NACP III: Differing needs of states

[Guest guest]

Discusison on NACP III: Addressing the differing needs of states

I think Dr Ajith has flagged a major issue that we confront in any health

programme: vertical vs comprehensive health programmes. In many planning

sessions we gloss over general health care needs of persons living the HIV with

the statement that health system will take care of these needs. But when the

health system is not operational PLHA, as any other person who needs health

care, is forced to get their health care needs met by paying for it. Even if our

focus is on any one disease, if the system is weak no disease control programme

can be managed well.

So when any new programme is planned how much should go to system strenghtening

and how much to vertical programmes? What should be the methods of integration

between the differnt programmes?

His message also raises another important question:

How to treat states with poor health systems? When all states are treated

equally the principle of equity will not be met. As has happened in other

vertical programmea and even in HIV " better " states would corner more benefits.

Those who need better intervention in view of their vulnerability would not be

able to use the resources alloted to them and would end up with higher burden of

morbidity. We have seen this in malaria, small pox, leprosy, polio and TB.

Can this be avoided in HIV? Can unequals be treated unequally so that they get

equal benefits? If this is to be so, do we need a national plan or state

specific plans that respond to local needs and capacities? If we need

standardisation is it possible to look at

groups of states based on their epidemiological situation and quality of health

systems?

Rajeev Sadanandan

E-mail: <rajeev_sadanandan@...>