The decaying states of AIDS money

[Guest guest]

The decaying states of AIDS money

In state after state, CAG points to the failure of NACO to achieve its

stated objectives in modernising blood banks, condom promotion or

establishing STD clinics

RAMI CHHABRA

(The writer is founder president of Streebal, former advisor of

National Family Planning Programme and Member, National Commission on

Population)

Haryana's case is illustrative. NACO released Rs 2.46 crore to the

Haryana State AIDS Society, although its approved annual action plan

was for Rs 2.24 crore and Rs 2.33 crore was already available with the

society as unspent balance! Further, differences were noticed in the

figures supplied by NACO and those by the State Accountant

General—indicating, as CAG says, ``deficient maintenance of accounts''.

Punjab figures, among other discrepancies, a difference of Rs 1.28

crore between its statement of expenditure and the audited statement

of accounts remaining unreconciled from 1998-2003! Perhaps CAG should

be thankful and not critical that only 46 per cent of the credit is

spent.

Sexually Transmitted Diseases (STDs) are established as a major

multiplicative factor for HIV/AIDS infection. But of 339 additional

STD clinics proposed for strengthening in Phase II, by March 2003,

only a quarter of the goal had been met while funds languished. NACO

was unable to furnish statewise details of the 594 equipped and

functional STD clinics in the country as of March 2003. But CAG

scrutiny of STD clinics receiving financial support in 2003-4 showed

large numbers of districts without any facilities whatsoever. Where

clinics exist, missing or malfunctioning equipment are a prominent

occurrence.

The modernisation and strengthening of blood banks—considered a NACO

success story—have equally indicting observations. Phase II was to

ensure a modernised blood bank in every district by 2002. NACO had no

list of uncovered districts as of March 2003. But the audit revealed

84 districts without modernised blood banks and as many as 44

districts in the country with no blood banking facilities. In some

states, the number of blood banks stated to be modernised exceeded the

numbers registered/licensed! As many as 86 blood banks in eight

states, including high-prevalence states like Maharashtra and

Nagaland, were non-functional or not fully functional.

Targeted Interventions—the kingpin of the Phase II strategic

thrust—numbered 792 by June 2003. But NACO had no data relating to

coverage of population, with compilation of output-monitoring reports

still at a trial stage in the fourth year of the five-year project.

Accessing a National TI Evaluation, CAG found the average quality of

the TIs rated ``a poor 37.8 per cent''.

Condom promotion—the mainstay of the current official mindset on AIDS

prevention, as 85 per cent of the cases are through sexual

transmission—did not take off effectively. NACO failed to procure,

much less distribute, the 3.3 million condoms it had estimated for

social marketing. Interesting is the saga of condom vending

machines—on which NACO did spend large sums of money. CAG reports 140

machines in Haryana, Himachal and Chandigarh inoperative since

1997-99, and in Punjab 55 of the 85 machines went out of order

immediately. Despite NACO directives to have the design evaluated,

delivery was taken of another 300!

Therefore, of a total 385 CVMs purchased at a cost of Rs 22.6 lakh,

230 were non-functional as of May 2003. Promotion of condom use in not

less than 90 per cent of the population in high-risk categories like

``commercial sex workers'' is a key programme goal. But CAG quotes

only 46-57 per cent of female ``sex workers'' reporting consistent use

with paying ``clients'' and a far lower average of 20-21 per cent with

non-paying clients.

The AIDS Care component is woefully underfunded. But even of the

meagre allocation, a mere 14 per cent was expended, spending Rs 15

crore. Even in high-prevalence states, the shortfall in establishment

of care centres ranged between 17-78 per cent.

Postscript: It would be interesting for readers to know that since

then, the NACO Project Director has moved on to become the Senior

Health Advisor in the Planning Commission. The previous project

director is the current Health Secretary, widely believed to be moving

on retirement to head UNAIDS in Bangkok. (The Health Secretary

initiating Phase II moved on to a plum post in WHO, Geneva.) Why the

hullabaloo on foreign consultants?

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