title: Monitoring and evaluating transition and sustainability of donor-funded programs: Reflections on the Avahan experience.
abstract: OBJECTIVE
  In low and middle-income countries, programs funded and implemented by international donors frequently transition to local funding and management, yet such processes are rarely evaluated. We reflect upon experience evaluating the transition of a large scale HIV/AIDS prevention program in India, known as Avahan, in order to draw lessons about transition evaluation approaches and implementation challenges.
  
  
  RESULTS
  In terms of conceptualizing the transition theory, the evaluation team identified tensions between the idea of institutionalizing key features of the Avahan program, and ensuring program flexibility to promote sustainability. The transition was planned in three rounds allowing for adaptations to transition intervention and program design during the transition period. The assessment team found it important to track these changes in order to understand which strategies and contextual features supported transition. A mixed methods evaluation was employed, combining semi-structured surveys of transitioning entities (conducted pre and post transition), with longitudinal case studies. Qualitative data helped explain quantitative findings. Measures of transition readiness appeared robust, but we were uncertain of the robustness of institutionalization measures. Finally, challenges to the implementation of such an evaluation are discussed.
  
  
  CONCLUSIONS
  Given the scarceness of transition evaluations, the lessons from this evaluation may have widespread relevance.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA. Electronic address: sbennett@jhu.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Bennett
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ozawa
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Rodriguez
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Paul
authors.affiliation: Amaltas Consulting Pvt Ltd., C-20 Hauz-Khas, New Delhi 110016, India.
authors.forename: Kriti
authors.initials: K
authors.lastname: Singh
authors.affiliation: Amaltas Consulting Pvt Ltd., C-20 Hauz-Khas, New Delhi 110016, India.
authors.forename: Suneeta
authors.initials: S
authors.lastname: Singh
mesh_terms: D003697:Delphi Technique; D005381:Financing, Organized / Q000379:methods / Q000458:organization & administration*; D005653:Fund Raising / Q000379:methods* / Q000458:organization & administration; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D007194:India; D007373:Interinstitutional Relations; D007390:International Agencies / Q000191:economics*; D008137:Longitudinal Studies; D019982:Organizational Case Studies; D016730:Program Development / Q000191:economics / Q000592:standards; D015397:Program Evaluation / Q000191:economics / Q000379:methods* / Q000592:standards
keywords: Evaluation; HIV/AIDS; India; International donor; Sustainability; Transition