New Delhi: In a drastic step, the Maharashtra State AIDS Control Society (MSACS) has decided to suspend its core health interventions from July due to a funding shortage. The state agency MSACS along with several NGOs has been reporting serious shortage of drugs and testing kits since early last year.
In a circular issued on 11 June, Khushalsinh Pardeshi, project director of MSACS, instructed all non-governmental organisations (NGOs) involved with the state-run HIV AIDS programme to suspend some of the activities from July to next March.
The activities that will be suspended include advocacy activities, crisis response, health camps, insurance of staff, documentation costs and demand generation activities, reads the circular, a copy of which has been reviewed by Mint.
The NGOs working in targeted interventions (TIs) have not received funds to carry out activities or pay salaries since April, said people at MSACS familiar with the situation.
The decision is a blow to the HIV community as Maharashtra is one of the six high prevalence regions in India along with Manipur, Andhra Pradesh, Nagaland, Tamil Nadu and Karnataka. The state accounts for nearly 420,000 HIV cases, second only to 500,000 cases in Andhra Pradesh, the highest number of HIV cases in India.
Maharashtra has an HIV prevalence of 0.40%, higher than the national average of 0.35%, according to the National AIDS Control Organization’s (NACO’s) HIV Sentinel Surveillance report of 2012-2013.
Since November 2013, India’s HIV programme has been starved for funds even as health experts and activists have been saying that disruption could lead to drug resistance. This in turn will heighten the risk of transmission and force patients on to a stronger and more expensive dose of drugs.
In 2013, for about 18 months, the health ministry sat on the $187-million international grant offered to the National AIDS Control Programme (NACP). During this period, the renewal of grant from Global Fund for AIDS, Tuberculosis and Malaria (GFATM) remained unsigned, thus delaying tenders and drug procurements critical for implementation of the fourth phase of NACP. Mint reported the development in the 25 November 2013 report.
This set in motion a chain of events that the HIV/AIDS community never recovered from, said Ganesh Acharya, an HIV activist with the Mumbai AIDS Forum, an NGO running a TI programme in Maharashtra. “Ground reality is that things are going from bad to worse with every passing day. We have not paid community leaders. We have not paid rents for our offices, electricity bills. There is no money for stationery. Such practical realities are difficult to handle, not just for the NGOs but for people who are living with HIV also. The government just refuses to understand the implications- they cannot just wash its hands of and let HIV community fend for itself. We have not been paid for the last 1.5 years. Their allocations comes in every 6 months. It seems like the government is just slowly phasing out the programme. We are extremely worried," he said.
The fund shortage increased with the decision of the Congress-led United Progressive Alliance government decision in 2014 that funds for health programmes will be transferred directly to state treasuries, who will then release it to individual verticals like HIV/AIDS, malaria and so on. Prior to this, the centre used to directly transfer funds to state AIDS societies, who could then immediately release them towards expenses.
“We can keep releasing money from the centre but if state government treasuries do not pass the money on, there is nothing we can do sitting in Delhi. All state governments have different priorities and cash flow issues- the money does not get to state AIDS societies for months. Additionally, the money is never released in one go. They get bits of it every few months- this can kill any programme," said a senior official in the health ministry who did not want to be named.
The fourth phase (2012-17) of India’s national response to AIDS, NACP-IV, is being funded mostly by mobilizing domestic financial support. National AIDS Control Organisation (NACO), the nodal agency for policy formulation for prevention of AIDS under the health ministry, estimates this to be 80% of the total budget.
For the past two decades, India’s HIV programme has been one of the best and free from stigma, where patients could depend on the government to provide free-of-cost treatment without any moral judgment. In fact, India is on track to meet the Millennium Development Goal of halting and reversing the HIV/AIDS epidemic.
“India is the only country that designed its own strategy based on evidence and was able to achieve a 57% reduction in incidence of new cases," says K . Sujata Rao, ex-secretary of NACO. “Africa is today looking at prevention strategies that India implemented so successfully in order to bring down and contain the epidemic. What is saddening is that instead of being proud of our achievements we are bent on undoing the gains and going backwards instead of forwards," she said.