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Annual Report 2008 - 2009 PACT Global Fund Project PFI |
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Promoting Access to care and Treatment
Promoting Access to Care and Treatment
reapnnuratl
2008 - 2009
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Annual Report
Promoting Access to
Care and Treatment
The Global Fund Round 6 HIV/AIDS Program
2008 - 2009
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Population Foundation of India | Annual Report June 2008 - May 2009
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Promoting Access to care and Treatment
Acknowledgement
Population Foundation of India (PFI) is pleased to present the second annual report of“Promoting
Access to Care and Treatment -PACT” program. This program is being implemented in the eight
highly vulnerable states of India for providing care and support for People Living with HIV/AIDS.
Population Foundation of India acknowledges the contribution of Indian Network for People living
with HIV/AIDS (INP+), Hindustan Latex Family Planning Promotion Trust (HLFPPT) and Catholic
Bishop’s Conference of India (CBCI) for their immense support and efforts in implementing the
program.
PFI expresses its gratitude to the Governing Board, the Project Advisory Board and the
management team for its support and guidance in the smooth implementation of the program.
PFI records its appreciation of the National AIDS Control Organization, the State AIDS Control
Societies and ART centers for supporting the program.
PFI expresses its sincere gratitude to The Global Fund for supporting the program and addressing
the needs of people living with HIV/AIDS in India.
We are indeed grateful to all PLHIV for their meaningful involvement and support in accelerating
care and support services through this program.
PFI conveys its appreciation to the members of the Project Management Unit at Delhi office
and Regional Coordination Units of Population Foundation of India for their sincere efforts in
managing the program.
Dr Mary Verghese
Project Director
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Contents
Executive Summary
Overview
The Global Fund Round 6 Program
Promoting Access to Care and Treatment
Care and Support Services
Advocacy
Project Management
Learnings
Annextures
Promoting Access to care and Treatment
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Population Foundation of India | Annual Report June 2008 - May 2009
Abbreviation
AIDS
ART
BPL
CBCI
CCC
CMIS
DLN
DOTS
GIPA
HIV
HLFPPT
IP
INP+
LFU
MIS
NACO
NACP
NGO
NREGA
NRHM
OI
OP
PACT
PFI
PLHA
PPTCT
PR
SACS
SDP
SLN
SR
STI
TB
Acquired Immuno- Deficiency Syndrome
Antiretroviral Therapy
Below Poverty Line
Catholic Bishops’ Conference of India
Community Care Centre
Computerized Management Information System
District Level Network for People Living with HIV/AIDS
Directly Observed Treatment Short course
Greater Involvement of People Living with HIV/AIDS
Human Immunodeficiency Virus
Hindustan Latex Family Planning Promotion Trust
In-patient
Indian Network for People Living with HIV/AIDS
Lost to follow-up
Management Information System
National AIDS Control Organization
National AIDS Control Program
Non-Government Organization
National Rural Employment Guarantee Act
National Rural Health Mission
Opportunistic Infection
Out-patient
Promoting Access to Care and Treatment
Population Foundation of India
People Living with HIV/AIDS
Prevention of Parent to Child Transmission
Principal Recipient
State AIDS Control Society
Service Delivery Point
State Level Network for People Living with HIV/AIDS
Sub-recipient
Sexually Transmitted Infection
Tuberculosis
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Promoting Access to care and Treatment
Executive Summary
“P romoting Access to Care and Treatment
-PACT” program aims to scale up of access
to care and support for PLHIV in line with the public
ART services. The program is being implemented
in the eight highly vulnerable states of India; Uttar
Pradesh, Madhya Pradesh, Rajasthan, Gujarat, Bihar,
West Bengal, Orissa and Chattisgarh. The program
is supported by The Global Fund to Fight AIDS,
Tuberculosis and Malaria under Round-6. This is a
five year program and has completed its first phase
of implementation in May 2009.
Under the program care and support services
have been provided to People Living with HIV
(PLHIV) through District Level Network (DLN) and
Community Care Centers (CCC).
INP+ has established 70 DLN in the states of UP, MP
and Rajasthan. 8573 PLHIV have been enrolled in
the DLN for care and support services. They have
been provided psycho-social support through peer
counseling, support group meetings and home
visits. To bridge the gaps between service providers
and PLHIV interaction meetings have been
organized in the districts where DLN have been
established. In many districts advocacy initiatives
have been taken by these networks. These efforts
helped PLHIV in accessing various social security
schemes from the government. The network has
also intervened and addressed issues of stigma and
discrimination.
and Rajasthan. CCCs work in close coordination
with the ART centers. In Phase 1, 67 CCCs have
been established. 22054 PLHIV have been provided
care and support services through CCCs. The CCC
provides intensive counseling on drug adherence,
manages minor Opportunistic Infections and trace
the defaulters through outreach services.
The national and regional level coordination
meetings facilitated by NACO has helped in
improving coordination. The streamlining of
monthly ART – CCC coordination meetings at the
district level has facilitated better linkages and
referrals.
To strengthen the skills and knowledge of service
providers in effectively implementing the program,
trainings have been organized. During Phase I, 1022
service providers have been provided trainings at
DLN and CCC.
PFI organized advocacy workshops to mainstream
HIV/AIDS and to focus on reducing stigma and
discrimination. Need based workshops were
organized at the state and district level.
Management Information Systems (MIS) and
Computerised Management Information systems
(CMIS) developed by PFI has helped sub-recipients
to assess accomplishments and measure the
progress of activities.
Hindustan Latex Family Planning Promotion Trust of
India (HLFPPT) and the Catholic Bishops’ Conference
of India (CBCI) are establishing and managing
CCC in the states of West Bengal, Bihar, Orissa,
Chattisgarh, Gujarat, Uttar Pradesh, Madhya Pradesh
This program has helped in bringing together PLHIV
to access treatment, care and support services. The
improved coordination of the ART center, CCC and
the DLN has facilitated timely and better access
services for PLHIV.
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Population Foundation of India | Annual Report June 2008 - May 2009
Overview
T he National AIDS Control Program (NACP) III aims
at halting and reversing the epidemic in India
over a period of five years by integrating prevention,
care, support and treatment interventions. The
NACP-III has adopted a comprehensive strategy
to strengthen family and community care, provide
psycho-social support to individuals affected by
HIV/AIDS and ensure accessible and affordable
treatment services.
The 2007 prevalence estimates show
that India has 2.31 million (1.8-2.9
million) People Living with HIV, with an
estimated prevalence of 0.34%.
The HIV epidemic in India continues to be
concentrated in high risk and vulnerable population
groups. The 2007 prevalence estimates show that
India has 2.31 million (1.8-2.9 million) People Living
with HIV, with an estimated prevalence of 0.34%.
Although the proportion of People Living with
HIV is lower than previously estimated, India’s
epidemic continues to affect large numbers of
people. The six high prevalence states; Andhra
Pradesh, Maharashtra, Karnataka, and Tamil Nadu
in the south, and Manipur and Nagaland in the
north east) contribute for almost two-third of the
HIV burden in the country. The data also shows that
the epidemic is on the rise in selected districts in
low prevalence states such as Mizoram (northeast),
Rajasthan (west), Bihar (north), Orissa and West
Bengal (east).
In response to these trends, and given the dynamic
nature of the epidemic, National AIDS Control
Program - III (2007-2012) shifted its focus from a
state-based response to a district-based response.
Accordingly, District AIDS Prevention and Control
Units (DAPCU) are being established in 195 A & B
districts to provide management oversight to HIV/
AIDS activities in the districts.
With assistance of The Global Fund under Round
4 HIV grant, ART services were launched in 2004.
The country focused on providing access to first
line ARV drugs. In line with this, ART Centers were
set up in medical colleges, tertiary hospitals and
large district hospitals. To ensure optimal drug
adherence, Community Care Centers (CCC) were
initiated to act as a bridge between the patient
and the ART centers and provide psycho-social
support, treatment literacy for drug adherence,
outreach services, treatment of minor OIs and
referral services.
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Promoting Access to care and Treatment
The Global Fund Round-6 Program
U nder NACP-III, treatment, care and support
services are funded primarily by The Global
Fund. The Global Fund Round 6 program envisages
scaling up testing, treatment, care and support
services in focus geographic area other than the six
high prevalence states.
This program is managed by three Principal
Recipients; National AIDS Control Organization
(NACO), Population Foundation of India (PFI) and
India HIV/AIDS Alliance
Goal
To reduce HIV related morbidity and mortality in
adults and children and to mitigate the impact of
HIV in children and women headed households.
Objectives
• Widen access to treatment (including ART)
• Ensure access to OI treatment and improve drug
adherence by establishing Community Care
Centres
• Expand access to counseling and testing
• Mitigate the impact of HIV on children and
women
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Population Foundation of India | Annual Report June 2008 - May 2009
Promoting Access to Care and Treatment
(PACT)
“HLFPPT was established by Hindustan Latex
Limited under the Registration of Societies Act. It is
responsible for managing CCC in Madhya Pradesh,
Uttar Pradesh and Rajasthan” of India as the Principal
Recipient of the Round 6 grant is contributing to
Objective 2 ‘Ensuring access to OI treatment and
improving drug adherence by establishing Community
Care Centres’.
The Round 6 grant is contributing
to Objective 2 ‘Ensuring access to
OI treatment and improving drug
adherence by establishing Community
Care Centres’
To achieve this objective, the following strategies are
in place-
• Creating and strengthening networks of PLHIV
for providing care and support, treatment
education, prevention and building effective
linkages for ART, PPTCT and other care services
in three states of UP, MP and Rajasthan;
• Establishing Community Care Centres through
Non-Government and Faith Based Organisations
in the 8 highly vulnerable states of Uttar Pradesh,
Madhya Pradesh, Rajasthan, Gujarat, Bihar, West
Bengal, Orissa and Chhattisgarh; and
• Creating an enabling environment for multi-
sector convergence to mainstream and
integrate gender, reproductive health and HIV/
AIDS.
The program Promoting Access to Care and
Treatment – PACT is a five-year program and has
completed its first phase of implementation of 2
years (1 June 2007 to May 2009).
The partner organisations involved in implementing
the program as Sub-Recipients are;
Indian Network for People living with HIV/
AIDS (INP+)
INP+ is a national level community based
organization representing PLHIV across the country.
INP+ is responsible to establish and strengthen State
and District Level Network of PLHIV in the states of
Madhya Pradesh, Uttar Pradesh and Rajasthan
Hindustan Latex Family Planning Promotion
Trust (HLFPPT)
HLFPPT was established by Hindustan Latex
Limited under the Registration of Societies Act. It is
responsible for managing CCC in Madhya Pradesh,
Uttar Pradesh and Rajasthan
Catholic Bishops’ Conference of India (CBCI)
CBCI is the apex body of the Catholic Church in India
and is responsible for managing CCC in Gujarat,
Bihar, West Bengal, Orissa and Chhattisgarh.
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Promoting Access to care and Treatment
Care and Support Services
U nder “Promoting Access to Care and Treatment
– PACT”program, PFI is responsible to establish
and strengthen 100 District Level Networks and 100
Community Care Centers to provide care and support
services to PLHIV. People Living with HIV/AIDS
require a range of services including care, support
and treatment depending on the progression and
the stage of the HIV infection. The ART centers
provide ARV services through the public health
system. The Community Care Centres and District
Level Networks of PLHIV provide care and support
services and treatment literacy to PLHIV, thereby
enhancing access to services, drug adherence and
reducing lost to follow up.
In Year 2 of Phase-1, 35 District Level Networks have
been established and strengthened in the states of
Madhya Pradesh, Uttar Pradesh and Rajasthan. A
total of 8573 PLHIV have been enrolled for care and
support services in the 70 DLNs in Phase-1.
DLN provides psycho-social support to
PLHIV by providing them a platform
where they can share their feelings
and experiences
Networks for People Living with
HIV/AIDS
The Indian Network for People Living with HIV/
AIDS has established and strengthened State and
District Level Networks of PLHIV in the states of Uttar
Pradesh, Madhya Pradesh and Rajasthan.
The process of setting up a DLN is initiated through
support group meetings in different parts of the
district which gradually evolves into a DLN. The
network of PLHIV is a registered body under the
Society’s Registration Act and has a governing board
The Program Management Unit (PMU) of INP+
and the State Level Networks provide oversight to
manage and monitor the activities of District Level
Networks (DLNs). They facilitate capacity building of
staff at DLN on peer education, positive living and
positive prevention, advocacy, MIS, administration
and finance.
Functions of a DLN
DLN provides psycho-social support to PLHIV by
providing them a platform where they can share
their feelings and experiences. The peer support
provided by the network has enabled PLHIV to
come to terms with their HIV status, access services
and lead a positive life. The DLN also advocate and
facilitate PLHIV to access social security schemes and
legal aid.
DLN enroll PLHIV referred by the ICTC, PPTCT, CCC,
ART centre, DOTS centre and other organizations as
well as those who have been identified as living with
HIV during the outreach.
DLN conduct Support Group Meetings (SGM) in their
respective districts for providing peer support and
information to its members and their care givers.
These support group meetings include topics/
Indicators
July 08 to May 09
Target
Results
Number of state level networks strengthened
3
3
Number of district level networks strengthened
70
70
Number of Counselors, Social workers, Treatment Education Coordinator
275
283
and other project staff trained at DLNs
Number of PLHIVs enrolled by district level networks for care & support
5800
8573
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Population Foundation of India | Annual Report June 2008 - May 2009
% of PLHIV enrolled at DLN by their sex, till May 2009
100%
90%
80%
43.5
44
47.6
45.4
70%
60%
50%
TG
Female
40%
Male
30%
56.4
55.9
52.3
54.5
20%
10%
0%
M .P.
(1675)
U.P.
(3342)
Rajas than
(3679)
Total
(8696)
* Figures include duplication cases from DLN to DLN referrals
Sex wise enrollment at DLN
issues on treatment adherence, nutrition, positive
prevention, self help group formation, income
generation activities and linkages with government
schemes. These meetings provide a platform to
PLHIV and their families to discuss relevant issues
and problems and share their success stories.
DLN follow up PLHIV on ART for drug and treatment
adherence through outreach activities. DLN, in
coordination with the CCC traces Lost to Follow Up
(LFU) cases and defaulter cases according to the
list provided by the ART centers in the respective
districts.
% of PLHIV enrolled at DLN by their ART status, till May 2009
100%
90%
80%
49.1
70%
54.6
46.6
50.2
60%
50%
40%
30%
50.9
20%
45.4
53.4
49.8
10%
0%
M.P.(1675)
U.P.(3342)
Rajasthan
(3679)
Total
(8696)
Not on ART ON ART
* Figures include duplication cases from DLN to DLN referrals
ART status wise enrollment
provides a platform to discuss problems faced
by PLHIV and enhance support for treatment
adherence. DLN members, ART centre staff, District
T.B. Officer, ICTC in charge and counselors, Human
Right Law Network (an agency working for rights
of PLHIV), family members of the PLHIV and other
NGOs working in the district participate in these
meetings. It also gives PLHIV an opportunity to
know their rights and the existing laws and how and
when they can avail legal support.
DLN build linkages with various public and private
centers. Linkages have been developed with ART
centres, CCCs and the ICTCs for treatment, care and
support services in the respective districts.
The DLN advocate with the community, health
department, government departments, private
organizations, media, NGOs & INGOs, religious/ faith
based organizations and groups to sensitize them to
the issue of HIV/AIDS. Public disclosure by PLHIV on
their HIV status also contributes to their community
acceptance and in reducing discrimination against
Interaction Meeting, Sultanpur, U.P.
Advocacy with District Administration for BPL
cards – Burhanpur, Madhya Pradesh
them. Every DLN has positive speakers amongst its
members. They share their stories with the general
community and advocate for reducing stigma and
discrimination.
Members of the Burhanpur (Madhya Pradesh)
DLN during their monthly meeting raised the
issue that majority of the PLHIV do not have
Below Poverty Line (BPL) cards which deprives
District level interaction meeting
them in availing benefits of various social security
schemes supported by the government. The DLN
District level interaction meetings with service approached the District Collector, government
providers has been initiated. These meetings bridge department heads and political leaders for issuing
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the gap between PLHIV and service providers. It BPL cards for PLHIV. After a few interactions, the
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Promoting Access to care and Treatment
PLHIV with BPL cards, Burhanpur
District Collector requested the Gram Panchayats
to undertake a survey and recommend for their
inclusion in the BPL category.
The Gram Panchayats undertook a household survey
of all PLHIV enrolled in the DLN. As per the criteria,
30 PLHIV were found to be in the BPL category. After
a tedious process of follow up over a year, they have
been issued BPL cards, which assure them access to
social security schemes.
The DLN also invited the District Women and Child
Officer in one of the support group meetings and
discussed for provision of services for infected and
affected children in the Anganwadi Centers. After
discussions, the District Women and Child Officer
issued instructions to provide services for children
to all the Anganwadi Centers in the district.
VINOD, Self Employment- Empowers
Ms. Vinod Kanwar resides in Alawa village of
Jalore district. She is married for 10 years and
has two children. Her husband died due to HIV.
She was also tested positive. After his death, she
has been living with her in laws. The family had
financial difficulties.
Vinod got in touch with the DLN and became a
member. She shared her problems with the DLN.
With many such cases, the DLN met Mr. Rohit
Kumar, District Collector, Jalore for employment
under NREGA. The District Collector was very
sensitive to the issue and with the request from
DLN; he forwarded the application form of Ms.
Vinod to the Gram Panchayat, Jalore for work
under NREGA.
The Gram Panchayat issued her a job card to work
under the NREGA. Vinod was given the charge of
the crèche to look after the kids of labourers and
serve water at the worksite instead of the usual
hard labour. With her 100 days employment she
is now able to manage her family
Her regular interaction with the DLN developed
her confidence and knowledge on various issues
related to HIV and livelihood. Recently through
an initiative from the Jalore DLN she was trained
on stitching under a livelihood initiative for
Women Living with HIV/AIDS. Vinod stitches
at home and sells her products through a local
NGO. She says, “Today I am confident to take care
of my family”.
Inclusion of PLHIV in National Rural Employment Guarantee Act (NREGA) in Jalore, Rajasthan
The (NREGA) is a flagship program of the government which aims to reduce poverty in rural areas by
providing employment to families Below Poverty Line.
The DLN, Jalore, Rajasthan approached the District Collector, Mr. Rohit Kumar to provide an opportunity
for PLHIV involvement in the NREGA program. On his directive, the District Rural Development Authority
(DRDA) provided two day supervisor’s (known as Meth) training to 38 PLHIV enrolled in DLN. Today these
PLHIV work as ‘meth’ and monitor the implementation of the NREGA program in various villages in the
district. The District Collector also requested Zila Panchayat Pradhan (Rural Local Bodies) to issue job cards
and give preference to PLHIV in NREGA job allocation. The Zila Panchayat Pradhan issued instructions to
block officials and subsequently to Gram Panchayats. Taking the example from Jalore district, the state
government has issued directive for inclusion of all PLHIV seeking employment under the NREGA across
all districts in the state. This initiative in Jalore has helped other DLNs in Rajasthan to take up the issue of
employment under the NREGA in their districts.
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Population Foundation of India | Annual Report June 2008 - May 2009
Ashok Pillai Memorial Rolling Trophy, Jaipur,
Rajasthan
Rajasthan Network for People Living with HIV/AIDS
(RNP+) with support from PFI organized a cricket
match -‘Ashok Pillai Memorial Rolling Trophy’ to
commemorate the World AIDS Day in December
2008 in Sawai Man Singh stadium in Jaipur.
Over four hundred PLHIV including eighty positive
children from Uttar Pradesh, Rajasthan and Madhya
Pradesh participated in the event. The Additional
Chief Secretary of Government of Rajasthan, Project
Director, Rajasthan State AIDS Control Society
(RSACS), Mr. Venugopal, former Indian cricketer,
Director- Doordarshan, Secretary- Rajasthan Cricket
Association and Project Officer- HIV Mainstreaming
Unit along with representatives from various
development agencies attended the event.
Community Care Centers (CCC)
The Community Care Centers (CCC) are 10 bedded
facilities and linked closely with the ART centers.
It provides intensive counseling to PLHIV who are
initiated on ART, monitors initial side effects of ART
and provides treatment for minor opportunistic
infections. In addition, CCCs follow-up PLHIV for
monitoring treatment adherence and link those
who have defaulted and are lost to follow-up with
the ART center.
The Catholic Bishops’ Conference of India (CBCI) is
implementing CCC in West Bengal, Bihar, Orissa,
Chhattisgarh and Gujarat and Hindustan Latex
Family Planning Promotion Trust of India (HLFPPT)
in Uttar Pradesh, Madhya Pradesh and Rajasthan.
As per the guidelines issued by NACO, Joint
Appraisal Teams (JAT) were constituted for short-
listing agencies for establishing CCCs in consultation
with the respective SACS.
In Year 2 of Phase-1 of the program, 37 CCC have
been established. At the end of Phase 1, a total of
67 CCC have provided care and support services to
20054 PLHIV
The staff at the CCC includes; Project Coordinator,
a full-time or two part-time Doctors, Counsellor,
Nurses, Outreach Workers, Cook and Janitors.
The staff at the CCC are provided orientation on the
program, MIS, administration and finance. Trainings
for the doctors, nurses and counselors are organized
at the NACO accredited centers as per the national
guidelines. The outreach workers have been trained
with support from Naz Foundation. The training
modules developed under Round 4 ACT program
Indicators
July 08 – May 09
Target
Results
Number of Community Care Centers set up
69
67
Number of PLHIVs provided care at Community Care Centers
5328
22054
Number of staff at Community Care Centres trained (including Doctors,
750
739
14
Nurses, Outreach workers and project support staff )
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Promoting Access to care and Treatment
Ms K Sujatha Rao, Secretary and DG –NACO interacting with clients and Medical Officers during her visit to the Jodhpur CCC, Rajasthan
by Engender Health Society have been used for
the ORWs trainings. Team training for all staff was
conducted to bring them on a same platform of
understanding.
The ORWs visit the ART centre, PPTCT, ICTC centre on
regular basis. They conduct home visits to trace out
the lost to follow-up and defaulter according to the
list provided by the respective ART center.
Exposure visits were organized for selected
board members of NGOs implementing the CCC.
These visits helped in developing ownership and
understanding on HIV/AIDS care and support
initiatives. Management Trainings were orgainsed
for Project Coordinators for effective management
of the CCCs.
CCC acts as a bridge between home-based care and
ART centre. PLHIV who are initiated on ART and
are not suffering from higher end opportunistic
infection are admitted in the CCC for the first five
days, to recognize side effects and for intensive drug
adherence counselling.
The CCC provides inpatient, outpatient and referral
services for PLHIV which includes;
• Monitoring of side effects
The Catholic Church network has a Social Service
Society under each diocese. These centers support
various development interventions like health,
education, community mobilization, watershed
development, community based disaster
preparedness and self help groups.
CBCI has trained 325 staff from Social Service Society
across 10 districts of West Bengal, Bihar, Chattisgarh
and Gujarat. Awareness on HIV/AIDS through the
community meetings and referrals for accessing
services has been initiated by these staff.
ART – CCC coordination meeting
• CCC regularly participates in the monthly
coordination meetings conducted by the
concerned ART center. Key discussions in the
meetings includes;
• Management of minor opportunistic infections
Supportive Supervision
• Counselling for drug adherence
• Verification of patient address
To improve the quality of care and support
services in CCC, supportive supervision approach
• Home visits for monitoring treatment
was adopted. It is participatory in nature
adherence.
and develops capacities of the implementing
• Preparing family and/spouse for acceptance of
partner in effective management of the CCC. The
test status
supportive supervision approach has helped in
• Referral of PLHIV to ART centres, DLNs, DOTS
building technical capacities of staff, improving
centres, and other medical facilities
project management skills of the implementing
partner and streamlining coordination with the
• Outreach and follow up of PLHIV on ART for
monitoring adherence
ART center.
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Population Foundation of India | Annual Report June 2008 - May 2009
% of PLHIV enrolled in CCC by their ART status, till May 2009
% of PLHA enrolled at CCC by their ART status, till May 2009
100%
90%
80%
34.6
70%
60%
52.8
58.0
35.5
64.7
50%
40%
30%
65.4
64.5
20%
47.2
42.0
35.3
10%
0%
Gujarat (5830)
Bihar(2666)
WB(2538) Chattisgarh(679)
Orissa(1671)
* Figures include duplicat io n cases fro m C C C t o C C C referrals
42.5
50.2
57.5
49.8
UP(4194)
MP(2370)
52.0
46.8
48.0
53.2
Raj(2656)
Total (22604)
ART
NON ART
• Referrals of PLHIV initiated on ART to CCC
• Home visit for address verification and
monitoring treatment adherence
• LFU and missed cases linked back to ART center
These meetings have helped in strengthening the
linkage between ART center and CCC
Implementing Partners Meetings
CBCI and HLFPPT have initiated state level meetings
with implementing partners. In these meetings,
performance of CCCs on various parameters such
as inpatient and out patient services, referrals from
ART centers, drug adherence levels is analysed.
To enhance coordination between different
stakeholders, NACO Regional Coordinators, SACS
representatives, ART nodal officers and State Level
Networks of People Living with HIV/AIDS are invited
to participate in the meeting .These meetings
have helped in improving the quality of program
implementation and strengthening linkages.
Exposure Visit
A cross visit for nodal officers from SACS, ART
center, CCC, SLN alongwith CBCI and HLFPPT State
Coordinators from Chattisgarh and Madhya Pradesh
to Gujarat was organized. They visited the ART center
(Center of Excellence) in Ahmedabad and discussed
with SACS on program implementation issues. They
also observed CCC – DLN coordination meeting and
the operational detailing of ART and Link ART center
in Himmatnagar. This visit helped them to develop
an understanding on treatment, care and support
programs and strategies in Gujarat.
The national and state units of HLFPPT visited
the ART center in Hubli, Comprehensive Care and
% of PLHIV enrolled at the CCC by their IP/OP status, till May 2009
% of PLHA enrolled at CCC by their IP/OP status, till May 2009
100%
90%
21.5
80%
43.3
70%
48.2
38.3
53.2
36.0
37.3
60%
50%
40%
78.5
30%
56.7
20%
51.8
61.7
46.8
64.0
62.7
10%
0%
Gujarat
Bihar
WB
Chattisgarh Orissa
UP
MP
(5830)
(2666)
(2538) (679)
(1671)
(4194)
38.8
46.8
53.2
61.2
Raj
(2656)
Total
(22604)
States
16
* Figures include duplication cases from CCC to CCC referrals
In-Patient Out-Patient
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2.9 Page 19 |
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Promoting Access to care and Treatment
Bal Utsav, Ujjain, Madhya Pradesh
Support Center (CCSC) - Freedom Foundation, DLN members and GIPA Coordinator declared their
Bagalkot, Care Center – Snehdaan, Bangalore, DLN positive status to explain how the community can
- Bangalore and Positive Living Center - Ramnagar. support a PLHIV to lead a better life. Thereafter, a
They also observed ART-CCC- DLN coordination local leader started talking positive but there were a
meeting.
few who still disagreed to the discussions. The Ward
Community sensitization by Sewa Kendra
CCC, Kolkata, West Bengal
Councilor, Ms. Kanan Das finally said, “we should not
stop a noble work started by Sewa Kendra CCC which
contributes to well being of PLHIV”. She assured that
Sewa Kendra CCC is located in the bustling
metropolis of Kolkata in West Bengal. As the CCC
was being set up, the local community voiced
their concerns over the setting up of the center
the CCC would take proper care of waste disposal
mechanism and cleanliness. After discussions the
community members agreed to accept the CCC in
their locality
for PLHIV in their locality. They had apprehensions Bal-Utsav, Saathi CCC –Ujjain, Madhya Pradesh
that children may get infected with HIV through air
while they are playing outside. They did not allow The SAATHI CCC, Ujjain, in collaboration with the
any clients to enter the CCC and even threatened to Ujjain DLN, organized a two day ‘Bal Utsav’ (Summer
burn down the CCC.
Camp) in May 2009. Over 73 infected and affected
children from the districts of Ujjain, Shajapur,
The CCC staff tried to convince the community Rajgarh, Dewas, Neemuch and Indore of Madhya
but met with stiff opposition. The CCC sought Pradesh participated in the Bal Utsav. The event
support from the Ward Councilor, local police provided children an opportunity to exhibit their
station, representatives from WBSACS and District talents through singing, painting competitions and
Level Network of PLHIV. A community meeting group games.
was organized by the CCC. During the meeting,
representative from WBSACS detailed the Sessions on yoga, health and nutrition, life-skill
modes of transmission of HIV and the myths and education were organized to develop a positive
misconceptions associated with HIV/AIDS. The approach to life among the children.
17
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2.10 Page 20 |
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Population Foundation of India | Annual Report June 2008 - May 2009
Advocacy
T he Global Fund Round-6, proposal aimed to ‘cre-
ate an enabling environment for multi-sectoral
convergence to mainstream, converge and integrate
gender, reproductive health and HIV/AIDS’. PFI orga-
nized advocacy workshops at the state and district
to mainstream HIV/AIDS and to focus on reducing
stigma and discrimination.
Department and Integrated Child Development
Scheme (ICDS) in September 2008. The meeting
was chaired by the Urban Development Minister
and District Collector. The participants including
people’s representatives were sensitized on
addressing issues of HIV/AIDS within their
mandate.
• PFI organized an advocacy workshop in
Darbhanga, Bihar for enhancing multi-sectoral
convergence involving Bihar State AIDS Control
Society, Panchayati Raj Institutions, Health
PFI organized advocacy workshops at
the state and district to mainstream HIV/
AIDS and to focus on reducing stigma
and discrimination
• The advocacy meeting in Gorakhpur, Uttar
Pradesh was organized in December 2008. The
meeting was chaired by the District Collector.
Participants from UPSACS, DLN, Health, ICDS
and PRI attended the meeting. The District
Collector emphasized on the need for inclusion
of PLHIV in all social welfare schemes and
treatment of PLHIV in government health
facilities. The Zila Panchayat Adhysakh stressed
on the need to initiate discussions on issues of
HIV/AIDS in the Gram Sabha meetings by the
DLN to reduce stigma at the community level.
The treatment for Opportunistic Infections
18
State Level Advocacy Meeting, Bhopal, Madhya Pradesh
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3 Pages 21-30 |
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3.1 Page 21 |
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Promoting Access to care and Treatment
Delegates at the State Level Advocacy Meeting, Bhopal, Madhya Pradesh
and basic laboratory investigations for PLHIV is
being provided free of cost to the PLHIV at the
public health facilities in the district.
• PFI organized a State level Advocacy Meet
on mainstreaming HIV with the support
of Madhya Pradesh AIDS control Society
(MPSACS) in December 2008 in Bhopal. The
participant included state level functionaries
from government departments; Health &
Family Welfare, Women & Child Development,
Police and MPSACS. Discussions focused
on improving coordination among HIV/
AIDS prevention with care, support and
treatment programs especially among groups
most at risk. Participants also discussed on
mechanisms to improve coordination with
PRI, ICDS and Accredited Social Health Activist
(ASHA) workers under the National Rural
Health Mission (NRHM) to promote voluntary
testing among pregnant women and link them
to PPTCT services.
• Population Foundation of India and Social
Policy Research Institute organized a workshop
on ‘Convergence of Sexual and Reproductive
Health and HIV/AIDS programs Jaipur, Rajasthan
in April 2009. The objective of the seminar was
to prepare a ground for advocacy with state
government to strengthen the availability and
accessibility of integrated services to increase
the access and off-take of services by a larger
user group. Participants included policy
makers, consultants, government officials, NGO
representatives, donor agency representatives,
service providers and clients, academicians
and PLHIV. In the seminar, discussion on
mechanisms of operationalizing integration of
SRH and HIV programs in the state of Rajasthan
took place.
19
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Population Foundation of India | Annual Report June 2008 - May 2009
Program Management
P FI has a Program Management Unit (PMU) to
manage the Global Fund programs. The team
comprises of specialists in program, monitoring &
evaluation and financial management. The PMU is
supported by Regional Units, which provides on-site
supportive supervision on program, MIS and finance
to the partner agencies and ensures coordination
with the State AIDS Control Units (SACS) and other
stakeholders.
Governing Board of PFI
The Governing Board of PFI consists of eminent
personalities from industry, public health,
To facilitate the smooth
implementation of the program,
coordination mechanisms have been
established at the national, state and
district level.
management and the government. It meets once
every quarter and is responsible for major policy
decisions.
Project Advisory Board
PFI has constituted a Project Advisory Board (PAB),
which includes Governing Board members, external
experts and partner agencies. The PAB meets on a
bi- annual basis and provides an oversight role and
guidance to the program.
Review and Coordination
Mechanisms
To facilitate the smooth implementation of the
program, coordination mechanisms have been
established at the national, state and district level.
A. Principal Recipient (PR) Coordination with
NACO and SACS
i. NACO
20
PFI has constituted a Coordination Committee
with NACO to strengthen coordination at the
national level for better implementation of
The Global Fund programs. The Secretary and
Director General, NACO chairs the meeting.
PFI participates in the coordination meetings
convened by NACO. The national and state
level plans are shared with NACO during these
meetings. These meetings were organized in
August 2008 and January 2009.
ii State Level Program Coordination
The State Level Program Coordination
Committees were set-up with State AIDS
Control Societies (SACS) in the program states.
These meetings are convened regularly by the
Regional State Units of PFI. The Project Director
of State AIDS Control Society chairs the meeting.
Officials of SACS, representatives of SRs, PMU and
Regional Coordination Unit of PFI participate
in the meetings. These meetings help to track
progress of the program and sort out issues in
implementation at state and district level.
PFI representatives also participate in meetings
organized by NACO/SACS at state and regional
level to review the implementation of the
program.
iii ART - CCC Regional Coordination
NACO initiated regional ART-CCC meetings to
review the functioning of ART centers and CCCs
and streamline coordination across the country.
PFI and its partner organisations participated in
the first meeting held in Varanasi (Uttar Pradesh)
in May 2009. These meeting helped in referrals
of PLHIV initiated on ART to the CCC, sharing of
information by the ART center on lost to follow
up and defaulter cases and institutionalizing
ART-CCC monthly coordination meetings.
B. Partnership Management
PFI convenes quarterly program coordination
meetings with the SRs at national and state level
to review program, M&E and finance. The meetings
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Promoting Access to care and Treatment
review progress, identify gaps, share experiences
and suggest solutions for effective program
implementation. PMU conducts field visits to
monitor and support the program
C. Program Review Meeting
PMU conducts regular review meetings with the
Regional Coordination Units. These meetings provide
a platform share and learn good practices, lessons
learnt and challenges. These meetings have
helped in helped in understanding implementation
processes at the state level as well as provide
feedback more effective management of the
program.
Monitoring and Evaluation
Monitoring and Evaluation system is developed with
the aim to;
• Collect evidence of activities and results
• Determine program effectiveness in reaching
predetermined objectives and
• Identify and address problems
PFI has developed Management Information
Systems (MIS) and Computerised Management
Information systems (CMIS), which enable the Sub
Recipients to assess their accomplishments and
measure the progress of their activities. Trainings
were provided to the Sub Recipients to build their
capacity and that of the service delivery points to
report accurate data.
1. MIS Refresher Trainings:
PFI conducted refresher trainings on MIS,
from August to September 2008, for all the
Community Care Centres and District Level
Networks set up till September 2008. The
aim was to ensure complete and correct
understanding on final version of MIS so that all
service delivery points implement it uniformly.
Six trainings were organized at different places
out of which two trainings were organized for
CCCs of CBCI (held in Kolkata and Delhi), one
training for CCCs of HLFPPT (held at Lucknow)
and three trainings for district level network
(held at Bhopal, Lucknow and Jaipur). A total
of 160 participants attended these workshops
out of which 80 were from 30 CCCs and 80 were
from 35 District Level Networks.
2. CMIS Regular Training – DLN and CCC
2.1 CMIS training for DLN:
The PFI-PMU has developed MIS software for
DLN and finalized it after a pre-test. CMIS
trainings were organized for all 56 DLNs
established till Quarter-6 (December, 2008).
A 3 days training in each of 3 locations (Jaipur
for Rajasthan, Lucknow for Uttar Pradesh, and
Bhopal for Madhya Pradesh) for the 3 states
were organized. A total of 92 personnel from
56 DLNs and 3 SLNs have been trained on DLN
CMIS.
DLN MIS Training
21
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3.4 Page 24 |
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Population Foundation of India | Annual Report June 2008 - May 2009
2.2 CMIS training for CCC:
Grants Management
The PFI-PMU organized training programs on
CCC Computerized Management Information
System (CMIS) during January-March 2009. A
total of 44 CCCs from CBCI and HLFPPT have
been trained on CMIS.
Against the total of 19 CCCs set up by HLFPPT
till March 09, PFI has trained 13 CCCs on
Computerized MIS, while 31 CCCs have been
trained of CBCI against the total 37 CCCs setup
till March 09.
During the reporting period, PFI received a
disbursement of USD 4,854,896 from The Global
Fund. The utilization of funds by PR and the SRs
amounted to USD 4,118,639. Overall, the cumulative
utilization amounted to USD 5,401,391 against
the cumulative receipt of USD 6,601,046 since
commencement. Interest on short-term investment
of funds during 2008-09 was USD 83,348, thus the
total funds made available for this year was USD
4,938,244. Thus the utilization during the year was
3. CMIS Refresher Training – CCC
83.40% of the funds received from The Global Fund.
PFI had conducted refresher trainings on CMIS
for CCCs in Gujarat (9 CCCs) and Rajasthan (4
CCCs) in April 09 and May 09 respectively.
4. Reviewing quality of care at CCC
Regular review meetings and monitoring visits were
carried out at various SDPs and with the SRs to verify
and validate financial reports and also to ensure
timely submission of reports.
Population Foundation of India commissioned Global Fund Workshop and
a special study to review the quality of care Training
provided at CCCs, by exploring client satisfaction
and client experiences of care. The study
captured both clients and service providers’
perspective. The study was conducted at 4
CCCs. The study results were disseminated to
PFI participated in the following workshops
conducted by The Global Fund;
A. Enhanced Financial Reporting (EFR) in July 2008
at Delhi, India
partner organizations and PFI regional units on
20th January 2009.
B. South & West Asia Procurement Workshop in
October at Cochin, Kerala, India
5. Data Quality Assurance - External MIS
Audit
PFI commissioned MIS Audit with the help of
an external agency. The audit was conducted
to assess the reliability and validity of MIS data
existing at service delivery point level. It was
conducted at 7 DLNs during December 2008.
The audit results were disseminated to partner
organizations and PFI regional units in January 09.
6. Client satisfaction Tool
A client satisfaction tool has been developed as
a part of the regular management information
system to understand client’s satisfaction with
C. India and Monitoring & Evaluation workshop
in October 2008 in Cochin, Kerala, India.
PFI facilitated a session on Monitoring and
Evaluation
D. Regional Meeting on Quality Implementation
and Management in November 2008, Colombo,
Sri Lanka
E. Regional Workshop on Financial Management
in March - April 2009 Kathmandu, Nepal. PFI
facilitated a session on PR-SR relationship which
included presentation on PR’s experience and a
brain storming questionnaire.
regard to care they receive and to ensure the
quality of service delivery. This tool has been
PFI conducted similar EFR exercises with
pre-tested at the Community Care Centers
all its SRs in August 2008 to
ensure that
and is being finalized. The analysis has been
they have the same level of understanding in
conducted for 3008 filled in tools received from
furnishing qualitative and timely reports on the
48 CCCs. This included 1529 form CBCI States
EFR format to the Global Fund.
22
and 1479 from HLFPPT states.
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3.5 Page 25 |
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Promoting Access to care and Treatment
Learnings
• The national effort to strengthen coordination
between CCC and ART center has helped in
streamlining referrals of PLHIV initiated on ART
to the CCC, sharing of information by the ART
center on lost to follow up and defaulter and
institutionalizing structured monthly ART-CCC
coordination meetings.
• ART Centres cater to a cluster of districts. CCCs
are positioned near the ART Centres. Therefore,
access to services and follow up of PLHIV in
remote areas is a challenge. Hence lateral
linkages between ART Centres, DLNs, ICTCs,
Targeted Intervention partners and NGOs need
to be further strengthened for early access to
services and tracing of defaulters.
• Most of PLHIV accessing services from the DLN
and CCC belong to the lower socio-economic
groups. Their access to social security schemes
and support for livelihood opportunities would
enhance the quality of life.
23
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Population Foundation of India | Annual Report June 2008 - May 2009
Annex 1(a): Finance Report
24
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Promoting Access to care and Treatment
25
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Population Foundation of India | Annual Report June 2008 - May 2009
Annex 1(b)
26
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Annex 1(c)
Promoting Access to care and Treatment
27
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3.10 Page 30 |
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Population Foundation of India | Annual Report June 2008 - May 2009
Annex 2: Establishment of DLNs in Year 1
Phase 1, Year 1 (October 2007 to June 2008)
Quarter
Q1
(June 07-Sept 07)
Q-2
(Oct 07- Dec07)
Rajasthan
SLN Rajasthan
1.Jaipur
2.Jalore
3.Jodhpur
Q-3
(Jan 08- Mar 08)
Jhunjhunu
Udaipur
Bikaner
Q-4
(April 08- June 08)
Badmer
Pali
Kota
Ajmer
Ganganagar
Alwar
Establishment of DLNs in Year-II
Phase 1, Year 2 (July 2008 to May 2009)
Quarter
Q-5
July 08 – Sep 08
Rajasthan
Sikar
Sirohi
Bharatpur
Q-6
Oct- Dec 2008
Tonk
Bhilwara
Nagaur
Churu
Uttar Pradesh
SLN Uttar Pradesh
Lucknow
Allahabad
Varanasi
Gorakhpur
Azamgarh
Bareily
Etah
Jaunpur
Chaunduali
Mirzapur
Agra
Khusinagar
Aligarh
Deoria
Sant Ravi Das Nagar
Kanpur
Uttar Pradesh
Ghazipur
Mau
Mathura
Pratapgarh
Meerut
Barabanki
Faizabad
Maharajaganj
Q-7
Jan- March 09
Chittorgarh
Banswara
Humangarh
Dhaulpur
Rajasmand
Jaisalmer
Jhalawar
Basti,
Sultanpur
Moradabad
Madhya Pradesh
SLN Madhya Pradesh
Indore
Bhuranpur
Ujjain
Dhar
Bhopal
Neemuch
Guna
Madhya Pradesh
Dewas
Jabalpur
Jhabua
Rewa
Neemuch
Gwalior
Sagar,
Shahjapur
Q-8
28
April – May 09
Balaghat
Mandsaur
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4 Pages 31-40 |
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4.1 Page 31 |
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Promoting Access to care and Treatment
Establishment of CCCs in Year-1
S.No. State
District
Name of CCC Implementing Partner
CCCs under HLFPPT
1
Uttar Pradesh(5) Lucknow
Umang
Foundation for Social Care
2
Varanasi
Umang
Center for Social Research
3
Meerut
Umang
Adarsh Sewa Samiti
4
Gorakhpur
Umang
Grameen Sewa Sansthan
5
Allahabad
Umang
Society for Welfare and
Advancemnent of Rural Generation
((SWARG)
6
Madhya Pradesh(2) Indore
Vishwas
Pavitra Atma Sevika Sangh
7
Ujjain
Saathi
Kripa Social Welfare Society
8
Rajasthan(3)
Bikaner
Jeevan Prakash Grameen Vikas and Paryavaran
Sansthan
9
Udaipur
Sewa Mandir Sewa Mandir
10
Ajmer
Sambal
Bal Sansar
CCCs under CBCI
11 West Bengal(7)
Greater Kokata Arunima
CNI Calcutta Diocesan Central Fund
12
Howrah
SPARASHA
SPARASHA
13
Darjeeling
Jesu Ashram Jesu Ashram
14
Darjeeling
Prayas
Anugyalaya DDSS
15
Malda
Ashar Alo
Social Welfare Institute
16
Burdwan
Chetna
Asansol Burdwan Sewa Kendra
17
W Midnapore
Snehalaya
Gandhi Misión Trust
18 Orissa(2)
Ganjam
Saathi
Tata Steel Rural Development
Society
19
Khorda
Aastha
The Medics
20
Cuttack
Kiran
Utkal Sevak Samaj
21
Koraput
Ashray
Lepra Society
22 Bihar(3)
Patna
Nai Asha
Mokamma Nazareth Hospital Society
23
Patna
Navjeevan
Khurji Holy Family Hospital
24
Muzaffarpur
Jeevansagar Fakrina Sisters Society
25 Gujarat(4)
Ahmedabad
Karuna Shakti Kaira Social Service Society
26
Rajkot
Navjeevan
Navjeevan Trust
Rajkot
27
Bhavnagar
Navjeevan
Navjeevan Welfare Society
28
Surat
Sarvajanik
Sarvajanik Medical Trust
29 Chattisgarh (2)
Bastar
LifelineCCC
Model Bastar Integrated Rural
Development Society
30
Raipur
Jeevodaya
Jeevodaya Social and Leprosy
Rehabilitation Center
29
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4.2 Page 32 |
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Population Foundation of India | Annual Report June 2008 - May 2009
Establishment of CCCs in Year-2
S.No State
CCCs under HLFPPT
1
Uttar Pradesh(4)
District
Agra
2
Kanpur
3
Varanasi
4
Aligarh
5
Madhya Pradesh(5) Jabalpur
6
Bhopal
7
Rewa
8
Indore
Name of CCC
Umang
Umang
Umang
Umang
Asha Kiran CCC
Maitri
Ayushmaan
Spandana
Implementing Partner
Center for Rural Entrepreneurship
and Technical Education
Jan Kalyan Maha Samthi
Shambhunath Research
Foundation
Sarnan Sanstan
Jabalpur Diocesan for Social
Service Society
Asha Niketan Welfare Centre
Anupama Educational Soceity
LEPRA Society
9
10 Rajasthan(5)
11
12
13
14
Gwalior
Jodhpur
Jaipur
Kota
Jodhpur
Jaipur
CCCs under CBCI
Sparsh
Jeevan Anand
Jeevan Asha
Jeevan Deep
Jeevan Adhar
Jeevan Dhara
Mr.George P Jose
Saint William Educational and
Social Welfare Society
National Institute of Rural Affairs
Prabhudasi Sisters
Gramen Vikas Seva Sansta
The Centre for Community
Economics and Development
Consultants Society
15 West Bengal(4)
16
17
18
19 Orissa(2)
20
21 Bihar(6)
22
23
24
25
26
Jalpaiguri
Kolkata
Midnapur
South Parganas 24
Balasore
Sambalpur
Bhagalpur
Kishanganj
Darbhanga
Gaya
Saran
Madhubani
Bhalobasa
Seva Kendra CCC
St. Joseph
Alor Disha CCC
Jyothi
JMJ
Holy Family
Life Line
Sanjeevani
Jeevan Jyoti
Saathi
Roshni
Bhoruka Trust
Seva Kendra, Kolkata
Seva Kendra, Kolkata
SNP+
Jyothi Hospital
Sambalpur Social Service Society
The Poreyahat Holy Family Society
Welfare India
Bihar Gramin Jagrukta Abhiyan
Samiti
Bhartiya Jan Utthan Parishad
Ghogardiha Prakhand Swaraj Vikas
Sangh
Shantidoot
30
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Promoting Access to care and Treatment
S.No State
27 Gujarat(7)
28
District
Ahmedabad
Vadodara
Name of CCC
Karuna Shakti
Plus
Jeevan Jyot
29
Mehsana
Sphoorti
30
Rajkot
Prerna
31
Jamnagar
Santwana
32
33
34 Chattisgarh (4)
Surat
Surendra Nagar
Durg
Reliance
Nav Vidhan
Karuna
35
Bilaspur
Maria Sahay
36
Ambikapur
Holy Cross
37
Raipur
Seva Niketan
Implementing Partner
Kaira Social Service Society
Kripa Foundation
Sabarmati Samruddhi Seva Sangh
Navjeevan Trust
St. Joseph’s Health Centre Trust
GSNP+, Surat
Jeet Prakash Trust
Society of Jesus Mary & Joseph
MP House of Mary Emmaculate
Pavitra Cruz Sisters Society
Seva Niketan, Cherikhedi
31
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4.4 Page 34 |
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Photograph Credits
• Indian Network of People Living with HIV/AIDS
• Hindustan Latex Family Planning Promotion Trust
• Catholic Bishop’s Conference of India
With Contribution From
PMU Office
• Mary Verghese
• S Vijayakumar
• Phanindra Babu Nukella
• Rashmi Sharma
• Aparna G
• Bijit Roy
• Tripti Chandra
• Neeraj Kumar Mishra
• Ritu Kumar Mishra
• Abhilasha M Rathod
• Piyali Sarkar
• Milan Rana
• Leena Krishnan
• Sanjeev Ranjan
• Sunil Kumar Singh
Regional Office
• Ramesh C Parmer
• Md Raza Ahmed
• Mukta Sharma
• Ashish Kumar
• Achint Verma
• Rajeev Kumar Singh
• Deepak Ranjan Mishra
• Subhash Kumar Sharma
• Mini Ramachandan
• Durga Prasad Gupta
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Promoting Access to care and Treatment
33
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Population Foundation of India | Annual Report June 2008 - May 2009
POPULATION FOUNDATION OF INDIA
B-28, Qutub Institutional Area, Tara Crescent,New Delhi – 110016
34
Phone: +91-11-42899770Fax: +91-11-42899795
Website: www.popfound.org