Forbes India today evaluates Avahan, the $258 million Gates Foundation HIV prevention initiative on the ground in India. And the program doesn’t fare well:

When it started on the ground in 2003, Avahan set for itself three
goals: Arrest the spread of HIV/AIDS in India, expand the programme
from the initial six states to across the nation, and develop a model
that the government can adopt and sustain so that the project could be
passed on to it. More than five years later, Avahan hasn’t achieved any
of these goals. Doubtless, the initiative has made a dent into the
HIV/AIDS problem, but the impact is marginal for a bill of $258
million. And now Avahan is leaving, handing over the reins to the
government-run National AIDS Control Organisation (NACO), which doesn’t
want to inherit it. It is too expensive for the budget-starved
establishment that is as nimble as a sloth.

The article is an indictment of the business-school principles used to plan and implement Avahan, including staffing up with high-paid consultants from the private sector, who had little public health background, weak local connections, and insisted on using English as the program’s dominant language.  Its directors rapidly took the program to scale, before community members could learn about its existence or become comfortable with its services.

Now that the Indian government is taking over the program, the National AIDS Control Organisation is trying to assess how much Avahan spends where, and what is sustainable:

Knowing that it would have to inherit the project, NACO sent out
evaluation teams to sites in four states to get some clarity on costs.
NACO’s head, Dr. Sujatha Rao, says the evaluation threw up one clear
message: Large parts of the programme are not sustainable by NACO. “We
told them you can’t create a huge number of assets and then just leave
and expect the government to take over everything,” says Rao.