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Millennium Development Goals in India Confronting the Challenge of HIV/AIDS, Malaria & other diseases June 18, 2004 Slide 2 Indias Health System At 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. Slide 3 (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. Slide 4 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 indicators Health & 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 Slide 5 MDG Goal 6 : Combat HIV/AIDS, Malaria & Other Diseases TargetIndicators Target 7: Have halted by 2015, & begun to reverse, the spread of HIV/AIDS HIV prevalence among 15-24 year old pregnant women Contraceptive prevalence rate Number of children orphaned by HIV/AIDS Target 8: Have halted by 2015, & begun to reverse, the incidence of malaria and other major diseases Prevalence & death rates associated with malaria Proportion of population in malaria risk areas using effective malaria prevention & treatment measures Prevalence & death rates associated with tuberculosis Proportion of TB cases detected & cured under DOTS Slide 6 HIV/AIDS goals within Tenth Plan & NHP 2002 Tenth Plan 80% coverage of high risk groups through targeted interventions; 90% coverage of schools & colleges through education programmes; 80% awareness among the general population in rural areas; Reducing transmission through blood to less than 1%; Establishing of at least one voluntary testing & counseling centre in every district; Scaling up of prevention of mother-to-child transmission activities up to the district level; Achieving zero level increase of HIV /AIDS prevalue by 2007) NHP 2002 Achieve Zero level growth of HIV/AIDS by 2007 Slide 7 Malaria & TB goals within Tenth Plan & NHP 2002 Tenth Plan Malaria ABER (Annual Blood Examination Rate) over 10 % API (Annual Parasite Incidence) 1.3 or less 25% reduction in morbidity and mortality due to malaria by 2007 & 50 % by 2010 Tuberculosis 50% reduction in mortality due to TB by 2010 NHP 2002 Reduce Mortality by 50% on account of TB, Malaria, other Vector and Water Borne diseases by 2010. Slide 8 National Vector Borne Disease Control Programme Tenth Plan Outlay Rs. 1370 crore National Vector Borne Disease Control Programme approved in 2003-04. Annual Plan (2004-05) Interim Outlay Rs. 269 crore Annual Plan (2004-05) Proposed Outlay Rs 296 crore Proposed Additionality Rs. 27 crore Includes 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. Slide 9 (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). Slide 10 (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 API 2002 8.93* 1.80* *Provisional Slide 11 National TB Control Programme Tenth Plan Outlay Rs. 680 crore Annual Plan (2004-05) Interim Outlay Rs. 125 crore Annual Plan (2004-05) Proposed Outlay Rs. 140 crore. Proposed additionality Rs. 15 crore Nearly 1/3 rd 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. Slide 12 (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 Slide 13 (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 population Global fund for AIDS, TB & malaria (GFATM) has accepted a proposal to extend RNTCP to 3 more newly constituted states to cover 56 million population. Slide 14 National AIDS Control Programme Tenth Plan Outlay Rs. 1392.80 crore Annual 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. Slide 15 (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 2003 Funding 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 Slide 16 (Contd.) Modalities adopted for service delivery includes: oTargetted interventions for high risk groups oAwareness generation and preventive interventions for the general population oBlood Screening and Safety oTreatment of Sexually Transmitted Infections oPrevention of Parent to Child Transmission oVoluntary Confidential Counselling & Testing Centres oCare and Support Slide 17 Political Commitment May 2002 : International Policy Makers Conference to focus upon the search for an AIDS vaccine July 2003 :1 st 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. Slide 18 Services Package PPTCT- 225 centers provide counseling testing & medicine VCTC-709 (628 through SACS) STD clinics -735 clinics Condom Promotion 171 million through free distribution and social marketing Medicines for Opportunistic Infection Community Care Centers -51 with NGOs 17 State networks of PLHAs ART- 8 centers (6 in high prevalence states + Delhi) Slide 19 (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 Slide 20 Emphasis on Behaviour Change Reaching High risk Groups through Targeted Interventions- (933 projects) through NGOs and CBOs Awareness 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 youth oSchool AIDS Education Programme (SAEP)-reaching 60,000 schools (coverage 55% of the total) oFamily Health Awareness Campaigns (FHAC) Slide 21 Increase in Approved Outlays: Ninth Plan v/s Tenth Plan Slide 22 Year-wise increase in expenditure : TB, Malaria & HIV/AIDS