NACP III A public-private partnership is essential (4)

[Guest guest]

Der Rajeev & the FORUM,

Thank you for taking the words out of my mouth. I agree with you to a large

extent. We need to have creative out-of-the-box strategies for NACP III if we

are to stop this virtual genocide of our people.

It is perfectly alright to say that the government has coopted NGOs into a

middle class or upper class agenda that seems to be supporting whole-sale

privitisation in healthcare and medicare. It is this that I'm very afraid of.

Let me give you an example.When the government ART roll-out was announced, all

of us at Humsafar Trust rejoiced; finally the government was taking

responsbility for something in this chaos of HIV/AIDS prevention.

However, imagine our surprise when we were told that the treatment adherence

would be " solely our responsbility " . Working with migrant and mobile populations

is hard enough; even in the pronounced-successful TB-DOT program, where

adherence is hardly 20 per cent,but how could we NGOs take charge of our clients

-- for life -- if more planning and programming were not in our hands for the

rollout?

Of course, nobody asked us when and how the roll out was to start and " roll " .

Unilateralism and up-down decision flows make mockery of even rigid management

techniques in the HIV/AIDS sector. In sectors like HIV+ MSM, for example, we are

dealing with a " hidden Population -- HIV positive men -- within another already

hidden population -- MSM " . So bad is it that despite having a human resources

policy within Humsafar Trust of recruiting 20% HIV positive MSM if every other

situation was equal, we learnt we had

crossed 20 per cent long ago.

In other words, we ourselves were not in a position to determine how many HIV

positive MSM there were within our sector. How could a small NGO which began as

a middle class support group for self-identified homosexuals, possibly swim in

this rising tide of middle class,working class and the absolutely underclass

(like hijras)sick and even deal with the situational problem?

This is where out-of-the-box unorthodox thinking needs to be done and calls for

not just public-private partnerships but for communities to be linked into

academia, professional institutions

and even trade unions.

For example, Humsafar Trust decided right at its inception that we would

" facilitate access to healthcare and never replicate any services within an

already resource-poor setting " . Hence, our community workers sit in public

hospitals teaching the poor and confused sick to fill casepapers, soften up

doctors with sweet talk

and generally make life easier for the poor flooding the public health care

system.

Over 8 of our " health facilitators " now sit in the skin and dermatoloogy depts

in muncipal hospitals. Besides we run internship for medical graduates about MSM

health issues and how to derive sexual histories.

But even here I do not see any reason why civic hospitals cannot be freed from

red tapeism.Why the hospital's core cannot be financed by the BMC while all the

staff salaries be funded through neighbourhood taxes on households according to

the rooms each family occupies.

Thus one-room tenements with more members pay less than three-room

apartments with the same number of members, pay more. Innovative methods of

medicare insurance, supported by banks, can be put in place. One such scheme is

already running very successfully in Kernataka for everything but major invasive

surgery.

We have trained 18 " committed community workers " who are like barefoot doctors

capable of doing pre-hospitalisation healthcare -- like taking

temperature,giving hydration for dysentary, stopping

vommitting, cleaning bed-sores, knowing common complaints and informing the

family when to call in a doctor. These are already being extensively used by

Hijra communities reeling under a 49.5 per cent HIV prevalence rate.

Rajeev is right that our NACP-III must be driven by communities but what happens

where communities themselves are under threat and hammered into disintegration

-- like the bar girls now being scattered to the winds in Mumbai! Groups of

homosexuals can hardly be called communities and MSM are mostly belonging to

regidly antagonistic networks of male-sexual-networks under seize from various

multiple stigmas. All these need a caring government hand.

Surely it's we who have elected them but nobody gave the mandate to a Mr.

R.R.Patil to close dance bars when we elected him. Or did we?

I know that there is a varigated analysis and dissection of the gaps in NACP-II

going on somewhere in the stratisphere of Delhi and I'm sincerely praying that

it is honest enough to show the gaping holes of the un-reached targets.

I also know that these hidden powerful forces read e FORUM avidly and

do take in comments and suggestions in the formulation of NACP-III.

As someone who is infrequently called in, i am very proud that some suggestiomns

have been accepted (the government and NACO accepted MSM in the core group that

must be intervened in -- after a concerted

adovcacy by Humsafar Trust over 10 years)and we hope that as the days go by,

more such advocacy result in a fruitful collaboration between infected, affected

communities and our government.

It is finally we who have elected them to run the state and us for a period

which we hope will result in progress and a healthy populace free from

discrimination and distress.

Ashok Row Kavi

Humsafar Trust

Mumbai Metro

E-mail: <arowkavi@...>