title: Management practices to support donor transition: lessons from Avahan, the India AIDS Initiative.
abstract: BACKGROUND
  During 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.
  
  
  RESULTS
  We 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.
  
  
  RESULTS
  Considerable 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.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: International Health Department, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, USA. sbennett@jhu.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Bennett
authors.affiliation: International Health Department, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, USA. drodri17@jhu.edu.
authors.forename: Daniela
authors.initials: D
authors.lastname: Rodriguez
authors.affiliation: International Health Department, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, USA. sozawa1@jhu.edu.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ozawa
authors.affiliation: Amaltas Consulting Pvt Ltd, C-20 Hauz Khas, New Delhi, 110016, India. ksingh@amaltas.asia.
authors.forename: Kriti
authors.initials: K
authors.lastname: Singh
authors.affiliation: International Health Department, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, USA. mbohren1@jhu.edu.
authors.forename: Meghan
authors.initials: M
authors.lastname: Bohren
authors.affiliation: Amaltas Consulting Pvt Ltd, C-20 Hauz Khas, New Delhi, 110016, India. chhabra.vibha@gmail.com.
authors.forename: Vibha
authors.initials: V
authors.lastname: Chhabra
authors.affiliation: Amaltas Consulting Pvt Ltd, C-20 Hauz Khas, New Delhi, 110016, India. ssingh@amaltas.asia.
authors.forename: Suneeta
authors.initials: S
authors.lastname: Singh
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy*; D003153:Community Health Services / Q000458:organization & administration*; D005380:Financing, Government / Q000458:organization & administration*; D015658:HIV Infections / Q000628:therapy*; D006754:Hospital Restructuring / Q000458:organization & administration*; D006801:Humans; D007194:India; D010067:Ownership / Q000458:organization & administration*