October 22, 2004
Haryana’s case is illustrative. NACO released Rs 2.46 crore to the Haryana State AIDS Society, although its approved annual action plan was for Rs 2.24 crore and Rs 2.33 crore was already available with the society as unspent balance! Further, differences were noticed in the figures supplied by NACO and those by the State Accountant General—indicating, as CAG says, ‘‘deficient maintenance of accounts’’.
Punjab figures, among other discrepancies, a difference of Rs 1.28 crore between its statement of expenditure and the audited statement of accounts remaining unreconciled from 1998-2003! Perhaps CAG should be thankful and not critical that only 46 per cent of the credit is spent.
Sexually Transmitted Diseases (STDs) are established as a major multiplicative factor for HIV/AIDS infection. But of 339 additional STD clinics proposed for strengthening in Phase II, by March 2003, only a quarter of the goal had been met while funds languished. NACO was unable to furnish statewise details of the 594 equipped and functional STD clinics in the country as of March 2003. But CAG scrutiny of STD clinics receiving financial support in 2003-4 showed large numbers of districts without any facilities whatsoever. Where clinics exist, missing or malfunctioning equipment are a prominent occurrence.
The modernisation and strengthening of blood banks—considered a NACO success story—have equally indicting observations. Phase II was to ensure a modernised blood bank in every district by 2002. NACO had no list of uncovered districts as of March 2003. But the audit revealed 84 districts without modernised blood banks and as many as 44 districts in the country with no blood banking facilities. In some states, the number of blood banks stated to be modernised exceeded the numbers registered/licensed! As many as 86 blood banks in eight states, including high-prevalence states like Maharashtra and Nagaland, were non-functional or not fully functional.
Targeted Interventions—the kingpin of the Phase II strategic thrust—numbered 792 by June 2003. But NACO had no data relating to coverage of population, with compilation of output-monitoring reports still at a trial stage in the fourth year of the five-year project. Accessing a National TI Evaluation, CAG found the average quality of the TIs rated ‘‘a poor 37.8 per cent’’.
Condom promotion—the mainstay of the current official mindset on AIDS prevention, as 85 per cent of the cases are through sexual transmission—did not take off effectively. NACO failed to procure, much less distribute, the 3.3 million condoms it had estimated for social marketing. Interesting is the saga of condom vending machines—on which NACO did spend large sums of money. CAG reports 140 machines in Haryana, Himachal and Chandigarh inoperative since 1997-99, and in Punjab 55 of the 85 machines went out of order immediately. Despite NACO directives to have the design evaluated, delivery was taken of another 300!
Therefore, of a total 385 CVMs purchased at a cost of Rs 22.6 lakh, 230 were non-functional as of May 2003. Promotion of condom use in not less than 90 per cent of the population in high-risk categories like ‘‘commercial sex workers’’ is a key programme goal. But CAG quotes only 46-57 per cent of female ‘‘sex workers’’ reporting consistent use with paying ‘‘clients’’ and a far lower average of 20-21 per cent with non-paying clients.
The AIDS Care component is woefully underfunded. But even of the meagre allocation, a mere 14 per cent was expended, spending Rs 15 crore. Even in high-prevalence states, the shortfall in establishment of care centres ranged between 17-78 per cent.
Postscript: It would be interesting for readers to know that since then, the NACO Project Director has moved on to become the Senior Health Advisor in the Planning Commission. The previous project director is the current Health Secretary, widely believed to be moving on retirement to head UNAIDS in Bangkok. (The Health Secretary initiating Phase II moved on to a plum post in WHO, Geneva.) Why the hullabaloo on foreign consultants?
The writer is founder president of Streebal, former advisor of National Family Planning Programme and Member, National Commission on Population
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