National AIDS control organization
was established under MoHFW in 1992 to address the program of HIV/AIDS.
The focus of NACP 1 (1992-1999):
was mainly on HIV surveillance and related activities, screening of blood and
blood products, and public education campaigns.
NACP 2 (1999 – 2006): focus
shifted to raise awareness and towards interventions focusing on promoting behavior
change. ART was rolled out during this phase.
NACP 3 (2007- 2012): Focus was to
halt and reverse the epidemic by 2012, by focusing on prevention efforts &
integration of care, support and treatment strategies.
NACP 4 is currently being formulated
with the objective to accelerate the process of reversal of HIV and further
respond to epidemic through a well define integration process with increase in
public-private partnerships.
Vertical Approach
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Integrated Approach
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Otherwise known as ‘stand – alone’ or parallel
program.
Interventions are provided through a separate
administration, budget and operational integration with wider health system.
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There is no separate administration or budget and
interventions delivered through the existing healthcare facilities that
provide routine or general health care services.
Belief is to focus on the priorities of local people
and tend to bring services together with minimum resource wastage.
This create a single system where resources are
shared and duplication is avoided
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Basic questions to be asked while
taking a major policy decision like planning for integrating with general
health system are
Will integration add value? Is it
the right time? Is it possible with existing infrastructure/human resource? Will
it strengthen the health system? Is there a clear plan and clear outcome
monitoring system?
As per WHO, 5 Basic competencies that apply to staffs working for
patients with chronic diseases are
1. Patient-centered care
2. Partnering
3. Quality improvement
4. Information and communication technology and
5. Public health perspective.
Tanwar et.al (2013) researched
the expert’s opinion on this regard and found that policies and policy makers
were rigid with little flexibility for regional requirements and their felt
need is to have flexibility guidelines. Experts felt that involvement of
hospital superintendents or senior doctors in monitoring and day to day
functioning of HIV care & treatment centres can make change in the attitudes
of staff at the general hospital and improve ownership. A District AIDS officer from a general health system can play important
role of coordinating with various HIV-related activities in a particular
district and plan them in collaboration with the general health activities.
But concern is, integration will
require utilization of multi-skilled workers and transfer duties from
specialists to non specialists.
Keeping in mind, Experts felt
that integration with general health system should happen in selected areas
like department of PPTCT, STI, and ICTC. This integration should happen to make
HIV-program sustainable leading to expansion of program activities and
increased capacity of healthcare workers to meet the people’s needs. HIV
programs should organize trainings like ‘pre-service’ followed by ‘In-service’ at staff level for interns, PG students and
doctors working in private and government sector.
Link ART system could be a major
step toward integration of HIV treatment with general system if closely monitored.
Vertical programs are justified
where the general health systems are weak, fragile states or places where integration
is not possible. Vertical programs should be time limited and integrated with
general system to avoid spill over. Disease specific vertical program and
general health system are working for the betterment of health of the people,
and these programs would become more and far effective if they work in
collaboration.
