Centre must rethink its public health policy
After outstanding successes in reducing new HIV infections and providing life-saving treatment to more than 800,000 persons, India’s AIDS control efforts are running into rough weather.
After outstanding successes in reducing new HIV infections and providing life-saving treatment to more than 800,000 persons, India’s AIDS control efforts are running into rough weather.
The latest bad news is the budget cut in the AIDS programme for 2015-16, which was allocated Rs 1,397 crore — hardly enough for priority interventions, let alone for scaling them up to reach national and global targets. India needs to put another one million people under treatment and enhance testing and prevention programmes to cover 90% of key affected populations for achieving its target of ending AIDS as a public health threat. With the current allocations, the programme will struggle to maintain current and this can potentially lead to a resurgence of the epidemic.
The programme is also dogged by other challenges. The national programme administered since 1992 through the National AIDS Control Organisation (NACO), a semi-autonomous entity established by the health ministry under a senior official of the rank of director general (DG), has scored significant gains in combating AIDS. The programme’s success is attributable to the active participation of affected communities and effective decentralisation to autonomous state AIDS societies, which received funds directly from NACO.
Annual new HIV infections dropped from over 360,000 in 1997 to 130,000 in 2013, bringing down the number of infected persons in the country from 3 million to less than 2.1 million. India’s success story has been quoted by UN agencies as the best example of a comprehensive response to AIDS.
All that now looks like the distant past in the context of current efforts. The decline started when successive governments experimented with the structure of NACO. First, it was elevated to an independent department of AIDS control (DAC).This was not sustainable since a single programme department is not a functionally viable unit. In 2014, the present government abolished the DAC and brought it back into the department of health — without restoring the autonomous status to NACO. The national programme subsequently lost some of its capacity for implementing critically needed prevention and care services.
Another setback was the serious dislocation in procurement of antiretroviral (ARV) medicines and diagnostic kits, leading to difficulty in ensuring a continuous provision of drugs for many undergoing treatment. Prevention programmes also suffered due to shortages of condoms and needles.
The problem was further compounded by the UPA’s decision to route all funds for national programmes through state treasuries instead of direct transfers to implementing agencies. The delay in releasing funds by state finance departments has affected programmes, including that of the National Health Mission. Critical supplies of medicines and prevention tools for AIDS control were not made available on time. The stoppage of treatment is endangering the lives of millions of HIV positive persons.
In the light of all these challenges, the Centre needs to seriously rethink its position on committing funds for priority public health programmes like AIDS and TB control and the National Health Mission. Apart from augmenting budgets, new methods of fund transfer, procurement and supply of life saving drugs and diagnostics to implementing units should be conceived to prevent the stoppage of interventions. NACO should be given back its financial and administrative autonomy under a senior-level DG, which alone would again make it an active and efficient unit for stemming the tide of the epidemic.
JVR Prasada Rao is former health secretary, Government of India
The views expressed by the author are personal