Health budget cuts and bureaucratic delays threaten AIDS control program

Doctor, we are not getting the  anti AIDS drugs from government hospital. Can you somehow help?

I was asked this question in my clinic the other day.

Though I was surprised by that question, I was expecting such a situation ever since the Indian government announced big cuts in budgetary allocations for health in December 2014. Situation is becoming bad not only for AIDS program but many other public health programs.

Volunteers of National Service Scheme (NSS) pose with HIV/AIDS awareness messages on their faces during a face painting competition ahead of the World AIDS Day in the northern Indian city of Chandigarh November 29, 2014. World AIDS Day is observed on December 1 every year. REUTERS/Ajay Verma (INDIA - Tags: HEALTH SOCIETY)

Volunteers of National Service Scheme (NSS) pose with HIV/AIDS awareness messages on their faces during a face painting competition ahead of the World AIDS Day in the northern Indian city of Chandigarh November 29, 2014. REUTERS/Ajay Verma

Compared to other countries, Indian government spends very less for looking after the health of their citizens. It is estimated that India spends only about 4% of its GDP as general government expenditure for health. Very few countries in the world spend so less.. It is in this background that  the Modi government announced a budgetary cut of about 22%. The explanation for the cut was that the allocated money is not being spend. More over the new government was keen on reducing the overall budgetary deficit.

Along with this the government took away the autonomous status of India’s National AIDS control Organisation (NACO). NACO was established in 1992. It formulates policies and implements programs of prevention and treatment for HIV/AIDS through 35 State AIDS control societies (SACS). The money for the program was provided by the central government and donors directly to NACO. NACO in turn disburse it too SACS.

This vertical model of program implementation was very successful. India, which is ranked 3rd among countries of the world in HIV prevalence with 2.1 million cases was able to cut the incidence of new cases by 57% by 2011. There was also a reduction of AIDS related mortality by 29%.

From 1992 to 2012, the bulk of funds that NACO received was from International donors. There were strict monitoring by donor agencies. From 2012 onwards, as donor funds decreased India had to raise 80% of its funds by itself. Monitoring reduced and red tapism became prevalent.

Vertical programs are usually more expensive. Thus there were allegations of waste of resources. Also, public health experts were doubtful about sustainability of vertical programs. Thus the government decided to integrate the AIDS control program with the general health care system.  To achieve that, NACO was absorbed into central government’s health ministry. Similarly the SACS were absorbed into health departments of respective state governments. The central government also began insisting that state governments should take care of the fund needs..

This sudden change suddenly caused a severe cash crunch. Since most state governments had much bigger budgetary deficits than centre,  AIDS program stopped getting funds. Even when they are allocated funds, they got it only after a big delay. Many health workers had to go without salary for several months. Many counselling and testing centres became dysfunctional. Medicine supply suffered.

The patient who asked for my help represented the final result of this bungling of affairs.

VR Prasada Rao, a former head of NACO and currently the UN Secretary General’s envoy for AIDS in Asia, said:

“India is on the brink. It can aim to eliminate the disease or it can go the way of the Philippines.Without quick action, infection trends will reverse and we will see higher incidences of new cases. If India continues to be complacent, more and more people will die.”

HIV/AIDS saga has come a long way. It is no longer a death sentence and the number of people living with it happily and healthy are ever increasing . I have witnessed directly this change in my clinical practice. It’s a huge triumph for Science and Humanism.

Hope narrow-minded actions without forward vision of people in power do not change this triumph into tragedy.

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