According to the Planning Commission’s proposal, the two-decade-old AIDS control department should be merged with the flagship National Rural Health Mission (NRHM). This has caused a stir in the health ministry, with officials even saying it could reverse whatever headway has been made by India in bringing down HIV infections. Whether NRHM can deliver the HIV-AIDS control facilities efficiently has been a huge concern.
With a population of over 2.5 million HIV positive people in India, (the third largest globally) the new HIV infections annually have come down by 50 percent in the last decade. ”The Planning Commission’s proposal on NRHM convergence is still under consideration. We need to first take stock of the preparations for this massive integration where there are multiple issues involved, with the fear of going wrong on sensitive AIDS control programmes,” a senior health ministry official told IANS on condition of anonymity. NACO, an autonomous body under the Ministry of Health and Family Welfare, was set up to combat AIDS – allocating funds to voluntary organisations and state AIDS control societies (SACS), structure policies for targeted interventions, disease-surveillance and implementation of programmes.
Post-merger, select NACO services would be available through the public health infrastructure of NRHM. The seven-year-old NRHM was launched to provide accessible healthcare in rural and remote areas of the country. The centrally-sponsored NRHM works through a countrywide string of health workers, accredited social health activists (ASHAs) and Auxiliary Midwife and Nurse (ANM). The steering committee report (health) for the 12th plan (2012-2017) had proposed to integrate NACO with NRHM, saying: “The HIV/AIDS programme should be integrated within the routine machinery for delivery of public health in terms of increasing access and promoting comprehensive care, support and treatment, expanding information, education and communication services…”
But officials say the health ministry will face a challenge in sensitising an additional task force towards the needs of the HIV-AIDS affected and branching funds from the NRHM which is facing a crisis due to lack of monitoring and accountability. ”Bringing AIDS control under the NRHM umbrella would mean training the overburdened ASHAs to reach out to sex workers, transgenders, MSMs and injectable drug users. There is a lot of sensitisation and monitoring needed,” the official added.
Steering committee chairperson Syeda Hameed feels the integration will happen over a slow phase with caution. “The whole idea is not to do it in a ham-handed manner and reverse achievements. It will be done in consultation with NACO officials,” Hameed said. ”We are reminded again and again that there are too many centrally sponsored schemes overlapping. We are also discussing a cross-sectoral approach to connect various ministries for AIDS control,” Hameed added.
With a budget of Rs 1,700 crore, NACO would gradually be converged with NRHM which was allocated over Rs.20,000 crore for 2012-13. The nearly 200-staffed NACO, headquartered in New Delhi, may witness downsizing after the merger.
“Most NACO services are located at government-run centres under the NRHM ambit; so some of the facilities have already been converged. But for targeted interventions that are specific to high-risk groups like MSMs, IDUs, truckers, migrants and sex workers, this integration is a challenge,” Aradhana Johri, NACO additional secretary, told IANS. For a sex worker to approach a district hospital under NRHM for any service means an increased level of sensitisation and understanding, say experts.
“Monitoring and management for this convergence has to be sharp,” Johri said, adding “ASHAs are overworked for NACO’s job.” However, even as the idea of coping with NACO’s shrinking expanse is under works, experts question if the wide-winged NRHM will absorb NACO’s well-crafted functions. ”NRHM may have evolved, but it is still at an infancy stage. We need to look into the individual accountability and tracking of funds in NRHM for successful convergence to happen,” Meenakshi Datta Ghosh, former principal adviser (health) in the Planning Commission, told IANS. ”There are issues of training of health workers, capacity building and structural changes. The health ministry has to get its act right to keep the quality of healthcare consistent,” added Ghosh, also former director general in NACO.