Strengthening government management capacity to scale up XXXX prevention programs through the use of Technical Support Units: lessons from Karnataka state, India.

@entity1 @entity645 @entity146
UNASSIGNED: Scaling up @entity645 prevention programming among key populations (female sex workers and @entity1 who have sex with @entity1 ) has been a central strategy of the Government of India. However, state governments have lacked the technical and managerial capacity to oversee and scale up interventions or to absorb donor-funded programs. In response, the national government contracted Technical Support Units (TSUs), teams with expertise from the private and nongovernmental sectors, to collaborate with and assist state governments. In 2008, a TSU was established in Karnataka, one of 6 Indian states with the highest @entity645 prevalence in the country and where monitoring showed that its prevention programs were reaching only 5% of key populations. The TSU provided support to the state in 5 key areas: assisting in strategic planning, rolling out a comprehensive monitoring and evaluation system, providing supportive supervision to intervention units, facilitating training, and assisting with information, education, and communication activities. This collaborative management model helped to increase capacity of the state, enabling it to take over funding and oversight of @entity645 prevention programs previously funded through donors. With the combined efforts of the TSU and the state government, the number of intervention units statewide increased from 40 to 126 between 2009 and 2013. Monthly contacts with female sex workers increased from 5% in 2008 to 88% in 2012, and with @entity1 who have sex with @entity1 , from 36% in 2009 to 81% in 2012. There were also increases in the proportion of both populations who visited @entity645 testing and counseling centers (from 3% to 47% among female sex workers and from 6% to 33% among @entity1 who have sex with @entity1 ) and sexually transmitted infection clinics (from 4% to 75% among female sex workers and from 7% to 67% among @entity1 who have sex with @entity1 ). Changes in @entity146 among key populations were also documented. For example, between 2008 and 2010, the proportion of surveyed female sex workers in 9 districts reporting that they used a condom at last intercourse rose from 60% to 68%; in 6 districts, the proportion of surveyed @entity1 who have sex with @entity1 reporting that they used a condom at last anal sex increased from 89% to 97%. The Karnataka experience suggests that TSUs can help governments enhance managerial and technical resources and leverage funds more effectively. With careful management of the working and reporting relationships between the TSU and the state government, this additional capacity can pave the way for the government to improve and scale up programs and to absorb previously donor-funded programs.
