Goa: AIDS control society failed on many fronts: CAG

[Guest guest]

AIDS control society failed on many fronts: CAG

NT Staff Reporter

Panaji, Jan 16: From coastal zones to hinterland, the rate of growth

of AIDS in Goa has gone up by 12 per cent in Goa in comparison to

2003. But the Goa State AIDS Control Society has not succeeded in

implementing `Inter-sectoral Collaboration', a programme for sharing

in work of creating awareness, advocacy by various sectors of the

society.

The report of the Comptroller and Auditor General of India for the

period ended on March 31, 2003 underlined that out of the five key

components of the programme, the GSACS has not implemented `Inter-

sectoral Collaboration'.

Besides, `Low Cost AIDS Care Programme', which aims to provide

appropriate care and support to HIV/AIDS infected persons, was also

neglected by the GSACS as only Rs 2.62 lakh was spent during 1999-

2003. For this component, the GSACS gave financial support (2002-03)

of Rs 1.811 lakh to a non-governmental organisation for setting up

of a `drop-in-centre' for the HIV-infected persons. But this centre

could not be set up as the NGO discontinued functioning by October

2002.

In the `institutional strengthening' component, the GSACS did not

monitor the installation/commissioning/maintenance of the programme

equipment resulting in their idling. Besides, STD clinics were not

renovated.

The CAG report also suggested that the GSACS should ensure mandatory

reporting of all blood tests carried out in the state — whether by

public or private agencies — so that the HIV positive cases are

monitored. The end usage of all equipment/materials received from

the NACO for programme implementation should be ensured by the GSACS

by effective monitoring/coordination with the public health

authorities, the report suggested.

The CAG also recommended that a time-bound plan needs to be

formulated for setting up of voluntary counselling and testing

centres and low cost AIDS care centres. It also called for

improvement in the functioning of STD clinics and ensuring privacy

of the patients.

While reviewing the implementation of the programme for the period 1-

998-99 to 2002-03, it transpired that the funds released by the NACO

could not be fully utilised by the GSACS notwithstanding the fact

that these were much less (65 per cent) than the original plan

allocation approved by the NACO.

The AIDS cell of the directorate of health services received from

the NACO a grant of Rs 50.72 lakh in 1997-1998. The directorate

spent Rs 26.02 lakh upto September 1998 and the balance Rs 24.70

lakh was required to be transferred to the GSACS at the earliest.

The DHS released the money to the society only in April 2001. Thus,

the scheme funds were retained by government for three years.

The GSACS utilised its resources mainly on `targeted interventions

in high risk group' (through NGO), `awareness campaign' and `blood

safety'. as a result, HIV positivity rate marginally improved from

10.65 per cent in 1998 to 9.09 per cent in 2003; rate of blood-borne

transmission of HIV infection remained stagnant at 0.3 to 0.4 per

cent during 1999-2003. Awareness level in Goa was 93.6 per cent,

according to a behaviour surveillance survey conducted in 2001.

However, achievement under `usage of condom' was poor, resulting in

increase in sexual transmission of HIV infection from 88 per cent in

1999 to 96 per certain 2003.

Total number of HIV positive cases and AIDS cases in the state were

537 and 15 respectively prior to 1995 which increased to 6212 and

331 respectively at the end of September 2003. However, the figures

of HIV and AIDS cases detected/reported are not reflective of actual

position of the state as results of tests done in private/NGO-run

institutions not funded by the government were not reported to the

GSACS or the Goa Medical College, Bambolim.

The GSACS Annual Report 2003-04 has estimated the HIV cases in Goa

close to 10,000. The GSACS has not taken any steps to ensure

mandatory reporting of all HIV positive/AIDS cases by institutions,

including those not funded by the government, to them. It is evident

from the above that possibility of achieving the stated target of

reducing the prevalence rate to one per cent by 2004 is very remote.

With the objective of raising awareness levels in youth, helping

resist peer pressure and adopting a safe and responsible lifestyle,

the NACO launched a School AIDS Education Programme in 1999-2000

under the component of information, education and Communication.

During 1999-2003, the NACO allotted Rs 25 lakh for the SAEP for

coverage of the members from 64 higher secondary and 240 high

schools. Two NGOs were selected in December 1999 and Rs 0.57 lakh

were disbursed to each in July 2001. Each NGO was to cover 40

schools during 1999-2000. While one NGO covered 20 schools, the

other refunded the money as the selected schools failed to send

their representatives.

In 2002-03, Rs 1.31 lakh were disbursed to a school in Mapusa to

cover 47 schools. However, Rs 1.04 lakh were utilised and only 22

schools were covered. The school authority did not refund the

balance amount to the GSACS as of December 2003.

Thus, out of 304 schools to be covered during 1999-2003, only 42

schools (11 per cent) were covered as of December 2003 and central

assistance of Rs 23.39 lakh (94 per cent) earmarked for the SAEP was

not utilised for the programme.

The primary emphasis in the voluntary counselling and testing is to

reach individuals with effective counselling, condom supplies and

peer and community support, rather than focus only on HIV testing.

Test-check revealed that out of 7177 patients, who were given pre-

test counselling during December 2002 to July 2003, only 827

patients (11 per cent) had been offered post-test counselling.

Further, there was a very poor turnout of only two to 11 patients

for the follow-up counselling during the period. Scrutiny revealed

that out of three voluntary counselling and testing centres

sanctioned during 1998-2004, two centres had been established at the

GMC (1987) and the Hospicio Hospital (February 2002). The VCTC at

Mapusa was not set up till December 2003.

Despite provision of an annual recurring grant of Rs 0.96 lakh

towards salaries of counsellors and Rs 0.24 lakh for furniture and

miscellaneous expenditures in respect of each VCTC/blood testing

centre, the GSACS did not provide proper accommodation to ensure

privacy. Incidentally, a sum of Rs 11.66 lakh was approved in action

plans of 2000-01 to 2002-03, but the actual expenditure was only Rs

4.96 lakh (43 per cent) as of December 2003. The GMC head in January

2004 confessed that there was little privacy where counselling was

done and hence, response from patients was low. However, new area

has been located to overcome this hindrance.

In the annual action plan for 1999-2000, the GSACS had provided Rs

13.75 lakh for civil works, viz, renovation of district hospitals

and the clinics of sexually transmitted diseases. Audit scrutiny

revealed that due to delay in preparation of plans and estimates by

the GSACS, the amount was not utilised and renovation of the

district hospitals and STD clinics had not been done as of December

2003.

The NACO also provided Rs 21 lakh during 1999-2000 for a blood

component separation unit to be set up at the blood bank of the GMC.

The amount could not be utilised as public works department

authorities delayed the execution of the necessary civil works. The

equipment ( Rs 19.64 lakh) was received in the GMC between July 2001

and March 2002, but the civil works to install the BCSU were

executed only in May-July 2002. The CAG report noted evidently there

was lack of coordination between the GMC and the PWD authorities.

Even after the civil works were complete, the BCSU could not be

commissioned as of December 2003. This was due to delay in obtaining

a licence to manufacture blood components from the food and drugs

administration, delay in training the technician and non-supply of

minor items (cost Rs 2.45 lakh) by the GSACS and the Goa State Blood

Transfusion Council.

According to the Phase-II of the programme, workshops were to be

held to train the doctors, nurses, lab technician, field workers,

NGOs and other grassroot-level workers. But it was noticed that

against the targets of 615 doctors and 952 nurses to be trained,

actual coverage was 417 (68 per cent) and 369 (39 per cent) during

1999-2003.

Similarly, during 2000-03, the GSACS distributed seven lakh condoms

costing Rs 11.20 lakh through the NGOs (6.90 lakh) and directly to

the public (10240), which were given free to the public. The GSACS,

however, failed to call for any reports from the NGOs regarding

distribution of condom during 1998-2003. Similarly, during the

period 2000-03, the GSACS spent Rs 9.09 lakh on printing of

booklets, labels etc. However, no stock accounts were maintained

showing receipts, issues and balances and no physical verification

of the stock was done.

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