Report of the National Consultation on NACO-proposal on VHAP Vs GoI case

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Report of the National Consultation on NACO-proposal in Voluntary Health

Association of Punjab v Union of India and others

On 30/31 August 2008, a National Meeting was held in New Delhi to discuss the

NACO-proposed directions in Voluntary Health Association of Punjab v Union of

India and others.

The meeting was attended by many heads and other representatives of positive

networks, as well as NGO partners and HRLN and VHAP are extremely grateful to

all those who attended and provided such active and valuable participation.

The outcome of the meeting was a set of revised proposed directions, a copy of

which is set out below.

These have been submitted to the Office of the Additional Solicitor General, Mr

Subramanium, and will be raised with the court the next time the case comes up

for hearing.

If you would like to comment on or make suggestions regarding these proposed

directions, please do so by contacting the HIV/AIDS and the Law Initiative of

the Human Rights Law Network (hri.delhi@...) as soon as possible.

Amended Proposed Directions

1.At present, 172 ART centres are functional.  All districts will have an ART

centre in them and medical college facilities shall be maintained.  Category A

& B districts (which shall include any district ever classified as A or shall

be covered first in a phased manner.

2. A plan for link ART centres has been formulated and put into operation by

NACO. NACO is directed to ensure that all districts which have a critical mass

of patients on ART shall have a link ART centre.  NACO shall ensure that 650

Link ART centres shall be made functional by 2010.

3. Presently, 139 CD4 machines are installed in the country to take care of 172

centres, by way of a sample transport mechanism for centres without CD4

machines.

The sample is transported by lab technician who brings back the report also

after testing at the Nodal Centre.  NACO has also entered into a comprehensive

maintenance contract with effect from May 2007 with an agency for maintenance of

the CD4 machines and stringent damage clauses have been inserted to ensure that

repair and maintenance of these machines is done in a timely and efficient

manner.

All ART centres will have a CD4 count machine. Every link ART centre will have

collection facilities for CD4 count samples. Wherever there is a CD4 count

machine or collection facility, kits and reagents shall be freely available

without any shortfall.

 

4. ART centres will be maintained by the Centralised State Governments in a

clean and hygienic manner and shall provide clean drinking water, seating

arrangement and clean toilet facility to all PLHA.

5. NACO and all State Governments are directed to immediately create a mechanism

for redressal of grievances at ART centres.  NACO shall post the names and

contact details of its Regional Coordinators as well as the Nodal Officers

heading an ART Centre on its website and these will be made available to INP+

also.

 

A mechanism will be set up as follows:

Accountability: District Aids Prevention and Control Units (DAPCU) shall be

accountable at district levels; a committee accountable at a state level will be

constituted in every State to be chaired by the Secretary, Health of the State

Government/Medical Education and consisting of among others, representatives of

PLHA networks.

Monitoring: A commissioner shall be appointed by the court at a national level,

and the court-appointed commissioner shall appoint state-level staff responsible

for monitoring implementation..

The state-level Committee shall meet every quarter and also act as a grievance

redressal mechanism. This mechanism will ensure that issues such as improper

facilities, shortage of medicines, non-functioning of machines, delays etc are

brought to the attention of the Nodal Officer, Regional Coordinator as well as

NACO in a systematic manner for timely response.

6. There has been a pilot programme for second line treatment. NACO will publish

a report on the second line treatment pilot programme, which shall include such

information as the reasons for carrying out the pilot programme, the number of

people treated under the pilot programme and the results.

Union of India is directed to ensure that second line treatment is available to

all those who need it by the end of this year, free of cost and without any

shortfall.

Viral load and resistance testing should be available in every state.  Union of

India and State Governments are directed to ensure that there is no shortage of

doctors trained to administer second line treatment regimens.

7.Union of India is directed to ensure that drugs for treatment of Opportunistic

Infections, in accordance with the NACO lists, will be available free for all

PLHAs without any difficulty in the same places at which ARV treatment is

available.

In particular, Union of India is directed to ensure that antibiotics shall be

available free of cost at all ART centres.

8. Union of India is directed to ensure that high quality testing kits shall be

available without any shortfall.

9. The NACO helpline shall be made fully operational at the earliest.

10.All PLHA travelling to a healthcare centre for any testing, diagnostic or

treatment purposes shall be provided with free transport, together with one

attendant and any minor children.

For HIV positive pregnant women, this shall include travel to access any

pre-natal healthcare services.

Transport shall be by any of bus, train, water-based services or ambulance

facilities, and may be local or interstate. The State Governments are directed

to evolve a mechanism for the same and to report compliance within a period of

six weeks.

11.Union of India and all the State Governments shall ensure that in all

healthcare settings, Universal Precaution kits and materials and PEP drugs and

materials shall be provided to all Doctors, nurses and hospital staff so that,

under no circumstances is a PLHA denied treatment on the ground that such

equipment and material are not available.

The State Governments shall ensure that all health workers are provided  a safe

working environment and that PEP will be easily accessible and available.

Under no circumstances will the patient be charged for or made to provide the

Universal Precaution or PEP kits, medicines or materials.

12. All Doctors and nurses in the public sector and private sector are directed

to immediately familiarize themselves and comply with the protocols and policies

as prepared by NACO.

The Medical Council of India, Dental Council of India and the Nursing Council of

India shall take steps to disseminate the NACO protocols and policies on their

respective websites as well as on the websites of the State Medical and Nursing

Councils.

Further, the Medical Council of India shall ensure that these protocols are made

part of the teaching curriculum/reading material at and disseminated to all

Medical and Dental colleges as well as other institutions for training of nurses

and other health care professionals.

The Medical Council of India, Dental Council of India and the Nursing Council of

India are directed to file a compliance report within six weeks.

13. All Doctors, nurses and hospital staff, whether in the public sector or

private sector shall treat PLHA promptly and professionally and in a humane

manner, treating them always with dignity and care.

No healthcare provider shall refuse to treat a PLHA on account of his/her

positive status.  In treating a PLHA, there shall be no discrimination or

stigma whatsoever.

Any healthcare provider in breach of this direction shall have disciplinary

action taken against him or her.

Union of India and State Governments are directed to ensure that facilities are

available in all district hospitals for positive women to give birth by

Caesarean section.  No woman shall be refused a Caesarean section delivery on

the basis of her positive status.

Every healthcare provider shall ensure that the confidentiality of his or her

patient is protected.

All healthcare providers shall, within a year of these directions, undergo

training on the treatment of PLHA in accordance with NACO guidelines and

protocols.  Positive networks and PLHA shall have meaningful involvement in the

preparation and execution of these training sessions.

14. Doctors in the private sector, in particular, are directed to immediately

familiarize themselves with the NACO's comprehensive protocols and policies with

regard to care and treatment, which are available on NACO website.

NACO approved ART regimen have proven to be cost effective, safe and PLHA have

shown good response to these regimen.  The private practitioners should use

these cost effective regimen in the first instance and other regiments should be

prescribed only in cases where these cannot be used for the reasons of

toxicity/failure etc.

The Medical Council of India and the Consumer Courts are to take a strict view

of private practitioners who take advantage of the illiteracy and poverty to

prescribe wrong or unnecessary regimens or drugs or charge exorbitant amounts.

Irrational prescriptions using wrong dosages/wrong combinations shall be dealt

with severely and appropriate action taken.

The Union of India shall ensure that all unqualified quacks and bogus doctors

shall be stopped from providing any treatment immediately.

The Union of India is also directed to ensure advertisements for fake cures for

HIV/AIDS are immediately stopped.

15. The State Governments shall strictly abide by NACO policies and guidelines

regarding counselling.  Counselling will be done in a meaningful manner,

spending time on each individual PLHA in an atmosphere that provides privacy and

confidentiality.

In particular, State Governments shall ensure the following numbers of PLHA

counsellors are maintained at ART centres:

1-500 people receiving treatment: 1 PLHA counsellor;

501-1,000 people receiving treatment: 2 PLHA counsellors;

1,001-1,500 people receiving treatment: 3 PLHA counsellors etc.

PLHA counsellors will receive a salary on par with that of other counsellors.

16.Union of India/State Governments are directed to ensure that every HIV+

person shall be provided with an Antodaya Yojana Card.

17. Union of India/State Governments are directed to ensure that all PLHAs shall

be provided with a job card and employment in accordance with the NREGA scheme.

18. A status report shall be filed by NACO, which is directed to act as a nodal

agency on behalf of the Government of India, before this Court every three

months on the steps taken by the Central Government pursuant to these

directions.

19. All State Governments, Medical Council of India, Dental Council of India and

Nursing Council of India shall file compliance reports as directed, within six

weeks.

Please contact us if you would like any further information.

 

Thanks and regards,

 

Laya Medhini

Senior Advisor - HIV/AIDS and the Law Initiative

Human Rights Law Network

www.hrln.org

laya.medhini@...