Red tape on grant delayed care for HIV patients, says Global Fund
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New Delhi: The health ministry sat on a $187 million international grant offered to the National AIDS Control Programme (NACP) for some 18 months, causing drug shortages that left about 1 million HIV-positive Indians treated under the programme without drugs and testing kits for at least five of those months.
The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), a multilateral funding agency that offered the grant, has written a 20-page note charging the National Aids Control Organization (NACO) and the ministry with endangering the lives of HIV patients across the country through the inaction.
A copy of the note, sent by the agency to the health ministry, has been reviewed by Mint.
India is home to the world’s third highest population of people with HIV, which stood at nearly 2.4 million in 2011. NACO is the country’s premier agency charged with crafting and executing the anti-HIV/AIDS strategy, NACP. 1 million people are treated under the programme.
In its strongly-worded memo—a potential source of embarrassment to the government—the Global Fund said it would not allow civil society to be subjected to service interruptions “traceable to government decision-making”.
As the health ministry sat on the grant offer, a shortage of drugs to treat HIV, the virus that causes AIDS, led to a collapse of the government-run anti-AIDS programme run by NACO for 18 months.
NACO , in reply to an email sent by Mint on 19 November, promised a response within a day; later, it said the secretary, department of AIDS control, would brief the reporter on 25 November. The briefing didn’t take place and NACO promised a statement before 8pm on Monday. Shortly before that deadline, the agency again rescheduled a briefing for Tuesday and Mint decided to run the story.
GFATM did not respond to questions Mint sent to the agency on 18 November.
“The grant renewal in question, worth around US$187 million, remains unsigned because an important Board condition remains unmet to date, namely submission by India of a finalized 2012-2017 National AIDS Control Program (NACP-IV) budget with components defined by funding source. The Ministry of Health and Family Welfare informs us that we can expect this document next month (i.e., 18 months late),” said the note dated 24 September.
The Global Fund note says that “delays in grant signings and/or disbursements (due to the absence of finalized budgets) should have absolutely no bearing on the government’s ability and obligation to conduct health product tenders and drug procurements for its forward-funded public health programs.”
The health ministry offered a strange explanation for the delay in the tenders for procuring drugs and testing kits, for which it would have received reimbursements from GFATM.
“There were some ego clashes between senior officials in NACO, ministry and Global Fund,” said Jagdish Kaur, under-secretary in the health ministry. “It has all been sorted out now and funds for HIV and tuberculosis programmes have been released. The grant agreement has been signed last week.”
GFATM reimburses the department of economic affairs in the finance ministry for actual expenditures run up against line items in its budget.
“But the health ministry had not submitted a budget at all,” a person close to the development said on condition of anonymity.
Basically despite having funds, NACO’s delay in placing tenders to procure drugs caused a collapse of India’s most critical national health programme, health activists say.
“In July, we had to sit inside NACO premises for three days in a protest before they acted on our complaints,” said Vikas Ahuja, an HIV/AIDS activist and president of the Delhi Network of Positive People.
“Even then there was no emergency tendering. NACO redirected drugs from those states which had some surplus to states where activists were most vocal. The problem was only superficially solved,” he said. Reports of those stocks running out have been coming in from various states since July.
What is now clear from exchanges between the health ministry, NACO and GFATM is that the Indian government failed to renew the contract of the government’s procurement agent RITES Ltd for nearly two years, which broke the drug procurement cycle.
The result was a massive shortage of not just HIV drugs but also diagnostic kits, as first reported by Mint on 13 November. The country’s government-run blood banks would not be able to provide safe blood because they had run out of stock of HIV, Hepatitis-B, and Hepatitis-C diagnostic kits, the story said. In the absence of centrally procured diagnostic kits, NACO had authorized local purchases by blood banks and supplies of diagnostic kits were likely to resume by the end of January, that story added.
In Maharashtra, HIV patients who should be receiving a month’s dosage at a time are getting a week’s supply, said Leena Menghaney, an activist with Médecins Sans Frontières or Doctors without Borders.
“The drug cycle is broken and the situation has reached a critical stage. This needs to be resolved quickly as the adherence of patients (to the drug regimen) is suffering,” she said.
HIV/AIDS activists maintain that drug shortages are still being reported from many other states as well.
“As of last week, we had reports from Maharashtra, Bihar, Delhi and Mizoram of drug shortages. In Maharashtra, a patient was given a five-day dosage and told to buy from retailers once that got over. In Delhi, treatment regimens of some patients have been changed due to lack of drugs given on regular basis. The issue with HIV treatment is not just of adherence but also of maintaining a steady treatment regimen,” said Ahuja.