NACP III: Suggestions for an effective National initiative

[Guest guest]

Suggestions for an effective National proactive initiative on HIV/AIDS – NACP -

2006

The National Programme needs to be objectively evaluated by an independent team

consisting of experts in the field with representation of all stakeholders this

group should be contracted for a specific period by NACO with a clear TOR; this

will ensure

accountability, responsibility & professionalism.

A leading Management Institution must be contracted by NACO to work with the

expert group and put together a working document. The evaluation needs to be

done in accordance with clear-cut objectives & impact indicators.

The same needs to be done at the level of all State Aids Societies; Government

Institution that implements NACO sponsored programmes. This needs to be done

with the involvement of all leading implementing NGO’s and PLWA networks.

(SOPs/Common Minimum Programme across all care & support/prevention

initiatives-both public and private alike. Participatory/equal

representation/cross sectoral).

In principle most of the strategies and programmes have been put together in the

first phase of NACP and hence needs to be restructured based on evidence of the

reality on the ground. New programmes and strategies need to be proactive with

an understanding

of future needs and challenges of controlling the HIV/AIDS epidemic in India.

External M & E, result oriented capacity building, operational research components

on all aspects of NACP.

All costing and budgets need to be revamped and updated; effective

implementations of programmes are grossly affected by low pay scales. Do away

with standardized approach-make room to support innovative proposals.

Strategies need to be more inclusive rather than exclusive, strategies and

programmes need to be more comprehensive in nature and not be dependent on

budget constraints.

Multi-sectoral approach is the need of the hour; an aggressive strategy needs to

be put in place both at the center and state linking other Ministries and

departments.

Programmes and strategies need to be more region specific taking into account

the issues and challenges faced by the implementing partners in these regions.

Cultural and traditional frameworks differ from region to region and this has

grossly influenced the spread of the epidemic in different regions in the

various

states. Specific strategies and programmes for rural communities need to be

designed.

While the support and guidance of the Bilateral, Multilateral and other overseas

agencies is highly appreciated, it is important that we do not blindly import or

have Top to bottom strategies.

Linkages of the Care – Prevention – Care dynamics need to be more illustrative

and tangible, focus needs to be on trying to legitimize and normalize the

epidemic.

Need to have programmes on new areas like infected and affected children, PMTCT

plus, etc. NACO has to devise schemes to bring more women and children into the

ART roll-out plan. NGO’s with a good track record of ART management need to be

facilitating ART roll out, PMTCT etc. and not just Government Institutions.

Proportionately equal focus on vulnerable groups with a broader spectrum. Recent

developments are moving towards exclusiveness i.e. public sector monopoly.

Greater focus is needed on developing public/private partnerships with an aim to

develop. Best practice on merged/shared basis.

The needs of HIV infected children & orphans must be understood and addressed

with priority. Currently there is a desperate need to have more adequate

institutional care and resources to shelter and care.

Policy change on alternatative long-term care options like adoption/foster

care/community care

Aggressive strategies for creating and enforcing Legislations to protect the

rights of children women and men infected and affected by HIV/AIDS especially

marginalized and vulnerable communities.

IEC needs to incorporate both Prevention and Care & Support. All forms of print

& visual media need to be sensitized, NACO, SACS need to be more proactive in

making use of media for awareness and programme implementation. Programmes for

civil society to work

with media in accordance with National guidelines needs to be encouraged. IEC

material specially designed for women and children is a must. There needs to be

more focus on the visual and audio media to enable the huge population of

illiterate people to be

able to have information to protect themselves.

Programmes & schemes for Advocacy and rights need to be formulated.

More Rural based initiatives need to be put in place urgently.

Leadership at State level is a must; decentralization must be more active and

demonstrative (States continue to strictly go by NACO guidelines)

States need to be given flexibility to formulate programmes based on

evidence-based needs. NGOs need to be given Flexibility for innovative proposals

that are backed by the State Aids Control Societies.

NACO and all SACS need to be less government centric and bureaucratic. There

needs to be an active involvement and participation of the civil society sector

at the highest level.

NACO needs to make sure that all SACS in the country have proactive Joint

Appraisal Teams, Tech. Advisory Committees, and Executive committees that have

an active participation of civil society. The NGO advisor (NGO advisors need to

be people with sound programme

knowledge) should be in a position to ensure that all these committees are

active and meet regularly The NGO Advisor should also ensure that the mandate

and responsibilities of these committees are met.

All programmes implemented by the civil society needs to be in the true sense of

partnership. Programme evaluation needs to be in the sprit of learning and

sharing and not from a purely financial audit

perspective as it is done now; this brings about mistrust and egocentric power

structures.

More programmes and schemes for people (women & children) in the unorganized

sector.

More active participation of cross-sectoral initiatives.

Linkages between Blood Banks, Blood Safety and other HIV/AIDS Interventions need

to be explored.

The existing TRG’s need to be more active and further decentralized right up to

the Districts.

The linkages of co infection of TB & HIV need to examined and programmes of

convergence of the existing DOTS programme to all HIV/AIDS interventions need to

be implemented. (e.g. All HIV/AIDS Care & Support programmes can become

effective DOTS centers; issues

of prophylaxes for TB may be explored) This need to be carefully though out so

that limited resources are not diverted especially human resource time.

India is in the generalized epidemic stage. We cannot just do targeted

interventions alone. Programmes for generalized populations is necessary, this

will also address issues of stigma and discrimination.

Targeted Interventions need to be facilitated with care and sensitivity

(remember TI’s bring about an unintended prize of more stigma, denial and fear)

All TI’s need to be linked to Care & Support

Rehabilitation strategies need to be formulated for infected and affected people

including women and children.

Established NGOs and CBOs need to be strengthened to build capacity and

replicate, partnership programmes with rural CBOs need to be encouraged.

There is a need for developing strategies around TI’s with better understanding

of what works and what does not and why.

India is rich with experience of HIV/AIDS interventions that may not be

documented or spoken about at a macro level; there is an urgent need to document

these as possible best practices and replicated. NACO needs to institute Best

Practice‘s locally rather that leave it to WHO, UNAIDS etc.

A linkage for PLWHA networks and NGOs to work together needs to be formulated.

A more tangible framework needs to be put in place at the Center, State and

Districts for an active participation of PLWHA networks and NGOs on policy,

design, and implementation. Exclusive status to PLWHA networks needs careful

consideration more focus of PLWHA networks, NACO and NGOs coming together in a

harmonious /productive implementation of GIPA

A team of experts needs to be put together at the Center with a few major

implementing NGOs who are rich with experience and understanding of regional

issues. For example constituting CCMs for prevention / Care & Support.

Up scaling of all activities is urgently needed, with a focus on rural

development in the HIV/AIDS sector.

Involvement of industry and the private corporate sector is an absolute must.

All schemes need to be more development focused. Schemes addressing livelihood

issues need to be formulated.

Understanding and developing strategies to address issues around linkages of

alcohol intake, alcoholism – risk behavior – HIV infection. In general

development of linkages between Substance Abuse and HIV/AIDS needs to be looked

at.

Though there are strategies for IDU’s like harm reduction, needle exchange, etc,

we need to try and legitimize these initiatives. Abstinence models need to be

promoted. Must look at Abstinence via

rehabilitation.

Many issues around TI’s are in direct confrontation with the Law of the land,

NACO needs to be more proactive in bringing about a sense of legitimization

around these issues by working with the various law

enforcement agencies at the Center, State & District levels. There needs to be

more sensitization around TI’s with vulnerable and marginalized communities that

are highly stigmatized.

The existing linkages with MSJ (Ministry of Empowerment and Social Justice) &

UNODC needs to be revisited.

All Training programmes need to be revamped to have a participatory approach

with clear linkages of people being trained having the scope and motivation to

implement, be it clinical or otherwise.

Training programmes need to be ongoing with refresher courses

for the same batch of Trainees. All Training of Trainers programmes need to be

reviewed for the scope and actual implementation of Training that has been done

by Trainers.

With the HIV/AIDS resource bank increasing in leaps and bounds, the need to

build more effective proposals in the true sense of partnership with Civil

Society, PLWHA, & Government (NACO) needs to systemically put in place. For

example The UN Global Fund CCM needs to be decentralized so that there are

Regional CCMs and Sub Regional CCMs. This will enable an active participation of

all stakeholders. All stakeholders need to be consulted and encouraged to be

involved

right from the design to implementation stage.

Ideally CCMs should not be controlled by NACO, though NACO/SACS need to

aggressively support and be involved at all levels of the CCMs. All major

external resources need to be processed and facilitated through the above

structure. This will ensure transparency and

accountability. All necessary resources and support needs to be put into place

to enable this to be implemented.

All Government postings in the Dept. of Health especially in important sectors

like HIV/AIDS should have minimum tenure of 3 years. It is important to have

periodic evaluation / review / feedback. All postings should be

performance/productivity based.

Civil Society needs to be respected for their expertise and programme

implementation. There must be an atmosphere of true partnership and

cooperativeness between NACO, SACS and Civil Society.

Finally under the Chairmanship of The Minister, Secretary Health & Family

Welfare, the Project Director NACO, a committee consisting of all senior NACO

Officials, PD’s of all SACS, senior programme

Director’s of leading National NGOs (Programme implementing NGOs), a national

expert group and a group of management experts needs to be urgently constituted

.. There must be gender equity civil

society participation at the highest level. While the support and expertise of

various Multilaterals/ Bilateral, Donors, International” NGOs” is appreciated,

there should be more emphasis for local support, expertise and leadership,

rather than a dependency to seek directions on strategy and implementation from

foreign agencies and individuals.

The National initiative cannot be driven by overseas agencies.

With the help and support of NACO, the Government of India and Leading NGOs, the

State Government should be in a position to ensure implementation of all

recommendations that have been agreed upon. It is further suggested that the

above structure can be split up into two committees, one for strategic planning

and programme design and the second for effective implementation.

Regards

Dr.Ashok Rau

Senior Research Fellow, HIP, The Terry Sanford Institute of Public Health, Duke

University, USA, Visiting Faculty, Yale University, New Haven, USA, Senior

ASHOKA Fellow, Executive Trustee/CEO

Freedom Foundation-India, Centers of Excellence- Substance Abuse & HIV/AIDS

Head Office:

180, Hennur Cross, Hennur Main Road,

Bangalore-560 043, India

E-mail: ashokrau@...