Performance appraisal of NACO by CAG

[Guest guest]

Govt Sits on World Bank Funds as AIDS Spreads

Ranjit Devraj

NEW DELHI, Aug 21 (IPS) - Critics of India's World Bank-funded

National AIDS Control Organisation (NACO) are finding a powerful

ally in the country's Comptroller and Auditor General (CAG), which

has taken the organisation to task for poor utilisation of millions

of dollars worth of funds meant for containing the HIV epidemic.

In a 'performance appraisal' presented to Parliament on Jul. 13, and

publicly made available this week, the CAG revealed that the NACO

was only able to utilise 46 percent of the more than 300 million

dollars made available to it for the second phase of a national AIDS

control programme (NACP-II) which completes its five-year term in

October.

This at a time when the NACO itself estimates that HIV cases in the

country have increased from 3.5 million in 1998 to around five

million cases at present. It also acknowledges alarming trends such

as increasing prevalence among antenatal women and has called for

tighter implementation and monitoring of the national AIDS

programme.

Because the AIDS organisation is considered as a government

department - where its operations are shrouded in bureaucratic

secrecy -- the CAG appraisal presents a rare glimpse into its actual

performance and functioning.

While the World Bank provides most of the funding for the NACO's

programmes, channelled through the Bank-affiliated International

Development Association, other major contributors include the

British government's Department for International Development (DFID)

and the United States Agency for International Development (DFID).

The story of how 46 percent of available funds was actually utilised

is grimmer with the CAG unearthing serious deficiencies including

misuse of funds in key targeted interventions such as promotion of

condoms, improving clinics treating sexually transmitted diseases

(STDs), behavioural change communication and baseline studies.

Promotion of condom use, considered the single most important

intervention in India where nearly 85 percent of HIV infections were

attributed to sexual transmission, seems to have shown maximum

failure.

Condom use along with other preventive measures such as encouraging

behaviour change are far more practical than anti-retroviral therapy

which officials say is too expensive for India - though ironically

this country manufactures cheap, generic anti-retrovirals or ARVs

for bulk export to other developing countries hit by the epidemic.

ARVs are substances used to kill or inhibit the multiplication of

retroviruses such as HIV.

The National Aids Control Organisation has repeatedly stressed the

importance of condoms and allocated substantial funds for its

promotion from 1992 onwards, when the first phase of the NACP was

set in motion with 84 million dollars worth of World Bank credit.

But the organisation has had little success in getting Indians to

accept condom use.

Free condom distribution by various State AIDS Control Societies,

which function at the provincial level and draw funds from the NACO,

increased from 52 million pieces in 1999 to over 90 million pieces

in 2003. Accessibility to the prophylactic, which doubles as a birth

control device in this country of over a billion people, however,

remains abysmal.

According to studies conducted by King 's Medical University

in Lucknow and other institutions, only a quarter of the 1.5 billion

condoms manufactured in the country annually are actually used for

their intended purposes. The rest are used as sealants for leaky

roofs or put over rifle barrels to keep out dust.

Even among high-risk groups such as commercial sex-workers, condom

use was less than 25 percent according to surveys conducted by the

independent Opinion Research Group and cited in the CAG appraisal.

Condom distribution was found to be inadequate even at the clinics

treating STDs, set up across the country from 1992 onwards on the

basis that there is a proven close link between sexually transmitted

diseases and the spread of HIV.

Worse, inspections by senior staff from various medical colleges of

321 STD clinics across the country revealed that few people went to

them. Also, they had few trained staff and were poorly stocked not

only of condoms but also essential medicines and equipment.

Only 33 percent of the STD clinics inspected had trained medical

personnel and only 17 percent had the services of a gynaecologist

although there is overwhelming evidence that HIV/AIDS was spreading

faster among women than men.

The CAG cited surveys that showed that the level of knowledge about

the linkage between STD and HIV across the country was at a low 21

percent and this, it said, ''pointed towards the failure to educate

the general public as well as those in the various risk groups about

the linkage.''

That failure was despite the fact that both phases of the NACP had

substantial funds allocated for information, education and

communication programmes to raise awareness levels using television,

plays and documentary films.

For example in December 2001, the NACO produced two versions of a 13-

episode satellite television chat show entitled 'Khamoshi Kyon' (Why

Silence). The Hindi version was aimed at rural populations and the

English version - renamed 'Talk Positive' - targeted urban viewers.

Although the organisation spent more than 500,000 dollars on the

chat show, televised through a relatively small, privately owned

satellite channel called 'Zee News', an impact study conducted in

August 2002 by the independent Centre for Media Studies reported

poor viewings for both versions.

While only 20.4 percent of respondents had heard of 'Khamoshi Kyon',

only less than 10 percent of them had seen a single episode.

The results for 'Talk Positive' were even more shocking when it was

revealed that less than one percent of the respondents heard of the

TV programme.

The CAG has questioned NACO's choice of 'Zee News' and is demanding

answers as to why other satellite channels popular with Indian

viewers were overlooked. (END/2004)

http://www.ipsnews.net/interna.asp?idnews=25172