Some Core issues and concerns surrounding CCCs under NACP III

[Guest guest]

[Community Care Centres (CCC) are expected to play a critical role in providing

treatment, care and support to people living with HIV/AIDS (PLHA)  under

NACP-III. CCC are attached to ART centres and ensure that PLHA are provided:

a) counselling for ARV drug adherence, nutrition and prevention

treatment of opportunistic infection

c) referral and outreach services for follow up and

d) social support services.

NACP III is expected to establish about 350 CCCs. The freedom foundation is an

agency which  has extensive experience in running CCC has identified the

following issues with the current running of Community Care Centres. Editor]

______________

Core issues and concerns surrounding CCCs under NACP III

CCC as the terms applies is provision of care for PLHIV within the confines of

the community

 

3 core components that constitute the CCC are namely Medico-Psycho-Social care

 

Scale & Scope of CCC as a continuum of care strategy is confined to a very

limited role that undermines the importance of the core components

 

CCC is now more intended to operate as an overnight shelter for PLHIV being

initiated on ART

 

CCC has a medical component yet governed by a very confusing guideline that

allows only minor management of cold, coughs, fevers and some very minor OIs

 

PLHIV seek services mainly for health related issues that range from minor to

major OIs and it is this window of opportunity that provides scope for psycho

social intervention

 

Disconnect between the ART unit & the CCC psychosocial teams with no inclusion

of the CCC in terms of treatment preparedness, education & adherence support

 

Demand by the ART unit to make travel reimbursements to the referred PLHIV in

context of social support

 

Limited medical care at CCC, which is very often, the first point of reporting

for the PLHIV leads to oversight, discounting & neglect of the underling

condition

 

CCC is now another futile stop for the PLHIV before being referred to the public

health service

 

PLHIV no longer access services from CCC because theirs needs are addressed &

referral to the public health services carries no weightage because the system

is open to all irrespective of their background.

 

CCC’s are now busy running behind the PLHIV to seek admission for the purpose

of fulfilling the performance criteria of the CCC

 

CCC as a strategy should exist based on performance and not as a mandatory

formality

 

CCC is not considered as an equal partner in a larger program with a common goal

 

Having provided for in patient beds with very limited scope is undermining the

prospects of the CCC being an integral component of medical care

 

CCC is now seen only as a follow up unit for PLHIV on ART for the purpose of

maintaining adherence

 

The workload at CCC consists of more clerical maintenance of registers rather

than service delivery

 

The reduced scope of services has laid more emphasis on numbers for the purpose

of performance thereby enhancing risk of accurate data

 

Many a CCC is noting decline in numbers accessing services due to limited

services being offered.

 

Many a time CCC are registering PLHIV for in patient services without actually

admitting the client solely for the purpose of numbers

 

Coordination between the ART centers & the CCC is fraught with gaps with the CCC

bearing the brunt for any negative outcomes

 

Coordination within the ART units is very conflicting at times, for which the

CCC invariably pays the price

 

Complimentary role of CCC in adherence requires greater integration

 

Admission of PLHIV for purpose of observation during lead in phase lacks any

value add and is perceived more as an inconvenience by the PLHIV

 

Follow up by ORW is perceived more as an intrusion and very often resented

thereby leading to many inconveniences faced by ORW

 

LFU lists are fraught with false addresses that have been collected at the ART

unit however the CCC is expected to trace out the entire list of false addresses

as well. This is impossible but reflects as under performance by the CCC

 

Addresses of children are provided without the parent’s names for tracing

thereby leading to utter dismay of the ORW

 

Work load expectations on ORW is high yet remuneration is considered more as an

honorarium and is also very meager

 

ORWs are required to be stationed at the respective ART centers for assisting

both pre & post ART cases thereby the house visits are severely short staffed

and beyond available times

 

The ORW in the CCC is like the Anganwadi worker who is burdened with any

additional activity and most often the ORW is doing the work of other

independent & responsible agencies like the ART centers

 

CCC manpower guidelines are limited and static with even the stipulated annual

increments not being released till date

 

Implementing NGOs are supposed to meet all the criteria for infrastructure

including the resource gaps with little or no reciprocation

Long delays in terms of fund disbursement with no allowances for collection of

interest on loans taken to run the center at such times

 

Further an NGO is not in an advantageous position to secure bank loans neither

is there always a sizeable corpus

 

Number of units & unit costs are not appropriate.

 

CCC grant is complimentary however once an institution receives a grant it is as

if they have been recruited full time only for the purpose of the NACO program.

This does not allow for the project to mobilize other resources, which are much

required to meet deficits

 

CCC positioned at government hospitals function with partial allowances hence

many tasks are then transferred to other CCC for completion

Dr.Ashok Rau

Executive Trustee/CEO

Freedom Foundation-India

(Centers of Excellence- Substance Abuse & HIV/AIDS)

Head Office: 180, Hennur Cross, Bangalore - 560043, India

Senior Research Fellow, TheTerry Sanford Institute of Public Health,Duke

University(USA)

Visiting Faculty, Yale University (USA)

Phone (O) +91 80 25440134, 25449766, 25430611, (Direct) 25443114

Fax (O) +91 80 25440134

email:freedom_ho@...