Millennium Development Goals in India

Confronting the Challenge of HIV/AIDS, Malaria & other diseases

June 18, 2004

Indias Health SystemAt cross roads today.Vast health infrastructure and manpower at primary, secondary and tertiary care in government, voluntary and private sectors.Institutions manned by professionals and paraprofessionals trained in the medical colleges in modern medicine and ISM&H and paraprofessional training institutions.Population aware of the benefits of health related technologies for prevention, early diagnosis and effective treatment for a wide variety of illnesses and accessed available services.Technological advances and improvement in access to health care technologies, which were relatively inexpensive and easy to implement, have resulted in substantial improvement in health indices of the population and a steep decline in mortality.

(Contd.)

At the same time, communicable diseases have persisted over time Malaria has also developed insecticide resistant vectors while others like TB are becoming increasingly drug resistant, HIV / AIDS has of late assumed extremely virulent proportion and is now projected more as a socio economic issue rather than merely a health problem. The 1990s has also seen an increase in mortality on account of non-communicable diseases arising as a result of life style changes and increase in life expectancy.

MDG Health related indicators MDG indicators related to health are a mix of health outcome (prevalence & death rate) and service output measures (coverage & use of specific health interventions)18 health & health related indicatorsHealth & health related refer to indicators that are truly health such as malaria prevalence or that concern critical factors for health, e.g. access to improved water supply or dietary energy consumption & so on

MDG Goal 6 : Combat HIV/AIDS, Malaria & Other Diseases

HIV/AIDS goals within Tenth Plan & NHP 2002

Malaria & TB goals within Tenth Plan & NHP 2002

National Vector Borne Disease Control ProgrammeTenth Plan Outlay Rs. 1370 croreNational Vector Borne Disease Control Programme approved in 2003-04.Annual Plan (2004-05) Interim Outlay Rs. 269 croreAnnual Plan (2004-05) Proposed Outlay Rs 296 crore Proposed Additionality Rs. 27 croreIncludes 3 ongoing programmes of Malaria, Filaria & Kala Azar; JE & Dengue / DHF have been added. 100 percent funding provided from central budget for 7 North Eastern states and also for the 100 districts covered in 8 EMCP States under the World Bank assisted programme. For rest of the country, cost sharing on 50:50 basis.

(Contd.)Malaria continues to be a major public health problem.However, modified plan of action for control of malaria has moderated the reported number of cases at much less than 2.0 million from approximately 7 million in the 1970s. Reported no. of cases during 2003 1.65 million (P).

Chart3 (2)

6.47

4.14

2.9

2.18

2.12

3.03

2.66

2.1

2.08

2.03

2.06

CASES

YEAR

CASES IN MILLION

Sheet1

YEARCASESPFDEATHS

196599667261630

1976646721575371359

19822182302551057187

19932207431852763354

199425113539905071122

1995292619711376621161

1996303558811795611010

199726600571007366879

19982098356914584866

199920781101009270992

Chart1

6.47

4.14

2.9

2.18

2.12

3.03

2.66

2.1

2.08

2.03

2.06

1.84

1.65

&A

Page &P

Cases in million

Year

cases in million

Sheet2

YEARCases in millionPf. in million

19766.470.75

19784.140.55

19802.90.85

19822.180.99

19922.121.13

19963.031.18

19972.661.01

19982.10.91

19992.081.01

20002.031.05

20012.061

20021.840.9

2003(P)1.650.7

(Contd.)During the 10th Five Year Plan, (2002-07) it has been proposed to achieve an Annual Blood Examination Rate (ABER) of over 10% and Annual Parasite Incidence (API) of 1.3 or less.The operational performance in relation to ABER and API for 2002 is as follows:YearABER API2002 8.93* 1.80**Provisional

National TB Control ProgrammeTenth Plan Outlay Rs. 680 croreAnnual Plan (2004-05) Interim Outlay Rs. 125 croreAnnual Plan (2004-05) Proposed Outlay Rs. 140 crore.Proposed additionality Rs. 15 crore Nearly 1/3rd of global TB burden is in India.Phase-I of Revised National Tuberculosis Control Programme, which started in Sept. 1997 was successfully implemented with an outlay of Rs.749 crore with World Bank funding.Under Phase-1 RNTCP, achievement of targets very high. 10 lakh patients have been started on treatment, more than 2 lakh lives saved and more than 20 lakh infections prevented.

(Contd.)Against a targetted coverage of 271 million population coverage has already reached 870 million.Aim is to bring the entire country under RNTCP by 2005 in order to meet the global targets of TB control

(Contd.)Phase-II RNTCP consists of no cost extension of two years' (2003-2004) expanding coverage to 730 million population.Under World Bank/DFID/DANIDA, total coverage by 2004 would be 830 million populationGlobal fund for AIDS, TB & malaria (GFATM) has accepted a proposal to extend RNTCP to 3 more newly constituted states to cover 56 million population.

National AIDS Control Programme

Tenth Plan Outlay Rs. 1392.80 croreAnnual Plan(2004-05) Interim Outlay Rs. 259 crore.Annual Plan Proposed outlay Rs. 476 crore.Proposed Additionality Rs. 217 crore.AIDS is not only a serious public health problem but also a major development issue on account of its potential impact on productivity & economic growth.

Chart1

3.51

3.72

3.86

3.99

4.58

Magnitude of infection

Year

Magnitude of HIV Infection( in Million )

Working Estimates of Magnitude of HIV Infection

Sheet1

Sheet2

Sheet3

MBD00019DEB.xls

Chart1

3.51

3.72

3.86

Magnitude of infection

Year

Magnitude of HIV Infection( in Million )

Working Estimates of Magnitude of HIV Infection

Sheet1

YearMagnitude of infection

19983.51

19993.72

20003.86

20013.99

20024.58

Sheet1

Magnitude of infection

Year

Magnitude of HIV Infection( in Million )

Working Estimates of Magnitude of HIV Infection

Sheet2

Magnitude of infection

Year

Magnitude of infection ( in Million )

Working Estimates of Magnitude of HIV infection

Sheet3

(Contd.)National AIDS Prevention and Control Policy as well as National Blood Policy approved. Action Plan developed for implementation. The extended NACP Phase II (1999-2004) project at a cost of Rs. 1941.91 crore was approved in December 2003Funding for the extended Phase II project would also be available from CIDA, AUSAID, UNDP and Global Fund (Rs. 122.74 crore), in addition to that already available from World Bank, DFID and USAID

(Contd.)Modalities adopted for service delivery includes:Targetted interventions for high risk groupsAwareness generation and preventive interventions for the general populationBlood Screening and SafetyTreatment of Sexually Transmitted InfectionsPrevention of Parent to Child TransmissionVoluntary Confidential Counselling & Testing CentresCare and Support

Political CommitmentMay 2002 : International Policy Makers Conference to focus upon the search for an AIDS vaccineJuly 2003 :1st National Convention of Elected Representatives organised by the Parliamentary Forum on AIDS April, 2004 :Introduced Antiretroviral treatment free of cost to one lakh patients in high prevalence States.

Services Package PPTCT- 225 centers provide counseling testing & medicineVCTC-709 (628 through SACS)STD clinics -735 clinicsCondom Promotion 171 million through free distribution and social marketingMedicines for Opportunistic Infection Community Care Centers -51 with NGOs17 State networks of PLHAs ART- 8 centers (6 in high prevalence states + Delhi)

(Contd.) Licensed Blood Banks-1938 (government, private and others)80 blood component separation units 10 State of the Art Model Blood Banks Substantial increase in Voluntary Blood donation HIV incidence from blood transmission dropped from 9 % in 1999 to 2.99 % in 2003

Emphasis on Behaviour Change Reaching High risk Groups through Targeted Interventions-(933 projects) through NGOs and CBOsAwareness creation and demand generation for services through synergized strategic response with mass media, advocacy, IPC, capacity building and partnership, networking Emphasis on reduction of Stigma and Discrimination and creating an enabling environment Addressing vulnerable segments - women and youthSchool AIDS Education Programme (SAEP)-reaching 60,000 schools (coverage 55% of the total)Family Health Awareness Campaigns (FHAC)

Increase in Approved Outlays: Ninth Plan v/s Tenth Plan

Chart1

10301370

450680

7601392.8

Approved Outlay 9th Plan

Approved Outlay 10th Plan

In Rs. Crore

Sheet1

Approved Outlay

9th Plan10th Plan

Malaria et al10301370

TB450680

AIDS7601392.8

Sheet2

Sheet3

Year-wise increase in expenditure : TB, Malaria & HIV/AIDS

Chart1

10301370

450680

7601392.8

Approved Outlays 9th Plan

Approved Outlays 10th Plan

In Rs. Crore

Approved Outlays

Sheet1

Approved Outlays

9th Plan10th Plan

Malaria et al10301370

TB450680

AIDS7601392.8

Sheet2

1997-981998-991999-002000-012001-022002-032003-04

Malaria et al200 (142.76)297 (163.71)250 (176.01)255 (188.32)225 (219.97)235 (206.61)245 (240.11)

TB90 (31.31)125 (68.88)105 (87.54)125 (108.75)136 (103.62)115 (96.75)115 (115)

AIDS100 (121)111 (99.36)140 (135.25)145 (173.30)210 (226.60)225 (241.04)225 (225)

Chart2

142.7631.31121

163.7168.8899.36

176.0187.54132.25

188.32108.75173.3

219.97103.62226.6

206.6196.75241.04

240.11115225

Malaria et al

TB

AIDS

Rs ( in crore)

Sheet3

1997-981998-991999-002000-012001-022002-032003-04

Malaria et al142.76163.71176.01188.32219.97206.61240.11

TB31.3168.8887.54108.75103.6296.75115

AIDS12199.36132.25173.3226.6241.04225