New Delhi: The National AIDS Control Organization (Naco) has discontinued almost 450 of its intervention programmes and sacked 350 non-government organizations (NGOs) as part of a massive clean-up and crackdown on non-performing partners in India’s battle against the disease.
The main agency in India’s AIDS and HIV prevention efforts evaluated the programmes—known as “targeted interventions” (TIs)—and the NGOs administering them in an internal survey in 2007. Another survey is scheduled for next month as Naco tightens quality control and scrutinizes effectiveness. Experts in the field have expressed concern over the presence of substandard grass-roots-level organizations—and say they are relieved by Naco’s resolve to eliminate them.
Cracking down: Sujatha Rao, director general, Naco.
“We have discontinued almost 450 TIs. We had 1,200 interventions and these have been brought down to around 756,” said Sujatha Rao, director general of Naco. The axed interventions constituted 37% of the whole programme, which is now supervised by 800 non-profits aiming to specifically reduce infection rates among high-risk groups such as prostitutes, drug users and men having sex with men.
“These organizations either had composite programmes that included street children or some of them were bogus while others were without relevant experience,” said Rao.
With an adult prevalence rate of 0.36%, India has the third largest HIV-positive population of 2.47 million, trailing South Africa and Nigeria.
“It is indeed a concern that the NGOs working in the prevention area were not effective enough. But this exercise has also indicated that Naco is taking quality seriously, which is good news,” said Denis Broun, country coordinator for India at UNAIDS. Broun pointed out that while the Indian government had a “good measurement of inputs” going into the HIV/AIDS programme, there was “a need for good measurement of output as well” that could tally efforts with outcomes as considerable resources were being spent on the initiative.
The third phase of the National AIDS Control Programme (NACP) calls for Rs11,585 crore to be spent between 2007 and 2011 on HIV awareness, prevention and treatment for those afflicted with the virus—an allocation that is five times the outlay proposed under the second phase. Under the current structure, Naco works through 38 state AIDS control societies which, in turn, assess and approve project proposals from NGOs found suitable by their technical advisory committees. Naco provides the funding to the societies, which oversee these organizations’ management.
A Naco official, who didn’t wish to be identified as he is not officially authorized to speak to the media, said Naco’s first independent survey was conducted in 2001-02 and resulted in no action against NGOs because it simply gauged the “processes” under which the societies were working. Thus, the 2007 survey began the real crackdown on non-performing NGOs, added the official, who will be part of the third survey next month to assess whether the guidelines of the third phase have been adopted.
There are 118 districts with HIV prevalence greater than 1%, according to the latest Annual Sentinel Surveillence Country Report 2006, and 81 districts in which prevalence among high-risk groups was greater than 5%.
The report also notes that although HIV prevalence had decreased among injecting drug users in Manipur, the rates in all its surveillance sites remained above 10%. Moreover, rates among female sex workers in Nagaland and Mizoram were increasing; at sustained levels of 10%, infection remained “uncontrolled among men having sex with men”.
Broun, in an earlier interview with Mint a month ago, had said there is need for research and investigation into whether the AIDS programmes were missing out on some portions of the target population.
Rao said its stringent action was not evidence of Naco’s ineffectiveness, saying the agency was merely streamlining interventions and weeding out ineffective organizations to stick to the objectives of the new AIDS policy, which include expanding focus to include truckers and migrants.
“Wherever we have done a TI, we have seen good results and prevalence rates have come down,” she added.