National AIDS Control Programme

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Performance Audit of National AIDS Control Programme in Punjab
(CAG of India, 2002) CAG of India
Acquired Immuno Deficiency Syndrome (AIDS) is a fatal disease caused by a virus called the Human Immuno Deficiency Virus (HIV). It has emerged as a serious public health problem. National AIDS Control Programme (NACP) was initiated in the country in 1985 in collaboration with Indian Council of Medical Research. Subsequently, in order to contain the spread of HIV/AIDS, Government of India (GOI) launched (1992) a hundred per cent Centrally sponsored programme (Programme) with World Bank assistance. The GOI established National AIDS Control Organization (NACO) an executive body in the Ministry of Health and Family Welfare headed by Additional Secretary as Project Director. The project was implemented in two phases. The objectives of the National AIDS Control Programme Phase-I (NACP-I) were (i) to slow the spread of HIV; (ii) to decrease morbidity and mortality associated with HIV; (iii) to minimize socio economic impact resulting for HIV infection. The National AIDS Control Programme Phase-II (NACP-II) was launched in November 1999 with two key objectives namely to (1) reduce spread of HIV infection in India and (2) strengthen India’s capacity to respond to HIV/AIDS on long term basis. The implementation of the National AIDS Control Programme in Punjab for the period 1996-2001 was reviewed in audit during December 2000 to April 2001 by checking the records of AIDS Control Cell in the office of DHS, Punjab State AIDS Control Society and Civil Surgeons of 10 districts. The performance audit revealed that the programme was not effectively managed and implemented. The achievements under sub-components were not substantial and in most of the cases targets were not fixed. The activities particularly under priority targeted intervention for groups at high risk and low cost AIDS care components were negligible and whatever the achievements were there under other components remained dormant due to lack of effective management, implementation and monitoring and evaluation of the programme at State level. The counsellors were neither appointed by the Society due to less salary nor any steps were taken with the NACO to increase the salary of the counsellors which deprived the benefits of counseling to the intended beneficiaries. The Society had sufficient balance in its account as on March, 2001 due to less expenditure on all the components. No expenditure was incurred for training of NGOs. The condom vending machines purchased for awareness of AIDS programme were defective which defeated the purpose for which these were purchased.
Performance Audit of National AIDS Control Programme in Kerala
(CAG of India, 2002) CAG of India
The National AIDS Control Programme launched by GOI in 1992 was intended to achieve maintenance of HIV prevalence rate below 1 per cent, reduction in blood borne transmission of HIV, creating awareness among youth, etc. This performance review of the implementation of the National AIDS Control Programmee in Kerala covering the period 1996-97 to 2000-01 was conducted by scrutiny of the records in the offices of the State AIDS Cell, State AIDS Control Society, Health and Family Welfare Department in the Secretariat, State Drugs Controller, Thiruvananthapuram, four out of 14 District Medical Offices, 10 (out of 31) modernised blood banks attached to Medical Colleges and hospitals, five (out of 20) STD clinics attached to hospitals, two (out of 3) blood component separation units and the Surveillance Centre attached to Microbiology Department of Medical College, Thiruvananthapuram. The performance review revealed lack of infrastructure for starting new blood banks even in hospitals where equipment were supplied by National AIDS Control Organisation (NACO), delay in renewal of licence to blood banks leading to illegal functioning of blood banks, non-functioning of blood component separation units leading to lack of optimum utilisation of blood.
Performance Audit of National AIDS Control Programme in Nagaland
(CAG of India, 2002) CAG of India
A review on implementation of National AIDS control programme in Nagaland for the period from 1993-94 to 1995-96 was featured in Audit Paragraph 3.9 of Report of the Comptroller and Auditor General of India on Government of Nagaland (Civil) for the fiscal 1995-96. The implementation of the programme during 1996-97 to 2000-2001 was reviewed in Audit during June-August 2001 by test check of the records of the Programme Officer AIDS cell, DHS, PD, NSACS, all 3 Blood Banks and ZBTC covering 68 per cent of the expenditure incurred on the programme. The performance audit revealed that the implementation of the programme suffered a set back due to the absence of a comprehensive policy, programme mismanagement, centralised financing and absence of accountability that resulted in excess reporting of expenditure, large scale misuse of funds through diversion and advance payments, non monitoring of the financial and physical performance of substantially financed Non-Governmental Organisations and non-initiation of remedial measures through monitoring and evaluation of performance of the implementing agencies. Resultant effect was that the State against achievement of target for HIV/AIDS infection rate below 1 per cent of adult population, had registered incidence rate of 2.52 per cent of the population marginally covered.
Performance Audit of National AIDS Control Programme in West Bengal
(CAG of India, 2002) CAG of India
The programme is implemented in the State by Department of Health and Family Welfare, AIDS Cell, from 1992 and by West Bengal State AIDS Prevention and Control Society (WBSAP and CS) from August 1998. WBSAP and CS was formed for smooth and speedy implementation and management and to ensure easy flow of fund. State Health Secretary is the President of the Society. Performance Audit revealed that Rupees 22.91 crore was spent during 1996-2001 under AIDS Prevention and Control Programme aimed at reducing the HIV and AIDS affected cases. The programme failed to have adequate impact as HIV positive and AIDS cases increased from 1246 (1998) to 2357 (2000) and from 114 (1998) to 637 (2000) respectively. The State Government failed to utilise 63-70 per cent of funds received from GOI during 1996-98. Again much of the utilised funds were actually advances for which accounts were not available. Large quantity of Blood was transfused without HIV testing. Modernisation of the Blood Banks was not completed in 30 out of 59 targeted Blood Banks though funds were not a constraint. Several expensive machines were lying unutilised in the hospitals. IEC activities and target intervention for sex workers, track drivers, migrant labour and street children were not effective.
Performance Audit of National AIDS Control Programme in Bihar (1998-2003)
(CAG of India, 2004) CAG of India
National AIDS Control Programme aimed at reducing the spread of HIV infection and strengthening the country's capacity to respond to HIV/AIDS on a long term basis. Implementation of the programme in the State suffered mainly due to absence of proper monitoring mechanism. Physical progress in the components of targeted intervention for high risk groups and prevention of HIV/AIDS among low risk groups was either nil or marginal except in the case of condom promotion. Blood banks lacked basic infrastructure facilities. No community centre was set-up for low cost AIDS care. Institutional strengthening was weak. Inter-sectoral collaboration was absent. Thus, the intended objective of reducing spread of HIV infection and strengthening country’s capacity to respond to HIV / AIDS on a long term basis was not achieved to a large extent. Main audit findings are summarised below: 1. During 1998-2002 due to poor spending only 46 per cent (Rs 11.14 crore) of funds allocated (Rs 24.27 crore) by GOI were released. Excess expenditure of Rs 0.49 crore during 1999-2003 on awareness campaign was incurred by diverting funds from different components. Against an allocation of Rs 15.00 lakh relating to civil works, AIDS Control Society advanced Rs 1.17 crore to District Magistrates in March 2003 for construction of rooms for blood banks without approval of NACO. 2. Physical progress in the components of targeted intervention for high risk groups and prevention of HIV/AIDS among low risk groups was dismal during 1998-2003. Lack of mandatory equipments like air conditioners and elisa readers in blood banks rendered the blood banks ineffective. 107 equipments supplied by NACO to 15 blood banks for their modernisation were non functional as the blood banks had no operational license from appropriate authority. Even in seven licensed blood banks 168 equipment supplied by NACO were lying idle. 3. Low cost AIDS care was not initiated in the State as no community care centre was set-up. 4. Intersectoral collaboration was non-existent. Level of awareness development was low and no society was formed at district level for effective implementation of the programme. 5. The number of AIDS cases which was 10 in 1998-99 increased to 63 in 2001-02. 6. There was absence of effective monitoring mechanism of the programme. The reports on the impact analysis of the programme done by ORG Centre (May 2000) and World Bank Mission (May 2002) were not available with the state Government.
Performance Audit of National AIDS Control Programme in Uttarakhand
(CAG of India, 2004) CAG of India
National AIDS Control Programme (NACP) was initiated (1992-93) to control the Acquired Immunodeficiency Syndrome (AIDS), a severe life threatening condition which represents the late clinical stage of infection with Human Immunodeficiency Retro Viruses (HIV). It often results in progressive damage to the immune system and central nervous system. HIV virus is transmitted through sexual contact, sharing contaminated needles and syringes, multiple blood transfusion of infected persons’ blood, transmission from infected mother to child, before, during or after birth. To implement National AIDS Control Programme Phase II (1999-2004), Uttaranchal State AIDS Control Society (UASACS) was registered under the Societies Act, in April 2001 under the chairmanship of the Chief Secretary, Government of Uttaranchal, Dehradun, following the creation of Uttarakhand on 9th November 2000. As part of this performance audit of implementation of the National AIDS Control Programme, records of Project Director (UASACS) Dehradun and three out of 13 districts, having a population of 34.86 lakh out of State’s total population of 84.80 lakh, were test checked in August/ September 2003 covering the period 2001-2003 and an expenditure of Rs. 59.98 lakh out of Rs. 140.09 lakh spent during these years. The performance audit revealed that the Society failed in meeting its objectives due to lack of equipment, shortage of trained staff, irregular procurement of medicines, non participation of non-government organisations, non-existence of facilities viz. blood bank, sexually transmitted disease clinics, Voluntary Counselling and Testing Centres (VCTC), blood testing centers, and failure to generate awareness among the people against HIV/AIDS.
Performance Audit of National AIDS Control Progrmme in Tripura
(CAG of India, 2004) CAG of India
To combat HIV/AIDS, the National AIDS Control Programme was introduced in 1987 for countrywide implementation. The programme has moved through three phases since its launching. The GOI negotiated with the World Bank and the International Development Association (IDA) to support a full-fledged National AIDS Control Project (NACP-I covering the period 1992-99 and NACP-II covering the period 1999-2004). In Tripura, The programme was implemented by the Programme Officer of the State AIDS Cell up to 1998-99 and thereafter by the Project Director of State AIDS Control Society (hereinafter called the Society) through four Chief Medical Officers (CMOs) of all the four districts, four Medical Superintendents of State and District Hospitals, 10 Sub-Divisional Medical Officers, nine Rural Hospitals, 61 Primary Health Centres (PHCs) and 19 Non-Governmental Organisations (NGOs). The performance audit revealed that the main objective of the Programme was not fulfilled in the State due to lack of effective planning, inadequate infrastructure as well as inadequate laboratory testing facilities, shortage of laboratory technicians, and non-availability of medicines for treatment. The performance of the intervention projects suffered due to non-formulation of viable projects according to the core principles of the programme.
Performance Audit of National AIDS Control Program in Delhi (1998-2003)
(CAG of India, 2004) CAG of India
Implementation of the AIDS Control Programme in NCT of Delhi requires strengthening in view of the steady increase in the reported cases of AIDS from 359 in December 1999 to 862 in October 2003. Shortfalls in setting up of STD clinics and PPTCT centres as well as in supply of both condoms and essential drugs were retarding the effective implementation of the programme. Efforts at dissemination of information relating to prevention as well as treatment of HIV/ AIDS need to be intensified, particularly amongst the more vulnerable sections of society like young people and high risk groups. Training of health workers, doctors, nurses and para-medical staff has to be geared up.
Performance Audit of National AIDS Control Programme in Andhra Pradesh
(CAG of India, 2004) CAG of India
The Centrally sponsored "National Aids Control Programme" was implemented with the aim to slow down the spread of HIV infection, reduce the future mortality and strengthen the capacity to respond to HIV/AIDS on a long term basis. The performance audit of National AIDS Control Programme in Andhra Pradesh revealed that the programme was not implemented effectively in the State. No physical targets were fixed for most of the components/ sub-components of the programme either by NACO or by the Society at State level. The Project Director of the Society failed to utilise the grants fully leaving certain major components unimplemented. Society did not set any parameters to assess the performance of NGOs and judge the success of their efforts. Functioning of NGOs in districts was not checked properly by the Society. While HIV prevalence rate among antenatal attendees reduced from 2.20 to 1.62 per cent the prevalence registered steep rise during 1998-2002 among STD clinic attendees. Up to 2001-02 the Society paid little attention for strengthening of STD clinics, establishment of modern blood banks and upgradation of the existing blood banks, delivery of condoms, etc. Resultantly, the incidence of HIV and AIDS cases increased. Monitoring of the programme was very poor.
Performance Audit of National AIDS Control Programme in Tamil Nadu
(CAG of India, 2004) CAG of India
For containing AIDS in the country, Government of India (GOI) approved National AIDS Control Project (NACP) with assistance from the World Bank. The first phase of the project was implemented during September 1992 to September 1997 as a cent per cent Centrally Sponsored Scheme and was later extended upto 31 March 1999. A performance review of the project appeared in the Report of the Comptroller and Auditor General of India – Government of Tamil Nadu (Civil) – for the fiscal 1995-96 (Para 6.8). This performance audit of the implementation of National AIDS Control Programme in Tamil Nadu state covers the period 1998-99 to 2002-03. The performance audit revealed that incidence of the HIV infection was very high in the State and the number of AIDS cases is increasing. Despite incurring huge expenditure on the main components of blood safety measures and standardisation of blood banks, no proper evaluation was done to streamline the system. The sentinel surveillance conducted in the State revealed that the high risk groups of Sexually Transmitted Diseases (STD) clinic attendees and Intravenous Drug Users (IVDU) continued to be vulnerable with higher percentage of HIV prevalence; funds available for targeted interventions among high risk groups were only partly utilised and so several HIV cases remained undetected. The coverage of population under Family Health Awareness Campaigns was low. Poor attendance in Voluntary Testing and Counselling Centres revealed that the message had not reached the public. The above deficiencies must be viewed from the angle that people carrying AIDS could spread the infection to others resulting in more number of AIDS cases.
Performance Audit of National AIDS Control Programme in Assam (1998-2003)
(CAG of India, 2004) CAG of India
National AIDS Control Programme a 100 per cent Centrally sponsored scheme was launched in Assam since 1997-98 to reduce and prevent spread of HIV infections, strengthen the measures to control sexually transmitted diseases (STD) and for building capacity to respond to HIV/AIDS on a long term basis. A review of the programme through test-check of records indicated that funds were utilized in excess of approved allocation in violation of guidelines of National AIDS Control Organisation (NACO). Deficiencies in perspective planning of targeted Intervention Projects, lack of modernised treatment facilities for patients with STD, non-assessment of impact of Information Education and Communication (IEC) campaign and social mobilisation, poor management of available blood banks in the districts, insignificant achievement of voluntary blood testing and counselling due to weak infrastructural base, lack of proper monitoring and poor financial discipline were the main reasons for which the objectives of the programme remained largely unattained. Following are the highlights of this performance audit: 1. Out of Rs.1.50 crore released by Government of India during 1997-98 the State Government did not release Rs.64.13 lakh to Assam State AIDS Control Society (ASACS) till May 2003 and thus implementation of the programme was retarded. 2. ASACS spent Rs.78.48 lakh during 2000-2001 and 2002-2003 under the “Preventive Intervention for General Communities” in excess of approved allocation in violation of National AIDS Control Organisation’s (NACO’s) guidelines. 3. Due to non-availability of modernised treatment facilities in 16 of the 23 districts, post detection treatment of sexually transmitted diseases and containment of HIV infection was insignificant. 4. As against 100 per cent achievement of awareness target by March 2003 the ASACS even after spending Rs.2.55 crore during five years ending March 2003 had not assessed the impact of awareness and social mobilisation generated by IEC campaigns. 5. Poor management of 16 blood banks out of 23 districts and weak infrastructure base of blood testing centres led to insignificant achievement of counselling (367 numbers) and voluntary blood testing (109 numbers) during 1998-2003. 6. Non-adherence to the norms prescribed by NACO for implementation of target intervention project on Commercial Sex Workers (CSW), resulted in excess expenditure of Rs.23.01 lakh on seven targeted intervention Projects during 1999-2003.
Performance Audit of National AIDS Control Programme in Arunachal Pradesh
(CAG of India, 2004) CAG of India
At the State level, in Arunachal Pradesh the first phase of the programme (National AIDS Control Programme-I) was implemented by the State AIDS Control Cell (SACC) created in 1992 under the Directorate of Health Services and Family Welfare which functioned from 1992 to March 1999. From April 1999 the implementation of the programme (NACP-II) was entrusted to the Arunachal Pradesh State AIDS Control Society (APSACS). APSACS formed in November 1998 has the Secretary (Health & Family Welfare Department) as the ex-officio Chairman, and the Director of Health Services (DHS) as its Vice-Chairman. APSACS is headedby a Project Director assisted by a State Aids Programme Officer (SAPO) who is also Member Secretary of the Society and functions as Chief Executive. In addition, APSACS has 16 other members from different departments of the Arunachal Pradesh Government including two members from Non Governmental Organisations. At district level the programme is implemented by District Medical Officers supported by para-medical staff. The performance audit of implementation of NACP-II in Arunachal Pradesh during the period 1998-99 to 2002-03 was reviewed by the CAG of India based on test check of records of office of the Project Director of APSACS, three out of 15 District Medical Officers (DMOs), two STD clinics, two blood banks and two out of 4 NGOs covering 87 percentage of total expenditure. The performance audit revealed that the programme was not effectively managed and implemented in Arunachal Pradesh. The achievements under the sub-components were not substantial and in most of the cases, targets were not fixed. Sexually transmitted disease clinics and blood banks were not strengthened as required under the guidelines. Condom delivery system failed to take off due to non-purchase of condoms after April 2000 and non-utilisation of condom held in stock. APSACS failed to implement the programme as per guideline after incurring an expenditure of Rs. 5.47 crore, despite availability of sufficient fund (Rs.6.28 crore).
Performance Audit of National AIDS Control Program in Goa (1998-2003)
(CAG of India, 2004) CAG of India
The Centrally sponsored National AIDS Control Programme (NACP) was implemented with an aim to slow down the spread of HIV/ AIDS on a long term basis. The number of HIV positive AIDS cases were however on the rise in the State. State Society did not implement ‘Intersectoral collaboration’, a programme for sharing in work of generating awareness, advocacy etc. by various sectors of the society and neglected “Low Cost AIDS Care Programme,” to provide appropriate care and support to HIV/AIDS infected persons. Installation and commissioning of the programme equipments was not monitored resulting in their idling, besides STD clinics were not renovated.

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