Gates cash for AIDS fight to stop in 2013
The decade-long flow of funds from the Bill and Melinda Gates Foundation into India’s HIV control efforts will stop from June 2013, a foundation official said today, intensifying fears among sections of health activists about the future of the programme.
Avahan was the first large-scale health initiative in India to be supported by the foundation, said to be t he world’s largest philanthropic organisation, and will be the first to be closed if it sticks to the deadline announced today.
Over the past five years, the foundation has also directly or indirectly funded several public health programmes, such as polio control, maternal and child health and tobacco control.
The Gates Foundation, which has funded targeted HIV prevention programmes in India since 2003, hopes to hand over the responsibility of continuing these programmes to the National AIDS Control Organisation (Naco) by June next year, the foundation’s country director Ashok Alexander said.
“We can’t fund the programme forever. It is always better to hand over the responsibility to the government and the community,” Alexander said. “But we would continue providing technical assistance to the government until early 2014,” he said.
Bill Gates himself had hinted during a visit to India three years ago that his philanthropic foundation would eventually scale down its support to efforts to curb the spread of HIV in India and increase its funding to other areas such as mother and child health. But this is the first time a specific time frame is being set.
The foundation’s Avahan AIDS initiative has committed $338 million (around Rs 1,818 crore), supporting HIV prevention activities such as condom promotion, empowerment of sex workers, education of high-risk groups such as men who have sex with men, users of narcotic drugs and truck drivers. A research study released last year had shown that the Avahan initiative may have helped India prevent about 100,000 HIV infections over a five-year period.
But the foundation’s announcement to withdraw from HIV control efforts in India has kindled concerns that the government, already facing a gap in funding for AIDS control, may not be in a position to run the foundation’s activities on the lines that it has established.
“There is this pervasive feeling that the foundation set up a high-cost, five-star programme that the government will find hard to continue on a sustainable basis,” said Kajal Bhardwaj, a lawyer and health activist who has been tracking India’s AIDS control efforts for several years.
“The decision by the foundation, along with other donors, to shift priorities away from HIV may provide a bitter lesson to the government and to the communities that have benefited from the programme,” Bhardwaj said.
A former Indian health secretary who is currently a UN special envoy for HIV had pointed out in the British Medical Journal two years ago that overhead costs Avahan incurs in the senior managerial cadre was an area of concern for India’s Naco.
“Avahan spends $18 per beneficiary on these overheads, whereas Naco spends $5 per beneficiary,” J.V.R. Prasada Rao had written in a commentary in the Journal on the options for a transition to a publicly funded programme.
But the foundation says it has developed a transition plan with the government that will ensure that the quality of services being offered to communities are not affected.
“We have a memorandum of understanding with the government for a phased transition over five years with complete cost alignment, and we are in the last phase of this transition,” the foundation said in a statement today. “We are privileged to partner with Naco on such a deliberate transition to ensure minimal disruption to quality of services provided to communities on the ground.”
Naco had received a plan outlay of Rs 1,700 crore for 2011-12, against a projection of Rs 2,466 crore. However, its actual expenditure in 2011-12 was lower than the outlay.
The parliamentary standing committee on health had in a report tabled in parliament last month had expressed its concern that Naco has for the past three years under-utilized its budgeted funds.