spend on the campaigns.
A paper by Dr Prasada JVR Rao had pointed that the organisation had been planning since 2006 when to transfer control of the programme to state authorities and while they had greater funds to spend on programmes, state government programmes which traditionally spent less wouldn’t find it as easy to sustain them on the same scale.
However, it must be noted that most of the studies of the programme don’t cover it’s entire period of operation from 2003 till date and most cover only the first half of it. But two things will be interesting to note: to what level did this much publicised campaign make a difference and how well will it be sustained by the government.
So while we can thank Bill and Melinda Gates for their philanthropy and generosity, the campaign may offer valuable lessons for how future philanthropists making donations to India ensure it makes an impact.