October 20, 2004
The National AIDS Control Organisation (NACO), set up in 1992, has been responsible for shaping policies and programmes to curb the spread of this deadly disease in India. It aims to effectively use nearly $300 million secured since then — in addition to the Government of India’s own inputs — for the implementation of its selected strategies. The Comptroller and Auditor General (CAG) of India’s Performance Appraisal Report No 3 of 2004 on NACO, tabled in Parliament in July, provides valuable insights on exactly how ‘‘valuable’’ this donor-created national institution has proven.
Unfortunately, the CAG does not enquire into the soundness of the policies whose programme implementation and public expenditure it audits. As it is, CAG shows an overwhelming reliance on desk research and an almost curious skirting of the intricacies of some technical issues — such as numbers’ surveillance and the efficacy of Targeted Interventions (TIs) — while offering very specific advice on other highly technical matters. Still, the CAG audit is devastating enough.
Interestingly, AIDS control is the only health project funded by the World Bank that the multilateral had assessed ‘‘very satisfactory’’ in the past. The CAG notes that Rs 783.66 crore was spent on NACO’s Phase II till March 2003; just 46 per cent of the available credit, although four of the five-year project period stand completed. The watchdog points out ‘‘failure in generating sufficient awareness among the masses and slow implementation of the components of the programme’’.
Cases of HIV infection are on the rise, the virus is spreading from high-risk groups to the general population through blood-related transmission, there is a 100 per cent risk, completely outside individual control. This should be a fundamental article of medical safety — percentage-wise reduction. But increased absolute numbers and the target of below 1 per cent is still not achieved.
CAG further observes: ‘‘Various activities under the programme could not be conducted efficiently for want of infrastructural facilities, drugs, equipment, trained manpower etc. The programme could not achieve the target of providing STD clinics, modernised blood-banks and voluntary counselling and testing centres in every district.’’
Infructuous expenditure through uninstalled equipment (worth over Rs 60 lakh) and more malfunctioning is one feature. More severe consequences arise from items such as faulty Elisa test kits — purchased in March 2002 for over Rs 60 lakh. By June-July 2002, several state societies complained of false positive results and demanded replacement, but that had not happened till June 2003. Other specific losses/irregularities in purchases of technical equipment are also noted.
Information, education and communication consumed the bulk of the $84 million in Phase I and absorbed large chunks in various Phase II components. Yet, CAG reveals superficial awareness on AIDS, high levels of misconceptions and low levels of knowledge, particularly of Sexually Transmitted Diseases and HIV linkages. NACO’s use of electronic media highlights utter whimsicality and selective patronage in decision-making.
The NACO-BBC-Prasar Bharati partnership reported to be Rs 100-crore plus, most of it outside the NACO budget, does not figure. But details of smaller media expenditures are illuminating: Rs 4.27 crore on sponsored telecasts of classical music and dance concert series at a particular cult shrine for short message inserts; Rs 2.24 crore on just two chat shows. ‘‘Poor viewership,’’ notes CAG. Similarly, poor listenership for radio programmes cost Rs 5.78 crore. Others — like the NACO Film Hit Parade — are not even evaluated. On family health awareness campaigns, ‘‘short notice, wrong selection of places’’, writes CAG, ‘‘failed to attract even 20 per cent of the targeted population’’. As for I&B field media units, over Rs 5 crore was spent with no monitoring.
The Computerised Management Information System, developed as an institutional framework for objective concurrent monitoring and evaluation, was operationalised much behind schedule and continued to be dysfunctional with less than 40 per cent of the required reports received even as late as early 2003. The National Aids Control Board did not conduct any National Performance Review from 1998-2003. The National Aids Committee — the highest-level body overseeing NACO’s performance — required to meet at least once a year, had not met since 2001!
Altogether, the report is a solid indictment of the cavalier attention from the Health Ministry, and NACO, towards its responsibilities and a cavalier attitude towards scarce resources. NACO failed to spend more than half the money available on credit; then claimed less than three-fourths of reimbursable expenditure from the World Bank. (The explanation: Rs 184 crore was released in grants only in March 2003). More significantly, it failed to receive reimbursement for over Rs 50 crore it did claim.
Both NACO and CAG are silent on any explanation. CAG highlights considerable delays in formulation and clearance of state action plans, resulting in large unspent balances with some societies. In 2002-03, as many as 21 state societies could not utilise even 50 per cent of the grants released. At the same time, more than Rs 80 crore was irregularly released. Widespread non-reconciliation of statements of expenditure at the state level and municipal societies and their final audited statements of accounts is noted. Differences were found in as many as 46 of the 49 checked.
The writer is founder-president of Streebal, former advisor of National Family Planning Programme and Member, National Commission on Population
To be concluded
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